House Approves Health Overhaul, Sending Landmark Bill to Obama

Woo hoo!

Agreed. This is excellent. Not ideal, but a bit first step.

And the people spouting racial slurs to those congressmen are mindless sub-humans.

"To pay for the bill, a 40 percent tax would be levied on high-value health insurance policies of over $10,200 for individuals and $27,500 for families starting in 2018. The Medicare Hospital Insurance Tax would be increased for individuals who earn more than $200,000 and families who earn more than $250,000. There is also a 3.8 percent tax on unearned income, including dividends and interest, for individuals making over $200,000 per year, or couples making over $250,000 a year."

The above is commonly referred to as "Taxing only the Cadillac health plans".

The favorite tactic of congress is to set limits in fixed dollars then sit back and let inflation drive everyone's costs to where even the inexpensive health plans are taxed.

Their actions were inexcusable, but unless I missed something, not related to the health care debate.

The first words I spoke to the wife after I head it passed – “I feel poorer already.”

Haven't heard an racial slurs where do you guys hang out.

So I have insurance from my employer now, there is a downside to everything so what bad will come of this if it passes for me and everyone else that already has health insurance from their employers ?

Ah, my apologies, I'd heard about it as though it were.

Please actually read the bill instead of making assumptions.


"Section 1(f)(3)" refers to the Cost-of-Living Adjustment defined in US Law, which is based on the Consumer Price Index as published by the Department of Labor.

First, it already passed. There are additional changes that may or may not pass, but the basic structure is now there.

Generally speaking, if you already have insurance, there are no direct changes, unless you have one of the so-called "Cadillac plans", which are super-expensive plans that provide little additional benefit compared to their increased cost. Unless you're part of a labor union, you probably don't have one. If you do, though, there is a tax on the cost of the plan over a set amount.

Indirectly, there will probably be a transition period where wait times for services may be longer, as the infrastructure comes to grips with a massive influx of people who suddenly have insurance. It's not as if all 23 million people get coverage at once, though. Only those who have preexisting conditions will be affected now. The rest will become covered in 2013.

I can't think of anything else that might have a more-or-less "soon" negative repercussion.

I am on the side of less “government is better.”

Free market will, in most cases, always outperform and be more cost effective than a government run or controlled environment. Medicare has been around for decades and they still can’t get that right. Medicare fraud is more prevalent now than ever.

The US Postal service is another example. UPS and FedEx are doing OK. Just making a simple decision like “should we drop Saturday service” seems to be a huge task for them. In a profit driven organization it would be a no-brainer.

People keep pointing to the fact that health care costs are going up every year “the government should put a stop to that.” The increase is mainly driven by the fact the population on average is getting older and medical advances have been developed to keep more people living longer. Another layer of bureaucracy will only add to rising costs, unless the “death panels” are real.

To your question – The estimated 10 year cost of this bill is over 900 billion. While taxing those SOB millionaires is always popular the SOB millionaire are usually smart enough to pass the expense on to us hardworking pee-on’s. As well as stated above. With inflation someday we may all be millionaires.

Please show your work. Provide examples.

Also show me at what point the costs of keeping a person alive outweigh the benefit.

Avoiding the snark, though, keeping people healthy should not be a profit-based business. When a company decides that it's simply too expensive to pay for that cancer treatment and decide to drop you, despite the fact that you've been paying premiums for years -- well, that simply shouldn't happen.

Outside, though, the limitation of the egregious excesses that the bill limits, there's almost the exact same free market now that there was before, only now there's a larger market as the government requires people to have health insurance, and subsidizes those who can't afford it. The biggest difference along these lines is that the individual market mostly goes away, as the government effectively created a new category of group coverage: those who don't otherwise have access to group coverage. One would assume that the insurance companies are making money now on the plan you purchase through your employer. If they weren't, they wouldn't offer it; there's no requirement that they do. But they're making an assload off of the individual insurees, as they have no carrot to wave. (See Anthem's 40% increases, despite increasing profits.)

Actually, that brings up a good point. If health care cost increases are driven by increased cost to the insurers, why are the insurers making record profits? It might be explained by the fact that there is very little actual competition in your "free market". Because of the way insurance is segregated, and due to mergers and acquisitions, there is usually only one major player available to each individual.


Heehee. That's a good one.

Congratulations guys. Long time coming, long time needed. It would be nice to see the US lead in universal healthcare in a few years' time.

Oh, why is it that most people who complain about spending tax dollars on healthcare have no problem with the trillions spent on war? Or military defense/offense in general?

I did, USPS and Medicare are a good example of a gov-o-fuck.

As far as creating monopolies the government is helping to do that by prohibiting insurers from sell across state lines decreasing competition a raising costs. I’ll let you Google.

I’m glad the insurance companies are finally becoming more efficient and making a profit. I would go for a money grab if I was in their shoes and had mounting concerns over looming new laws aimed at putting me out of business.

I wouldn't want to be paying $20 to send a letter or a package costing a couple of ounces to UPS or FedEx if the USPS wasn't around.

Okay, I ignored your examples.


Yeah, it's too bad that the government took over that market. The competition between all those companies looking to insure the elderly and disabled really kept the prices down. Huh? What? No one was competing for those plans? You don't say! Oh, nevermind. Government is bad. Let's repeal Medicare and let those folks find their own insurance on the common market again.


This may actually be a reasonable example.

It may work out to $20 a letter if the USPS doesn’t quit losing money. If you pay it up front or through taxes $20 is still $20.

Are you sure you’re not “Comic book guy,” It sounds like I’m watching the Simpsons.

Yep, you can never drop an entitlement program. That’s why it better be damned good and well thought out before you create one. But that’s not my point. Medicare is run poorly and is full of waste and fraud (again, you Google it’s all over the news). If the government can’t get that right, for decades, what makes them think that if they throw Medicare away the next, more expensive, program will be any better?

I don't think you can argue with these figures...

http://news.bbc.co.uk/1/hi/health/8201711.stm

The NHS here in the UK is a real bargain compared to the system you currently have in the US.

I think this is a real mile stone for your country, you should all be very proud that steps are being taken to take care of the most needy in your society.

Cheers

Cris.

One more point on this. By design, the law eases into the tax payer slowly so that the answer to the immediate question: "How does this impact me now?" is "Not much." Most USA’ers only look to the now. As the laws finally become effective the insurance companies will raise rates more and more as they are mandated more and more. They are not going to eat the costs of these new laws. While I’m not against all these mandates they will raise rates and soon.

An example to this is the recent explosion of credit card interest rates since the banks were spanked by the government with new credit card laws.

In my personal experience. All the uninsured poor I knew over the years had fine medical care.

I however do see issues with the uninsured lower middle class that IMO needed addressing.

I hope this does all work out for the best.

Being someone who doesn't like being in debit. This makes me nervous. I think if most worker-bees had to write a check to the government instead of having a payroll deduction taken , a lot more people would be asking where the hell it all goes.

In addition to Bitt's reply, perhaps this article could help?

In broad brush strokes, the U.S. plan is most similar to the plan that's currently in place in Switzerland. In the Swiss plan, there's something of a basic coverage plan that's state mandated, with identical prices from every insurance vendor. They then compete to offer you extras on top of that. If hospitalized, do you want a private room versus a shared room? Pay a little more now, get better service later.

To my mind, there are two big unknowns in the U.S. plan:

- Will insurance premiums go up, due to the new requirements imposed by the government, people voluntarily dropping their coverage, and/or insurance companies cooking their books to justify premium increases? The whole financial balance of the system depends on mandatory insurance, yet the mandatory bit doesn't kick in for several years. It's interesting to ponder how insurance companies may try to game the system, and how the system might respond.

- Will the new plan pass constitutional muster? Lawsuits are already being planned to challenge the legality of various aspects of the new system.

I'm also curious the extent to which this will play out politically for the balance of power in Congress. My guess is that there will be a shift toward Republicans, but that the Democrats will retain their majorities. And, while I'm curious about politics, I'm curious if the Republicans will play the same "sky is falling" card for every Democratic initiative over the next year, and whether that will continue to work for them.

Let's see. I'm overweight, sarcastic, have a ponytail, frequently unshaven, and worked at a comic shop. So, no, I'm not sure. (At least I'm not balding.)


Yeah, it is. So is private insurance, though. (Admittedly, not as much so.) But let's take that as read, for the sake of argument.

Medicare provides health provider payments for services rendered. This health care bill (as far as providing health care to people) does no such thing. All it does is create a group for existing health care companies to compete for that is comprised of those who aren't members of another eligible group. All of the sections about the government providing a health care plan of its own were stripped.

This is actually creating a new market, and giving people bargaining power. I'm not really sure how anyone can be opposed to that.

While not the goal of most USA'ers we are some lard asses. That sure doesn't help costs.

http://www.cnn.com/video/#/video/bestoftv/2010/03/17/behar.donna.simpson.intv.cnn?iref=allsearch

So Medicare is good when you have personal experience with it, but it's bad when not confronted with the ramifications of it not being there.

We can stop arguing about it now and sit back and see who is right. Do you want a concrete example of the free market? Look at veterinary medicine. Drugs, diagnostics and procedures are a small fraction of the price of the same thing for humans. And no cute comments about sanitary conditions, etc. That doesn't apply to drugs and x rays. The primary difference is that the consumer pays for his own vet bills, while someone else pays for his health bills. When someone else pays, there is no incentive to be a smart consumer. This is the root of the problem that nobody wants to talk about. Of course prices are high in America! They can be, and nobody really cares because someone else is paying. It only matters if you're outside of the corrupt system. Get rid of that, and you'd have market competitive prices. This "solution" is simply to make sure everyone is part of the corrupt system -- it doesn't deal with the root cause of the corruption.

Go to an optometrist: if you have insurance, an exam is $250 (someone else is paying), if you don't it's $80 (what the market will bear).

I will make some predictions:

1. This will be a far worse intrusion into liberty than even the Patriot Act. You will see many, many more bills like the absurd New York salt ban bill. All in the name of "public health" and "lower healthcare costs". Now that the government is paying, like any good parent, they now have the right to tell you how to live healthily.

2. McDonalds will become a target and be forced to change their practices, despite the fact that they make a product that people like and want, and nobody is forced to buy it. No matter! The government can't be asked to pay for all of the downstream consequences of this unhealthy food. McDonalds is the new Phillip Morris, poor bastards.

3. Speaking of Phillip Morris, you will see an all-out offensive to completely ban tobacco products.

4. Etc. more of the same. Welcome to the Therapeutic State. You now have your government daddy who will happily force everyone to live healthily.

5. There will be practical considerations, too, like government specifications on exactly which tests and treatments doctors can prescribe. The doctor will not have the authority to make the right decision. This has already happened with the equally absurd war on drugs, with many doctors being scared to prescribe effective levels of pain medications due to federal government oversight.

I'm done. Let's see what happens. Those who refuse to learn from history...

Jim

I didn't say Medicare was good. I've never used Medicare but know those who have and they have gotten more out of it than I ever expected. I just think it could be run better. Maybe even run better by a private company.

If outsourcing sending people into space is good enough for NASA I’m sure an insurance company could do a good job with Medicare. After all it’s not rocket science (sorry had to do that).

Yes, the smaller insurance companies can't compete against the big boys now, so, clearly, giving them a bigger market to be washed away in would help.

As point of comparison, when I was a kid, there were dozens of five-and-dimes and hardware stores around town. Then Home Depot, Lowes, and Wal-Mart moved in and they're all gone. It's certainly not because Home Depot and Lowes are cheaper now. I'm sure I never had to pay 43¢ (or the equivalent in '80s cents) for a screw. And Wal-Mart keeps their prices down by exploiting everyone they come in contact with. Yay for the free market!

I certainly know that when my wife started having stroke-like symptoms a few weekends ago that had I not had insurance I would certainly have been doing some comparison shopping before heading out to an emergency room.

There are certainly cases to be made for excess in the insurance system, and other aspects of the bill speak to at least some of those issues. And while I'd certainly appreciate lower healthcare costs, it remains not my primary concern.


And if you can't afford that $80, then I guess it's just too bad about that glaucoma that you didn't know you had. Fifteen years down the road, your optic nerve stop functioning, and you know you should have chosen to skip a few meals that month. Or we could make sure that everyone can see the doctor. But that doesn't jibe with your free-market ideals.


The only additional people government will be paying for are the people who can't afford insurance. Which they're doing now with Medicaid, except usually only as emergencies, not as preventative care. And they've made no such mandates in the last 45 years. So I don't see this happening.


If they're selling poison under the guise of food, then they should change. Other than trans-fat shortenings and maybe HFCS, I don't think that's the case. Regardless, I call your prediction. Won't happen.


Gee. Darn. More poison. Still, won't happen.


How, exactly? Hard to refute a prediction that doesn't predict anything.


Because God knows that they are free to prescribe drugs and tests without restriction now. Again, though, why do you think that the government is going to tell insurance companies what products they're allowed to sell? You still seem to be under the impression that the government will be reimbursing healthcare providers, when this bill will likely decrease that practice, as some people are moved from Medicare to the public group plans, which, again, are private insurance.

On the other hand, assume that the 32 million uninsured (or whatever the number is) were just put directly on Medicare, and the doctors were told that they couldn't prescribe some set of tests and treatments. How, exactly, would that be worse than those people not having any reasonable access to health care at all?

Maybe if we had one government run hardware store that sold 43¢ screwdrivers to everyone that would be the answer. But wait, I don’t want a cheap ass screwdriver. But since we all have to have one you don’t have a choice. Or maybe you could buy the cheap ass screwdriver you don’t want, then buy one you do want. Unfortunately now you are now being taxed at 50% because you can afford a better one because you worked hard and made some money.

But then you figure, heck with it, why try, why work. I’ll just quit take my now free 43¢ screwdriver, brink beer and do crack all day.

There is bad on both extremes. I just lean toward less government interference. Luckily I can still vote for others that feel that way as well.

Screw, not screwdriver.

OK, but my sarcasm is still valid

One of the things the Health Care Bill does which actually helps free market competition is encourage people to find there own insurance. Employer-based health care masks the true value of health care and provides an incentive for consumers to not shop around for cheaper plans and health benefits. If employers stopped offering health plans as a required benefit and raised salaries a corresponding amount then it could be a real boon to the economy- assuming increased risk pools and competition drives down health care plan prices.

Is that in fact the case? I only go by what I read in the news, of course, but I had gained the impression it was more like "If you have insurance, price is $80 (insurer has collective bargaining power), if you don't, it's $250 (individual pays rack rate)"?

Peter

It seems to be true, in my experience. I have no idea why. However, that statement applies only to optometry, which is frequently separated from the rest of your health insurance. Again, I have no idea why.

It's a microcosm. Melanie found exactly the same thing with mamogram when we spent 5 years uninsured. $700. Oh wait, no insurance? $90. That is not a typo.

And I'm telling you why: nobody in the transaction has a motivation to keep prices down.

I'm not a doctor, nor am I close enough personal friends with one to ask about pricing. However, I did find this thread with optometrists talking about pricing and they don't seem to mention any difference in pricing between those insured and not.

I don't want to place motive on actions without evidence, but it is possible that the practitioners simply feel sorry for you if you have no insurance and discount as much as they can.

That said, I do know that there are negotiations between doctors and insurance companies as to how much money changes hands for insured patients. If you're going to apply free market principles to one side of the equation, you need to apply them to the other, too, and blame the insurance company for not being a better negotiator.

Insurers have no interest in negotitating. The more health care costs the more it benefits them as well. They are taking a percentage off the top just like any other business. If a procedure costs $70 they don't get as much profit as if it costs $700. Employers could try to negotaite for better insurance rates but that doesn't do much good for a number of reasons. One good reason being health care insurance is exempt from anti-trust laws so there really are no other choices in health care- the rates are fixed. Small business has even less leverage to negoitate health care, especially if the employees of the business are mostly older. The only way to lower health care plan rates is to increase pool size so you have more younger people with health care who can balance out the older people.

For the record, I'm not a free market fundamentalist. I don't think markets are the "answer" to anything, I think they are a necessary consequence of property rights. Markets do not solve all problems, nor should that be the goal. In fact, I would argue that solving all problems shouldn't even be the goal. There is a higher principle.

I believe in man as a free moral agent and that the highest philosophical principles are autonomy and liberty. I believe in unqualified self-ownership, and that results in the right to property (one's own body and labor and their fruits being property). It is this dedication to property rights and self-ownership that gives rise to supporting markets. I do not support markets because they are efficient or "better" at doing something than a non-market approach. I support markets because they are a direct result of property rights, and infringing on markets infringes on property rights.

That said, I believe that nobody has the right to infringe on the property rights of others, so I support restrictions on liberty which would cause harm to other people or their property (or the communal property of the environment, for example). This is why it is OK to regulate markets to protect property and to protect the market mechanism itself.

Refusing to serve someone, for any reason, does not directly harm them, it merely fails to enrich them. I believe it is immoral to force a person to provide a service to another. It is stealing their labor (their property). A human's labor must be given voluntarily, otherwise it is slavery. Voluntarily means in exchange for what they themselves decide is adequate compensation. You will recognize this as resulting in a "free" market for goods and services. They might discount for me for any number of reasons, that's up to them, however.

This new law will require that I purchase health "insurance" (it's not really insurance at all, but that's another topic). I either purchase it through my employer or I'm forced to get it from the government. It forces me to surrender my property to buy something that I might not want. Whether YOU think I SHOULD want it is entirely beside the point.

In my view of the world, people are fallible. What you call "poison", others may call "tasty" or "enjoyable". Who is right here? I maintain that we can't know. If you think cigarettes are poison, don't smoke them. But it is extremely arrogant to assume that you should make this decision for everyone. Since we are fallible, I believe we must allow people to make decisions for themselves, even if they decide things that we think are ridiculous (as long as they don't infringe on their fellows). You seem to feel that, at least as far as health care and "poisons" are concerned, you know what's best for everyone and are willing to use the legislature and ultimately the police to see your will imposed on others.

Isn't there a way for us to each pursue our own vision of the good life? That is the fundamental goal of the philosophy of liberty. I consider it the highest goal.

Let me opt out of your utopian central planning and then do what you will. But let's be honest here: "universal" health care means that health care is forced upon me whether I want it or not (or whether I want to pay for it or not).

Yes. The only thing that will work is for people to pay their own way.

Umm.. Cell service in the US (and Canada for that matter) is shite. Even in urban areas. Data on cell in NA is slow. And the prices are high. Why is this a good example again?

To be fair, you can pay a fine instead, if you're desperately opposed to getting something for your money.


The entire rest of your post would seem to belie that.

What would happen if you decided that you weren't interested in the services of the fire department? Fair enough, your house burns down. But when it does, it burns down the rest of the houses around you. There's no way to prevent the spread of the fire without dousing your house. So we require that all people pay taxes to provide firefighting service, as it benefits us all.

Now what if you contracted tuberculosis? You've refused the health care insurance, and you can't pay for treatment. Besides, you just have a bad cough. So you just spread it around willy-nilly until someone realizes that there's a TB epidemic. In order to prevent its continued spread, you're treated for TB, at the taxpayer's expense. So we require that all people have health insurance so that, hopefully, you won't be reticent to get your cough taken care of early, and so that the taxpayer is not out of pocket. It benefits us all.

Obviously, that's a somewhat extreme example, but it scales down, too. You didn't get that toothache looked at, it developed into a full-blown infection, and now you're septic. You can't afford to see the doctor for that cold, so you went to work anyway and spread the flu to all of your coworkers. You declined the health insurance because you've never been sick a day in your life, and then you contract cancer, the treatment for which eats you out of house and home and you have to declare bankruptcy. Or even as simple as: you fell down and broke your arm, and now the emergency room has to set it for "free" because you couldn't pay. (Unless you want to argue that people with broken limbs or cancer who are unable to pay for their treatment should be turned away.)

That must be the leftist definition of the word "fair", and I think it proves my point rather well.

I am always on that side my dealings with the government have shown me they can not do anything better than a private company.

And if I refuse to pay, the police will come and make me pay at gunpoint, or take me to prison at gunpoint. Your *opinions* about what's best for me will be enforced with state-sanctioned violence. It can't be denied that these are merely your opinions. The issue is so phenomenally complex that intelligent people differ drastically. I, for one, find it extremely hard to believe that these 1200 pages, written by people who have no deep understanding of the problem, are the absolute best solution -- we can't even agree where the problem is. Since we can't be sure, this is a perfect example of where we need to respect liberty instead.



Not correct. A market fundamentalist believes that markets should not be regulated. I believe markets must be regulated to protect property rights and the market mechanism. Like I said, markets aren't the solution to anything, self-ownership and property rights are.



Bitt, you obviously feel that people are too stupid to be entrusted with making choices on their own. Except for those who agree with you, of course, who should be empowered to make these decisions for all of us. Even a rushed, politically motivated and bureaucratic "solution" is better than nothing as far as you're concerned. In the 60's, Khrushchev called people who thought like that "helpful idiots", as he himself saw the economic disaster of socialism.

In addition to the profound arrogance of this position, I consider it evil. It's just complicated slavery. This attitude infantalizes people and eventually you become right -- they can't make decisions for themselves (or won't). These arrogant policies (and the right-wing equivalents!) deprive people of the right to become free, autonomous human beings.

Freedom and self-ownership (and hence property rights) are vastly more important than protecting society from the ridiculous and extreme examples you cited, or thousands like them. Freedom might be messy business, but I'll take it over a nice tidy prison any day. You obviously choose the prison, assuming of course that you get to be the warden. You don't want a republican-styled prison, but you don't object to a prison (for me) of your own design. You're going to continue to get your prison, incrementally, all the while blaming those nasty right-wingers who took away the civil liberties, never realizing you've done the same, only with different liberties.

Yeah I have never met anyone that runs a small business that doesn't bitch about the government because they have to pay quarterly. Plus having to pay the full 15 percent on social security. I don't know how my dad can do it without jumping off a bridge.

I know that is how it really works and I know why but it has to cost the medical provider less if you don't have insurance because they just have to bill you and not mess around trying to get an insurance company to pay.

I have a lot to say on this topic, but have been spending most of my "free" time recently fighting with our existing health-care system on behalf of my wife. I'll probably jump in here again when I get a few round tuits, but looking over the thread, it's clear that some people are flat-out misinformed about what is and is not in the bill that Obama's going to sign into law tomorrow.

The most clear and concise summary I've seen is here.



Read on for an honest discussion about things the bill is expected to do well and things it really won't be able to do. The source of this information is the Kaiser Family Foundation, which is generally considered reliable by people on both sides of the political spectrum, and is who the health insurers themselves often look to for guidance.

Ultimately, this bill is VERY close to the Republican alternative proposal to Clinton's 1993 plan put forth by Sen. John Chafee, and mirrors the Mitt Romney Massachusetts plan in most respects as well. The idea espoused by many that it's a government takeover, or an incursion upon one's personal liberty, is preposterous.

Sweet, that "prevention component" will win me my bet with Bitt! :-)

PS: the fact that it's close to a Republican bill means nothing to me as the Republicans have just as bad a track record on liberty.

"Liberty" is such an abstract and loaded word that it's really not productive to debate how much "liberty" we want, or who's got a good track record on "liberty." Absent any context or clarification, it's little more than a rah-rah buzzword to rile up constituents for or against something you don't like. We all want it in the abstract, but without specifying where to draw the boxes around your liberty to swing your fist and my liberty to live without having my face punched, we're really not getting anywhere.

You did a very thorough job earlier in the thread explaining what liberty means to you, and that is interesting from an academic standpoint, but you're not really explaining the concrete steps within our existing political system to get from where we are now to where you want to be. Republicans might not have a good track record on "liberty" in general, but they've certainly slashed federal regulation at every opportunity, so they're the team that comes closest to your stated free market economic ideals -- irrespective of the fact that those ideals originate from property rights.

Much to my chagrin (and I reckon yours), we have a two party system, so those are the only practical choices we have on economic issues. Individuals within those parties may have different views or interpretations, but when push comes to shove, they either favor "more" or "less" regulation, so simply saying that the Republicans didn't do well protecting "liberty" doesn't begin to address my point that the health-care bill is centrist, and, frankly, was considered the "conservative, free market" approach a couple of decades ago. But now it's suddenly a massive encroachment upon our liberties? It can't be both based on who puts it forth or what the political environment is when they do it, and that's all I was trying to say by comparing it to the Republican plan.

Obviously, I'm not thrilled that the end result of the sausage-making looks like what Republicans wanted 15 years ago, but it's a start. What would be your libertarian alternative for dealing with the exploding health-care costs?

What taxes do you feel you should pay?

(I split out the USPS subthread. Some tangentially relevant healthcare stuff was in there, and if I screwed up someone's argument, I'm sorry. If so, let me know and I'll try to fix it.)

Thanks for pointing that out. I'm now really curious what has happened in the past 17 years to cause the GOP position to change so drastically. The chart here pretty much lines up the GOP proposal in 1993 with the bill that passed, along with putting in the GOP 2010 proposal.
http://www.kaiserhealthnews.org/Graphics/2010/022310-Bill-Comparison.aspx

17 years, and a party completely reverses it's position. Or were they not sincere when they proposed it back then?

That's pretty well said.

You know what would mean "liberty" for me? A single-payer health system, administered by the government. I'd have the liberty to change jobs, without worrying about losing/downgrading my health care. I'd have liberty from worrying about where the hell I'm going to get the funds to pay an additional $500+ bill every month, after losing my job. I'd have the liberty to go to any doctor I want, instead of being artificially restricted to whoever my insurer dictates (yay, Kaiser HMO!). I'd have the liberty to go to the closest, least-busy hospital, when I need to. I'd have the liberty to get out-of-state medical care when I'm traveling, without worrying about how much is covered by insurance.

Having lived on both sides of the US/Canada border, it's the Canadian system (even with all its imperfections) that's more liberating, by far. Even though it's government administered. (The higher taxes thing is a red-herring -- by the time you pay for health insurance post-taxes, the difference is negligible.)

I think it's a bit of both. John Chafee was uncharacteristically independent compared to the other Republicans of 1993, and though his bill gained 23 other co-sponsors, I don't think it's fair to say it was the truly mainstream Republican alternative. It would have been interesting if the Democratic leadership had called their bluff and accepted that as a starting point for further negotiation, but unfortunately, Clinton and the congressional Democrats thought they could grab the whole loaf instead of settling for a quarter or so. Sometimes that works out, sometimes it doesn't.

That is the wrong question. The right question is, "under what circumstances is it morally justified for a group to forcefully impose their will on others, without their consent?" Or, if you prefer, "what are the morally acceptable functions of a central government?" They amount to the same thing.

You mean it would provide you, personally, with more of what you call "liberty". You aren't considering that someone has to pay that $500. That there is no such thing as a free lunch. If you aren't paying for services (labor) that you receive, someone else is. That doesn't seem to matter to you as long as that someone isn't you. That is very far from the philosophical principle of liberty. In fact, it is the complete opposite, and more correctly referred to as "selfishness" or simply "stealing."

I think you mean that the term is misused. The philosophical principle of liberty is extremely well defined. Unfortunately, it's also extremely misunderstood.



My opinions about this are very complex, and in some ways controversial, but I'll give it a shot.

We all know that there are different fields in which humans can develop. Someone who is really good at math might have very poor interpersonal skills. Or a great musician might not be able to do much of anything outside their specialty. The specialization of the modern world, resulting from the faster pace of change, aggravates this condition.

There is a ton of widely accepted evidence that human cognition progresses through developmental stages, as does human moral development. Kohlberg's moral stages are a classic explanation of how human moral "skill" or "development" progresses through stages.

When we are infants, we are completely dependent, helpless and self-centered. There is no other way we can be. Human psychological development is often thought of as a decrease in this self-centeredness, or narcissism. But since we all start out as infants, we all start out at square one.

Consider mathematical education. It builds in stages. There will *always* be more people who understand addition than there are those who understand multiplication, and there will *always* be more people who understand algebra than those who understand calculus. There has to be: all those who understand calculus must first understand algebra, but the opposite is not the case. Human development is like that.

Research shows that moral development progresses much the same. We start out as totally self-centered infants, and progress from completely selfish, to family-centric (kinship morality), to ethnocentric (nationalistic morality), and perhaps eventually to global-centric or world-centric morality. But these unfold in stages. There will *always* be more people at the lower levels, because everyone starts out at square one. We were all completely selfish when we were 2 years old.

The ideas of universal rights (liberty) are fairly high up that moral development, and there will always be more people who don't function at that level than those who do (this is the part that upsets the egalitarian left like Bitt). When you really look at a document like the Constitution, it is a document which, above all else, seeks to protect the system from the selfish levels of moral development. The goal of the Founders was to create a system that required people to behave at the moral level of universal rights, even if they didn't think that way themselves.

The principle of universal liberty is based on the notion that we are all fundamentally flawed, and it must be up to the individual to make important moral choices. The only restriction is that they don't intrude on others. We all get to pursue our own idea of the good life.

What's particularly interesting about this is that the system is designed to protect the minority opinion. The majority doesn't need any protection, because they can jam their laws through the system. The system is literally designed to protect the "whackos" (as Bitt calls guys like me), as long as we don't harm others.

Ultimately, though, the majority will destroy these protections. The Harrison Act was a big one, which paved the way to the Therapeutic State. So was the 16th amendment. There are thousands of other examples. As Hume said, "It is seldom that liberty of any kind is lost all at once."

I actually think it's too late for America. We're way too far down the path of collectivism. I ask myself why I bother, to be honest. I guess because it's an interesting conversation to me; I enjoy discussing ideas.

I also think that I might be able to get Bitt (or people like him) to admit that what they are fundamentally doing is using force to impose their *opinions* on me, and that Bitt is smart enough to realize that HIS OPINIONS MIGHT BE WRONG, no matter how fervently he believes them. The obvious logical conclusion, then, is that we need to figure out a way to pursue our own destinies in peace with each other. I might be wrong, too, but my position has the advantage that it allows me to be wrong without imposing my will on others with force.

We are very far away from this kind of thinking. People actually say things like "people have a RIGHT to healthcare." It's just a preposterous point of view. Imagine an island with 10 inhabitants and one doctor. The 9 non-doctors get together and have a vote which decides that the doctor has to treat all of their ailments for whatever they decide is a "fair" amount to pay him. In my view of the world, the doctor is completely in his rights to say, "go fuck yourself." What people refuse to acknowledge is that health care is a *service*, and as such it must be provided by other people (as do the artifacts of medicine like the machines and the medicines). Nobody has the RIGHT to the labor of others. That is called slavery. You have the right to your body, and your life, and to labor and to keep the fruits of your labor. You do not have the right to take the fruits of other people's labor, nor to force them to work for compensation that you unilaterally deem is "fair". Calling it by fancy names does not change the reality of what's going on here.


I think I've answered this above. It's not a "sudden" encroachment on liberty. It's just a particularly large one. In fact, it's not, in itself, that large. My concerns are that it opens the door for all kinds of central control in the name of "public health", just as our "war on terrorism" has.

You are wrong about one thing. People don't all want liberty, even in the abstract. Erich Fromm wrote a book about it called "Escape from Freedom". Sadly, most people operate at the selfish level of moral development (remember, it has to be this way, we were *all* at this level once). They don't want liberty (which implies radical self-responsibility), they want to be taken care of and protected from the risk of making a bad decision. Or, at best, they want liberty for themselves, but not for others. They may be free moral agents, but they reject that about themselves.

We had a good run.

You can play semantics all you want, but that doesn't mean you answered the question.

Governments provide services. Services, as you've pointed out, are not free. Unless you want to claim that governments shouldn't exist at all, at some point you have to admit that taxes are required, as the services that the government provides are often not the type of services that are payment-for-services-rendered based. ("Hello, Mr. Government Man? I was calling to find out how much it would cost to repel the foreign hordes storming my village.")

It is perfectly reasonable to make the argument that there are limits on the services that the government should and can provide, as, at some point, there is a breakdown of the cost benefit. For example, I don't think that the government should provide free dirigibles to all US citizens when they pass the age of thirteen. There is no societal benefit.

My question to you is: what is the point at which governments should stop providing services, and how did you reach that conclusion? I mean, you want people to accept personal responsibility, which is a sentiment that I can agree with. But I think that we have a difference of opinion on what people should be required to take responsibility for. For example, to the heart of the current matter, I don't think that it's a person's fault if they develop spongiform encephalopathy. You might argue that they should have been more careful about the beef that they chose to eat, and that FDA regulations on the sale of diseased cows shouldn't exist.

On the other side of the coin, assume someone who is poor. Sometimes this is their fault, oftentimes it is not. If they develop idiopathic cancer, and are unable to pay for treatment, what do you think should happen to them? Should they be allowed to suffer and die, or should someone take care of them? Lots of libertarians claim that charity should be the answer to that question, but there's no restriction on charity now, and people still die of treatable diseases all the time. (I know, I know: if only we weren't taxed so heavily, charity would step up to the plate. Horse pucky.) Anyway, if you agree that these people should not be simply allowed to die, then you have to admit that the government is the one that is ultimately going to take responsibility for them. No profit-based organization is going to systematically eat costs for some random person they have no relationship to. After all, insurance companies regularly find ways to get rid of their clients when they start costing too much. Why would they be more generous toward someone who never paid them a dime? Assuming that the government is going to end up being stuck with the bill in one way or another, wouldn't it make sense to try to reduce the costs associated with that service? And wouldn't one of the ways to do that be to make sure that those people have access to preventative services and lower-cost medications?

I guess, ultimately, what I'm saying is that not only is the newly mandated and subsidized health insurance beneficial to the currently uninsured individuals, it's also beneficial to society, and probably beneficial to each individual through what is likely to be lower taxes.

I understand that you have this idealist notion that every man should take care of himself and deal with the consequences of not doing so. This would be great, if not for the fact that all of us need someone else's help at some point. If you don't want to be part of this society, fine. But if you don't want to pay the costs, don't take any of the benefits, either. Don't drive on my roads, don't call the police when someone is breaking into your home, and don't expect me to protect you from invaders.

And yet you take a position that I cannot find any way to qualify other than as "selfish". From my point of view it seems to boil down to "I'm all right Jack; keep your hands off of my stack."


Ooohh. You're one of those.

Can you explain to me why direct taxation is so evil? The constitution clearly calls out that clause as one that's likely to be amended (at least that's how I interpret the time restriction), so why is there so much concern over it? There's no reason that the Federal government couldn't levy an indirect payroll tax that, these days, would have basically the same effect as the direct income tax. What difference does it make that it passes through someone else's hands first? Or is your argument that there should be a regressive taxing system? Because, again, that could be implemented as either a direct or indirect tax.


Absolutely. That is the basis of all society, from the smallest anarchist collectives, to the largest capitalist states and everything in between. Society makes rules that state how others can behave. There are societies that exist(ed?) that didn't really have a notion of personal property, so isn't it possible that your requirement of the sanctity of personal property is also opinion?


I think he is, too. And while I realize that you're making a larger point about taxes, I think you're being disingenuous by using that particular metaphor. In the post-HR3962 world, no one is required to be a doctor, and no doctor is required to perform services for any payment he does not wish to agree to. (Except in emergent circumstances, which was true before.) No doctor is required to accept Medicare payment, and doctors are allowed to negotiate contracts with insurance companies, including the rejection of any such contracts. In summary, if they're not happy with the amount they're being paid, there is nothing that compels them to work for that amount.


To be pedantic, that's a specious argument. (I'm notably not denying the basic claim, just the argument that leads you there.) To use your prior example, if we all know how to add before we know how to multiply, if we use your argument, most people don't know how to multiply. Or taken to a larger extreme, if we all know how to say individual words before we know how to speak in sentences, then most of us don't know how to speak in sentences. I think this is demonstrably untrue. (Ignoring poor grammar; it's still a sentence even if it's improperly constructed.)

It's not about that. I think I've explained fairly thoroughly that my position is not about avoiding paying taxes for morally legitimate functions of government. My position is the exact opposite of selfish, since I am saying that I don't have the right to take labor or property from others by force, no matter how difficult my personal situation. And, I personally spent just over 5 years without health insurance because I couldn't justify the expense. You can't reduce my argument to a greedy person not wanting to pay taxes. This is about people being able, as much as possible, to pursue their destiny and happiness based on their own definition.


The problem is that once you allow it at all, then it tends to be used for all kinds of things. The original income tax was around 1-2%, from memory, and nobody would have imagined that it would be 30+% at the time. Again, taxation is not the issue. It's the government proscribing what "good" is for people. Not killing or robbing each other? Fine. Protecting the system from foreign invasion? Fine. Forcing people to buy a product (health "insurance")? Not fine. Prohibiting people from buying useful products (Vicodin, experimental drugs)? Not fine. These things clearly fall into a category where a person should be making those decisions for themselves.



Of course! But, you see, that's the beauty of my position. If I'm wrong, I haven't imposed my beliefs on others. You have. Property rights are a logical consequence of self-ownership. Self ownership means being able (among other things) to make moral decisions for yourself (that don't affect others), to eat and drink what you want, to labor and keep the fruits of your labor.



But I am required to pay money for health insurance I might not want. And the government WILL restrict liberties to improve public health. We're seeing it already with smoking laws, trans fat laws, etc. You think that's OK, and that's the problem.


Yes, you are absolutely correct. Research does show that 60% of Americans are operating at ethnocentric or lower morality, but that isn't a logical requirement or hierarchical development.

And everyone else I know, too. I know a great many people who were afraid to look for a better job, consequently improving their lot in life, because they were concerned about keeping their medical insurance. I know a great many people who are frustrated about losing doctors they liked, because they had to switch insurance. What I wrote above would provide liberty to a greater class of people than just myself.


Really? I'm not considering that? When you decided that, perhaps you weren't considering that I'm somewhere above "moron" on the scale of intelligentsia? I'm quite well aware that the funding for a single-payer system comes from somewhere, and that there's no such thing as a free lunch. The notion that people in favour of "socialized" medicine just want something for nothing is nothing but an old canard.


IMHO, you have it exactly backwards. By paying into a single-payer system via my taxes, I know that my funds are being used to provide anyone and everyone with medical care. Including you, if necessary. Because I believe so strongly in the importance of everyone having good access to medical care regardless of their financial situation, I'm willing to contribute so that everyone has the same liberties that I described above; so that everyone can have the opportunity to be as healthy as possible. And in the event that I need to draw on it? So be it... but so far, I put far more into the (Canadian) system than I ever took out. I pay into it so that everyone can benefit... not just me. I've paid far more into the US system than I've ever taken out, too, but here I have no confidence that any surplus funds have done anything but line the pockets of an insurance executive.

On the other hand, you seem to be arguing for your funds only being of benefit to you. And you accuse me of selfishness?

Cheers,

Edit: Trimmed incendiary comment...

And I have asked you define what you feel are the "morally legitimate" functions of government, and you have yet to do so.


And people who do that often end up costing the taxpayer more money than would have been spent by the individual on the insurance to begin with. Unless you feel that society has no moral imperative to take action against treatable disease and injury, which would be another way to reduce costs that you currently pay in taxes and in health insurance premiums.


If your concept of self-ownership is wrong, then you have imposed your beliefs on others. You did not get where you are today solely through your own actions; society played a part in that, as much as you may want to believe otherwise. As part of living in this society, it is part of the social contract that we give back to the society, and paying taxes are one way we do that.

It strikes me as similar to the people who won't donate to the Red Cross, because their money won't go solely to Haiti earthquake victims. The Red Cross is going to do everything it can to take care of the needy in Haiti and everywhere else, regardless of their funding. (Obviously there have to be limits somewhere.) So when you donate to the Red Cross, you fund the Red Cross, not their operations in a particular place. When you pay taxes, you pay into the fund; you don't get to pick and choose which services you want.

That said, I still want to know what your ideal set of services is.


Smoking affects more people than just the smoker, unless he does it in complete solitude in a place no other people ever go.

No one has banned the sale of trans fats. What has been banned is the sale of trans fats as food. People can sell rat poison all day long, but if they start putting it in Oreos, I think it's legitimate for the government to do something about it.

I will admit that I'm generally not a big fan of telling other people what to do, or being told what to do myself. I am not a fan of drug laws, nor am I a fan of the restriction of civil liberties of any nature. However, I don't see universal healthcare as a restriction of liberties, rather as an expansion of them.

That said, there are times when the needs of the many or the whole do outweigh the needs of the few. I would personally prefer universal healthcare that is paid for directly by taxes, rather than the somewhat onerous mandate to purchase health insurance independently. I recognize that as politically impossible. I gather that you would be opposed to that, as well.

I continue to claim that you are currently paying money towards other people's healthcare now, just through circuitous paths. With this bill, that money not only goes towards helping those same less fortunate people, but also gives you a personal benefit, unless you choose to reject that benefit.

As I see it, there are only a few valid arguments against universal health care:

1. The government should not provide for anyone's health, regardless of circumstance.
2. I'm willing to spend more money in order to make sure that the government doesn't provide any direct health benefit to anyone.

I was thinking I would come up with three or four, but I think all the other ones eventually simplify into one of those two.

Which of those do you subscribe to? Or, if there's another that I have missed, please share.

At the end of the day, it's not my country and I really have no say nor stake in the healthcare issue. But I'll bring it up again, why don't we see the same people arguing about the military spending?

What is it about government-sponsored/mandated/whatever healthcare coverage that gets some people so wound up (against it)? I can see from this thread that it doesn't seem to be exclusive to people who already have coverage through their employer. Pure selfishness would otherwise be my guess as to the primary motivation for objections to universal healthcare.

How much is it going to cost to pay for all this anyway? Half the price of a single aircraft carrier? A couple of months worth of killing civilians in the middle East?

There is a strong sentiment in the US against the federal government overreaching its power. The US Constitution explicitly states what powers the federal government has and what powers the states have. (The original Constitution consisted of the main article, plus the first ten amendments, which are collectively referred to as the Bill of Rights.)

One of the things that is explicitly defined as a federal power is the power to form a military. There are other vaguely worded clauses that some people interpret very conservatively and others interpret very liberally, as well as everywhere in between. For example, the Constitution states that the federal government is to "provide for the … general welfare of the United States". Liberals believe that providing healthcare can be reasonably seen as providing for the general welfare. Conservatives seem to believe that general welfare doesn't comprise much beyond the prevention of dissolution. In general, liberals see the Constitution as a "living document" that must fit with the times, while conservatives see it as set in stone and uninterpretable, meaning nothing more than what it denotatively says.


For the federal government, predictions are that it will reduce the deficit. For those that don't currently have health insurance, it will cost them a payment they're not making already. I imagine that the majority of those people don't have health insurance because they can't afford it, and will likely be subsidized. The people who get "screwed" are those that can afford health care, but choose not to have it anyway. My opinion is that those people are being selfish. Few people can afford to pay outright for cancer treatment, so those people are willing to chance that they won't get cancer against someone else picking up the tab. (Cancer being a standin for any expensive illness.) There are also increased taxes on the wealthy (those that make over $200,000 a year individually or $250,000 as a family) to pay for the subsidies given to the poor. (Also, people don't like redistribution of wealth, unless it's to generate a greater income disparity. "You're taking my hard-earned money to give it to some lazy slob!")

The estimated total "cost" of the bill in higher taxes and repurposing of Medicare funds is just under one trillion dollars over ten years, but that doesn't include any cost reduction estimates. A Nimitz-class aircraft carrier is about $4.5 billion.

Ok, maybe not an aircraft carrier, but the US is spending money at a faster rate in Iraq... Shame.

http://costofwar.com/

Thanks for the details Bitt. I'm glad you guys are getting some reform finally. It's been a long time coming.

I hate to pay taxes as much as the next guy, but I do have a sense of priorities for where that money should go. Healthcare is pretty high up there.

I'll answer your other post when I have some more time, but I seem to recall reading a response to the General Welfare clause by Thomas Jefferson where he explicitly states that the clause is NOT intended to give the federal government the authority to provide services not explicitly given in the rest of the Constitution, but rather that it gives them the authority to tax for those powers specifically granted.

The constitution is not vaguely worded, no matter how much the central planners (right and left) would like to believe. It states very unambiguously as the 10th Amendment:



Health care is not specifically "herein granted" the federal government by the Constitution. Period.

You see two philosophically different points of view between me and Bitt. Bitt (it seems to me) is a collectivist, who sees the function of government to increase the welfare of it's citizenry through central planning. I believe that the function of government is to maximize individual liberty as much as possible so that individuals can pursue their welfare as they see fit.

Bitt says he doesn't support dirigibles for 13 year olds because there is no "social value". Says who? Says him, of course. That's the whole problem.

To suggest that self-ownership may be a flawed philosophical concept is to place the value of the collective above the value of the individual. This is the core issue. The mainstream political parties in America place the collective above the individual (differing in how they define "social value"), the libertarian rejects this notion.

Either one of us could be wrong, I suppose, but there is absolutely NO QUESTION which the Founding Fathers believed. The collectivists will respond that these are dated ideas, which is why the Constitution needs to be a living document. The libertarian will say that the Constitution is based on philosophical principles which are just as valid today as they were 200 years ago.

To answer Bitt's question directly: which do I consider to be morally legitimate functions of government? It wouldn't be my *exact* list, but I could live with those functions *explicitly* granted in the Constitution. This would eliminate the vast majority of our federal government.

From a practical point of view, I promise to eat my hat if this reduces the deficit or health care costs one iota.

I think what's needed here is a time machine. Folks who feel that everything should be by the precise letter of the constitution would be given the opportunity to travel back in time for a spell to see how they enjoyed living in that period.

Doesn't the "or to the people" sort of invalidate the notion that this is something the government can't do? I mean, the government represents and was put in office by the people. In fact by a majority of people. A majority of people who want healthcare reform. So while these people can't necessarily all get together in the same place to hash all this out, their representatives can. Oh... And have.

You don't need to worry about the social order. The poor will still be poor at the end of the day and the rich will still be rich. The middle class will still be there too. Your nation can afford it. Easily.

You're casting me as one of these anti-libertarian types, and, while I see where you get that impression from this particular discussion, I can assure you that that's not true.

I think that this legislation is seriously flawed. However, I also believe that the country is significantly better off with it than without it. I understand your point about individual liberties, and when taken without context, I agree 100%. When taken in context, I agree about 95% of the time. (Assuming that your notion of the individual does not extend to non-natural persons.)

However, I believe that there are times when the practicality of the liberty of the group has to trump the liberty of the individual. I am definitely not a "central planner". I merely believe that the government has a responsibility to provide needed services to its citizens. What services are needed may change over time. I believe that access to healthcare has become one of those needed services.


Yet you prefix that with Thomas Jefferson providing clarification on a particular clause. If you have to provide clarification, it is vague. I do not believe that it was unintentionally vague, either. Certainly Jefferson and Adams had very different ideas about the role of government, and I'm sure that much of the phrasing was due to compromise. I have no doubt that Thomas Jefferson's ideals for government match yours, but Thomas Jefferson is not the final arbiter of what the Constitution says.


And you say that there's no value in universal healthcare. If you can come up with a reason why universal dirigibility is good for the country, I'm more than willing to listen, and we can come to a decision together.


As I've said before, my concern is far less with the cost than with doing our best to make sure that everyone has the best opportunity to live and be able to pursue happiness.

That said, I'll ready the steak sauce.

That was a great Duckman episode. Wish I could find the clip on Youtube for you.

The vague gist was: Thomas Jefferson (voiced by Ben Stein, IIRC) appears through a time wormhole and says, "Freedom of speech applies to everyone. No exceptions. And we didn't mean that every Joe Sixpack should have a gun... we're not stupid."

As Bitt suggests, you better prepare to eat that hat. Uncle Sam has a stellar track record of fiscal solvency and restraint which is never compromised by political interests. If history for some reason doesn't repeat itself, this new bill will create a national surplus, raise the life expectancy to 1000 years, and slash the unemployment rate to 0% (as you know every bill that comes from this Congress is really about creating jobs; the other benefits are secondary).

You really should learn to take comfort in the fact that Big Brother has your back and wants and knows what's best for you far better than you yourself could ever know!

Stu

Is it that you're opposed to providing healthcare to those who can't afford it? Because that's the only real governmental outlay here: subsidies for the poor to afford health insurance. Otherwise, the entirety of actually providing medical payments is going to be done through the insurance companies that you already know and love.

As I've said in other threads I am not opposed to treating the disadvantaged, as if this bill is some magical absolute with no other alternative. Why must we dismantle the free market insurance system just to get 30-40 million people insurance and treat pre-existing conditions? A small fraction of the price tag of this thing could buy private insurance and where needed cover those that get dropped or excluded. There are already plenty of programs to treat people with chronic health conditions and perform general health care anyway. This bill is just a pathetic excuse for the libs to get their clutches into our every day lives and tax us to oblivion.

Everything is not as cut and dry as you try to make it out to be. We'll gradually lose private insurance until we have no other option but government health coverage. Once the profit is gone from the industry do you really think innovation will continue? Do you honestly think health care will be just as available to those that already have it once everything is fully implemented when medical personnel pursue other more lucrative less opressed fields? We'll be paying more and getting far, far less. I can only hope some of our states with some balls decide to opt out of this disgrace of a bill that has been forced on us.

Stu

While I'd not be opposed to that, I see nothing of the sort in this bill. The bill applies restrictions as to how insurance companies can treat their customers (minimal coverage, pre-existing conditions, recission, etc.), and allows the general populace to act as a group for the same sort of collective bargaining that existing groups (employees, etc.) currently do.

Can you be explicit about what sort of free-market dismantling you're referring to?

To be clear, there is no provision for any government-run health plan in the bill.

Here's the thing. Republicans did offer various "alternatives", but they were all "here are our ideas, take them or leave them" proposals. That's how they're used to negotiating, and they haven't adjusted to life in the minority. The minority party in Congress doesn't get to set the starting point for negotiations.

Republicans were more than welcome to provide serious ideas and proposals for changes to the bills as they were being drafted in committee, but that's not what happened. Instead, all of their proposals, including the Paul Ryan plan that got a lot of attention at the end, involved tearing the Democratic bills up and starting over with a purely Republican bill.

Despite this, as I said, the final product had over 200 Republican amendments in it. Democrats *did* water down the bill and made it more friendly to the existing system. There's no single payer. No truly universal coverage. No public option. No immediate effect on the employer-based system, and only a moderate effect on it a decade from now.


If the "free market insurance system" wasn't leading to exploding costs, maybe there'd be no need to reform it. This isn't just about covering the 30-40 million without coverage, it's about putting downward pressure on costs for those who do have coverage. Tell me how the current free market system is working when costs are skyrocketing. Or if you acknowledge it's not working to control costs, tell me how you'd prefer to control them.

Total bullshit. The bill's cost over ten years, negating cost savings, is around a trillion dollars. With the low-ball estimate of 30 million uninsured, that's around $3500 per year per uninsured. Show me the insurance plan for *healthy* folks that costs that much, let alone a plan that someone with a pre-existing condition could get. Your statement has no basis in fact.

Name them.

Last I checked, the team that ran on health-care reform won overwhelming majorities in congress. If people didn't want it "forced" on them, they would have voted for the other team.

Oh, and your point about doctors hating this bill and wanting to leave the medical profession because of it? The AMA supported the bill. Thanks for playing.

Stuart says:
Stuart, based on the work that you have done on Empegs, I long ago concluded that you are way smarter than me, but I don't get this. We have a bunch of Canadians on this BBS, just a short hop away via Boeing 737 or Airbus 320, who seem to be surviving the oppression of "federally"-funded single-payor health care without any serious Orwellian side effects so far as I can tell. OK, there are issues raised about waiting lists for brain transplants and such, but aren't Canadians' life expectancies and health outcomes the same if not better?

I planned a vacation in February/March in a *Socialist* republic (Vietnam) in part just to avoid watching news coverage of this mess, but I came back and it hasn't stopped!

It just kills me that discussion of such a basic issue should turn in to a debate about the merits of Alisa Zinov'yevna Rosenbaum's objectivist philosophy or Marx's spin on the fruits of labor. I often don't think of myself as an exceptionally nice guy, but the grim grumbling about "property" makes me feel like a pretty cheery dude. Bitt, I admire your patience. TigerJimmy, I have concluded that you must be a robot.

OK, I jest, I exaggerate, but I just don't get it. I feel like the American body politic is essentially antisocial. There is no sense of the commonwealth. Republicans aren't *for* anything, just against. Democrats pretend to be *for* something and talk about putting insurance companies in their place while taking exceptional care to please special interests (like insurance companies and pharma).

I won't ever vote for a Democrat or Republican again, but I have to say that it concerns me to no end when Republican demagogues spout bullshit about how they have the will of the American people behind them. Goddamn proto-fascists and a bunch of freaking maladjusted children. They lost a few elections but seem to have conveniently forgotten their lessons in Democracy 101. If I wasn't going to be dead within 15-20 years I would be hugely concerned.

And it is a total riot. The teabaggers and wingnuts with whom I would expect TigertJimmy to make common cause are railing about the "Socialist!" Obama and his evil designs when, in fact, Obama has turned out to be the most miserable, ineffectual, middle-of-the-road-to-nowhere, Harvard-trained tool of special interests that I can recollect.

But he's a socialist

Stuart, was the Canadian single-payor initiative just a pathetic excuse for the (Canadian) libs to get their clutches into their every day lives and tax (Canadians) into oblivion? Or was there maybe something more to it?

At best!

Peter

When you tell a business what sort of products it can offer and in fact what sort of product its customers 'shall' buy, it fails to be a free market system. I suppose you believe the insurance companies have exclusions and limits simply because they are greedy inhumane assholes with no concern for human life. The problem is, they are businesses whose purpose is to make money; they owe this to their stockholders/owners. They have low margins as it is. If you increase their costs by applying restrictions, forcing them to take on customers that they know from the start will lose them money they could very easily be forced out of business.

Stu

There is none of that yet. Obama and the rest have said that's what they want and that this is just the beginning. They've definitely laid the groundwork to make this happen all on its own with all the onerous regulations and profit squeezing.



I think the insurance industry needs to get back to actual insurance and doling out payments for the truly unexpected rather than paying for routine office visits and minor medical procedures. Tort reform needs to be in place to reduce defensive medicine and we need to nationalize the insurance market rather than limit it to state by state offerings.


I've never paid that for private insurance. Sorry... You know I've never been that great at math, but using your assumption is roughly a 10th of the advertised cost of this bill.





As I've stated in other threads, I used to work at an HIV clinic. The vast majority of those patients were free care. They weren't out in the gutters dying as Obama and the dems would lead you to believe. The clinic was funded patially by the state and partially with federal grants. One of these was called the Ryan White grant.





And last I checked, this BBS' residents not withstanding, the majority of people are against this bill. They voted for reform but like this.


This may surprise you, but not all doctors share its position.

Stu

Thank you for that (I think ). Yes suppose they are about the same, but I have to ask, why, if it so wonderful has there been talk of scaling it back for more private options and how do you explain away the waiting lists and residents that come to the US for treatment because their lives depend on it? If it is so effectual and efficient should it not have vastly better outcomes? Ostensibly they don't have the 'greed' and evil 'profits' that stand in the way of patient care.


As if there is but one side to a coin???



The US is not Canada and it is not Europe. I'm saying in this case that is what is at play here. It seems rather hard to believe that it is mere coicidence that some of the most far reaching tax increases and other 'goodies' don't come into effect until after Obama's potential section term. Just because everybody's doing it does not mean it's the only way. The US was founded on the freedom of the individual, not the collective. Let's leave that to Europe where people seem to love it.

Stu

Then there has never been a free market system in the history of any nation no this great Earth. By your definition, telling a pharmaceutical manufacturer they can't sell methamphetamine is a restriction on the "free market." As is making people buy car insurance so they can drive a car. As is *any* form of taxation -- after all, mandatory payment into the Social Security fund is just forcing people to purchase a form of "retirement insurance", isn't it? (I reckon you're probably in favor of privatizing that, too.)

Look, I agree that markets are very good for many things, but health-care isn't one of them.


How do you explain away these problems, keeping in mind that costs have exploded during a time when the insurers faced very little regulation?


And that's exactly the problem with using for-profit institutions to insure the the health and well-being of our citizens. I would not *expect* a corporation to have my health as its primary concern when there are profits to be had. As Krugman alludes to above, it's not as simple as "if an insurer screws over its customers to make money, people will go find another insurer." We have very few choices from our employers, and even on the individual market, one or two players dominate each region, and they're all just about as stingy when it comes to paying claims. I recognize those exclusions and limits are there to ensure they make money -- I just don't think that should be my primary concern when I have just had an expensive life-saving medical procedure and then they deny my claims because I didn't "shop around."

How on Earth is telling a company that provides *insurance* that they can't take away a policy as soon as they are required to pay out a claim on it "onerous regulation?" How is insurance "insurance" if it's rescinded as soon as it's needed? The standard free market answer to this is that insurers who don't do right by their customers will lose market share -- but again, with so few competitors in any given market, that doesn't happen. The health insurance industry is a complete failure of the free market, and you can't explain that away by complaining about onerous regulations when those regulations are the only thing keeping the companies from paying out on any claims at all.


So, your solution to skyrocketing medical costs involves making preventative care less affordable? Really?


Jury awards and defensive medicine account for less than 2% of medical costs. Show me a state that's implemented tort reform that has significantly decreased medical costs. The idea that lawyers are pushing up costs is just not borne out by the facts.


Right, then they just move to the states that does the least regulation, the way credit card companies are all in South Dakota and Delaware. Because we all know the credit card companies are doing such a good job of serving customers...



Are you saying math is wrong? $1 trillion / 30 million uninsured / 10 years is about $3400. I know you're trying to make a distinction between what the experts at the CBO say it will cost versus what you think it will cost, but I don't get what you're saying about my assumption being 1/10th of the cost.



The average cost for individuals on the non-employer market is around 3 grand a year. At worst, this bill costs a little more than that per uninsured person, but it's also reforming the system for the hundreds of millions who do have insurance. Your original statement that this amount of money could pay for everyone's care is just false, Stu, and vague accusations about how it will really cost more than that aren't persuasive if you don't have supporting evidence.


Okay, that's one program in Louisiana for people with a specific condition. Do you really believe if programs were available for every condition, that people wouldn't take advantage of them? And how about people who are sick but haven't been diagnosed with a specific condition yet? Generally, the piecemeal programs for specific illnesses are designed to fill gaps in our system. I don't think they're a legitimate answer for health-care overall.


The Republicans did a great job sowing doubt and misunderstanding of the bill, with their "death panels are going to kill your grandma" rhetoric. Despite that, opinion prior to passage was just barely in opposition to the bill, but in favor of all of the individual provisions. Post-passage, public opinion favors the bill.


Let's be real here... Is the AMA in the business of favoring policies it thinks will harm physicians, or that aren't supported by a majority of its members?

A lot of it has to do with this notion that EVERYTHING must be paid for by insurance. It's something that has evolved over time and it basically removes any incentive for the health care consumer to control costs. What does it matter if they run 5 tests or 10, if I go to the doctor everytime I have a hangnail, etc, etc? Routine stuff should be out of pocket, period. There's also the rising fraud in the industry and new technologies which happen to cost money. And of course there is defensive medicine and the staggering cost of malpractice insurance. I realize you like to marginalize this and low ball the hell out it but I've seen figures as high as 34% of expeditures go towards defensive medicine. Cost of Defensive Medicine.




I might be okay with some government safety net to cover those that slip through the cracks but this premise that bodies pile up in the street for lack of treatment is blown way out of proportion by those trying to sell this. If it really was just a safety net that's one thing but the bill is structured to put the insurance companies out of business so that those paying for all this (that's you and me) will be forced into the government plan- no thanks.

Stu

I've been reading along, and I have to applaud a few people in here for not losing their cool. Even though the positions against healthcare reform are presented intelligibly and are from otherwise intelligent people, I'm sorry, but some of the drivel being written shows predominantly the desire to toe the anti-government line and nothing more. I don't really think the specific topic matters - this line of argument is always going to be the same and from the same people.

I've really had to hold back from being judgmental, but some of the comments in here are precisely the type of ignorance that fuels the disdain for the US around the world. It really does help paint the US as nothing but a cesspool. Luckily I know that's not the case and that this is not even the voice of the majority.



You know, routine stuff like TB, chicken pox, pneumonia, cervical cancer, etc. Did you slip out this weekend to get a medical degree? Most of the population hasn't had the time to do that either, so self-diagnosis and treatment is likely not in the cards. I'm not sure how well medical-roulette would play out as a policy. Maybe in Vegas. I can see someone sitting on the exam table... "Come on big money, no whammies, no whammies..."

Nothing is routine until it's been diagnosed as routine. And anything "routine" can have complications and dire consequences from time to time. You'd think people were out trying to get their cock-enlargement surgeries covered by insurance or something.

I think reasonable people, especially those from other countries, are going to see this argument having two distinct sides, a right and a wrong, I'm afraid.

That Jackson Healthcare study is from an online poll of doctors reporting their own ideas of what defensive medicine costs them. "Defensive medicine" itself is a catch-all term that can basically describe any test that's done on someone that doesn't have a confirmed diagnosis. Given that doctors have a financial interest in over-reporting how much of their work is "defensive" in nature, that 34% number is not even remotely credible.

I found this blog post on the subject of "defensive medicine" from an ER doctor very persuasive.


In other words, there are a lot of other reasons other than lawsuits that doctors order tests or provide treatment that someone might find unnecessary, and those don't go away once you eliminate junk lawsuits.

It's funny how the left always resorts to name calling and insulting of one's intelligence as some sort of valid argument against the naysayers of their policies (in addition to violence). They are the enlightened, elites and the do gooders, while the opposition are the lackwits, the ignorant redneck slobs and haters of the world.

I was referring to check-ups if you are so inclined.

Stu

If they are in breach of contract of course they should pay. But generally there is a reason for their actions. If you become too great a risk then yes they will drop you but the decision can't legally be made in lieu of payment if the policy covers that person's condition. I realize this happens and sometimes you have to fight to get what's coming but guess who leads in denials of care, why it's your hero the federal government!


There's a saying, you might have heard it before- you can lead a horse to water but you can't make him drink. You seem to assume that just because it's there everyone will be clamoring to go get their (as you seem to see it) God-given preventative care). I fail to see that the poor and often uneducated will see fit to take part in that just because it's there.



See my answer in the previous response above.



You've proven my point actually. Of course they ar going to go where they stand the best chance at making a profit. It's just common sense. Regulations limit profits and push businesses not only out of state but overseas too.

As far as the credit cards, well they are a business too. They are not a welfare entity. People need to learn to read up on things and what they are getting into before they use their cards irresponsibly, but I guess that will never happen because the liberals take them by the hand make it all better before they learn from their mistakes. We are seriously getting to the point where no one is responsible for anything anymore. The answer to everything is not more government. Why can't people be permitted to fail and make mistakes? Isn't that how we achieve greatness and excel in life? If all our choices are the 'right' ones because the chance to choose poorly has been eliminated, are we really free anymore? With no risk, there is no reward.



You are right, missed a zero in there. Such a simple analysis is really far removed from how insurance works anyway though. The CBO has to crunch whatever numbers it's given, no matter how bogus or fraudulent they are. Garbage in garbage out.




Why not? Obama makes his straw men arguments all the time in speeches. Seems to work for him.



It's a national program but whatever. Many people who qualify for things don't join. Medicaid being one of them. What about them? You can't force them to the doctor. They'll go to the ER when it worsens and nothing will change that. It's well documented that Medicaid patients use the ER far more than any other group. I cited one example but they are other programs and grants that are more far reaching. There are community health clinics- yes, even for your panacea preventative care.



Funny, they took what was actually written in the bill and pointed it out, cutting through the legalese that obfuscates the true intent. Just because you label it "sowing doubt and misunderstanding" doesn't make it any less true. That's fine too if you want to cherry pick your polls. It's understandable that with such a PR opportunity as the bill passage that there would be a bump in support, but most polls show that opposition remains. In fact, 55% support its repeal.



The AMA has its political agenda like any large organization. Not every physician is a member and certainly not everyone who is is in support of the bill. I have yet to meet one who is, but I suppose they are out there.

It's been fun debating you guys, but this is like the water boy taking on the football team in a brawl. I don't have the energy or the time to keep up with this. I'm glad you take comfort in big government being in every corner of your life. I myself but faith in my own abilities and believe in the freedom not only to succeed but to fail. A big government that has an answer to everything stands in the way of this. I have come to terms with the fact that there is suffering. We can do what we can to help. I am as eager to help people as the next guy, but there is only so much out there in terms of financial resources. Not everyone will be in perfect health and be independently wealthy. It's just not possible. True we can dilute the wealth and health of everyone so everyone is more or less equally poor and unhealthy, but where then is our incentive to improve and to move our society forward? If I work and work and the fruits of my labor are all just going to the government, why should I make an effort to create the next life saving gizmo? This is where your big government policies will lead us and it is an afront to the priniciples on which the US was fonded. The alternative has been tried in other countries and brought about untold suffering, I pray it never happens here.

Stu

Name calling and insulting intelligence? In fact I said that opposition was coming from some otherwise intelligent people. I was thinking of people in this forum when I used the word intelligent.

It's also coming from some people that I would not consider intelligent, like Sarah Palin. But I don't need to call out any such lack of intelligence or anything about the woman, she does fine on her own letting everyone know what's she's all about. The international image problem of the US has been caused by people who share some of the same opinions as Palin. Recently the people trying to make a lot of noise. It's name calling to point this out? These folks sully the US image and someone who points that out is to blame? it's funny because I've always found it to be the other way around. The name calling and labeling coming from buttoned-up conservatives. You did it yourself by calling me a leftist. Maybe next you can call me a socialist. And then I can call you a fascist and then we can share a dance.

Anyway, this rant is all the same old same old. Some people don't want progress and the title of this thread is completely apt.

Even found an Op-Ed in the (today's) NYT that agrees:

http://www.nytimes.com/2010/03/28/opinion/28rich.html


Referring to check-ups...

Oh, like the check-ups that may find prostate cancer, lime disease, lupus, heart disease/defect or maybe communicable stuff like hep, herpes, mono, HPV, etc... Like I said, roulette is for Vegas, not the doctor's office. If you want to play the odds and self-diagnose before going into the doctor on the chance you may or may not have to pay, good luck with that.

This is a "post hoc, ergo propter hoc" logical fallacy. There is no question that the conditions of life were harsh in that period. But it does not follow that the reasons for that were that they lacked the kind of central planning we "enjoy" today. In fact, I would argue the opposite -- that the conditions of liberty that prevailed at that time gave rise (eventually) to the tremendous wealth of our society today. That's the major reason why I wish to protect those conditions.


No, what you end up with then is simple majoritarianism, or mob rule. Many people today think that majoritarianism is the same thing as democracy, but this is not the case. As I've said earlier, our system was set up specifically to protect against this, and it is always the minority opinion that needs protecting (as you eloquently demonstrate). The US system was set up for the express purpose of preventing the majority from squashing the minority with their view of the good life, so that we can all define that for ourselves.


If you think that is my concern, then you don't understand my arguments at all. It's fine that you disagree with me, but try to understand what I'm saying.

Currently, insurance companies provide insurance to all of the employees of a company at lower cost under the assumption (occasionally requirement) that most of the employees will accept the insurance, and the costs of the few sickly will be overcome by the lack of costs of the healthy. There is, to my knowledge, no requirement that insurance companies provide these deals to employers, so they must be making money at it.

What this bill does is create a new group from the set of people who don't have employer-based coverage. Many of these people don't have coverage merely because they cannot afford individual rates. There are certainly some who feel that they are healthy enough to chance not having it. However, I find it hard to believe that there is a significant difference in the ratio of sick people to healthy people between the employer-covered group and the rest.

Assuming that there is no difference, why would a plan that makes them money when it's done with the employees of a company not make them money when done with the general populace? Imagine instead of the government intervening with this bill, that those 36 million people all suddenly got jobs that provided health insurance. Would the health insurance providers be complaining that they were going to start losing money what with all of the new customers? Of course not; they'd be making more money than ever.

I understand your problem with being forced to purchase insurance, but there are honestly very few people who are opposed to buying insurance, yourself probably included. I understand that your concern is the force. But in order to maintain the ratio, you have to make sure that there isn't a statistical bias in the numbers by preventing the self-selection bias that might exist from the healthy removing themselves from the pool. It's there both to make sure that as much of our society as possible is covered, and to make sure that the insurance companies can still function while keeping premiums relatively low. It's the same reason that the bill prohibits (new) individual policies.

Will it force some people who don't want to buy insurance to do so? Yes. Sorry. We also force you to pay for highways that you may or may not directly use. C'est la vie. Will it cause insurance profits to go down, or rates to go up? Maybe, as insurance companies will no longer be able to drop people who start to incur large expenses. Then again, they're unlikely to be spending money on finding "legal" reasons to drop those people, so there probably won't be as big an effect as seems likely on the surface. Does it make insurance companies provide a minimum level of coverage? Yeah, but we also make companies that sell beef actually provide beef to the consumer, not cellulose with real-beef-flavor, and we require auto companies to put brakes in their cars. I don't think any of that is unreasonable, and it's these provisions that the insurance companies are actually opposed to.

I also understand your point about insurance companies being profit driven. It makes financial sense for them to reduce their costs. Which, honestly, is why a profit-driven system makes bad sense for healthcare. Imagine a scenario where an insurance company gets a claim for a medicine that costs $100,000. If the patient doesn't get it, they will die in three days. It's in the insurance company's interests to just stall for three days and let the person die. Would you be okay with that? I'm sure (at least one of) your rejoinder(s) would be that that person would still get that drug somehow. Which is probably true. But should the insurance company be able to foist that cost off onto someone else? And how is that different from dropping them because they went searching and found that ingrown toenail they forgot to report?

I don't really understand what you're saying. I'm guessing that you believe that I feel no compassion for the unfortunate of the world (or perhaps that I'm an unthinking follower of Ayn Rand), but that is absolutely not the case. I just feel that a totalitarian government is not the way to care for them. I believe that a rising tide of wealth that comes from economic freedom (with regulations and constraints to protect the system) lifts all boats (albeit unevenly). I assert that the reason we have the nearly magical (though expensive) health care treatments in the first place is because of property rights and liberty. When we compassionately try to extend these benefits to everyone without considering that there's no such thing as a free lunch, I fear that we will eventually destroy the system which created them in the first place.


It is not anti-social to mistrust a strong central government, and it does not follow that I believe we shouldn't help those who can't help themselves. I just don't want to incrementally install the next bankrupt socialist government that controls every aspect of citizen's lives in order to do so.



Huzzah! I would only add that the proto-socialist Democrats are just as bad.



Yes, he's nearly totally ineffective in a Jimmy Carter magnitude, and this "reform" will be also. The war on drugs or the USA Patriot Act bother me far more than this legislation. But it's just another duck bite.

We must stop seeing a strong central government as our national parent. If believing that makes me a teabagger and wingnut, so be it.



Sure there was. Sure people are compassionately motivated. Sure they want to help the unfortunate. But they are misguided because they destroy the protections against a totalitarian state believing the ends justify the means.

It's the same as the people who (overwhelmingly) passed the Patriot Act. They were motivated to protect people from an external threat. But the result has been abused and is now seen by almost everyone as a terrible assault on liberty. I agree we need to help the unfortunate. I disagree that we can trust the government with broad powers. In fact, I think that putting these matters on the federal government is a form of the anti-social attitude you talk about -- since the government takes care of the problem, we don't need to care for our neighbors or our community. That's a bad thing.

I don't think you'l find any objection from people who want healthcare reform on that comment. It's a far stretch, regardless of how slippery a slope you think you're down, to call your government totalitarian. It would have been less of a stretch to use that term a few years ago, but a stretch nonetheless.

I'm all for smaller (and leaner) government and less government involvement in many aspects of society. But healthcare is one place I think it needs some oversight and ability to assert guidance. The US government is already there in a large way and I don't think this is the beginning of the end of liberty, profit or capitalism.

Seriously, if anyone opposed to this had actually put forth a valid and tangible argument for why it's a bad thing, I probably wouldn't be so interested in commenting. All I've seen so far is unfounded proclamations of doom and gloom. Chicken Little style. Oh, and of course a call to arms from the bigger nutters.

I wasn't going to get into this anymore, but this is a quickie. Bitt, either you don't know what you're talking about or you're being duplicitous. You fail to mention anything about employer contributions to health plans which definitely hide much of the cost borne by employee health plan members. Employers often contribute as much or more than the employee for the employee health care offered. In my case I have one of those much maligned cadillac plans that has all kinds of stuff I will probably never use. It's not by choice, but rather because it's all that is offered. I myself don't pay that much for it, but my employer pays through the nose. I will probably have to get off of it once I am taxed at 40% (that would be $4000 in tax) of it since it will no longer be cheaper than buying it on my own.

Stu

This is an absurd comment. There has been no repeal of any of the liberty-destroying policies that were put in place by the last administration, despite promises to do so. These measures have a different flavor, but still increase the size and bloat of a government that has become so corrupt, bureaucratic, expensive and burdensome that we serve it more than it serves us.



It certainly is not the beginning of the end of liberty. As far as medicine is concerned, that may have been the Harrison Act, almost a century ago. I'm not claiming that it's the beginning of anything. It's just more sliding down the slippery slope you alluded to.



There have been several valid and tangible arguments mentioned here. You just don't agree with them. This is a complex issue and your assertion that those opposed to this bill have completely baseless positions seems a bit extreme. While the majority may have supported some kind of reform in health care, the majority (of citizens) did not support this bill. Even if it passed, it was a very, very narrow majority. Perhaps there are actually valid arguments on the other side?

This idea of majoritarianism makes me think of an answer to Bitt's question of me regarding the role of a FEDERAL government. It does not follow that because I oppose the Patriot Act, War on Drugs and National Health Care that I don't see a morally legitimate use for an Army, freeways and some forms of environmental protection.

Here's an idea I had that bridges the gap between philosophy (where I hope to have made my arguments), and practicality (where I think almost every counter argument has been in this thread). If an overwhelming majority of the nation supports Something (like the existence of an army or freeways), say over 95%, AND that Something is impractical to provide through non-governmental means, then I think there is a reasonable case that the Something is a legitimate "public good" (used in a very specific philosophical sense, not just meaning beneficial to people), and probably should be a service or function of the federal government.

Private industry could never create something like a fighter plane or an aircraft carrier, for example, as nobody would buy such an extremely-designed piece of machinery. As an example, I would guess that easily 95% of Americans would support federal measures to ensure clean water supply and to protect our borders.

You guys, let's be real. We have FEDERAL laws encouraging the purchase of hybrid vehicles, while we DESTROY used vehicles they replace. This is insanity! We destroy real wealth (used vehicles) to try to create fake demand for vehicles. If we really cared about the environment, we'd drive USED cars (recycling the car by driving it), rather than providing tax credits for hybrids which use extremely toxic batteries. The energy saved during the life of the hybrid can't compare with it's shorter life and production expense (in energy and hazardous materials) vs. driving a used car. Meanwhile, I get no tax credit for a motorcycle, which gets 25% better fuel economy than the Prius. These things happen because as soon as we want the federal government to fix everything it becomes an avenue for corruption and special interests. Why in the WORLD does anyone expect heath care to be any different? The government is incompetent and corrupt. Amazingly, almost everyone agrees with this, but still looks to government to fix all their problems. Our Founding Fathers knew this, and saw it all throughout history, which is why they took fairly extreme measures to contain it.

Those non-Americans on this board who don't understand this argument probably don't understand that point. America was founded, at root, on the principle of extreme distrust in government. Much of that distrust is gone today, despite overwhelming evidence that such distrust is well founded.

My prediction is that group health care plans will be going away.

They will die off in the same way that the defined benefit retirement is dieing. Existing contracts will be honored but a new tier of employee will be created.

Employers will convert the health benefit into income and you will be responsible for getting your own health care. Which it not an option any more!

Employers will do this to limit their exposure to escalating costs, putting it onto the individual. It will be the employee's income getting squeezed, and their choice as to how much their insurance is going to cover.

Yeah, because it's not relevant. I'm not sure exactly what your point is, but at a guess, I'm not saying that the cost paid by employees is less than what's paid on an individual policy; I'm saying that the total amount, employee plus employer contributions, is less.


That implies that your healthcare insurance costs either $18,500 a year if it's just you, or $33,000 a year if it includes anyone else. (Assuming you aren't in a "high-risk" profession.) That's, uh, some expensive health insurance. Chances are that your employer is really just pretending to pay you more by giving you this giant healthcare package, and getting out of paying some payroll taxes. I'd be very surprised if your employer didn't find you an $8,500/$23,000 plan before 2013 rolls around.

The bill requires employers with over 50 employees to provide health insurance as a benefit to their employees, as shown here. Otherwise, there's a fine. They will be allowed to offer plans from the health care exchange, though. (ISTR that there's some size and time limitation there. I can't find it now.)


Huh? Yeah, you won't be able to get an individual plan anymore, but you can get in on the same group plans that those without employee-sponsored health plans can get on. That is, assuming that your employer decides it would rather pay a fine than deal with getting you health insurance.

To be fair, the cars we destroyed were those with notably lousy gas mileage. And I'm sure the cars were recycled (in the "traditional" sense of being melted for scrap, etc.) And the replacements were required to have significantly better mileage than the ones that were disposed of.

I'm not a huge fan of hybrid cars. It's neat technology, but I imagine that the majority of the fuel efficiency comes from having the engine turn off when it is not needed to provide acceleration. I expect that history will eventually see them as having been a stopgap measure. That said, I assumed that lithium batteries are highly recyclable. Maybe I'm wrong.

You also won't get any argument from me that a significant portion of the "green" movement is hypocritical and uncritical. If it sounds "green", it must be. So, uh, yeah. I guess I kinda agree with you there. Except I think that it made enough sense to try to get rid of the cars with the lousy mileage. And they needn't have been replaced with hybrid cars, but merely cars with better mileage. There was also an economic benefit to prompting money to be moved around through those purchases, but that's another story.

I would hope that 95% of Americans support the idea of everyone having access to healthcare ?

I would appear that it is impracticable for people on low wages in the US to afford their own healthcare through the private healthcare system ?

That would appear to make government provided healthcare for all (or at least everyone who can't afford it themselves) meet your criteria.

Covered in another thread ranting about the US.

Come on, that's disingenuous, and you know it. The Feds insure the highest risk population (the elderly) via Medicare, and they can't terminate anyone's policy whenever they feel like it. So, of course they deny claims that other insurers don't have to deny -- the private insurers already refused to carry the sick person's policy in the first place, or jacked up the rates so as to be prohibitively expensive.



Then explain the thousands who show up at clinics held by the National Association of Free Clinics. One was just held in your state of Louisiana recently.


Go ahead and move the goalposts -- I don't mind. First you claim without any basis that we could cover all the uninsured with the cost of this bill, then when called on your fact-free assertion, you backtrack and insist that the numbers must be wrong.

The fact is that CBO has a Panel of Health Advisers on staff who are tasked with understanding the real-world implications of the legislation, not simply spitting out numbers based on what Congress tells them. The CBO is not a rubber stamp -- they do their own research and forecasting, and are the only referees on the field. Their forecast was good enough to pass Bush's tax cuts on the wealthy, but now that they're giving their blessing to something that helps the not-so-well-off, they must be a rubber stamp bunch of stooges who just slap a sticker on the bill's cover sheet.



I assume you own a credit card, so do me a favor. Without digging out your agreement, which is no doubt dozens of pages of 6-point text, tell me if any of the following terms/conditions are in your agreement:

• Double cycle billing
• Universal default
• Trailing interest

Now, I'm sure a responsible, hard-working fella like yourself never plans on being behind on his payments, so surely these will never come into play. But, in the real world, people do miss payments, or are forced to carry a balance for a few months, and instead of paying the advertised interest rate, they end up paying more due to these arcane fine-print clauses that let the banks either jack the rates up, or apply payments to portions of the balance that were borrowed at a lower interest rate.

These are all gimmicks that the banks have come up with to extort money from people. What other excuse is there for this?


This is exactly what happens when free markets run amok, and no amount of "personal responsibility" is going to make everyone able to follow along with the ever-increasing complexity of credit card terms. It's a boondoggle, plain and simple, just like health insurance.

You are right that the banks that issue credit cards are a business, but they've made a business out of tricking people with agreements that nobody can read. These abusive practices are a direct result of a lack of regulation, some of which was recently addressed with legislation, but the banks are already working on their next gimmicks, which will no doubt add more pages of incomprehensible text to all of our agreements. How does that benefit the consumer?


Fantastic, so when he stops by the BBS to debate you, go ahead and use those tactics. Until then, I would hope you can engage the arguments I've made, rather than refuting ones I haven't.


This is the best argument you've made, and I agree that under-enrollment in Medicaid is the problem. Unfortunately, the only way to improve that is to fund it more to educate people on who is eligible, and to reach out to them to help them sign up, just as a private health insurer would advertise to them. I assume you'd support an increase in Medicaid funding to increase enrollment of people who already qualify?


Ah, so you see my cherry-pick and raise me a cherry-pick from Rasmussen, which is known to have a large house effect that favors conservative candidates and positions.

Look, I have my polls, you have yours. We can argue about which side of an obviously polarizing issue the public narrowly favors, but remember that much of the criticism of the bill is coming from the left, who wanted it to be more progressive. You're always going to end up with people not liking the finished product after it gets through Congress, but in a choice between "reform the system" or "status quo", the public favors reform.

Additionally, those 55% of people are idiots, because repeal is impossible. (Two thirds of both houses of Congress to override Obama's veto -- good luck with that!)


That's absurd -- you have Redrum and TigerJimmy supporting your side of the debate quite well. All we're asking you to do is defend the assertions you made earlier, and frankly, it's been demonstrated that several of them were made carelessly and without supporting evidence. There are differences of opinion and political philosophy, but when you're backing up your positions with shoddy evidence (or none at all) you should expect to get called on them. Go ahead and walk away from the table if you're not prepared to show your work, but it's not an unfair fight just because you came unarmed.

On the constitutionality of the individual mandate:

John Adams -- Constitution shredder!

For free? No way. It was barely 50% of the public that supported this bill.



Not true. Veterinary medicine is our example.


I think it's off by at least 30%.

I remember, it was just last week when I had my cat run through an MRI.

Which actually brings up a point I meant to make earlier. I don't want to put words in your mouth, as I don't remember you espousing this theory, but a lot of anti-universal-healthcare types like to say that if you limit medical pricing, then fewer people will be interested in investing time and money to become doctors, develop drugs, etc. Well, if that's the case, then wouldn't the fact that basically no one could independently afford the cost of an MRI mean, if health insurance didn't exist, that it's unlikely that the MRI would have been developed?

(After 3 days of flakey POTS/DSL I, for better or worse, return. Plus, I was unkind, impolite. Let's see what I can do....make that better? worse?)



I know that there are no robots on the BBS. I avoided the term "bot" because I thought that would be insulting My frustration is that I find many expressions of "big L" Libertarian principle to be somewhat mechanistic, dogmatic, inflexible and lacking nuance. Certainly you can credit free enterprise with helping nurture innovation and over-priced treatments, MRIs and such, but you seem to rely on a flimsy straw man -- that polity is a binary function and that places like Sweden (and Canada?) must fall into the "totalitarian state" category because their approach to social welfare is not pure "L".


We have lots of reasons to worry about our government, but I think that the chance that we might ever adopt a Canadian-style single-payer system that could reduce costs and take those costs out of big pockets of existing liability (read: corporate-funded employee and retiree health plans) should be low on anybody's list of concerns.

But don't worry. Obama was never too serious about this.



I'll admit to liking elements of socialism. Public libraries and public schools (more Horatio Alger stories! Everybody can grow up to be president!) and single-payer-style health care. But I mostly like the last one because it take administrative and entitlement overhead/waste out of the system and sets some expectation that therapies get judged on their merits and the effect on outcome.



I meant to reply to Stuart's reply that I find myself in a unique spot of unhappiness in that I feel almost nothing worth advocating for in this plan...a plan that accommodated the interests of all those "free market" insurance companies and pharma at the very outset. So I could hardly imagine trying to convince anyone to favor the current plan. Yet I find the bases of much of the "teabag" opposition to be appalling. And I obviously think that Libertarian fixation on free-market medicine to be naive and wrong-headed.



I think to qualify as a real wingnut you have to be a birther. But such are your allies in the current circumstance



I asked rhetorically, but your answer really seems "way out there". If I were Canadian, my feelings might be hurt. I have to say I drive up to BC 4 or 5 times a year and I have to say, not only do people *not* seem depressed like they are toiling in an Orwellian Hell, they mostly seem (on average) 10 percent nicer than folks down here. And certainly nicer (and happier?) to me than a lot of the folks down here who are screaming about "LIBERTY!" "FREEDOM!" all the time. Why are big L Libs so grumpy?



Sorry. I have been around the health care system in various capacities for a long time. I believe that your view, if not naive, is just dogmatic and "binary". Do the socialized citizens of Canada not care for their neighbors?

I think I have posted the link before, but I always reply on smarter people to make a point better than I can. So I rely on The Onion

Not at all.



Well, my argument is a philosophical and ideological one, not a practical one. When you reason from a particular set of core principles, then once those are well understood I imagine it could seem "robotic", but I prefer to think of it as deductive.

There are practical arguments both ways, I get that. To me, the practical side of the argument is really two-fold:

1. "Insurance" is for risk aggregation of large impact, but rare events. Since nearly everyone is guaranteed to become sick and require increasingly expensive (and magical!) treatments, almost everyone will have the opportunity to spend frightful amounts of money to stay alive a few more months, unless they die quickly from an accident or something. There is nothing rare about getting sick. Specific diseases, perhaps, but in aggregate everyone will eventually have something that could break the bank. So, there is no "risk" here, properly understood. As a result, insurance is the wrong model. Nearly everyone will have the opportunity to spend more than their entire fortune on medical care, and nobody wants to have to spend their own money on it. This is the core problem. The only thing to do is to let people decide for themselves how much of their family's fortune they want to spend on treatments. Yes, the rich will have more options, just like they do in nearly every other aspect of existence. That's life. It's also a good reason to try to become rich (and yes, I understand not everyone has that opportunity). Life is not fair. But in our outrage at that injustice, we can't simply ignore economic reality that everyone can't spend more than they have.

2. A free market on medicine would lower costs on average. There is a valid point to be made of collective bargaining and leverage that a national plan would have, but my veterinary example is intended to show that the exact same treatments (drugs mostly) are available for a small fraction of the price than they are with human healthcare. This is primarily due to government bureaucracy and regulation. MRI scanning is also used for animals, despite Bitt's funny comment, and the costs are way lower than for humans. But the machine is also smaller. If you look at the exact same treatment for animals vs. humans (drugs allow this comparison), the free market system is always dramatically cheaper.

I don't think that this particular bill means we have a totalitarian society. I believe that it removes important checks and balances against totalitarianism and that it is fundamentally not the role of federal government. I gave another practical standard: 95%+ agreement from the public and no ability to deliver it through a market mechanism and you probably have a genuine "public good" on your hands. Roads fall into that category. Prescription drugs and seeing a doctor do not.



That's extremely naive in my opinion. What government bureaucracy works this way? Even if you can name one (someone mentioned the post office), that would be a very rare exception. In fact, the exact opposite happens. Perhaps I misunderstand you - you ARE really saying that the government will *remove* administrative overhead and waste? Where WERE you that you didn't have DSL? Mars?




That's funny as hell. However, it's based on a gross misunderstanding of libertarian ideas. Libertarian philosophy has a place for things like fire departments and roads and national defense and even taxes. We do not, generally speaking, ask the federal government to provide fire departments for every citizen, do we? That would be stupid. Communities organize this for themselves.

For better or worse, people, on average, value the lives of animals far less than they value the lives of humans. So we have to limit the scope of drugs to encompass only drugs that are available to both humans and animals.

Here's 500mg Cipro for animals and 500mg Cipro for humans. 35¢ vs. 39¢. I think that's probably pretty close.

Fluoxetine (Prozac): veterinary 30¢, medical 57¢. That's a sizable difference.

Lysodren: veterinary $9.99, medical $4.87. Also a sizable difference, now in the other direction.

Selegiline: veterinary $2.50, medical $1.70. Still leaning the wrong way.

Tapazole: veterinary $1.79, medical 87¢ (or 33¢ for the generic). Your argument's not starting to look so good.

For the record, I went through this page and picked the ones that seemed likely to have a human analog (I guessed wrong a lot) and appeared to maybe be non-generic (except for the fluoxetine and cipro). I don't think I cherry-picked any data. Honestly, I was surprised. I thought you would be more right; I thought I was just going to show that the differences weren't all that significant. I recognize that this is largely anecdotal, given my non-scientific data set selection. If you have other better data, I'd be glad to see it.

I disagree with this, entirely. The whole notion of insurance was created back when traders were sailing the oceans. Since nearly every trading company was guaranteed to have a ship sink and lose significant investment, almost every trading company had the opportunity to spend frightful amounts of money to stay in business a few more months, unless they lose their whole fleet at once in a freak storm or something. There was nothing rare about losing a ship. Losing one (or more) with an extremely costly cargo, perhaps, but in aggregate every company will eventually have a ship sink which could put them out of business. So, there is risk there, properly understood.

It's no different with being sick -- I don't know when, or where I'll get sick. It could be now, it could be 20 years from now, but I do expect I'll get sick at some point. The risk is, will it be catastrophic enough to wipe me out financially for whatever reason. With the traders, they don't know when, or where they'll lose a ship. They might lose one this trading season, or not for several years, but they are expecting to lose a ship. The risk is, will it be catastrophic enough to wipe them out financially?

That said, private insurance makes sense for traders -- it's a small group of people amongst whom the risk needs to be shared. With health care, it's silly to have private insurance -- the group of people needing such insurance isn't small, it's the entire population. That's why it makes sense to have a single-payer system, IMHO.


Who are you trying to kid? If this is true, why doesn't the US have lower costs for the health care system, than any other 1st world country with government-run systems? I'd say the free market on medicine isn't exactly working out too well.


The oft-quoted statistic is that Medicare has ~2% administrative costs, compared to %15-30 for private insurance companies. Of course, the rebuttal is that that doesn't include a lot of hidden costs of Medicare, but even with those costs included, the analysis suggests that Medicare costs are, at worst, no worse than private insurance companies. For a program that doesn't pick and choose who they're going to cover, I'd say that's pretty reasonable. If the private insurance companies are showing as much (or more) overhead and waste as a government organization, and not covering everyone, then let's get rid of 'em all, and just have the government do it -- at least everyone would be covered, then.

Sorry, but you're misunderstanding this entirely. A smallish fraction of the total number of cargoes were lost. If all cargoes were lost, or nearly all, as in the case with sickness, insurance would not work. As the probability of loss for each individual voyage increases, risk aggregation becomes less and less effective. Technically, it is still effective, but less worthwhile. When the probability approaches 100%, as in the case of sickness and death in humans, then it is of almost no value. Risk, in this sense (which I called "properly understood" means a small chance of a large consequence. It's not risk if you know it's going to happen -- it's certainty.

Your argument compares insurance of a single shipment or cargo to a long sequence of events in which loss is almost assured. That's a logical mistake.

Just look at it this way: if everyone (or nearly everyone) will eventually face medical bills higher than their wealth, who will pay for it? The idea of medical "insurance" is a Ponzi scheme, because the probability of catastrophic expense is nearly 100%.

How much of the administrative expense of private insurance companies is a result of federal regulation?

It's very different from when I last looked at it, which was also a small sample size (a drug I was taking). It would appear, at worst, that an mostly unregulated market is just as effective as a highly regulated one? What, then, is the value of this regulation?

And institutionalizing hybrids (or any specific "solution") through federal regulations and mandates will ensure that they stick around much longer than they should.



Why do you think that health care will be any different?

I don't think I'm misunderstanding, at all.

Am I going to die? Yes. Does that mean that I'm going to require medical care costing huge sums of money in the process? Not in the least -- perhaps you have better prognostication skills than I? The insurance companies have huge swathes of actuaries calculating these sort of risks. Along the way, I may need the odd bit of medical service, however, just like the trading company that eventually closes for reasons other than "all our ships sank" might lose a few ships through the lifespan of the company. Hence, the need for medical insurance.


Look at it this way, if the probability of catastrophic expense is nearly 100% for all people, then how do insurance companies stay in business, let alone make profits? The answer, I think, is that the probability of catastrophic expense is not nearly as high as you think. You're starting from a false premise, drawing whatever conclusion you like. That's a logical error.

Huh?

Let's ignore the cipro, as that's not going to be a maintenance medication, and take a look at a 30-day supply of all those drugs. If you were paying for yourself, you'd be out $240.30. If you were paying for your dog, you'd be paying $437.40. That's 82% more for veterinary medicine than, uh, human medicine. (Not that I had to multiply by 30 to get that number, but merely to put it in a familiar context.)

That said, I'm unfamiliar with any pricing regulations on pharmaceuticals. I am familiar with collective lobbying for prices via insurance companies.

I was going to say that I no longer know what I'm arguing for, but, in reality, I'm not taking a side at the moment. I'm just trying to set the record straight as best I can.

I guess how this applies to this argument, though, is that you claim that prices are inflated when insurance companies are involved, because no one has a horse in the pricing race. But it would seem that prices are actually lower when an insurance company is involved. Again, hardly a scientific measurement, and I'm not inclined to draw a conclusion (not least because I don't want to be commending the insurance companies ).


You weren't self-medicating with veterinary drugs, were you?

Why is that repellent? Do I really think that pharmaceutical companies' quality standards lower when making veterinary medicine? Maybe I do. If it's true, that sucks.

That would be ILLEGAL! But, in a strictly hypothetical argument, as an engineer with quite a lot of operations experience, there is almost NO WAY there is a separate production line for the two... Not cost effective.

You can see why I prefer the philosophical argument to the practical one. The issue is vastly complex and I doubt anyone understands it very well at all. For that reason alone, we should be reluctant to mandate an approach at the federal level. Nobody is likely to have THE answer.

I think our differences boil down to this: I think government is a largely wasteful, corrupt and incompetent monster that seeks to grow itself and needs to be controlled and minimized. It makes me a classical liberal, in the Jeffersoninan sense. We have to call ourselves "libertarians" because the Left has taken our word "liberal". Most people don't mistrust the government as much as (I think) they should. I also think that history shows that government grows until it cripples the society and then the society collapses. I'd like to avoid that -- for another 40 years, anyway, but there I go being practical again :-)

I understand where you're coming from, and I'd like to be Mr. Pie-In-The-Sky, too. I'd rather see a single-payer healthcare system, for example. But we've got 40 million people getting fucked over right now, and practicality has to win the day.

I still can't believe we're comparing medical costs for animals. Forget about drugs, have you looked into how much it costs for surgery for your pet?

I'm sorry, but it's just not comparable. They're too different.

Jimmy's point is that when the same drug is used to treat both animals and people, they are almost certainly the exact same thing. I tend to agree. If you want to compare labor, they are certainly not the exact same thing.

I understand, but I thought we were talking about medical expenses. Drugs aren't the only thing to consider. Sorry, I would just laugh if anyone said that medical care for pets was inexpensive. Perhaps it varies with where you live, but it's expensive around here.

Expensive as compared to pre- or post-insurance human medical services?

Well you're right, I'm comparing to post-insurance human services. But the last time I looked into pet insurance, I still had quite high co-pays and plenty of things that weren't covered unless I paid far more than I pay for my own medical insurance.

:-)

This is the kind of crap you guys should be up in arms about the government even entertaining.

And no shit, it's being proposed by private industry/special interests:

Mandatory spyware to monitor copyrights

The government requested comments and recommendations from everyone. I would assume that the EFF also provided such comments. Are you surprised that the MPAA, et al., want to put our nuts in a vise?

BTW, a recent GAO study found most of claims of enormous losses suffered because of "piracy" and counterfeiting unsubstantiated.