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.