A Matter Of Opinion

What is insurance for?

Posted by Doug

Aug. 20, 2009 3:52 p.m. • 218 comments

I just read a list serve comment by a woman who had an insurance issue over the cost of her son’s physical exam for high school football. The details aren’t important.

My question is as follows:

Hypothetically, an insurance policy provides one free physical exam every year. The cost is spread out among all the policy holders, all of whom are entitled to one physical every year.

They won’t all avail themselves of that, but if they did, the insurer would theoretically pay out the same as it collected in premiums, less copays or deductibles, wherein it would realize a profit. Since many people won’t take the physicals, the profit will go up…and maybe the premiums would even be adjusted downward slightly once the state insurance commissioner weighed in.

Still, individual policy holders would, at worst, break even if they just paid for the physical out of pocket. Then might even save money by removing the insurance company profit from the calculation.

So why are such routine and predictable things part of a health insurance policy? Shouldn’t insurance be to spread the risk around over things that can’t be anticipated, like being attacked by a Grizzly?

218 comments on this post so far. Add yours!

richard on August 20 at 4:44 p.m.
I totally agree, Doug. I am not sure how medical insurance came to be, in essence, a pre-paid medical policy as opposed to a true insurance policy for unexpected, serious and expensive situations.

But it really should be changed so it works more like an auto insurance policy works.
MatthewRoot on August 20 at 5:28 p.m.
Bingo, this point has been brought up elsewhere in this blog.

Insurance companies do negotiate lower prices for routine procedures and exams, however.
spokelooneh on August 20 at 5:51 p.m.
The reason for an insurance company paying for an annual exam is do identify any budding problems that if caught early, are treatable if not curable at a far lower cost than if discovered and treated later.

I’ll agree that for most younger people, it’s probably not cost effective at all.

And far more women than men get such annual exams.
gmorton on August 20 at 5:55 p.m.
The rationale for paying for, and thereby encouraging, annual physicals is to catch incipient conditions early, when they are cheaper to treat, thereby saving policy holders money in the long run.

But you are right that “health insurance” is no longer insurance. People have become convinced that they have a “right” that someone else pay for their health care, and so It has been transformed by government into a hodgepodge of schemes and scams for delivering that free lunch.
sue on August 20 at 6:14 p.m.
I believe health care is a right and something we can all count on needing at sometime in our life. It’s a community responsibility, and a healthier community benefits everyone. This is not a commodity that lends itself well to the free market system. Who can shop around in the middlle of a heart attack, or during a car accident? It’s unconscionable that people in the midst of a life-threatening illness should be doing battle with an insurance company, or holding a bake-sale to fund treatment. No one should have to declare bankruptcy because of an unforeseen medical expense. Those costs get spread out to us in a tax of sorts, high deductibles are taxes of sorts, but there’s no coherence or fairness to the system right now.
MatthewRoot on August 20 at 7:27 p.m.
Let’s change the scenario to an office visit for the cold or flu, or for a minor ailment like a poison ivy rash. When employer-sponsored insurance pays for a $75-100 office visit, it drives the cost of insurance up. It is analogous to expecting auto insurance to pay for oil changes and lubes. How expensive would auto insurance be with that kind of coverage?
Sue, I basically agree with you, and when the underprivileged can not afford a needed $100 office visit, then we should have social safety nets. For most of us who work, however, we should be responsible enough to save a little for a rainy day, and pay for a visit to the doctor’s office. It is just a matter of priorities and personal responsibility for most people.
We could reduce public spending by reducing the cost that the state pays for health insurance – those state employee policies are very expensive.
richard on August 20 at 7:40 p.m.
What is your solution to the problems you laid out Sue? You have identified several problems, which I would agree with. The solution, though, is where the dabate lies.

I am not sure under what authority someone can maintain that health care is a “right,” however. Rights as we know them “free speech,” freedom of religion, freedom to vote, are NOT things that government delivers to the individual … but rather, they are things that govenment cannot take away.

We don’t have a situation where govenment is denying anyone health care. And I am all for government doing all it can to ensure that health care is accessible to everyone; I just am totally convinced that government is not equipped to do the delivering.

And it really isn’t a community responsiblity to deliver health care, that is an individual responsibility. If you define health care as a “right,” what else could then be argued to be a right?

Having a job is right up their in importance to health care … should government “gurarantee” everyone a job? How about owning a home (a sore topic at the moment, since we are still recovering from a disaster, caused, to one degree or another because Democrats tried to “guarantee” home ownership).

And the list could go on.
spokelooneh on August 20 at 8:24 p.m.
You cannot “promote the general welfare” nor assure the “pursuit of happiness” if the provision of health care is based on the size of your wallet.
gmorton on August 20 at 8:30 p.m.
Well, Sue, since health care consists of a variety of goods and services others must produce and provide, you are claiming a “right” to others’ time, talents, and the products of their labor. Someone who claims a right to others’ time, talents, and the products of their labor is declaring them to be his slaves.

Yes, we will all need health care of some sort at some time or other. So do we all need food, shelter, clothing, heat in wintertime, and numerous other things. But our needs do not entitle us to enslave others to obtain them.

And, of course, you should not be shopping around in the middle of a heart attack. You should have had the foresight to do your shopping in advance. That’s what “being responsible” means. Nor, had you done so, would the heart attack bankrupt you.

To be sure, your health insurance options in this state leave much to be desired. In 1993 19 different health insurance carriers offered a wide variety of policies in Washington State, from fairly costly, compehensive managed care plans to inexpensive, high-deductible catastrophic coverage. Special coverages, such as for maternity, prescription drugs, and mental health, could be obtained at extra cost. But then the legislature, at the behest of then-Insurance Commissioner Deborah Senn and Governer Mike Lowey, enacted a massive package of insurance “reforms” which mandated community ratings, guaranteed issue, low-income subsidies, mandatory maternity and mental health coverage, coverage of “alternative” therapies (quackery) and a host of other edicts. As a result, by 1999 17 of the 19 carriers had ceased doing business in this state: they notified policy holders that their policies would not be renewed beyond the current terms, closed their doors, and walked away. The 2 carriers remaining nearly doubled their premiums, and, of course, the number of uninsured in the state also doubled, being unable to afford the premiums. When those two remaining carriers also threatened to leave the state the legislature met (in special session, if I recall) to deal with the disaster. They reformed the “reforms” to some degree, but health insurance in this state remains mired in mandates, costs remain high, and choices are few.

Health care and health insurance costs are unaffordable because they are hagridden with government mandates, edicts, and free-lunch schemes. And now, having broken the system, the politicians propose to “fix” it with even more mandates and edicts.
richard on August 20 at 8:59 p.m.
An orthopedic surgeon and former head of the Canadian Medical Association says that the Canadian system is imploding. He was asked what the number one problem was, and his answer is a shocker! By the way, the current head of the Association is saying the same thing.

The number one problem is … access! No, I am not making that up; it is a fact that 5 million Canadians - out of about 34 million - do not have access to the first line of defense in medicine … a family physician!

This surgeon said that in British Columbia - where he works - health care is soon to reach 18-19% of the entire budget! He said it is just not sustainable!

Unless someone can demonstrate that this surgeon was lying and that figures he gave are distorted or outright fabricated … is there now ANY rational argument left for why we should even continue to consider a single payer system?

Write your representatives and demand that they stop the nonsense!
nslopeofw on August 20 at 10:12 p.m.
Roger that, very refreshing to here someone speak in facts, rather than whipped up liberal hysterics, while trying to make one feel guilty for paying for services rendered.

I, too, do not see health care as a right, for those very reasons. People provide services, and expect to paid for them. It’s no ones “right” to expect the service providers to do it for free, just as it’s not your employers’ right to ask you to work for free.

Good post, gmorton!
Lulubelle on August 20 at 11:10 p.m.
All you big talkers would be singing a different tune if you were to suddenly drop over with a $150,000 heart attack and be required to pony up without the benefit of employer-based insurance or that nasty “socialist” Medicare.
You’d all be crying like a weak baby sister.

And you Richard wouldn’t recognize “clear, rational and lineal thinking” if it flew up your snout.

woof woof
Jeffrey_Grey on August 21 at 4:54 a.m.
gmorton,

I agree with the well-deserved compliments you’ve received so far. It is indeed a lesson in how persuasive someone can be when they stick to simple, unadorned facts without wrapping them in needlessly polarizing partisan rhetoric or agenda. (I note with approval that you managed not to scream ‘Socialism!’ once in your entire post.)

In any event, you make a good case. We apparently had things a lot better before government intruded and screwed up the system with some really bad, really poorly thought out regulation.

And now the system is broken. Badly so.

Which leaves us with the question: how do we fix it?

Is the contention that just going hands off, walking away and trusting to the free market system to fix itself is the way to go?

Quite frankly and given this nation’s recent experience with the excesses and abuses the free market system is capable of wreaking upon us, I don’t think you’re going to find much support for that.

To be blunt, I for one simply don’t trust the health care industry and more especially the health insurance industry to fix the problem if left solely to their own devices. Therefore I simply won’t accept any proposal for a fix that has as it’s cornerstone leaving them alone and letting them do their thing unsupervised.

So yes - I’m saying more regulation is the answer. But I’ll take your well-stated lesson to heart and demand that this time around, the regulation has to be much better crafted and thought out.

To say it again - if circumstances have brought us to the place where we must set the coyote to guard the fox as the fox guards the hen house - and I’m not happy about it, but I think that’s where we’ve indeed arrived - then we better make damn sure we keep a very close eye on the coyote this time around.
Gary D Rhodes on August 21 at 8:02 a.m.
Grey, do you say that you agree that 19 insures down to 2 is a problem? And that over-regulation helped end meaningful competition?

What I don’t understand is your insistence that fixing this is not a partial solution to the “crisis”.

Do the easy things first. Eliminate regulations that stop interstate purchasing.
Stop mandating coverage.
Give tax incentives to people who purchase private insurance.
Go to a loser-pay litigation system. (Defensive medicine practiced to avoid malpractice cases adds more to the cost than just insurance and pay-outs).

The federal and state governments interference is directly responsible for much of the huge increases in insurance rates as private parties are being charged in order to make up for the shortfall caused by free ER visits, underpayment by Medicare and Medicaid, illegal aliens and etc.

Fix these things first and see where we are.
I know you will say again that the conservatives just say no, and have no ideas.
WRONG.
We should give free enterprise a fighting chance before we go to a government run system like the Indian reservations have.

Government causes the problems, then swoops in to save us.
If they follow the script, our healthcare will go steadily downhill. and lives will be lost.
Jeffrey_Grey on August 21 at 8:42 a.m.
“Grey, do you say that you agree that 19 insures down to 2 is a problem? And that over-regulation helped end meaningful competition?”

Yes. Of course I do. I’ve never said differently. In your rush to justify your dream of a libertarian utopia, you might have heard something different. But you didn’t hear it from me.

I have *never* said that *all* regulation is good. It isn’t’. And I have never said it is because I unequivocally disagree with that proposition.

*Poorly designed* and *poorly executed* regulation, regulation simply for the sake of regulation (and thus for getting power) is a case where the cure is every bit as bad as the disease.

But I also adamantly and equally disagree with the notion that *all* regulation is inherently bad. It isn’t.

A shining example of this is your simplistic demand that we simply (completely?) de-regulate the interstate purchase of insurance. I notice you ducked my request for your comment on the experts who have said that simple de-regulation will only make the problem worse, and then they make what in my opinion is a good case argument for that assertion.

Another example is your assertion that we can fix part of the problem if we simply stop mandating coverage for everyone. You say I don’t think things through. Well, here’s you chance to do it. In a system as currently over-regulated as you claim ours is - a system where one of the major flaws is the fact that it refuses to cover everyone who needs coverage - you assert that the answer is to regulate even less? Seriously - do you really think that removing regulation will cause all the insurers to suddenly start covering more people?

If they don’t have to cover as many people as they currently do, even the most cursory glance at the way they’re doing business at the moment leads me to a deep suspicion that if we remove regulation they’ll cover even *fewer* people, not *more.* Again - deregulation will only make a current problem only that much worse.

You say it’s regulation that’s to blame for making all of us have to pick up the tab for people who currently can’t pay for their medical care themselves. And perhaps that’s at least partly true.

But jeeze, Rhodes - don’t you think part of the problem might also lie in the fact that medical care is just too damn expensive to begin with? And don’t you think that *part* - and please notice I only said *part* - of the reason for that is that profits are currently just way too high?

I notice that in all the conservative and libertarian screed, nobody ever does much more than gloss over that little tidbit. I have to wonder why.

So since I’m trying to be honest and forthright with you, how about you return the favor on this issue. Here in Washington State, medical insurance premiums have risen 105% since 2000. 105%! What other sector of our economy has seen a 105% increase in costs since 2000? And if costs haven’t risen but the price charged has, where does all that surplus go? Hint: medical insurers have seen a dramatic increase in their cash surpluses (read: profit) at the same time that the number of people they insure has dwindled.

Direct question: do you think a 105% increase in health insurance premiums over a nine year period - an increase in costs that I don’t think is mirrored by any other sector of our economy - do you think that’s right? Do you think medical insurers increasing their cash surpluses at the same time they’re covering fewer and fewer of us is a good thing? Do you think those things are not also something that needs to be addressed?

What’s your direct answer to that direct question?
Gary D Rhodes on August 21 at 9:16 a.m.
Competition is the answer to excessive profits.

I meant to say that the government should eliminate regulations that mandate what coverage is required.

Young people might opt for a package that only covers catastrophic care.

The only thing the government should do is make sure contracts between individuals are honored.

Obamacare is dead.
Let’s fix the simple things outlined.

If people were financially responsible for their own care we would see a lot more Americans taking better care of themselves. A fitter, healthier populace that has to write a check for healthcare will bring prices down, in my utopian, Libertarian view.
Jeffrey_Grey on August 21 at 10:03 a.m.
Again, I have never said that competition is either a bad thing nor have I said competition isn’t *part* of the answer to fixing high costs.

Indeed, part of the ‘socialistic over-regulation’ at the heart of the current Democratic (and Republican for that matter) proposal(s) is a desire to increase competition.

The devil lies in the details of *how* to increase that competition. Once again, Rhodes, you’ve ducked that part of the question. HOW do you propose to increase competition without at lease *some* ground rules regulation?

Should we allow insurers the ability to offer some plans aimed at healthy individuals who are comfortable with only catastrophic care insurance and they’ll handle the rest out of pocket? **I have no problem with that.** Indeed, set some ground rules about minimum coverages and regulate the implementation of those plans and then sit back and watch insurers begin to compete with each other to capture that market. I might be over-looking some objection, but absent that, **such a thing would be just fine in my opinion.**

But what about the high-risk folks? What about folks who don’t want to gamble on only catastrophic care? In other words, how about the people who aren’t so profitable to insure? To hell with them? That’s exactly what’s happening now in this country. Are you okay with that? How does that fit into your utopian scheme?
spokelooneh on August 21 at 10:47 a.m.
“In 1993 19 different health insurance carriers offered a wide variety of policies in Washington State, from fairly costly, compehensive managed care plans to inexpensive, high-deductible catastrophic coverage. Special coverages, such as for maternity, prescription drugs, and mental health, could be obtained at extra cost. But then the legislature, at the behest of then-Insurance Commissioner Deborah Senn and Governer Mike Lowey, enacted a massive package of insurance “reforms” which mandated community ratings, guaranteed issue, low-income subsidies, mandatory maternity and mental health coverage, coverage of “alternative” therapies (quackery) and a host of other edicts. As a result, by 1999 17 of the 19 carriers had ceased doing business in this state:
-gmorton

Gmorton “forgets” to mention that in 1994, the Republicans took control of the State House, and reduced the Democratic majority in the State Senate to 1 member.

By early 1995, the 1993 health care reform that gmorton conveniently blames for all the health care problems in WA was REPEALED by passage of legislation sponsored by Republican Phil Dyer, Chairman of the House’s Health Committee, and signature by the Governor.

It was in effect for all of a year and a half. And yet gmorton claims that this NON-EXISTENT health care regulation was responsible for the exit of the insurance companies from the WA state market from 1993-1999.

Laughable.
spokelooneh on August 21 at 11:15 a.m.
“In substance, the new (April 1995) health care bill, ESHB 1046, amounted to repeal of the major components of the (1993) Washington State plan. Specifically, it:

* Eliminated the Washington Health Services Commission and other new bureaucracies;

* Repealed government specification of the uniform benefits package;

* Repealed the employer and individual mandates;

* Repealed the requirement that people buy only managed-care coverage;

* Repealed the caps on insurance premiums;

* Allowed businesses to form voluntary purchasing cooperatives;

* Repealed provisions mandating government-controlled health insurance purchasing cooperatives;

* Repealed community rating;

* Repealed requirements for government risk adjustment of private insurance plans;

* Repealed the state-wide computer health data system; and

* Repealed the new controls over medical school access.

In short, the (1995) bill repealed almost every major element of the 1993 reforms.”
nslopeofw on August 21 at 2:21 p.m.
Once again, instead of worrying about the problem, and how to fix it, Spokehlooneh has to make it partisan. It is what the liberals do. Blame, blame, fear, laugh, blame, blame, more fear, avoid the issue, blame.

Its just a whole lot better to avoid the blame game, and deal with the issues. What happened in the past means nothing now, other than the need to fix it. Other than liberals, no one really cares who caused it. All the liberals are looking for is to strengthen their control. All the rest of us want is to have the problems fixed, while not raping the taxpayer for un-needed programs for people who either choose not to work, or spend all the money they have on frivolous things like cable, cell phones, high cell plans, smokes and booze, etc.
Rifleman_Dodd on August 21 at 2:26 p.m.
spokelooneh has mastered the art of cut-n-paste, but not the skill of analysis of the facts.
gmorton on August 21 at 2:47 p.m.
Jeffrey_Grey wrote,

“Quite frankly and given this nation’s recent experience with the excesses and abuses the free market system is capable of wreaking upon us, I don’t think you’re going to find much support for that.”

I assume you’re referring to the “subprime crisis” and the collapse of the housing bubble. If you look into it a bit, you’ll find that origins of that “crisis” parallel those of the “health care crisis” – government interference in the housing market, specifically, its campaign to promote “affordable housing,” and the edicts imposed upon banks and the secondary market (Freddie and Fannie) to accomplish that goal. But that’s another issue.

“To be blunt, I for one simply don’t trust the health care industry and more especially the health insurance industry to fix the problem if left solely to their own devices. Therefore I simply won’t accept any proposal for a fix that has as it’s cornerstone leaving them alone and letting them do their thing unsupervised.”

They will not be unsupervised. They will be supervised by their customers, who are more than capable of deciding which type of coverage works best for them – what conditions they need to insure against, which types of care should be covered, what fraction of costs should be covered, what the “stop loss” and deductible should be. A single male, for example, or a couple over 50, will probably will not wish to pay for maternity coverage; a person with no history of mental illness or substance abuse in the family will probably forego those coverages. Young people, whose risks of major health care costs are low, will probably opt for no coverage or catastrophic coverage only. In an open, competitive market served by dozens of carriers, nearly everyone will be able to obtain coverage that fits their needs very closely. How do we know that? Well, because that was in fact the case until states began intruding in that market in the 1970s.

(For a list of the mandates on insurers in Washington, see http://www.insurance.wa.gov/publications/health/2105-Mandates.pdf)

There are some respects in which consumers cannot effectively supervise the insurance market. Insurance regulation began for the purpose of assuring that firms proffering insurance were in fact sufficiently well-capitalized and prudently invested to pay claims on their policies, especially when some kind of disaster (such as the great fires in Seattle and Spokane in the late 19th century) resulted in many simultaneous claims. There is nothing
wrong with regulation for that purpose. But over the last few decades many people have come to believe (as we’ve seen in this thread) that they have a “right” that others pay for their health care, a perverse notion promoted by enterprising politicians foraging for votes. So the health insurance industry has become, not an assortment of competing private enterprises trying to make a profit for their stockholders by offering a valuable service to customers ready and willing to pay for it, but a quasi-public charity program commanded to deliver free lunches to vocal consituent groups at private expense.

(continued next post)
gmorton on August 21 at 2:50 p.m.
Jeffrey_Grey (continued)

The costs of health coverage are only partially due to mandates on the insurance industry itself. They are also due to the costs imposed on hospitals, physicians, drug manufacturers and retailers, and other health care providers who are also commanded to deliver free lunches to the politicians’
political patrons. Per the federal Emergency Medical Treatment and Labor Act (EMTALA), every emergency room has been transformed into a free public clinic – care paid for, of course, by other patients and their insurance companies. Malpractice insurance for hospitals, physicians, nurses, and other medical professionals, and “defensive medicine” add billions to health care costs (annual malpractice premiums for OB-GYNs in Washington State averaged $51,000 as of 2002, nearly $300,000 in Florida). In Washington State, virtually every type of health care facility must obtain state approval (“Certificate of Need”) before offering any new service or expanding its capacity to deliver a service, thus restraining competition. Licensing laws which restrict entry into health care professions and dictate which services can be offered by whom have the same effect.

The most serious problem with the health care industry in the US, however, and the root of many of the others, is the lack of a nexus between the customer (the patient) and the provider. Market mechanisms simply don’t work when demand is not coupled to supply, i.e., when the person receiving a product or service is not paying for it. Prior to WWII everyone paid for whatever health care they needed out of their pockets, just as they paid for dental care, veterinary care for their animals, or necessary repairs to their houses or cars. If they had insurance it was for catastrophic costs only; if their kid fell out of a tree and broke her arm, had a bad reaction to a bee sting, sliced her hand with a kitchen knife, or developed whooping cough, her parents gritted their teeth and paid the bills. That’s life, and such costs, while always unanticipated and unwelcome, bankrupted nobody.

But wartime wage and price controls, combined with the shortage of manpower, forced industry to devise novel means of attracting workers. They could not offer higher wages, but fringe benefits were exempt from controls. So they began offering comprehensive, company-paid health insurance. Those benefits, moreover, were tax-free to the worker. By the 1950s health insurance had become a standard benefit, and therefore expected, in larger, unionized industries.

Employer-paid health insurance creates a triple “moral hazard.” First, a person who is not paying the bills, who just passes them on to his insurance company, has little incentive to shop prudently – no incentive to compare fees before choosing a physician, hospital, medication, or course of therapy, and no incentive to consider whether a particular health problem requires professional attention or not. If the patient is not even paying the insurance premiums the hazard doubles: a patient paying his own premiums at least knows that the more bills he submits to the insurer, the more likely he will be to see a rate increase or a cancellation. When the employer is paying them, that constraint is also removed. And finally, the patient begins to think of health care as a “right” which others are obliged to provide him, with no need or obligation on his part to exercise the diligence, circumspection, and forethought he would routinely invest before making other important (and even no-so-important) decisions in his life. Health care becomes “manna from heaven.”
gmorton on August 21 at 3:23 p.m.
spokelooneh wrote,

“In short, the (1995) bill repealed almost every major element of the 1993 reforms.”

Er, no. They repealed some of the provisions, as I mentioned in my post, but not open enrollment, guaranteed issue or community rating. By 1999, even after further reforms in 1996 and later years, individual health insurance was unavailable in 32 of the state’s 39 counties.

Subsequent reforms have relaxed the community rating and guaranteed issue mandates, but not eliminated them.

http://www.heartland.org/publications/health%20care/article/15036/Washington_Still_Suffering_From_ClintonCare_Experiment.html
gmorton on August 21 at 3:33 p.m.
Jeffrey_Grey wrote,

“Another example is your assertion that we can fix part of the problem if we simply stop mandating coverage for everyone. You say I don’t think things through. Well, here’s you chance to do it. In a system as currently over-regulated as you claim ours is - a system where one of the major flaws is the fact that it refuses to cover everyone who needs coverage - you assert that the answer is to regulate even less? Seriously - do you really think that removing regulation will cause all the insurers to suddenly start covering more people?”

That is very simple, Jeffrey. There are indeed persons who would be uninsurable in a free, unregulated insurance market, whether because they could not afford even the low premiums that kind of market would present, or because they have existing conditions. Insurance, we must recall, is risk-pooling. It is a method of distributing risks which cannot be anticipated individually, but can be estimated for a group. A person with an existing condition does not present a *risk* to an insurance pool, he presents a *certainty*. An insurer is no more likely to insure that condition than to issue a fire policy for a house that has already burned down. That person does not need insurance, he needs a free lunch (if he cannot cover the costs himself).

The way to handle those situations is with private charities (including *pro bono* services freely given by providers), or with an explicit healthcare welfare scheme (e.g., Medicaid) as generous as taxpayers prove willing to pay for. It is not to try to deliver that charity care by embedding and concealing its costs in private care delivery and the private insurance market, or by pandering to the economically nonsensical fiction that everyone has a “right” to “free” health care. Those irrational approaches simply drive up the costs for everyone.
terrymr on August 21 at 4:24 p.m.
The reasoning is that preventative care actually saves the insurance companies money. Many conditions can be caught early and treated avoiding a much more expensive claim later.
spokelooneh on August 21 at 9:03 p.m.
Gmorton is spouting more half truths and outright fabrications.

““In short, the (1995) bill repealed almost every major element of the 1993 reforms.””

-I- didn’t say that. I was quoting the author of the 1995 repeal bill, Republican Phil Dyer, Chairman of the House Committee on Health.

http://www.heritage.org/research/healthcare/bg1121.cfm#53

“Per the federal Emergency Medical Treatment and Labor Act (EMTALA), every emergency room has been transformed into a free public clinic – care paid for, of course, by other patients and their insurance companies”

EMTLA, signed into law by Ronald Reagan in 1986, only requires a participating hospital to diagnose and treat an emergency condition which requires immediate treatment. If they diagnose you have no emergency condition, they don’t have to treat you at all. And in any case, they will bill you for services rendered, and send such billing to collections if they think you have available assets/income to pay the bill. If you are very poor/low income, in most hospitals you will fall under their “charity care” programs, and have your bill substantially reduced, if not eliminated.

You don’t get cancer treatment in the ER. You don’t get diabetes treatment in the ER, unless there is a related, life-threatening condition happening which requires immediate treatment.

While the cost of defensive medicine is high, the cost of actual malpractice payouts is minuscule in the over all cost of health care.

“Medical malpractice payments were at record low levels in 2008, according to an analysis by the consumer-advocacy group Public Citizen. For the third straight year, 2008 saw the lowest number of malpractice payments since the federal government’s National Practitioner Data Bank began tracking such data in 1990, the group said. The data showed that 11,037 payments were made last year, which Public Citizen said was nearly one-third lower than the historical average. The monetary value of payments was either the lowest or second-lowest since 1990, depending on how inflation was calculated, the group said. The total cost of all malpractice insurance premiums fell to much less than 1% of the total $2.1 trillion in annual health costs in 2006 (the most recent year for which full data were available). The cost of actual malpractice payments to patients fell to 0.2% of overall health costs, the group said.”
http://www.familypracticenews.com/article/S0300-7073%2809%2970626-7/fulltext#section2

Ever ask yourself WHY OB/GYN malpractice rates are SO different between Florida and WA? There is no discernible reason. Except one: “Whatever the market will bear.”
Rifleman_Dodd on August 21 at 9:29 p.m.
spokelooneh… can you share some of your personal insight on the medical malpractice of mental health providers?
spokelooneh on August 21 at 10:44 p.m.
Mucus McCain, aka Rifleman, if you have something of substance to contribute, please do so. Otherwise put a cork in it.
zelda on August 21 at 11:32 p.m.
To the original subject — “free” annual exams. They’re not free; they’re built into the cost of the premiums. It’s a marketing tool to make people feel they’re getting an expensive service for free. For most people, the annual exam is the chance to get your vital signs checked, have a brief discussion w/your doc and get your Rx’s renewed. Period.

But if your doc goes down the diagnostic path during the exam, your free exam immediately turns into a diagnostic office visit with a different code and it’s not free anymore.

As for the 1993 bill and Deborah Senn, they didn’t repeal coverage for alternative medicine, so all of us in the risk pool still get to pay for sham treatments and quackery. Ever wonder why you see so many therapeutic massage places around town? Massage therapists make a living billing insurance for 30 min. of cutting-edge work such as putting hot stones on people’s back, playing an Enya CD and telling you to drink plenty of water to wash away the toxins. She may even refer you to a naturopathic “doctor” from Bastyr who can cure diabetes with herbs.

I don’t have much good to say about insurance companies, but they are pretty good at recognizing voodoo when they see it. But chiropractors and a whole host of alternative medicine people have powerful lobbies of their own with people more than willing to give testimonials about how shoe magnets cured their gout.

It’s time to go back to the fundamentals and decide what really fits the definition of health care and what kinds of evidence-based treatment qualifies.
nslopeofw on August 21 at 11:54 p.m.
Lulubelle,

I, for one, would not be worrying, due to the fact that i have purchased health insurance to “hedge” against such occurrences. It was my choice to purchase said insurance, and if i never use it, well, then i will loose all that money. Now, if i do have “the big one”, i have taken precautions, by willingly choosing to pay for an insurance policy, which will cover those things. It was not my right to have this policy, none the less, i, with my own money, have paid for this insurance policy to exist.

Its the same with everyone else. They can choose to pay for a policy, or they can choose to pay for cable TV, a real nice cell phone (with unlimited texting), XM satellite radio, an x-box, a new LCD TV, super noisy, boomer, car stereo speakers, smokes, booze, whatever. It’s all a matter of priority. And, here in WA, they can have the option for low cost group health, or the other choice (don’t know what it is called).

So, you see, i don’t feel guilty for choosing to insure myself and family for health. It isn’t a “right”, but it is a responsibility.
nslopeofw on August 22 at 12:07 a.m.
in·sur·ance (in s̸ho̵or′əns)

noun

1. an insuring or being insured against loss; a system of protection against loss in which a number of individuals agree to pay certain sums (premiums) periodically for a guarantee that they will be compensated under stipulated conditions for any specified loss by fire, accident, death, etc.

This is the definition of insurance. A number of individuals AGREE TO PAY for a guarantee to cover what has been insured. Just like the blackjack table, you don’t have to take the insurance against the dealer having a 21, but if you want it, you can pay for it.
spokelooneh on August 22 at 12:11 a.m.
Jeebus, Zelda, WA state does not REQUIRE insurance companies to cover Licensed Massage Therapy treatments, and the small minority of plans that do cover such, usually at 50% of the already low (comparatively speaking) charge do so because they have found that it is cheaper for certain conditions and just as effective and same efficacy as far more expensive Physical Therapy.

The infantesimal amount of health care spending going towards Licensed Massage Therapy and other “Alternative Medicine” is NOT, not at all, what’s breaking the bank.

M.D.s practice the art of placebo therapy all the time at $400 an hour, and up, completely billable to the State and insurance companies, should that be prohibited as well?
Jeffrey_Grey on August 22 at 4:14 a.m.
gmorton,

You make several good arguments, but I remain unconvinced.

“I assume you’re referring to the “subprime crisis” and the collapse of the housing bubble.”

Indeed I am. And you can throw the auto industry bail-out in with the mix. But staying with the sub-prime crisis for a moment…

I’ve heard the rationalization before. ‘Fannie Mae and Freddie Mac are to blame as is the government for forcing their bad conduct.’ First of all, the argument isn’t wholly without merit. The government did, indeed, pressure both lenders to make questionable loans. But the pressure was hardly resisted to any great extent. Far more importantly, Fannie Mae and Freddie Mac were hardly the only culprits. ‘Ninja’ loans became the order of the day when *many* other lenders saw the potential for quick profit. And it wasn’t Fannie Mae or Freddie Mac or the unwise government who built the incredible house of cards of bundled bad loans marketed as securities.

Perhaps the government opened the door. But no one forced corporate America to step through. Their greed and desire for profits meant they couldn’t rush through fast enough.

I see the same corporate greed and lust for profits at work in both the health care and health insurance fields. (More about why I see it in a later post.) Again - perhaps ill-considered and badly implemented regulation opened the door. As a result we need to be as skeptical of regulation as we do of a completely unregulated free market.

I see either course of action - over-regulation and under-regulation - as equally perilous choices.

Apparently you recognize the peril of un-regulated insurance as well. If not, why do you think it is prudent to regulate things like proper capitalization and policy enforcement? If the inclination is there to engage in the bad conduct of under-capitalizing or of refusing to honor policy commitments, why aren’t other kinds of bad conduct possible and worthy of policing?

And if the free market apparently cannot operate to prevent abuses like under-capitalization and refusing to honor policies, and if, therefore, *well-considered*, *effective* regulation is the answer to those bad deeds, why isn’t it the answer for other abuses?

– continued–
Jeffrey_Grey on August 22 at 4:58 a.m.
“The costs of health coverage are only partially due to mandates on the insurance industry itself. They are also due to the costs imposed on hospitals, physicians, drug manufacturers and retailers, and other health care providers who are also commanded to deliver free lunches to the politicians’ political patrons.”

This is the first time you make this point, though you repeat it in several other places.

I really brindle at the notion that we have become a nation of free-loaders living off the efforts of a dwindling few who pay the way for the rest of us.

You point with nostalgia at the halcyon days of pre-1970, the time before everything was wrecked by government meddling. Meddling in the form of forcing health care and health insurance to start tending to the needs of a previously unserviced throng of deadbeats.

Where did this throng come from? Where were they before 1970?

You say that the fault for the skyrocketing costs of health care and health insurance lies at the feet of this throng.

But if - as the opponents of health care reform are quick to point out - most Americans have health insurance, if the frankly exorbitant policy prices they pay at least offset some of the increased costs, why are costs continuing to rise?

More and more people are simply deciding to let someone else pay their way? The Deadbeat Horde increases every day?

Do you have any statistical proof of that?

And if the Horde is indeed increasing in numbers, is it solely a result of choice on their part?

Might the fault not also possibly lie in the fact that insurance companies are themselves adding to the Horde by refusing to insure more and more individuals thus transferring a greater and greater burden upon the few remaining policy holders?

If that’s not the case, how do you explain the fact that health insurance premiums have increased by 105% here in Washington since 2000? And while we’re on the subject, how do you explain the fact that insurance companies’ cash reserves have also increased while the number of insured has declined? (I said in the prior post that I remain skeptical of the good intentions of corporate America and its ability to resist the siren call of profits if left solely to its own devices. Explain the phenomenon of rising profits from fewer purchasers to my satisfaction and you’ll go a long way toward setting my skepticism to rest.)

As I say, I brindle at the notion that it’s *solely* the fault of the consumer’s desire for a free lunch and *none* of corporate America’s lust for profits that is driving this.

– continued –
Jeffrey_Grey on August 22 at 4:59 a.m.
Yes. Perhaps we expect too much from health insurance. Maybe it should only be, as has been suggested, what insurance was always intended to be: a hedge against catastrophe.

I could live with that.

Provided you also brought affordable health care back within my ability to afford.

The problem is that health care in this country for anything more than the most routine things has simply moved beyond the means of most people. In Washington, health insurance premiums alone average approximately $13,000/year for a family - the same as one year’s income from a minimum-paying job. And if the insurance costs that much, and if insurance is *supposed* to spread the cost over time, what might one year’s expenses be without insurance?

gmorton, I’m one of the uninsured. But I’m NOT asking for anyone to pay my way. I’m not a freeloader looking for a free ride. I don’t expect or frankly want you to pay my way for me. I only want to be able to pay my own way. But if I can’t afford the care for myself - it being simply beyond my means - and the insurance companies won’t let me contribute to an insurance policy and thus bear my share of the weight spread over time and over a large population of co-contributors…

What do you expect me to do? Depend on charity or simply go without? Would you throw me to Medicaid?

Even though I want to pay my own way, would you force me to be the freeloader you condemn?
nslopeofw on August 22 at 10:32 a.m.
Jeffery_Grey,

My mom was on Group Health for a few years, and they have a sliding scale based on your income. She had a small job (20-30 hours per week at close to min. wage) and was too young for medicare/aid. She said her monthly premiums were $38. I don’t know what they are now, but it has to be close to that. Might want to check it out.
zelda on August 22 at 10:36 a.m.
Spokelooneh — Yeah, I had myself a bit of a rant. However, I was told by a top exec at one the hospitals that the requirement to cover some forms of alternative medicine (a move backed by Deborah Senn when she was insurance commissioner) was a big reason that most private insurers pulled out of Washington state.

No argument that docs use placebo treatments and they do work. I just don’t like the shamanism involved with much of alternative medicine. They dispense false information and in some cases do harm to people.

Maybe its popularity is a sign of how docs fail to meet patients’ needs. There isn’t a lot of personal care that can be given in a tightly scheduled 10-min. office visit.
gmorton on August 22 at 12:42 p.m.
Jeffrey_Grey wrote,

“Apparently you recognize the peril of un-regulated insurance as well. If not, why do you think it is prudent to regulate things like proper capitalization and policy enforcement? If the inclination is there to engage in the bad conduct of under-capitalizing or of refusing to honor policy commitments, why aren’t other kinds of bad conduct possible and worthy of policing?”

Any form of bad conduct is a proper subject of regulation. But I suspect we’ll differ on the definition of “bad conduct.” Per my definition, “bad conduct” is perpetration of some kind of fraud, or breach of contract. An insurer engages in bad conduct if it does not honor claims it has contractually obligated itself to honor, or if it misrepresents what it is offering, or if does not exercise its fiduciary duty to keep its financial house in order so that it can perform its contractual obligations. It does not engage in “bad conduct,” however, by refusing to insure certain persons or certain conditions (or charges extra for insuring them), or declines to cover certain kinds of care. Nor does it engage in “bad conduct” if it raises its rates or cancels a policy, unless the policy includes some kind of rate cap or non-cancellation clause.

I suspect you share the underlying assumption which has driven most insurance regulation in recent decades and which now drives the demands for some kind of government health care program, i.e., the belief that one has a “right” to health care and that everyone else (especially corporations and “the rich”) has an obligation to provide it to one. Per that assumption, insurance companies are no longer perceived as merely private associations of entrepreneurs and investors organized for the purpose of earning profits for themselves by providing a service some persons might find valuable and be willing to pay for, but as quasi-public entities, like the post office, which exist to provide a public service and which have “social obligations.”

An insurance company is no more a public entity and has no more “social obligations” than a restaurant. A restauranteur goes into business because he likes to cook, believes that others will like his cooking also and will be willing to pay for it, and that he can make a profit by cooking for those people. He has a duty not to poision his diners with bad food, or misrepresent its ingredients, method of preparation, or the portions served, but he has no duty of any kind to feed anyone. Nor does he have any duty to offer dishes he does not care to make, nor to cater to anyone’s particular dietary needs or preferences. He may charge whatever his customers prove willing to pay, and he “reserves the right to refuse service to anyone.” He is in business to meet *his own* needs, and those of his family and employees, *by* meeting certain needs and desires of certain others – others who want what he has to offer and are willing to pay the price he is asking. He has no duties to anyone else.

“But if - as the opponents of health care reform are quick to point out - most Americans have health insurance, if the frankly exorbitant policy prices they pay at least offset some of the increased costs, why are costs continuing to rise?”

Health insurance costs continue to rise for several reasons, mainly, because the costs of care continue to rise, and because, due to overbearing regulation, competition has fallen precipitously, and because they anticipate payouts to increase even more in the future. Rates have also risen in recent years because, due to the financial crisis, assets and investment income have fallen, and in order to maintain the large capital reserves insurance companies must maintain to service future claims, they must make up those losses from policy holders. Insurance has been an unprofitable business the last couple of years.

http://money.cnn.com/magazines/fortune/fortune500/2008/industries/223/index.html

(continues)
gmorton on August 22 at 12:48 p.m.
Jeffrey_Grey wrote,

“I see the same corporate greed and lust for profits at work in both the health care and health insurance fields. (More about why I see it in a later post.) Again - perhaps ill-considered and badly implemented regulation opened the door. As a result we need to be as skeptical of regulation as we do of a completely unregulated free market.”

Well, that overworked phrase, “corporate greed,” is a sure clue that the misconception I mentioned above is at work, i.e., that insurance companies (and businesses generally) are quasi-public entities obliged to serve some public purpose – some sort of *de facto* contractors charged with delivering some product or service necessary for the “public good.” And of course they are not. They are groups of private individuals organized to provide a service to other private individuals who may wish to do business with them. They are in business to make a profit, and will offer their services only as long as they make a profit at least comparable to those they could earn by investing in some other enterprise.

You should keep in mind, BTW, that the three largest health insurance carriers in Washington State (Blue Shield, Blue Cross, and Group Health) are all non-profits. They distribute no dividends to no investors. They are also subject to the 72% loss ratio in Washington, i.e., not less than 72% of premiums collected must be paid out in claims. In fact, all three of those carriers’ loss ratio hovers around 80%. And their rates have climbed apace with the industry as a whole.

You asked,

“More and more people are simply deciding to let someone else pay their way? The Deadbeat Horde increases every day?”

Yes. More and more people have been persuaded that their health care is someone else’s responsibility. So politicians, having promulgated that fiction and now seeking to capitalize on it, impose more mandates, more restrictions, more compliance costs on both providers and insurers. And premiums go up.
Jeffrey_Grey on August 22 at 1:28 p.m.
“I suspect you share the underlying assumption which has driven most insurance regulation in recent decades and which now drives the demands for some kind of government health care program, i.e., the belief that one has a “right” to health care and that everyone else (especially corporations and “the rich”) has an obligation to provide it to one.”

I’ll say it again. (By my count this makes the fourth time.)

I do NOT expect or want anyone else to pay for my health care. I will happily pay for it myself.

I only ask for a way to do so - one that is available to a person with my current health and somewhat modest (but by no means impoverished, more like lower-middle-class) financial means.

Quite frankly, I don’t see that as an unreasonable request.

At the moment, I do manage to budget in routine doctor visits and my two prescriptions without undue strain on my finances. ‘So far, so good.’ But I solemnly assure you; any ‘catastrophic’ illness, especially one requiring hospitalization for any length of time, and I will more than likely be forced into bankruptcy, at which point you will wind up paying for my health care anyway (in the form of recouped losses passed along to other users of the health care system.)

And I do see that as unreasonable and unfair - both to you and to me.

So… How do we fix this?
nslopeofw on August 22 at 3:28 p.m.
is your current health really bad? Do you have some existing conditions, that are going to force whomever insures you to pay way more out, than you are going to put in? If you can’t get insurance, you either have some serious health issues, or can’t afford it. Since you say money isn’t the problem, then i’m guessing you have a condition that is going to cost a lot of money to treat. No one in their right mind would give you a policy based on this. After all, (as gmorton has said) they are in business to make money, not to lose money.
Jeffrey_Grey on August 22 at 5:39 p.m.
nsl,

I do have a pre-existing condition. I’m one of this nation’s 23 million Type II diabetics. However, I’m pleased to say that my diabetes is currently well controlled with medication, nutrition and exercise. Still, as a diabetic I fully expect to have higher medical bills and therefore a higher insurance premium than someone in perfect health.

That’s only reasonable.

My question is; what’s reasonable?

I don’t really want to get into the numbers because it’s not really anyone’s business and further, and to be honest, I can’t exactly recall what the last quote I got for health insurance was. I do remember it was in excess of $1000/month with a per incident deductible higher than any amount I’ve ever paid out of pocket to date.

In any event, whatever the numbers were, they were simply out of my financial reach. I mean… there it is. I wanted medical insurance. I wanted the safety net. I still do. But I simply couldn’t afford it. And given the news lately and though I haven’t recently checked, I rather doubt the prices have come down significantly.

So for now and as I say; I’m paying my own way out of pocket. And since my current health is overall pretty good and my current prognosis is therefore ‘guardedly optimistic’, I’m not terribly concerned over my continued ability to pay my own way - at least for the foreseeable future.

Of course, I could get run over by an uninsured drunk driver while crossing the street tomorrow. In which case I could potentially face an extended hospitalization that would be entirely out of my financial reach. In which case, as I have said, I would have no choice but to file for bankruptcy.

In which case you would be picking up at least part of the tab, as would most of the people reading this blog.

I don’t like that. You don’t like that. So how do we fix it?
nslopeofw on August 22 at 8:11 p.m.
I agree, if the only reason you are getting outlandish quotes at $1000 a month for diabetes, then, something is wrong. If you can pass a physical, are on existing meds, and everything is fine, then they should insure you. As far as fixing it, have you tried to get group health through the state? Have you checked with the state and feds for any help programs?

As far as fixing it, my choice is to provide coupons to make up the difference between what you can afford, and what it costs, on a case by case basis. That way you are doing as much as you can, and to keep from going broke, we, the taxpayers pay the rest using said coupons. This must be done on a case by case basis, to prevent waste, and to keep people from chosing not to pay any, because the government pays.
spokelooneh on August 22 at 9:29 p.m.
“Insurance has been an unprofitable business the last couple of years.

http://money.cnn.com/magazines/fortun…”
-gmorton.

Ummmm, WHAT?

The link you provided shows that EVERY SINGLE ONE of the health insurance companies ARE profitable.

Out of the top 5 on that list, all but one (#5 Cigna) were MORE profitable in 2008 than in 2006.

Doubleplus good.
spokelooneh on August 22 at 9:41 p.m.
Well Jeff, contrary to gmorton’s assertions that WA State’s bloated health insurance regulatory environment is a model of socialism and freecare for everyone, turns out our fair state is one of the very few in the country that doesn’t mandate that insurance companies cover diabetes treatment.

I’m sorry about that for your situation.

“Laws in Mississippi, Missouri and Washington require only that insurers offer coverage, but not necessarily include the coverage in all active policies. Most states require coverage for both direct treatment and for diabetes equipment and supplies that are often used by the patient at home.
…
“Washington is one of three states that require health insurers to offer at least one type of policy that includes coverage of diabetes treatment, but does not require such coverage as a mandated benefit.”

http://www.ncsl.org/IssuesResearch/Health/DiabetesHealthCoverageStateLawsandPrograms/tabid/14504/Default.aspx
nslopeofw on August 22 at 10:43 p.m.
Jeff,
Get a PO box in post falls, and get some Idaho insurance. Or, just move there. That way there is no way they can burn ya. If Spokehlooneh is right, you should be OK in ID.
spokelooneh on August 23 at 12:30 a.m.
No, slope.

Idaho is one of the few states that doesn’t require diabetes coverage AT ALL.

See my link.

Jesud Christo pay attention.
Rifleman_Dodd on August 23 at 12:52 a.m.
spokelooneh how much does your psychotropic meds cost a month?
Jeffrey_Grey on August 23 at 4:18 a.m.
nsl,

Thank you for your concern. (Sincerely.)

But your suggestion inevitably leads me to ask you if you can honestly support a system that forces people to scam it in order to make it work.

And for Rhodes who I bet will be tempted to say that if I could find a way to scam Idaho into paying for my health insurance, that would prove his contention that making insurance legitimately available across state lines is a big answer to fixing things…

If I could indeed find a way to scam Idaho into covering me, and if other Washingtonians found a way to do it too, what do you think would happen to Idaho’s premium costs and coverages in very short order?
Jeffrey_Grey on August 23 at 4:39 a.m.
Look, in the end it seems - to me at least - to boil down to this:

Should the disaster occur and I do suffer a catastrophic medical expense, *somebody* IS going to be paying for that. That’s just the simple reality.

Unless the proposed solution is to toss me out the door and tell me to go home and die quietly in my bed. And if that’s the proposal…

Well, I all have to say is all the righteous indignation and shrill panic ‘Be very afraid!’ fuss about government intrusion into my health care choices and rationing of care and even death panels that make life and death choices… Well, all of that sounds suddenly quite silly and suddenly quite hypocritical.

So; absent absent ‘pay for it yourself or do without’ - which would be better:
- A system that eventually shifts the entire burden to everyone else…
…or…
- A system that says *everybody* contributes as much as they reasonably can, and though some of us will inevitably be carrying the weight of others, at least they have some help with the load.
Arch_Druid on August 23 at 7:15 a.m.
GMorton, I’m afraid that as a member of the free market system both as an employee in the retail industry and as a business owner, I do believe that you are talking through your hat. I don’t expect that in this society that I would expect to get free services. That most anything I get I have to pay for. The same thing with anything to do with medical care. However, to pay for the costs of a doctor’s visit, tests, prescription drugs and etc.; should not be on a “for profit” basis. But because the doctor expects to earn a living in his profession as I do in mine. He must be able to pay for his insurance of what ever type, he must be able to pay for his training, he must be able to pay for his equipment and supplies, his office space (dental in particular) and pay for staff. I don’t mind that. But “for profit” motivations that become hospital stays that are outrageously expensive: thousands of dollars a day for example, surgeries that can cost 10s of thousands of dollars if not more. Is this any longer a doctor simply earning a living and other abovementioned items described? 3,000 dollars a day during hospital stays does a lot more than pay for hospital staff, equipment, supplies, nurse and doctor visits… It becomes the effective price of a luxury condo when you only have money to rent a one room apartment.

I know what Sue means about health care as a right. If you have to pony up a 20 dollar co-pay while a doctor misdiagnoses you and demands outrageous moolah to the insurance company; then you have a serious problem.

The day that only the wealthy can pay for health care and by the way GMorton, they can fly to foreign countries and get the SAME care cheaper than they can here, then yes, we have a problem. Sorry that I can’t afford the plane travel to India and get world class care the way the wealthy can. And yes, this was in the news over a year ago.

You haven’t made your case. You are handing out the same sort of talking points that even the wealthy products of the free market don’t believe in, don’t believe it? Reread above.
gmorton on August 23 at 10:02 a.m.
“I don’t expect that in this society that I would expect to get free services. That most anything I get I have to pay for. The same thing with anything to do with medical care. However, to pay for the costs of a doctor’s visit, tests, prescription drugs and etc.; should not be on a “for profit” basis. But because the doctor expects to earn a living in his profession as I do in mine. He must be able to pay for his insurance of what ever type, he must be able to pay for his training, he must be able to pay for his equipment and supplies, his office space (dental in particular) and pay for staff. I don’t mind that.”

But you do mind if he also sets his prices to allow him to buy a nice car, nice house, send his kids to good schools and good colleges, and spend a couple of weeks a year in Hawaii?

If all he is able to accomplish after 20+ years in school is cover his costs, why would he have bothered? Would you remain in business if the return on all time and energy you invest in it merely allowed you to cover your costs? Would anyone invest time and money in developing a new drug if all they could earn from it was just enough to cover their costs? Why not invest in developing a new video game instead?

Profit drives progress, Arch. That is why the lion’s share of medical innovation and advancement over the last century has occurred in America, just as has advancement in most other industries and technologies.

“But “for profit” motivations that become hospital stays that are outrageously expensive: thousands of dollars a day for example, surgeries that can cost 10s of thousands of dollars if not more. Is this any longer a doctor simply earning a living and other abovementioned items described? 3,000 dollars a day during hospital stays does a lot more than pay for hospital staff, equipment, supplies, nurse and doctor visits… It becomes the
effective price of a luxury condo when you only have money to rent a one room apartment.”

And you think that is because hospitals, doctors, et al, are reaping enormous profits? You do realize, don’t you, that every hospital in Spokane is a nonprofit, except Deaconess, which only recently converted to for-profit in order to raise some capital?

“I know what Sue means about health care as a right. If you have to pony up a 20 dollar co-pay while a doctor misdiagnoses you and demands outrageous moolah to the insurance company; then you have a serious problem.”

You are confusing two different rights. The right to get what you pay for – competent treatment – is not the same as a right to free treatment.

If you want to reduce health care costs, Arch, you’d better look elsewhere than at “outrageous profits.” You’d better look at the mandates and restrictions placed on all health care providers and facilities by politicians scrounging for votes from persons who believe they have a “right” that others serve them.
gmorton on August 23 at 11:49 a.m.
Jeffrey_Grey wrote,

“Of course, I could get run over by an uninsured drunk driver while crossing the street tomorrow. In which case I could potentially face an extended hospitalization that would be entirely out of my financial reach. In which case, as I have said, I would have no choice but to file for bankruptcy. In which case you would be picking up at least part of the tab, as would most of the people reading this blog.

“I don’t like that. You don’t like that. So how do we fix it?”

Fair question. A good beginning would be implementing the suggestions Whole Foods CEO John Mackey listed in his Aug. 11 Op/Ed in the Wall Street Journal. (His comments provoked a rebellion among the green/vegan/organic food set who constitute most of his customers). Op/ed here:

http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html

Gary Rhodes also mentioned some of them in this forum.

In addition to eliminating all mandated coverages and creating a national market for insurance, allowing hundreds of insurers to offer policies tailored to the actual needs and risk profiles of customers, the states must modify, if not eliminate, their medical and hospital licensing laws, allowing anyone to offer any type of health service he or she pleases. (Of course, no one who does not have the implied credentials should be able to describe herself as an “MD” or “RN”, etc.). Customers can decide for themselves which treatment approaches to utilize and who is competent to provide them. There are many types of health care which can be competently provided by persons other than physicians – midwives can handle most maternity patients, for example; paramedics can handle most minor trauma (as medical corpsmen do in the military). Nurse practitioners can diagnose many common complaints and prescribe suitable treatment. Midwives, for example, who are fully licensed in Washington State, deliver babies at far less cost than hospitals, with outcomes that are comparable, if not superior. See:

http://www.macpm.org/Washington_Midwifery_Cost_Study_10-31-07__1_.pdf

Midwives had to fight tooth and nail to be allowed to practice in those states where they are so allowed. They still cannot practice in many states.

Similar savings could be achieved in many other health care sub-specialties and niches.

Licensing laws have cartelized the health care industry and eliminated competition (which was their purpose). They need to go.
Jeffrey_Grey on August 23 at 12:57 p.m.
I find some of Mr. Mackey’s comments persuasive and some of his ideas quite attractive.

The high-initial deductible scheme - ‘You pay the first $2,500 and then your insurance kicks in’ - I particularly like that one. At least at first blush, I see a lot to recommend that. It seems to me that would start making health ‘insurance’ actually insurance in fact and not just in name.

“Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.”

It seems to me that’s just common sense. Or am I missing something?

“Repeal all state laws which prevent insurance companies from competing across state lines.”

The one problem here is who regulates/enforces the policies? Currently each state does it for itself. But how would Washington State regulate a policy ‘issued’ in Virginia?

“Repeal government mandates regarding what insurance companies must cover.”

Then what insurance company will insure ‘high-risk’ clients? I’m sorry, but here’s one where Mr. Mackey and I disagree - rather forcefully. I don’t believe that if you remove regulation *more* people will be covered by more companies. As heavily over-regulated as some people claim they currently are, insurance companies struggle mightily to limit the number of ‘unprofitable’ policies. The ever decreasing number of insured suggests that they’re fairly successful in this struggle. De-regulate this particular aspect and the cherry picking will just run rampant. You’ll have to go a long way before I buy into this one.

“Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year.”

Yes. Absolutely. If the rebuttal is that tort reform and medical malpractice insurance reform would only fix ‘a small part of the problem’, then it ought to be an easy problem to fix to everyone’s satisfaction.

So I think some of those ideas are good ones and are well worth looking at. But some of them… not so much.
richard on August 23 at 1:01 p.m.
<<you cannot=”” “promote=”” the=”” general=”” welfare”=”” nor=”” assure=”” the=”” “pursuit=”” of=”” happiness”=”” if=”” the=”” provision=”” of=”” health=”” care=”” is=”” based=”” on=”” the=”” size=”” of=”” your=”“ wallet.=”“>>

As you (should) know, “pursuit of hgappiness” has nothing to do with government “providing” health care. It means governmnet will not infringe on your right to “pursue” happiness (unless, of course, that would violate laws or infringe on someone else’s rights).

Providing “free” health care does nothing to ensure your pursuit of hapiness … unless of course you belong to the fraternity which believes other people should donate to your happiness. Why not “free” food? Why not “free” housing? Why not “free” flat panel TV’s?

And as far as “promoting” the general welfare; most rational folk would understand that that means something well short of “providing” any “free” commodity or service.

Using the the wording from the Constitution is a very disengenuous way to argue for government-run health care, I would argue.

But thanks for the thought, Loone”
spokelooneh on August 23 at 2:11 p.m.
“Health insurance costs continue to rise for several reasons, …

Insurance has been an unprofitable business the last couple of years.

http://money.cnn.com/magazines/fortune/fortune500/2008/industries/223/index.html

-gmorton on August 22 at 12:42 p.m.

If you go to the link provided by gmorton, these are the data:

2008 Revenues and Profits compared to 2006.

UnitedHealth Group
$75.4B revenue, a 5.4% increase over 2006. $4.7B in profit, an 11.9% increase over 2006

WellPoint
$61.1B revenue, a 7.3% increase over 2006. $3.3B in profit, an 8.1% increase over 2006.

Aetna
$28B in revenue, a 7.9% increase over 2006. $1.8B in profit, a 7.6% increase over 2006.

Humana
$25.2B in revenue, an 18.1% increase over 2006. $833.7M in profit, an astounding 71.0% increase over 2006.

Cigna $17.6B in revenue, a 6.5% increase over 2006. $1.2B in profit, down 3.5% from 2006.

Those are the five largest health insurance companies in the nation, covering over 50% of the market.

EVERY single one of the companies was profitable. EVERY single one of these companies (except Cigna) had an INCREASE in profits, in 2008 compared to 2006.

Perhaps gmorton is practicing some sophistry, and that, in aggregate, the entire insurance industry has not been profitable for the last couple of years.

But we’re talking about HEALTH insurance, and the subject companies have indeed been profitable over the last couple of years.

I haven’t looked at the others, but I know that United Healthcare Group has reported increased revenues and profits for the first half of 2009.

“For the first half of the year, UnitedHealth’s earnings grew 38 percent to $1.84 billion, or $1.54 a share, from $1.33 billion, or $1.05 a share, in the first six months of 2008. Revenue in the first half grew 7 percent to $43.7 billion from $40.6 billion.”

http://www.bizjournals.com/columbus/stories/2009/07/20/daily15.html

Hmmmm, not bad, an 7% increase in the top line resulted in a 38% increase on the bottom line, aka profit.

To imply that the health insurance industry is not profitable is simply and utterly wrong.
spokelooneh on August 23 at 3:02 p.m.
Ahhh yes, just what we need. More insurance companies with less regulation so such companies can write more 300 page insurance contracts written in the most arcane legalese and filled with unique coverages and exclusions and even MORE hoops for the actual providers to go through.

“…a new national survey of physician practices finds that physicians on average are spending the equivalent of three work weeks annually on administrative tasks required by health plans.

… physician practices report that overall the costs of interacting with insurance plans is $31 billion annually and 6.9 percent of all U.S. expenditures for physician and clinical services

On average, physicians spent three hours a week or nearly three weeks per year on these activities, while nursing staff spent more than 23 weeks per physician per year, and clerical staff spent 44 weeks per physician per year interacting with health plans. More than three in four respondents said the costs of interacting with health plans have increased over the past two years.
…”
http://www.rwjf.org/newsroom/product.jsp?id=42728

(continues)
spokelooneh on August 23 at 3:04 p.m.
(continueing)

So what does this insurance company BS look like at the individual Doctor’s level in private practice?

“I’m a liberal centrist, and mostly a pragmatist, and I could care less if a demonstrably good idea came from Dennis Kucinich or Newt freaking Gingrich. If it’s logical and it works, I do not care. My approach to the whole question of healthcare reform is not rooted in ideology. At all.

Instead, it’s rooted in the years I have spent in the healthcare field. As a retired nurse, married to a Family Practice physician, I have spent many years observing how our system works from the inside.

I was both nurse and office manager, billing/referral/pre-authorization clerk, phone person, lab tech, and chief cook and bottle washer for my husband’s solo private practice. I helped him set up that practice from scratch, with all the insurance contracts, credentialing, inspections, and everything else it entails.

So, now that I’ve established that I know (at least a little) what the hell I am talking about, let’s talk about insurance companies. Let’s talk about what goes on, on a daily basis, in a real live medical practice. We’ve all heard the horror stories from the patient end, the big denials.
…
It’s a chess game, played mostly blind, in which the rules and players on the board change constantly, at the will and whim of something much bigger than you are. It’s exhausting. It’s frustrating. It’s a real morale-killer. Oh, you thought I was talking about diagnosing and treating disease? No, I was talking about getting anything a)covered and b)paid for. You will see later that those two are not the same thing.
…”

She continues on with an example about Cigna, who won’t pay for Tamiflu until a lab test is performed to confirm with 100% certainty the influenza in office test that is 70-80% accurate. It takes 3 days to get the lab test back, and by then, Tamiflu is useless. But Cigna paid for the expensive test anyway. Ridiculous.

“The insurance companies are not stupid. A lot of the sheer bureaucracy and nit-picky requirements and hoop-jumping is now designed for exactly the effect it has. To exhaust the providers. To make them give up. To make them decide that it is just easier and cheaper to treat the patient, and eat the loss themselves if it’s not covered, than to spend the time, effort and man-hours necessary to figure it all out. They know damn well that most of what they are requiring a pre-approval for is, in fact, quite routine and WILL be approved if you spend that hour on the phone. They are banking on your inability to do that a lot of the time – it is a planned strategy.

This is important for you to understand, because it is NO ACCIDENT. It is deliberate. It is calculated. It did not used to be that way, but it is now. This is not your father’s Blue Cross Blue Shield. This is not “competition”, and this is not “free-market forces”. They are engaging in a predatory war of attrition, daily. It’s relentless. It’s exhausting. It’s confusing. It’s maddening.

And it is crippling and killing the practice of medicine in this country.
…”
http://riverdaughter.wordpress.com/2009/08/13/the-view-from-the-belly-of-the-beast-part-one/#comment-383388
Gary D Rhodes on August 23 at 3:13 p.m.
If McDonalds was the only place to get fast food, they would have a huge profit margin.

The problem for Mac is that there is competition. Even if they were the only chain selling burgers, if their price was too high, people could switch to tacos or subs.

People are influenced by prices. I would normally have three or four beers at Silverwood. They raised their price to what I considered exorbitant, so I had just one.

When my son was born in Alaska, and I had no insurance, I priced the cost of delivery at the Palmer Hospital. They wanted $2,000 minimum. I decided to have him at home with a midwife for one tenth the price. Everything went fine, even though the midwife got lost and I delivered my son.

I did not feel like I was owed anything by the Palmer Hospital.

It doesn’t matter how much profit the hospital makes. It doesn’t matter how much profit McDonalds, Exxon, Green Peace or anyone else makes.

In a free market, if profits are big in some industry, competition will follow.
Rifleman_Dodd on August 23 at 4:20 p.m.
spokelooneh take your tripe back to the cut n paste shop and get your money back.
spokelooneh on August 23 at 4:50 p.m.
Rifleman_Dodd, I repeat, if you have something of substance to say, please do so.

If not, pipe down and go back to cleaning your guns or something, so they’ll be nice and shiny when the G-man comes to pry your private health insurance policy from your cold dead hands.
gmorton on August 23 at 5:25 p.m.
Jeffrey_Grey wrote,

“The one problem here is who regulates/enforces the policies? Currently each state does it for itself. But how would Washington State regulate a policy ‘issued’ in Virginia?”

The quickest way to implement that reform would be for the feds to repeal the McCarran-Ferguson Act, a 1945 statute which delegated insurance regulation to the states after the Supreme Court ruled in 1944 that insurance was interstate commerce and thus within the exclusive regulatory purview of the federal government. That would eliminate all state regulation of insurance in one fell swoop, except for carriers based in and doing business entirely within one state. They could also amend the act, allowing states to regulate insurance carriers based in their states in any manner they like, but forbidding them from interfering with commerce between customers in their states and carriers in other states. I.e., the “full faith and credit” requirement would apply to insurance. That should lead to some states becoming “insurance meccas” where in-state companies can offer any kind of policies they think there is a market for, and sell them in any state.

“’Repeal government mandates regarding what insurance companies must cover.’

“Then what insurance company will insure ‘high-risk’ clients? I’m sorry, but here’s one where Mr. Mackey and I disagree - rather forcefully. I don’t believe that if you remove regulation *more* people will be covered by more companies. As heavily over-regulated as some people claim they currently are, insurance companies struggle mightily to limit the number of ‘unprofitable’ policies. The ever decreasing number of insured suggests that they’re fairly successful in this struggle. De-regulate this particular aspect and the cherry picking will just run rampant. You’ll have to go a long way before I buy into this one.”

You don’t think the increasing number of insured has anything to with the increasing cost of policies?

In a free insurance regime there would be many companies willing to insure high-risk clients. If states impose “community ratings,” where all clients pay the same rate regardless of risk, and mandate coverage for all conditions, then the only way the companies can break even is by 1) raising rates on all policies to cover the costs, thereby making the policies unaffordable for more people (as has been occuring in most states in recent decades), or 2) refusing to insure the risky patients. Without those mandates companies would be happy to insure the risky patients, but they would pay premiums proportionate to the risks. Companies could also offer policies which exclude the risky condition, but would cover you for all other (non-related) conditions that might arise. Those policies would be no costlier than anyone else’s policies.

If you are expecting some kind of coverage where the payouts to everyone in your risk class exceeds the premiums they pay, then you are looking for a free lunch, i.e., a welfare system. Such a system might be seen as necessary, but if so, it should be considered on its own merits and funded through explicit appropriations, so that taxpayers can have some basis for comparing costs to benefits. The present approach attempts to foist an obligation of government onto the private health care and health insurance industries, where the inevitable costs can be blamed on “corporate greed.”
spokelooneh on August 23 at 6:55 p.m.
Reducing the number of enrollees while more than doubling their profit worked for United Healthcare so far this year. But let’s not call that corporate greed or anything. That would be mean. And unfair to that good corporate citizen who is just following the rules.

“The Minnetonka, Minn.-based parent of UnitedHealthcare of Ohio Inc. reported Tuesday a second quarter (2009) profit of $859 million, or 73 cents a share, which is more than double the $337 million, or 27 cents a share, earned during the same quarter a year ago.
…

The company’s revenue rose to $21.7 billion for the second quarter of 2009, up 7 percent from $20.3 billion from a year ago despite a 2 percent drop in enrollments compared with last year.”

http://www.bizjournals.com/columbus/stories/2009/07/20/daily15.html

‘Course they did have big expenses last year in settling shareholder lawsuits. Yeah, they’ve cooked their books more than a few times.
spokelooneh on August 23 at 6:58 p.m.
And I do appreciate gmorton supplying a link to data which proves his own claim to be utterly false.
gmorton on August 23 at 7:30 p.m.
Well, spokelooneh, if you do the math there you’ll see that the company’s profit amounted to a bit less than 4% of revenues. I know you expect those investors to cover your health care costs for nothing, but that is not going to happen. They have much better things to do with their money. You’ll have to find another sugar daddy. Those folks have invested in that enterprise to make money, not to deliver you a free lunch.

How much profit they make is none of your business. They are a private enterprise, not a government agency answerable to “the public.” If you find their rates unacceptable, you are free to take your business elsewhere, or self-insure.
spokelooneh on August 23 at 7:44 p.m.
The point is, and you know it, gmorton, you CLAIMED the health care insurance companies were not profitable, when in fact, they very much are.

A RATIONAL and informed discussion about the nature of insurance companies, provisioning of health care etc has no place for outright fabrication, as you did.

You still won’t man up and admit your lie, and I and anyone with half a brain should consider your mutterings to be absolutely suspect.
spokelooneh on August 23 at 8:17 p.m.
“How much profit they make is none of your business. They are a private enterprise,…”
-gmorton

Wrong again, bucko. They are PUBLICLY-TRADED stock corporations. They are required by law to report a plethora of financial data under GAPP and SEC regulations for ALL publicly traded companies.

Do you have even an elemental understanding of market transparency?

Of course, the largest of the companies that make a profit off the care of sick people has violated the law numerous times to the tune of hundreds of millions of dollars, but still, their feet must be held to the fire.
Jeffrey_Grey on August 24 at 4:54 a.m.
“You don’t think the increasing number of insured has anything to with the increasing cost of policies?”

I most certainly do not because every statistic I have seen says the number of insured is *decreasing*.

“In a free insurance regime there would be many companies willing to insure high-risk clients.”

I’m sorry, but given the clearly observable conduct of insurance companies to date, I have seen *nothing tangible* that would lead me to believe that de-regulation would cause them to issue more policies. ‘Why, of course they would!’ is hardly sufficient reassurance.

If other areas are de-regulated, if competition is increased via some of the ‘good ideas’ suggested, then surely regulation that says insurers have to issue policies to high-risk clients wouldn’t be over-burdensome.

Not if they would do it anyway even if they weren’t required to.
garyc on August 24 at 9:44 a.m.
To belatedly answer Doug’s opening question, it makes no sense to deliver everyday health care via insurance. It’s like tapping your auto insurance for spark plugs and tires.

However, most auto policies will allow cover that small chip in your windshield to ward off the bigger cost of replacing the whole thing down the road.

There was no market for prescription drug for seniors. Government invented it by bribing insurance companies (via subsidies) to get involved so they could call it “privatized.” The result was to make it more expensive than it needed to be — and it left that doughnut hole in coverage.

What policies could seniors buy before there was Medicare? Insurance companies don’t want “pools” of people made up of all old people. They want to avoid the sick and the elderly. No profit there. Thing is, we all get old and we all break down at some point.

The current employer model would go belly up if the government didn’t offer huge tax breaks for providing coverage. So that’s already socialized.

Even then, more and more companies are dumping coverage each year. It’s now less than 60 percent of employers.

Cost containment. It’s the only way. We have too much health care. Unneeded tests; unneeded prescription; unneeded procedures. It’s astonishing how many procedures don’t have scientific backing. But providers keep doing them, because it’s profitable.

This isn’t like buying a Big Mac. Don’t need any expertise to do that. But when the doc says you need a stent or spinal fusion or some other questionable procedure, how many of us have the information and the expertise to challenge that?

How many of us can figure out that an MRI would do nothing to illuminate our problem?

The more health care there is in an area, the more spending there is. Outcomes are not better.

That’s antithetical to market economics, which says more supply = more competition. What happens is that if some providers can’t get new patients, they deliver more health care to those they already have.

Instead of phoning the results, a scheduled office visit they can charge for.

Read “Overtreated” by Shannon Brownlee while on vacation. It was really eye-opening.
gmorton on August 24 at 9:47 a.m.
Jeffrey_Grey wrote,

“‘You don’t think the increasing number of insured has anything to with the increasing cost of policies?’

“I most certainly do not because every statistic I have seen says the number of insured is *decreasing*.”

Oops! That was a typo. I meant “decreasing number of insured.”

Jeffrey, the number of policies issued is a function of price, just as is the size of the market for anything else. The higher the price, the smaller the market. Deregulation would increase coverage because it would lower costs and thereby reduce prices. It would reduce prices because customers would not be compelled to pay for coverage they don’t want and don’t need, nor subsidize coverage for persons in a higher risk category.

But I’m curious why you think it’s OK for the State to dictate to any person what services he must offer to another person, that the State may enslave its citizens as long as the chores imposed on them are not “too burdensome.” How did America devolve from the “land of the free” to the “land of State slavery”?
garyc on August 24 at 10:04 a.m.
So what state has these low insurance prices we could all be benefiting from? And what do those policies look like? What if there are pre-existing conditions?
Jeffrey_Grey on August 24 at 10:04 a.m.
gmorton,

So in essence if I can’t afford health care, I should just go home and die quietly in my bed.

That’s what you’re saying without saying it. Or at least you’re saying, ‘Of course I don’t want that. Just don’t expect me to lift a finger to prevent it.’

So come on. How about putting your cards on the table and actually saying it. How about admitting that rationing and death panels already exist - in fact if not in name - in the person of ‘Big Medicine’ and health insurance companies who decide who can afford treatment and who can’t. How about admitting that ‘free-ing’ insurers from the burden of covering people who would cut into the profit margin would only ensure an expansion of what is already indisputably happening now.

Convince us that - ‘If you can’t afford it, do without even if that means your suffering and your doing nothing to help but rather only increase the burden on others’ - is the American Way.
Gary D Rhodes on August 24 at 10:18 a.m.
In case you missed my posts where real doctors, such as Ron Paul, talk about the free clinics where doctors and nurses would donate their time to treating people whom could not afford to pay, just like they used to do before the federal government got involved.

I believe that if the cold hand of nanny government were gone, and we were back to the way it was before Medicare, you would see compassionate Americans helping those deserving people who need a hand.

Freedom doesn’t mean equal access for all.

The solution to denial of coverage due to pre-existing condition is to buy a long-term policy.

Obama identified employer based healthcare in this country as a problem. His solution, demand more employers offer coverage through extortion.
Jeffrey_Grey on August 24 at 10:18 a.m.
(Now I’m getting riled up and I suppose it’s starting to show. Oh well.)

When I go into MacDonald’s and order that Big Mac, I don’t think I’m ‘enslaving’ corporate American when I expect “100% USDA certified beef” to actually be “100% USDA certified beef” and not ground kangaroo - even though ground kangaroo is apparently most cost efficient and therefore better for the bottom line.

I don’t think I’m ‘enslaving’ corporate America when I insist that cars be built to certain minimum safety standards - even though if left to its own devices, I’m sure Detroit could build cars much more profitably if they didn’t have to also make them safe. (Corvair, anyone?)

And I don’t think I’m ‘enslaving’ insurance companies when I say to them, through the government, ‘It’s in this nation’s best interest to make sure we cover as many people as possible, including those who perhaps aren’t the most profitable to cover. Therefore, while it’s perfectly okay for you to make a reasonable profit, you’re going to have to do so within some specified parameters. Now, it might be that you have a reasonable objection when you say that health care is too expensive and as a result of that, there’s no way to do what we require of you and still turn a profit. Well and good. We will also turn to health care providers and say the same thing to them. Profit is okay. But you have to find a way to be profitable within certain parameters.’

You point with nostalgia to the halcyon days of pre-1970 when everyone had health care and everything was good. Okay. If they did it then, we can do it now. If that means that burdensome, inefficient regulation has to go by the wayside, so be it. If you’re right, the politicians will just have to find some other way to seize and hold power.

But if it also means that we have to institute price controls and meaningful, efficient regulations to bring us back to where we once were, then that’s the price the corporations will have to accept.

Nobody gets a free lunch.
Jeffrey_Grey on August 24 at 10:21 a.m.
Rhodes,

Once again - why is it objectionable to have a regulation that says, ‘Do what you’d do anyway’? (Other than that having such a regulation would offend libertarian sensibilities.)
garyc on August 24 at 12:23 p.m.
There’s no law stopping doctors from being compassionate and donating services. Locally, we have Project Access. It’s just that the scale of need is so much larger.

The olden days of medicine were not better. Medicare came about because of the tremendous need. It didn’t replace charity care, but it sure helped the elderly.

Will you be forgoing Medicare, Gary?

<<the solution=”” to=”” denial=”” of=”” coverage=”” due=”” to=”” pre-existing=”” condition=”” is=”” to=”” buy=”” a=”” long-term=”“ policy.=”“>>

Let’s place this in the real world. You’ve had a group policy via your employer for 20 to 30 years. You no longer work there. Now what? Should’ve bought a redundant policy 20 years ago?
gmorton on August 24 at 12:28 p.m.
Spokalooneh wrote,

“Wrong again, bucko. They are PUBLICLY-TRADED stock corporations. They are required by law to report a plethora of financial data under GAPP and SEC regulations for ALL publicly traded companies.

“Do you have even an elemental understanding of market transparency?”

Yes, I do. Publicly-traded companies are required to report their earnings in order to allow investors and potential investors to know whether a company’s profits are *sufficient* to justify the investment they contemplate. It is not to invite free-lunchers on the sidelines to ponder whether their profits are “excessive.” If you are an investor or prospective investor, then a company’s profits are your business. If you are just a customer or a 3rd party standing on the sidelines, then they are not. If you are a customer then the company’s *prices* are your business, and if you deem them too high, you do business with someone else, forego the product, or produce it for yourself.

There is no such thing as an “excessive” profit. The more profit a company can earn, the better for its investors, as long as the level of profits it seeks does not require it to raise prices so high that customers go elsewhere, thereby *reducing* its profits.

Your confusion stems from your mistaken understanding of the roles of corporations and other businesses in a society, which in turn stems from an archaic and badly mistaken understanding of the structure of societies and of the relationships among the individuals who constitute them.

You imagine modern societies to be a kind of organism, composed of “cells” (persons) and “organs” (corporations, organized interest groups, etc.) all of which are obliged to do their part in promoting the well-being and achieving the goals of the “organism” as a whole. On that view, every company (and person) has a designated role to play in the larger purposes of the “organism.” It abdicates its “social responsibilities” if it fails to play its prescribed role diligently and dutifully, and it’s profits are “excessive” if it is capturing a larger share of “society’s wealth” than the other “cells.”

But all of the terms and phrases in quotes in the above paragraph are nonsense expressions, derived from a conceptual model of society that is wildly inaccurate and entirely irrelevant to the actual structure of societies. There is no social “organism,” and persons (and any voluntary associations they may form, such as corporations) are not “cells” or “organs” within it. There are no “social goals” or “social purposes,” and no person has any “role” to play in achieving those imaginary goals and purposes.

Societies are, instead, random collections of autonomous individuals who happen, by accident of birth, to occupy a common territory. The only goals and purposes to be found within any society are the several goals and purposes of the individuals who consitute it, which differ from individual to individual. There are no preordained or *a priori* relationships among those individuals with any moral implications, but any of them may form such relationships with any others similarly interested. While all individuals who find or place themselves in a social setting have duties not to inflict losses or injuries on others while pursuing their own goals, none has any duty to forego his or her own goals in order to further those of other individuals, unless they freely enter into some kind of contract to do so, for some purpose the contracting parties perceive to be mutually beneficial.

(continued below)
gmorton on August 24 at 12:29 p.m.
(continued from previous post)

Apart from public goods, which persons in a society may have created or donated for general public use, societies have no wealth. The only other wealth to be found in any society is that produced or discovered by particular individuals, whose wealth it is. Those who had no role in discovering or producing that wealth have no voice in its distribution or its uses, nor any claim upon it.

Nor are there any such things as “social obligations.” Any obligations to be found within a society, apart from the universal obligation upon all persons not to injure others or interfere with their own pursuit of happiness while pursuing one’s own, are obligations one individual person may have to another arising from the contracts mentioned above.

Modern civilized societies are not organisms, not kinship-based tribes, not “big happy families.” They are “societies of strangers.” There is no “social contract,” nor any other agreement, explicit or implicit, among those unacquainted, unrelated individuals to “share their fate” or to subordinate their own interests and goals to some alleged “public interest” (which is never more than an interest of other particular individuals) nor any “common goals” (which are never more than someone else’s goals).

Once you purge yourself of that atavistic conception of the structure of society the status of insurance companies, other associations of persons, of persons generally, and the nature of the relationships among them should become clearer.
gmorton on August 24 at 1:00 p.m.
Jeffrey_Grey wrote,

“So in essence if I can’t afford health care, I should just go home and die quietly in my bed.”

I think I answered that one in a previous comment. There will indeed be people who are not insurable, or not insurable for certain conditions, because those conditions have already manifested themselves. “Insurance” is pooling of risks, not reimbursement for losses already suffered. An insurance company is not going to issue a fire policy for a house that has already burned down.

People with existing conditions are not candidates for insurance; they are candidates for charity care. If some members of the public believe that the charity care currently offered by voluntary donors or providers is insufficient, they should increase their donations or pay more taxes for that purpose (e.g., by expanding Medicaid). They should not try to hide those costs by foisting them onto private health care providers and insurers, thereby raising the costs of care and coverage for all their other patients and clients.
gmorton on August 24 at 1:11 p.m.
Jeffrey_Grey wrote,

“When I go into MacDonald’s and order that Big Mac, I don’t think I’m ‘enslaving’ corporate American when I expect “100% USDA certified beef” to actually be “100% USDA certified beef” and not ground kangaroo - even though ground kangaroo is apparently most cost efficient and therefore better for the bottom line.”

You are drawing an invidious parallel, Jeffrey. Neither McDonalds nor insurance companies may misrepresent their products or breach their contracts. If an insurer contracts to cover X condition, then it must pay claims for X condition, just as McD must use 100% beef if that what it is contracting, through its advertising, to provide. The insurer has no obligation to cover X condition, however, any more than McD has an obligation to offer veggie burgers, just because some vegans want them. Neither business has any duty to provide any good or service to anyone, but they do have obligations to provide whatever they have contracted to provide.
gmorton on August 24 at 1:32 p.m.
Gary Crooks wrote,

“Let’s place this in the real world. You’ve had a group policy via your employer for 20 to 30 years. You no longer work there. Now what? Should’ve bought a redundant policy 20 years ago?”

No. You should have insisted on a policy with a guaranteed renewal clause after a vestment period, and a conversion-upon-retirement clause. And you should also have accumulated some savings over those 30 years, such as an MSA. What you may not do is neglect responsibility for your own health care for 30 years and then expect others to pick your tab.
gmorton on August 24 at 1:56 p.m.
Gary Crooks wrote,

“Cost containment. It’s the only way. We have too much health care. Unneeded tests; unneeded prescription; unneeded procedures. It’s astonishing how many procedures don’t have scientific backing. But providers keep doing them, because it’s profitable.”

They keep doing them because someone may accuse them of malpractice if they don’t, and because someone other than the patient is paying for them. As I described in a comment above, the root source of rising health care costs is the absence of the required nexus between supply and demand, i.e., the persons receiving the services are not paying for them. Combined with licensing laws which limit competition (professional licensing, “qualified provider” laws, “Certificates of Need” for health care facilities, etc.) we’ve created a runaway cost regime in the health care field.
spokelooneh on August 24 at 2:23 p.m.
gmorton, you lied about the health insurance companies profits, now you’re spouting this Ayn Randian political theory which never existed in this country or any other, because it completely ignores the concept of the “Commons” which goes against pretty much every religious belief system there is.

Your “Greed is good” blather is utterly unconvincing.
Jeffrey_Grey on August 24 at 2:24 p.m.
“People with existing conditions are not candidates for insurance; they are candidates for charity care.”

So you would put this all on charity?

Let’s examine the magnitude of what you’re actually proposing.

The 2008 Census fixed the population of Washington State at 6,549,224. That same Census found that 12% of Washingtonians have no health insurance. Now, I don’t know the actual numbers. (If someone does, please advise and I’ll re-think my position accordingly.) But let’s assume that of that 12%, half - or 6% - could actually afford insurance.

That would leave 6% ‘uninsurable’.

Six percent of 6,549,224 is 392,953.

So in essence, what you’re proposing is that we say, ‘Exclude the population of Spokane County from any insurance coverage. If they develop any health care problems that they can’t pay for themselves, just let charity handle it. And further, don’t even set up a system that lightens some of the load on charity by requiring those 392,953 people to contribute at least as much as they can. Furthermore - once they have completely exhausted their ability to pay and have declared bankruptcy, then shift the burden onto the rest of Washington’s population.’

And you’re arguing this is a good policy for our state and our nation to adopt?

If so, you and I have reached a point of insoluble disagreement and we’ll just have to let the majority decide the issue.
Jeffrey_Grey on August 24 at 2:34 p.m.
“Neither business has any duty to provide any good or service to anyone, but they do have obligations to provide whatever they have contracted to provide.”

So if Detroit doesn’t want to provide safe cars, then there is no duty to do so if they didn’t agree to a contract for that?

I have never argued for some kind of totalitarian, Utopian state where the corporations are the slaves of the consumer. That’s absurd and obviously unworkable upon its face.

But there comes a point when profits aren’t everything or the justification for anything. Corporations - like people - have rights. But with rights come responsibilities. If corporations reap the reward of profit from the people, they then have at least *some* *minimum* obligations owing back to those people. To say, ‘Sorry, not my job’ when honoring an obligation would prevent - not any profits at all - but only the absolute maximization profits…

I’m not a socialist or a communist. In fact, if I’m anything, I’m a capitalist.

But that is simply UNACCEPTABLE.
garyc on August 24 at 3:01 p.m.
<<whats worse=”” to=”” read,=”” morton=”” or=”“ spokaloonie?=”“>>

This, actually. Focus on topics not people. Thanks.
garyc on August 24 at 3:06 p.m.
<< No. You should have insisted on a policy with a guaranteed renewal clause after a vestment period, and a conversion-upon-retirement clause. What you may not do is neglect responsibility for your own health care for 30 years and then expect others to pick your tab. >>

Unrealistic. One employee is not going to dictate company policy. It doesn’t even make sense to run this through employers in the first place.

So you’re against Medicare and the law that says providers must provide care to people in dire need? If you were a doc, you’d just let them die?
garyc on August 24 at 3:11 p.m.
<<as i=”” described=”” in=”” a=”” comment=”” above,=”” the=”” root=”” source=”” of=”” rising=”” health=”” care=”” costs=”” is=”” the=”” absence=”” of=”” the=”” required=”” nexus=”” between=”” supply=”” and=”” demand,=”” i.e.,=”” the=”” persons=”” receiving=”” the=”” services=”” are=”” not=”” paying=”” for=”” them.=”” combined=”” with=”” licensing=”” laws=”” which=”” limit=”” competition=”” (professional=”” licensing,=”” “qualified=”” provider”=”” laws,=”” “certificates=”” of=”” need”=”” for=”” health=”” care=”” facilities,=”” etc.)=”” we’ve=”” created=”” a=”” runaway=”” cost=”” regime=”” in=”” the=”” health=”” care=”“ field.=”“>>

So what needs to happen? Get rid of licensing of doctors? And who makes it happen? This doesn’t begin to explain the wide divergence in health care costs within the same system.

Some regions spend twice as much per patient as others without better outcomes. All of the regions have the “problems” you’ve described.

Other nations license their doctors. Costs are much lower without having a market system. In fact, the only market systems you’ll find are in third world countries, where if you can’t pay, you’re out of luck.

Is that a model you prefer?
Gary D Rhodes on August 24 at 3:17 p.m.
< It doesn’t even make sense to run this through employers in the first place.>

So why are Obama and the Democrats trying to force employers to cover more people?

As GMorton states, third party payers are one significant reason for rapidly increasing healthcare costs.

Why aren’t you and other progressives advocating a system where costs will come down over time.
garyc on August 24 at 3:47 p.m.
<<so why=”” are=”” obama=”” and=”” the=”” democrats=”” trying=”” to=”” force=”” employers=”” to=”” cover=”” more=”“ people?=”“>>

Caving to the usual political interests when this topic is approached.

<< As GMorton states, third party payers are one significant reason for rapidly increasing healthcare costs. Why aren’t you and other progressives advocating a system where costs will come down over time.>>

Single-payer is not third party. It is the best answer for bringing down costs. Progressives have been advocating this from the beginning. They don’t hold power.
garyc on August 24 at 3:53 p.m.
From wiki:

“Recently Baucus, as chairman of the Senate Finance Committee, caused controversy when calling the first Senate meeting of interested parties before the committee to discuss health care reform, which included representatives from pharmaceutical groups, insurance companies, and HMOs and hospital management companies, but did not include representatives from groups calling for single-payer health care.

“Opposition to single payer health care
Advocate groups attended a Senate Finance Committee meeting in May 2009 to protest their exclusion as well as statements by Baucus that “single payer was not an option on the table.” Baucus later had eight protesters (among them physicians and nurses), removed by police who arrested them for disrupting the hearing. Many of the single-payer advocates claimed it was a “pay to play” event.

” A representative of the Business Roundtable, which includes 35 memberships of HMOs health insurance and pharmaceutical companies, admitted that other countries, with lower health costs, and higher quality of care, such as those with single-payer systems, have a competitive advantage over the United States with its expensive private system.”

“At the next meeting on health care reform of the Senate Finance Committee, Baucus had five more doctors and nurses removed and arrested.

“Senator Baucus admitted a few weeks later in June 2009 that it was a mistake to rule out a single payer plan. Senator Baucus said excluding consideration of a single payer plan was a mistake not because he supports it but because doing so alienated a large, vocal constituency and left Mr. Obama’s proposal of a public health plan to compete with private insurers as the most liberal position.”

Single-payer has not been seriously considered.
Gary D Rhodes on August 24 at 4:02 p.m.
<single-payer is=”” not=”” third=”” party.=”” it=”” is=”” the=”” best=”” answer=”” for=”” bringing=”” down=”“ costs=”“>.

Huh??

If person A, goes to doctor B, and Uncle Sam C pays the bill, wallah, we have a third party paying the bill.
gmorton on August 24 at 7:32 p.m.
Gary Crooks wrote,

“Unrealistic. One employee is not going to dictate company policy. It doesn’t even make sense to run this through employers in the first place.”

I certainly agree with that, Gary. That employers have become the *de facto* providers of health insurance in the US is an unforeseen result of decisions hastily made by the government in WWII, when it had other pressing issues to face. It is a bizarre situation – one of those “unintended consequences” that tend to ensue upon government interference in markets.

Employees cannot reasonably be expected to carefully scrutinize insurance policies which they are not paying for and over which they have little control. They would scrutinize them, however, if they were choosing them and paying for them themselves. They would also question much more carefully any test ordered, medication prescribed, or course of therapy if they were paying for all those themselves, and be much more likely to “price shop” before choosing a provider or treatment.

“So you’re against Medicare and the law that says providers must provide care to people in dire need? If you were a doc, you’d just let them die?”

No, I wouldn’t “just let them die.” Nor would hardly any doc, with or without a law. The trouble with enacting laws forcing people to do what someone else has decided in advance they should do, and cooked up some formula for providers to follow, is that it substitutes the information-poor decisions of distant bureaucrats for those of the persons actually on the scene, robbing them of the freedom to exercise their own discretion and moral judgment. And, like the decision to exempt fringe benefits from wage-price controls in WWII and exempt them from income taxes, it has unintended consequences – such as
those which followed enactment of the EMTALA.

http://edwinleap.com/blog/?p=151
gmorton on August 24 at 8:11 p.m.
Gary Crooks wrote,

“So what needs to happen? Get rid of licensing of doctors? And who makes it happen? This doesn’t begin to explain the wide divergence in health care costs within the same system.”

The state can continue to license doctors and other health care providers. That would give them bragging rights; no one would be allowed to hold themselves out as an MD, RN, CNM, etc., unless they met the statutory qualifications and had obtained the required license. Those laws should not, however, presume to dictate who could offer particular health care services or erect a health care facility. If a patient believes a naturopath, iridologist, witch doctor, or even their neighbor is competent to provide the treatment they need or desire, that is his decision to make. There are all kinds of health care services which can be effectively provided by persons other than physicians, some of which are allowed to practice in some states, e.g., midwives, denturists, paramedics. If my neighbor happens to be a former Army medical corpsman and tells he he can irrigate, suture, and dress the laceration my bandsaw just gave me, I shall certainly consider letting him do it, and I will gladly pay him the $50 he asks for his trouble.

Restrictive licensing laws cartelize the health care industry and have all but extinguished vernacular medicine.

All kinds of factors contribute to regional differences in health care costs. But the local regulatory environment is always a major one.
gmorton on August 24 at 8:44 p.m.
Jeffrey_Grey wrote,

“So you would put this all on charity?”

If the care, or payment for it, is being provided by persons other than the patient (or others with whom the patient has freely joined in a voluntary risk pool), then it *is* charity care. The only question is whether the costs of that charity care are explicit, visible, and therefore open to scrutiny, as is the Medicaid budget, or are hidden in insurance premiums others are paying or invisibly built into the fees charged by providers.
spokelooneh on August 24 at 9:30 p.m.
As the New Yorker article pointed out, there were HUGE differences in costs in the SAME State, i.e. under the same regulatory environment, so, par usual, gmorton’s example is neither realistic nor pertinent.

And sure, millions of people know a former Corpsman and are going to go to he/she for stitches. What an entirely laughable example.

These completely pie in the sky Ayn Randian crackpot “reforms” are NEVER going to happen in this country, or any other. There are plenty of systems around the world that vary widely but work quite well, we need to take the best ideas from those systems that are complimentary, add a dash of good old American ingenuity, and get this reform started ASAP. It’s bankrupting us as it stands now, the the future costs are beyond staggering.

To propose with a straight face that MDs and RNs and ARNPs and PAs are all going to be licensed for vanity purposes only and that there be no regulation whatsoever of who is allowed to perform heart surgery and such is pure insanity.

That’s not discussing reforming health care. That’s philosophical naval pondering and sophistry.
spokelooneh on August 24 at 11:41 p.m.
“5 Myths About Health Care Around the World

By T.R. Reid
Sunday, August 23, 2009

As Americans search for the cure to what ails our health-care system, we’ve overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they’ve found ways to cover everybody — and still spend far less than we do.

I’ve traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as “socialist,” we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:

1. It’s all socialized medicine out there.
…
3. Foreign health-care systems are inefficient, bloated bureaucracies.

Much less so than here. It may seem to Americans that U.S.-style free enterprise — private-sector, for-profit health insurance — is naturally the most cost-effective way to pay for health care. But in fact, all the other payment systems are more efficient than ours.

U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France’s health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada’s universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.

The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.
…”

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html
Jeffrey_Grey on August 25 at 4:39 a.m.
“If the care, or payment for it, is being provided by persons other than the patient (or others with whom the patient has freely joined in a voluntary risk pool), then it *is* charity care.”

Then all insurance - fire, auto, malpractice, etc - is a charity. (To the degree that any specific policy pay-out hasn’t already been fully amortized by that policy’s to-date premium payments.)

“The only question is whether the costs of that charity care are … hidden in insurance premiums others are paying or invisibly built into the fees charged by providers.”

They already are. As it currently stands the inevitable costs of health care incurred by those refused insurance are ultimately absorbed by the tax payer. As I have pointed out elsewhere, those un-recovered costs are currently being recouped in the form of a ‘tax’ that amount to something like $1,300 per year per tax payer here in Washington State.

And that tax is increasing with every new policy that is refused, and a new uninsured ‘free-loader’ is added to the burden.

Perhaps it is in recognition of this ultimately unsustainable policy that both the liberal Democratic and conservative Republican reform plans prominently feature a prohibition against refusing coverage based on pre-existing conditions.

Perhaps both plan’s architects realize that there are health care costs out there that have to be recouped somehow. Someone has to pick up the tab. This is just a simple, indisputable fact. So far, in this discussion (and out in the larger real world) it seems there are four possible payers:
- Individuals and business who would absorb the costs in the form of increased taxes and costs of health care (including ever increasing premiums)
- Insurance companies who would absorb the losses by, again, increasing the costs of their coverage, albeit while spreading that cost across a larger population of payers
- The government, in the form of a completely subsidized health care system financed presumptively through increased taxes.
- Charities.

Of the four:
- Shifting the burden to charity is simply ludicrous upon its face. There is no charity currently in existence that could shoulder such a burden. It’s completely unrealistic and frankly not worthy of serious consideration.
- Socialized (government mandated and funded) care is possible, but would require the understanding of those governed that they would of necessity be paying for that care in the form of increased taxes. Given this nation’s current fiscal situation - read ‘appalling deficit’ - there’s no other realistic way to fund socialized medicine. Costs of care could be lowered and the tax burden thereby lessened - but at some point, payment for services rendered is still going to come out of someone’s pocket. There’s simply no way of avoiding this painful fact. (And anyone who says there is, is selling something.)
- Shifting the ever increasing costs directly onto the individual (in the form of hidden ‘taxes’ and costs) would have the same practical effect as socializing the system, it would just leave the nuts-and-bolts details of how the costs are passed along in the hands of Big Business versus Big Government.
- Requiring insurers to shoulder the burden would be a compromise whereby Big Government mandates the coverage and then leaves the details of how to do so in the hands of Big Business, subject to oversight to make sure that coverage is in fact provided.

As I say; from all appearances - the current path reform seems to be following is the last one mentioned.
garyc on August 25 at 8:46 a.m.
<<all kinds=”” of=”” factors=”” contribute=”” to=”” regional=”” differences=”” in=”” health=”” care=”” costs.=”” but=”” the=”” local=”” regulatory=”” environment=”” is=”” always=”” a=”” major=”“ one.=”“>>

McAllen, Texas, twice the per patient costs as El Paso. Same regs, same licensing, same malpractice laws, which includes a strict cap on noneconomic damages.

Washington state has more regs than Texas. McAllen has much higher costs than Spokane, Seattle or anywhere else in the state. Texas also has one of the highest rates of uninsured people.

The idea that people who are reluctant to second-guess a plumber will second-guess a surgeon is pie in the sky. Plus, part of the skyrocketing costs is that people are demanding more care. They hear of the procedure, then ask about it. They see the drug ad on TV and request it.
garyc on August 25 at 8:51 a.m.
<<if person=”” a,=”” goes=”” to=”” doctor=”” b,=”” and=”” uncle=”” sam=”” c=”” pays=”” the=”” bill,=”” wallah,=”” we=”” have=”” a=”” third=”” party=”” paying=”” the=”“ bill.=”“>>

If Person A goes to Doc B and Aetna C pays the bill …

We prepay Uncle Sam. Just as we prepay an insurance company. But Uncle Sam doesn’t have a fiduciary responsibility to shareholders first.

Thus, more of the money goes directly to care. Plus Uncle Sam doesn’t try to dump patients who cause a “medical loss”, aka payment.
Gary D Rhodes on August 25 at 8:52 a.m.
<plus, part=”” of=”” the=”” skyrocketing=”” costs=”” is=”” that=”” people=”” are=”” demanding=”” more=”” care.=”” they=”” hear=”” of=”” the=”” procedure,=”” then=”” ask=”” about=”” it.=”” they=”” see=”” the=”” drug=”” ad=”” on=”” tv=”” and=”” request=”“ it=”“>

Writing a check from your MSA will put a stop to much of that.
garyc on August 25 at 8:54 a.m.
<<1. It’s all socialized medicine out there. >>

Exactly. So why hasn’t any industrialized nation followed the simple dictates of economic libertarians? What is the model nation out there for health care?

You can theorize all you want on how it should be, but it isn’t that way anywhere, except third world countries.

…
garyc on August 25 at 9:10 a.m.
Flaws with HSAs.

http://www.cbpp.org/cms/index.cfm?fa=view&id=2222

It’s sort of like offering college financial aid to families who could afford it anyway. Plus it upsets “the pools” that make group insurance affordable.

Devil is always in the details.
garyc on August 25 at 9:12 a.m.
<<writing a=”” check=”” from=”” your=”” government-subsidized=”” msa=”” will=”” put=”” a=”” stop=”” to=”” much=”” of=”” that.=”” <<=”” fixed=”” it=”” for=”” ya!=”” why=”” are=”” you=”” turning=”” to=”” uncle=”” sam=”” for=”” a=”” solution?=”” suddenly=”” like=”” the=”” idea=”” of=”” social=”” engineering=”” via=”” the=”” tax=”“ code?=”“>
Gary D Rhodes on August 25 at 10:04 a.m.
Gary, what is your plan for bending the cost curve? I haven’t heard how Obamacare will lead to better care, more R&D, or lower costs.

<what is=”” the=”” model=”” nation=”” out=”” there=”” for=”” health=”” care?=”” you=”” can=”” theorize=”” all=”” you=”” want=”” on=”” how=”” it=”” should=”” be,=”” but=”” it=”” isn’t=”” that=”” way=”” anywhere,=”” except=”” third=”” world=”“ countries.=”“>

Americans lead.
garyc on August 25 at 10:45 a.m.
<<americans lead.=”“>>

What’s taking so long? Highest costs/middling outcomes/many not covered.

I’m not arguing for Obamacare (whatever that means). Though that’s still better than the status quo. If there’s no public option, then it will really will fail.

Evidence-based medicine (google it).

Incentives for coordinated care, not fee for service. See: Mayo Clinic.

Incentives for more primary care docs and fewer specialists. Disincentives for running CT scans and PET scans so liberally.

Measuring and rewarding outcomes. Not paying for every test and visit.

Single-payer for greater efficiency in record-keeping, which cuts down on administrative costs. Also would allow other doctors to quickly pull up records for coordinated care and to head off medication errors. The VA crushes private care on the efficiency end of things. Adopt their computer network

Nonprofit, which cuts out the marketing and advertising for profit centers, or as some hospitals call them “centers of excellence.”

R&D becomes a budgeted item. Most medical breakthroughs already occur at public universities. Then private businesses swoop in with patents. Until the patent runs out, prices stay high. End this, so we can get generics to the market more quickly.

Clinical trials run by objective people, not drug companies with skin in the game.

I can go on, if you’d like.

This would be paid for with taxes or fees. Upfront costs would be considerable, but it would save money in the long term.

Your turn. The family that has to put a backpack on layaway. Where do they get the money for an HSA or MSA?

The family with members with chronic conditions (but not catastrophic). How would they pay?

How to “incent” prevention with high deductible plans?

Who would provide the objective information for patients to decide whether they really need that stent or not? Medical journals have had ethics scandals because, for example, drug companies finance the studies and this has not been disclosed.

What to do with drug reps who treat the office staff to lunch and breakfast and bring in free samples? This causes overprescribing.

The problems go so much deeper than the debate about which form of socialism we’ll have. The current one or a better one.

In short, model the low-cost regions of the country and punish the high cost regions. And, once and for all, pay all regions the same amount for the same procedures and tests with Medicare patients.

Start all of this with Medicare. See how long the privates can hold on being inefficient.
.
Jeffrey_Grey on August 25 at 11:17 a.m.
Gary C,

You and I mostly agree, especially on the point that screaming “Socialism!” and chanting “Just say NO!” aren’t substantive replies.

One point I’m pondering, however:

– How to “incent” prevention with high deductible plans?–

Well, if the front line trench of prevention is the routine office visit, how about returning the cost of a routine office visit back to the price realm of an oil-change for your car? How about lowering the deductible if you pay for those visits yourself as part of a reasonable routine? (Once a year for normally healthy people. More often for people with conditions that would require more ‘prevention’.)

See, I agree with the people who say that health insurance really should be insurance. Let the consumers pay the ‘nickel and dime’ stuff - *provided it really is nickel and dime!* - and then let them turn to insurance for the really big-ticket items on as needed when catastrophe strikes basis.
nslopeofw on August 25 at 1:10 p.m.
I like the way the liberals all thought the “death panel” was taking things to the extreme, to garner sympathy, when in fact, it was to prove a point. It was a metaphor explaining the fact tat the government wanted to be able to choose who got HC and for what.

Yet, here in this subject, they do the same. “What would you do, let them die?” Over and over we hear this heart string pulling question. If you don’t want hysterical crap used against your position, then don’t use it to “enhance” your position.
garyc on August 25 at 1:54 p.m.
Totally agree, Jeff.

Nslope,

The death panels were not a metaphor. Nice try. They were said to exist in the bill. They did not.

I ask the question — repeatedly — about letting people die, because it is a logical extension of the personal responsibility argument.

Currently, that is against the law. So who how these libertarian schemes work while the law is still in place?

BTW, who chooses what is covered or not now with Medicare? Name that person at your insurance company. Good luck.
Jeffrey_Grey on August 25 at 1:59 p.m.
“It was a metaphor explaining the fact tat the government wanted to be able to choose who got HC and for what.”

A metaphor??!

It’s the Limbaugh Limbo!

“Since I would never say anything that blatantly untrue or anything that blatantly foolish, clearly *you* misunderstood.”
garyc on August 25 at 3:14 p.m.
Chico: It’s a metaphor.

Groucho: What’s a metaphor?

Chico: To catcha the ball.
Gary D Rhodes on August 25 at 3:51 p.m.
Har

If we were to try the free market for a change of pace, these would be some of the changes.

End Social Security, Medicare, Medicaid, food stamps, welfare, etc.

End the Federal Reserve and print our own money backed by gold and silver.
End the IRS
Go through every law and regulation and eliminate all that aren’t Constitutional authorized.

People will have to learn from an early age that they are responsible for their lives. Parents will have to teach children that if they don’t get a good education and job, and if they aren’t prudent with their money they will end up on the “poor farm”.
garyc on August 25 at 4:12 p.m.
The lament of a Primary Care Physician.

http://www.thehealthcareblog.com/the_health_care_blog/2009/08/-commentology-thoughts-on-the-death-of-primary-care-.html#more
spokelooneh on August 25 at 5:15 p.m.
“You keep harping on the Constitution; I should like to point out that the meaning of the Constitution is what the Supreme Court says it is. Consequently no powers are exercised by the Federal government except where such exercise is approved by the Supreme Court (lawyers) of the land.
…
Now it is true that I believe this country is following a dangerous trend when it permits too great a degree of centralization of governmental functions. I oppose this—in some instances the fight is a rather desperate one. But to attain any success it is quite clear that the Federal government cannot avoid or escape responsibilities which the mass of the people firmly believe should be undertaken by it.

The political processes of our country are such that if a rule of reason is not applied in this effort, we will lose everything—even to a possible and drastic change in the Constitution. This is what I mean by my constant insistence upon “moderation” in government.

***Should any political party attempt to abolish social security, unemployment insurance, and eliminate labor laws and farm programs, you would not hear of that party again in our political history.

There is a tiny splinter group, of course, that believes you can do these things. Among them are H. L. Hunt (you possibly know his background), a few other Texas oil millionaires, and an occasional politician or business man from other areas.

Their number is negligible and they are stupid.”

President Dwight D. Eisenhower
writing to his brother Ed.
November, 1954
http://www.eisenhowermemorial.org/presidential-papers/first-term/documents/1147.cfm
“Negligible and stupid”.

Poifect!
richard on August 25 at 6:34 p.m.
Barbra Waggoner 64 year old woman in Oregon found out the hard way that government “does in fact” run death panels. She had lung cancer, she was divorced, couldn’t work, had no money or insurance, so she applied for Oregon Health Care.

She had a doctor who prescribed a pill that would slow the cancer and lengthen her life. She applied for coverage and she received a letter from a government bureaucrat saying … “we are sorry to inform you that your application has been denied.”

But they would pay for her to obtain “ease 0f dying” care from the GOVERNMENT.

Read page 425 of the bill. Stop lying to those who say it does not exist. It doesn’t have to actually spell out the words “death panel” for the practice to be created in the bill. You know, sometimes “it doesn’t take a weatherman to know which way the wind blows.” This is one of those times! Wake up! And stop lying! We are not so stupid that we can’t read and interpret what was written.

So, I don’t know how Democrats, most in media, and the leftists, define a “death panel” … but when Oregon had its PANEL of experts consider Ms. Waggoner’s application for assistance, they obviously concluded that her life was not worth treatment or prolonging.

They told her to go die!

Keep your collective heads in the sand, if you must, but most rational, responsible Americans do not want themselves, or their loved ones be put in a situation where GOVERNMENT tells them to go die.

How about you?
richard on August 25 at 6:52 p.m.
Obama says one thing, but is willing to do another … he is, in essence as much a liar as any other politician who went before him. He is “using” language to try to control the debate … which is fine; both sides use it. but not if you read Media Matters and other leftist blogs. Every day they attack Republicans for using language. What a joke.

Obama says he will cut “reimbursements” to Medicare; trying to imply that “those overpaid, knife-hungry doctors will receive less payment. WRONG! Anyone with a 10th grade education can figure out that if you reduce reimbursements, you will have fewer doctors who will receive Medicare patients, fewer hospitals that will accept them, labs, clinics, etc.

That is called “rationing” by anyone’s analysis. I don’t know that there is anything that the Democrats are telling us about their plan (which is very, very little) that is plain truth.

Do none of you not realize you are being manipulated no differently than a used car salesman would use to sell you a clunker. Lies, exaggerations, spin is about all I hear coming out of the proponents for health care.

And we all know that the Democrats are going to use the “reconciliation” vote procedure will be used in the Senate to ram something through whether anyone wants it or not. It is dastardly what these radicals in congress are prepared to do to ram socialism down our throats.
richard on August 25 at 7:28 p.m.
I just read your attempt Gary, to try to revive an argument for single-payer healthcare. Same old tired arguments, my friend. They just do not justify the radical changes and the toxic budget deficits it will create.

The head of the Canadian Health Service said last week that the system is about to “implode.” I don’t know what she meant by that, but I listened to a cardiac surgeon in Vancouver, BC, and former head of the Canadian Health Service, explain what the current head meant.

He used British Columbia as an example of how a government run health system implodes! Currently, health system amounts to 42% of the BC government budget. FORTY-TWO PERCENT! He said projects indicate that without changes, that will be 80 to 90% of the budget in the next 15 years!

It doesn’t matter how wonderful single-payer plans look like on paper … they don’t work! If we have a system that doesn’t work, why get another system that also doesn’t work? Why? Other than to give government more power and control.

This cardiac surgeon was asked what the number one problem facing citizens in Canada. He said it was clearly, access to health care! Wow, where have you heard that before.

He offered statistics that demonstrated that in Canada, there are 5 million citizens who use emergency rooms for primary care … because they can’t get a primary care doctor. They aren’t paid enough, there aren’t enough who go into that practice and government has been impotent to change the situation.

I am so tired of hearing the argument that medical costs are rising faster than inflation and it is the result of insurance companies who gouge people. I refer you to Sunday’s paper and the article about the north side freeway. Today’s cost for it is $2.1 billion; in 2002 it was only $1.4 billion. That is a 50% increase in seven years.

Now how is that different than the costs for healthcare, and why aren’t you liberals up in arms over the “rising cost” of new highways?

Because you are ideologues, that is why!
gmorton on August 25 at 10:12 p.m.
Spokelooneh wrote,

“gmorton, you lied about the health insurance companies profits, now you’re spouting this Ayn Randian political theory which never existed in this country or any other, because it completely ignores the concept of the “Commons” which goes against pretty much every religious belief system there is.”

You apparently missed the thrust of the comments to which you refer. Far from “ignoring” the “concept of commons,” the point of those comments was to show that concept to be bogus. There is no “commons” (in the sense in which you are using the term). The term is vacuous; it denotes a figment of your imagination, a chimera of pop mythology. It corresponds to nothing discernible in reality.

I’m surprised you rely on “religious belief systems” as authoritative voices in matters ontological, they being among the most prolific producers of imaginary entities throughout history.
nslopeofw on August 25 at 10:19 p.m.
You liberals think that just because you slam reality, it makes it wrong? It is a metaphor. Its a was of getting people to think about the reality. If someone said there will be a panel of “experts” deciding how HC will be distributed to the elderly, most people wouldn’t care too much. If you make it out to be some grand conspiracy, suddenly everyone is looking. Even the Huff-Po’s of the land gave it plenty of press. Of course, you all are the same ones who thought Palin meant she could see Russia in the literal sense, rather than as most Alaskans look at it. Being so close in proximity to Russia during the cold war, created sayings like that.

Its not the literal sense these people are looking for, its looking at it metaphorically. I understand where you libs get messed up, what with Clinton’s lack of reality on words such as sex, but please try to think with your own brain, not the hysterics of the party.

The HSA article was really off base. What is so wrong with having people pay their own costs? So what if it is better for the rich, its better for the rich in most parts of life, anyway. They get treated better by the law, they get a different TSA line, that is the way it is, and until you liberals have redistributed all the wealth, it will stay that way. The company i work for has an optional HSA, and as far as i’m concerned, it works great. Its tax differed up to a certain amount, and it makes me “plan” my major health events. If i can’t afford to do them, or if something unplanned happens, then i guess i wait until next year. How does that not make sense?
lessee: 1) Use your own tax deferred money. 2) Plan any major expenditures. 3)It cost no one else anything. 4) I still have regular employee health insurance. 5) It can be used to pay the deductible, co-pays, OTC drugs, dental, in short, anything health care related.
That is my reality, not some bullhockey report from people who never have used HSA’s.
spokelooneh on August 25 at 11:10 p.m.
As usual, Richard takes anecdotal examples to rant and rave about rationing and single-payer health care.

The past and current heads of CMA fully support their government single payer system, and specifically do not want a US type health care for profit system. More than 85% of Canadians have a very positive or positive view of their health care system.

Without knowing quite a bit more medical information about (30 year smoker) Ms. Waggoner’s condition, and being an oncology doc, it is impossible to determine if the Tarceva prescribed is indicated. It appears to be an “off-label” use.

“Genentech, a drug company from San Francisco plans to
double the price of its colon cancer drug Avastin, to about $100,000
per year, when Avastin’s use is expanded to breast and lung cancer
patients.

“Recently, Genentech raised the price of erlotinib (Tarceva),
a lung-cancer drug, by about 30%, to $32,000 for a year’s treatment.
These prices have little relation to the cost of developing or
making the drugs. Comprehensive health care reform must address
this kind of blatant profiteering.”

http://www.doctormanagedcare.com/ChaptersMDM.pdf

It’s hard to tell for sure, but it looks like there have been just two recent trials of patients using Tarceva in Ms. Waggner’s condition. One study indicated a lengthening in life of just over 1 month. The other study had it a just over a week.

“The median progression-free survival — the time it took for the cancer to get worse in half the patients — was 4.8 months for the combination therapy versus 3.7 months for the placebo group, researchers said.

The study was halted early because the improvement in efficacy found in the Tarceva group was deemed to be statistically significant.

It remains to be seen how investors will view the results given the modest 1.1-month difference in progression-free survival seen with the expensive combination therapy.

“Anything more than a month warrants attention and will lead people to consider this strategy in treating their patients,” Miller said.
…
The next step, Miller said, will be biomarker research to determine just which patients are likely to benefit most from the Tarceva/Avastin therapy.
…”
http://www.reuters.com/article/healthNews/idUSTRE54U1GY20090531

The maker of Tarveca has agreed to supply the drug to Ms. Waggoner for a year. Looks they’ll be doing some of that testing on their own nickle, instead of the State of Oregon taxpayers coughing up $32K. I’m guessing Genetech’s fully loaded cost of supplying the drug is less than $2500.

The state of Oregon has apologized for conflating their decision of denial for this medicine, with their suggestion of other treatments the taxpayers would pay for, namely, pain medication, palliative care, hospice, and Dr.-assisted suicide.

The practice of medicine is complicated. Shouting ABORTION! DR. DEATH! RATIONING! SEE, LOOK AT THE COST OF HIWAYS! DEATH PANELS! is for simpletons and hyper-ideologues..
spokelooneh on August 25 at 11:27 p.m.
Well I pick out just one of nlsope’s so very tortured illogical arguments:

“If i can’t afford to do them, or if something unplanned happens, then i guess i wait until next year. How does that not make sense?”

First of all, I have to ask, you might want to risk your own life, but do have a spouse and kids whose live’s you’re also gambling with? That’s pretty sick, if so.

So something unplanned happens, like they do a routine test for Colon cancer, which indicates you need a colonoscopy. OK, so you’ve got enough in your HSA for that. They find major cancerous lesions, and you will need several surgeries for removal, and to see if the cancer has spread. Let’s say $40K, far more than is in your HSA. Plus another $20k for followup costs.

You mean to tell me you’re going to WAIT until your next benefit period starts to treat your cancer? You might be dead. It may have spread far and wide by then, and cost triple to treat it. And you would subject your spouse, your child to such? That’s just plain monstrous.

Or do have catostrophic coverage? Does it cover cancer? Many don’t. What’s your out of pocket deductible on that, $5-10K? Then you’ve got 20% of the $50K left to pay out of pocket, or another $10k.
gmorton on August 26 at 12:12 a.m.
Gary Crooks wrote,

“McAllen, Texas, twice the per patient costs as El Paso. Same regs, same licensing, same malpractice laws, which includes a strict cap on noneconomic damages.”

I mentioned two drivers of health care costs – the lack of nexus between suppliers and demanders (the persons receiving the services are not paying the bills), and cost burdens imposed by regulation, with the former being the most culpable. Both of the essays you cited reinforce that thesis.

(I had not read the New Yorker piece, which was very informative. Thanks for citing it. Since no one else has explicitly posted the link, it is here:
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande)

The author of the New Yorker piece expressly considers the “nexus” issue: “The third class of health-cost proposals, I explained, would push people to use medical savings accounts and hold high-deductible insurance policies:

‘They’d have more of their own money on the line, and that’d drive them to bargain with you and other surgeons, right?’

“He gave me a quizzical look. We tried to imagine the scenario. A cardiologist tells an elderly woman that she needs bypass surgery and has Dr. Dyke see her. They discuss the blockages in her heart, the operation, the risks. And now they’re supposed to haggle over the price as if he were selling a rug in a souk? ‘I’ll do three vessels for thirty thousand, but if you take four I’ll throw in an extra night in the I.C.U.’ — that sort of thing? Dyke shook his head. ‘Who comes up with this stuff?’ he asked. ‘Any plan that relies on the sheep to negotiate with the wolves is doomed to failure.’”

Well, sorry, but that little hypothetical “what-if” scenario hardly constitutes evidence. It is not even a respectable argument; it is a straw man.

Unlike the comparative cost data the author cites to illustrate cost differences in different cities, he cites no data whatever which would support rejecting his “third class” of health cost proposals. The scenario, indeed, ignores the very sources he earlier identified as being responsible for McAllen’s high costs: unnecessary diagnostic procedures, specialist referrals, and surgeries. The “haggling” would not be over the price of the surgery, but *whether it was necessary*. And the elderly woman would be far more likely to ask that question if whe were paying the bill herself. Nor would she “negotiate with the wolves” on her own: she would get as much info as she could from her doc, then talk to her kids, her best friend who had a similar problem a year ago, and perhaps see another doc on that friend’s recommendation. She, or one of her kids or grandkids, would research the matter on the Internet.

And, of course, bypass surgery is not likely to be gratuitously recommended in the first place. Is the endoscopy and referral to a gastro for heartburn that are.

(continued)
gmorton on August 26 at 12:14 a.m.
I mentioned in an earlier post the “extinction of vernacular medicine.” In its broadest sense, “vernacular medicine” is the medical knowledge which is dispersed throughout a community – the “common knowledge” which people glean from experience and from the medical “experts” in the community and then share among one another. When that is well-developed, gratuitous and self-serving medical advice has much less chance of being swallowed by the patient. It will not jibe with what he knows, or thinks he knows, about the matter, and so he’ll question and investigate it (“Hmm. My brother Pete had that done a while back, and he didn’t say anything about getting an MRI”). But unless the patient is paying the bill himself, he doesn’t ask those questions or pay much attention when others discuss their health care experiences. Why should he? (The same phenomena occur in many other fields. Auto mechanics, for example, are much less likely to try to slip unnecessary repairs by male than female customers, because they know the men probably have a fair amount of “vernacular automotive knowledge,” and women less).

Gawande (the author of the New Yorker piece) ends up recommending the “Mother Theresa” solution: give practitioners an incentive to adopt the motivations and ethical standards of Mother Theresa. Or devise some new regulatory mandates which force them to adopt them. That approach has never worked in any field; the shysters will just figure out ways to game the new rules, just as they did the old ones. Moreover, that problem is itself largely a consequence of a system involving third-party payers: most docs would not overprescribe or overbill if they knew their patients – the living, breathing, sick persons they actually see – were paying the bills. They are not inhuman beasts. But they have no qualms about sticking it to insurance companies or to the government, which most of them regard as “the enemy” anyway. For them, the question is whether they or the insurance companies scoop up the loot.

Only systemic solutions can work – solutions which rely on the laws of economics, rather than trying to revise or cirvumvent them, or which attempt to transform men into angels. Costs in any economic realm are minimized when supply and demand are in equilibrium (when they mutally constrain each other) and when competition is maximized. Demand can check supply only when the consumer’s own money is on the table; only then will it be worth his while to become an informed consumer.
spokelooneh on August 26 at 12:25 a.m.
“There is no “commons” (in the sense in which you are using the term). The term is vacuous; it denotes a figment of your imagination, a chimera of pop mythology. It corresponds to nothing discernible in reality.”
-gmorton

Just as your word’s belied the truth as to the health care company’s profits, so are your factless pronouncements.

“I’m surprised you rely on “religious belief systems” as authoritative voices in matters ontological, they being among the most prolific producers of imaginary entities throughout history.”

Ahhh, we’ve got one of those “holier-than-thou” Ayn Randian atheists here, eh gmorton?

The concept of The Commons goes back to Roman law. “Res communes”.

I sure you deny the existance of any sort of Commons, like any good uuber-Libertarian.

We protect the commons of public health, so that preventable communicable diseases do not run rampant through the population. The government spends billions to research science, technology, and medical advances for the benefit of the Commons.

We regulate what is put into the air we breathe and into the water we drink, so those Commons are available for all to use without detriment, or depletion.

As Jeff has pointed out, we ALL pay one way or another for the care of the uninsured when they wind up in the ER with a serious condition, and we pay at THE HIGHEST rate for health care there is.

“From my reading of history, medical care was once a more intimate and ethical endeavor, a calling that involved a respectful communion between doctor and patient. However, in recent decades, at least in the United States, it is clear that medical care has become a technology-driven market transaction. Doctors who were once skilled at seeing illness in the context of the “whole person” are more likely, in today’s environment, to know how to rush patients through 15-minute assembly-line appointments and game the insurance/Medicare system with the right billing codes.

Paradoxically enough, a system that ostensibly aims to improve efficiency has resulted in soaring costs. As health care has become more of a market service, and less of a professional calling, Big Pharma, hospitals, insurance companies and medical device makers have become the masters of the system, with each jostling for a piece of the action. It is now standard practice for companies to offer gifts and junkets to doctors — all in the name of improved health care, of course — and to market new diseases, technologies, treatments and so forth. The goal, in short, is to “grow the market,” not necessarily to make people healthier.

Could the commons hold some answers?

Amazingly, two doctors writing in the Journal of the American Medical Association (JAMA) seem to think so. Drs. Christine K. Cassel of the American Board of Internal Medicine and Troyen E. Brennan, a medical doctor and lawyer with Aetna, suggest that the commons may offer some distinct advantages over the fee-for-service model that now prevails in U.S. medicine. Their article in the June 13, 2007 issue of JAMA, “Managing Medical Resources: Return to the Commons?” argues that “physician engagement in a medical commons, ideally with communities of consumers, is arguably the only approach that will ensure proper allocation of health care resources.”

The problem with the current system, the authors argue, is that individual physicians cannot assert their moral agency for health care choices by participating in a commons. Any money that doctors might save through “bedside rationing” would be siphoned away by insurance companies and hospitals, and would not necessarily be used to improve patient care. Individual doctors therefore have little incentive to keep a lid on costs or make ethical judgments because those choices have been taken away from them. They have no “community responsibility” for aggregate costs or outcomes.
…”
http://www.worldchanging.com/archives/008841.html
spokelooneh on August 26 at 12:58 a.m.
Vernacular medicine is more difficult than ever to ascertain, because the of the explosion of treatment regimens, drugs, devices. All serious conditions typically have a myriad of ways in which they may be treated, all highly individualized to the provider’s training and experience, and detailed knowledge of patient, including such patient’s stated values, which for most people, is not how much it’s going to cost. Nor should it be, as gmorton posits, because in his worldview, EVERYTHING can quantified into a simple denominator, money. All aspects of self-interest do not come down solely to money. The often invisible hand of the market does not always make informed, value-affirming decisions.

Certainly, there’s a long history of physician paternalism, and it’s not erradicated, but especially since the 60’s the “patient self-determination movement” has made great strides, and most practitioners understand that and act accordingly. But patient self-determination does not translate solely to cost.

The quality of vernacular knowledge that a patient is further degraded by the stunning amount of pure quackery that exists on the internet, accessible with ease.
gmorton on August 26 at 1:34 a.m.
Spokelooneh wrote (quoting Eisenhower),

“You keep harping on the Constitution; I should like to point out that the meaning of the Constitution is what the Supreme Court says it is.”

Er, no. Eisenhower was wrong about that, as was the late Chief Justice Earl Warren, to whom the cliche is usually attributed. Nor does the Constitution mean what “the majority” or “the people” think it means or want it to mean. It means what it says, when its words are assigned the meanings intended when they are used in everyday speech, and as they are given in ordinary dictionaries, i.e., the same meanings those words have when they appear in a novel, newspaper article, contract, love letter, or your grocery list. They have the meanings which every competent speaker of English would assign to them in ordinary contexts. They do not take on spurious, Newspeak meanings because the Supreme Court says they do.

It is true that various provisions of the Constitution are ambiguous, especially as they apply (or as to whether they apply) to certain situations. That is, they can be construed (as can many other ordinary language expressions) in different ways, all of which are (arguably, at least) equally valid. Then the Court must try to ascertain which of the possible meanings was intended, by researching the history of the provision and the context in which it was proposed, discussed, and adopted, just as it would try to ascertain the intent of the parties when trying to interpret an ambiguous provision in a real estate contract. It is not free, however, to read a provision into it or out of it because they approve or disapprove of it or because they think “the public” does. To the extent it does so it forfeits its legitimacy, and any literate citizen is perfectly entitled to dismiss that decision as pseudo-law and ignore it whenever it may be advantageous and prudent for him to do so.

“Now it is true that I believe this country is following a dangerous trend when it permits too great a degree of centralization of governmental functions. I oppose this—in some instances the fight is a rather desperate one. But to attain any success it is quite clear that the Federal government cannot avoid or escape responsibilities which the mass of the people firmly believe should be undertaken by it.”

Eisenhower is surely right on that point. But that does not alter the role of the Court. That role is to enforce the Constitution as it is written, by declaring what it says and then refusing to convict any person prosecuted by the government under an unconstitutional law. If “the people” are unhappy with the rerstrictions the Constitution imposes on the federal or state governments they are free to remove them by amendment.
gmorton on August 26 at 2:05 a.m.
Gary Crooks wrote,

“The idea that people who are reluctant to second-guess a plumber will second-guess a surgeon is pie in the sky.”

Who do you know who is reluctant to second-guess a plumber? Who do you know who, if they had no “vernacular plumbing knowledge” themselves (which most men do), would not consult with their husbands, boyfriends, sons, or handyman neighbors about the problem before they called the plumber, and thus have some idea what the cost would be before he arrived?

“Plus, part of the skyrocketing costs is that people are demanding more care. They hear of the procedure, then ask about it. They see the drug ad on TV and request it.”

And you think the fact that they are not paying for it has nothing to do with that apparently insatiable demand for services?

Free lunches are an extremely easy sell.
spokelooneh on August 26 at 2:41 a.m.
It’s less of a problem with Medicare, but the reason physicians may not like insurance companies anymore, is strictly because of how the companies are treating them. Plans more complicated than ever, illogical policies, convoluted processes, numerous delays, denied coverages, all of which contribute to physicians having to spend 3 hours a week dealing with insurance companies, and that’s in a small group practice, in a solo, it’s closer to 5 hours. Their RN’S spend better than 60% of their time dealing with insurance companies.

The insurance companies are vastly driving up the administrative costs for the docs. Yeah, maybe THAT’S why. Their utilization review practices have become completely onerous on the doc’s business, which has the perverse effect of driving UP costs, unless the doc just decides to eat it, not worth waiting and fighting with the bean counters. Which is EXACTLY what the insurance companies are counting on. Goes STRAIGHT to their bottom line.
gmorton on August 26 at 3:25 a.m.
Spokalooneh wrote,

“The concept of The Commons goes back to Roman law. ‘Res communes’.”

Yes, I’m quite familiar with that term and its history. But you will recall that I said “There is no ‘commons’ (in the sense in which you are using the term).”

And that is the sense whereby a problem for some individuals becomes a “common problem,” or the interests of some individuals a “public interest.” No problem and no interest is common to all members of any large society; they are all the problems and interests of particular individuals, and they differ from individual to individual.

The “commons” in Roman and English law referred to “natural commons,” such as the atmosphere, major bodies of water, or common lands open to all for hunting, berry picking, firewood gathering, etc., or to such public goods as roads and bridges. That understanding of “commons” is perfectly legitimate. What is not legitimate – is nonsensical – is the idea that there is some kind of collective consciousness or body of which all the individuals in a society are interdependent component parts, such that a problem or interest of one becomes a problem or interest of “the whole.”

Plato described it thus:

–––––-

And is not that the best-ordered State in which the greatest number of persons apply the terms ‘mine’ and ‘not mine’ in the same way to the same thing?

Quite true.
Or that again which most nearly approaches to the condition of the individual —as in the body, when but a finger of one of us is hurt, the whole frame, drawn towards the soul as a center and forming one kingdom under the ruling power therein, feels the hurt and sympathizes all together with the part affected, and we say that the man has a pain in his finger; and the same expression is used about any other part of the body, which has a sensation of pain at suffering or of pleasure at the alleviation of suffering.

Very true, he replied; and I agree with you that in the best-ordered State there is the nearest approach to this common feeling which you describe.
––––
– Republic, Bk. V

And of course no such “common feeling” exists in any civilized society. In none of them does “everyone apply the terms ‘mine and not mine’ in the same way to the same things.”

Your health care problems are your problems, mine are mine, and what may work best for you will not necessarily work best for me, even if we have the same *kind* of problem. I have no duty to help you with your problem and you have no duty to help me with mine. We may, to be sure, decide between us that a common or joint or cooperative approach would work best for both of us. But that is a decision each of us must make for ourselves.
Jeffrey_Grey on August 26 at 4:09 a.m.
I’d like to get back to the specific for a moment, if we could?

Richard,

With respect to Barbra Waggoner; is the foundation of your arguments that Ms. Waggoner should receive her medication at the State of Oregon’s expense? Yes or no.

Here’s a real-life ‘burned down house’. What should be her fate? Let’s hypothetically move her residence a few hundred miles to the north. Let’s make her one of Washington State’s 12% uninsured. Now what’s your answer regarding her situation?

Same question for gmorton. (And yes, gm - that’s a ‘trap question’. But I didn’t build it. In his rush to “Just hysterically scream ‘NO!’”, Richard built this particular tiger pit all on his own. Now I want to watch him try to climb out. You too, for that matter.)

So… Let’s get down to brass tacks. No long-winded philosophy lecture, please. No doctoral thesis on the roots of dogma. Here’s Ms. Waggoner who can’t pay $45,000 a year for her medication. What do you tell her? What’s the specific answer for her specific situation?
spokelooneh on August 26 at 5:54 a.m.
Given your lack of truthfulness, gmorton, I’ll go with Eisenhower’s opinion which matches a century’s worth of the SCOTUS’s real world decision making over your feeble attempt at defending strict constitutionalism, Founder’s intent, plain meaning and the rest of your gibberish.

“The “commons” in Roman and English law referred to “natural commons,” such as the atmosphere, major bodies of water, or common lands open to all for hunting, berry picking, firewood gathering, etc., or to such public goods as roads and bridges.”

Wrong. Again.

Public roads and bridges were not in the commons. They were res publicae.

“Res publicae was defined as those things built by municipalities, governing bodies, the State or federal government. Examples include public schools, roads, sidewalks, and libraries.”

“Res communes literally means “things common to all” and comprises those things extra patrimoiium (incapable of being possessed) and thus available to all organisms. These resources by their dynamic nature include water, air, and biological and genetic diversity.”

I’ll leave for you to guess what the other “res” is.

The government already regulates and manages the commons for its natural health, as that affects our ability to use it in commonality, and affects our health as well.

“Your health care problems are your problems, mine are mine, Your health care problems are your problems, mine are mine, (irrevelant) I have no duty to help you with your problem and you have no duty to help me with mine. We may, to be sure, decide between us that a common or joint or cooperative approach would work best for both of us. But that is a decision each of us must make for ourselves.”

Sorry, no, it does not have to be a decision each one of us makes ourselves. It CAN be, does not HAVE to be. We ALREADY decided that our elder’s health care problems are MINE and YOURS, as we pay into the system that funds their care.

And in the rest of the civilized world, the one with better health care systems, lower costs, and superior outcomes, and based upon their faith traditions, mutual social contract to help one another, the people, as a whole, have decided to institute that social compact, and take care of one another in providing some sort of government managed health care system. They vary in exact type, and scope.

It is simply your naval glazing and spouting of Ayn Randian Libertarian dogma which you have convinced yourself, that the people of the United States are incapable or prohibited from making that social contract decision.

Guess what? We already have. Most of health care dollars are spent through those systems. Military. VA. Medicaid. Medicare. Federally supported Community Health Clinics.

So, sorry to break it to ya bub. We already have pure socialized medicine (VA), hybridized (Military), and single payer, private provider (Medicare/Medicaid). We’re only talking now about who gets to join that system, or a similar one. This ultra-individualism you speak of exists only in theory.

Neither I, nor you, nor anyone else made a PERSONAL decision to support VA healthcare, Military Hospitals, and the rest. It was done by the people’s elected representatives, signed into law, and survived court challenge, if any. It’s called the law of the land. Ever heard of it? Ever heard of “well settled” law of the land? That’s what it is.

Wanna change it? Get a few hundred John Birchers and Libertarians elected to the House, and at least 60 Senators of the same ilk. Good luck with that.

You try and make it look like you know something about this, but when it comes right down to it, you don’t. Public roads are most certainly not in the commons. If you don’t that, you don’t know anything about what you’re talking about.

You might want to put down that shovel. Approaching cave-in depth.
Gary D Rhodes on August 26 at 8:25 a.m.
< Get a few hundred John Birchers and Libertarians elected to the House, and at least 60 Senators of the same ilk. Good luck with that.>

Once people figured out that they could get free stuff from someone else’s effort, they started electing people whom were good at doing that.

Look around Washington DC or Olympia. Many of these people have let power go to their head. That power corrupts, and absolute power corrupts absolutely, is well understood. But what is needed to be understood by Americans is;

“It’s not the abuse of power that is the problem, it’s the power to abuse.”

The reason the founders gave us the blueprint of how to form a vibrant and fair civil society, was with this in mind. Keep the federal government small. They delineated each function, and then specifically said that the federal government could not do more.

When so much power and money are at the disposal of these men and women, abuse will happen.
If Boise gets a new bike trail paid for by the federal government, then why can’t Spokane get the same? If one school district in a state doesn’t want to build a new school, then should the people of the adjacent state tax themselves to pay for their school as well as the neighbors.

Wars are like this also. Eisenhower warned of the military industrial complex. Do you think that the quest for profits, combined with an army of lobbyists can affect lawmakers?

How about the power of the Federal Reserve and the nexus with Wall Street firms such as Goldman Sachs? Is it just coincidence that GS came out of the bail-outs in such a comfortable position, while Washington Mutual is gone?

The founders had it right. Limited government equals more individual liberty and equity.

It’s not the abuse of power we need to control. It’s the ability (power) to do so we need to keep under control. We can not do that by increasing the power and size of the federal government.
garyc on August 26 at 9:14 a.m.
Richard,

You keep invoking the fear of a radical transformation. Single-payer is off the table. It was never on the table. The public option for insurance is on its death bed.

There is no big, bad radical solution left to whine about. What is left is there because it is acceptable to insurance companies and other powerful players.

If we spend 10 percent of GDP on health care — like Canada — would you call that imploding? Health care inflation outpaces regular inflation. It isn’t even close. That’s the problem. You seem to think that’s OK.

But money spent on HC is money not spent on roads, education, entertainment, and other goods and services. People don’t suddenly have more money because they’re spending it on health care. It also affects the deficit and debt.

This is why it affects us all. Annual raises — if you can get one anymore — are wiped out my HC costs. So the total compensation package gets worse each year. At what point will you declare that to be unsustainable?

More and more employers are dropping coverage each year. Why? Costs keep climbing. It’s now below 60 percent of employers who offer coverage. At what point is this implosion?

International businesses have a competitive advantage because they don’t have to deal with delivering HC to workers.

Slope says death panels are a metaphor. You say they are for real. Your claim has been debunked. Live with it.

Barbara Waggoner was forced to turn to government. Why? If what the state of Oregon did is a death panel, then what do you call the insurance companies, who would never accept her?

What is the solution for a woman like her if government is to be excluded?

Gmorton,

You need to read “Overtreated.” Doctors themselves are mistaken or misled about the efficacy of various treatments and drugs. You’d be surprised at how many procedures are done despite the lack of evidence that outcomes warrant the expense. But patients themselves will know this?

Not going to happen.

UW did a 10-year study on whether CT scans improved the misdiagnosis rate for appendicitis. Didn’t happen. Yet, those tests are still ordered and somebody pays.

You think someone in intense pain is going to protest that test? Please.
garyc on August 26 at 9:16 a.m.
<<the founders=”” had=”” it=”” right.=”” limited=”” government=”” equals=”” more=”” individual=”” liberty=”” and=”“ equity.=”“>>

For white males. Fortunately, we reversed their thinking for the betterment of the country.
nslopeofw on August 26 at 9:27 a.m.
Spokehlooneh.

What part was so hard for you to understand? I said i have regular insurance, too. How is that in any way “sick” for my family? My HC insurance isnt the greatest, but with HSA, (my own money) it is a lot better.

Please keep the liberal hysterics for when you are preaching to the koolade masses, and just read and think, it will keep your blood pressure down, and help you be more informed.
Gary D Rhodes on August 26 at 9:27 a.m.
Someone in my white family didn’t get the memo that they were in some sort of a superior position due to their pigmentation.

I feel I am owed a little of my “white privilege”. My step-father lived in a sod-roofed hut in North Dakota. My grandmother was born into a dirt poor family that gave her away. She rode in a boxcar full of cattle to Spokane. Maybe the government can write me a check.
Gary D Rhodes on August 26 at 9:32 a.m.
My other grandmother lived in a logging camp in Idaho where she cooked for the crew. When my Uncle was born, my grandfather tried to get to town to find a doctor, but there was so much snow, the doctor could not make it to their tent. My uncle, George Clark LaValley got his middle name from, and is the only person known to have been born in the Clarkia township.
garyc on August 26 at 9:37 a.m.
<<someone in=”” my=”” white=”” family=”” didn’t=”” get=”” the=”” memo=”” that=”” they=”” were=”” in=”” some=”” sort=”” of=”” a=”” superior=”” position=”” due=”” to=”” their=”“ pigmentation.=”“>>

White males were in a superior position at the founding of the nation. That was the point. There was nothing equitable about that. You mentioned equity. That was only achieved through improvements to the founders’ work.

This is often forgotten when the good old days are invoked.
Gary D Rhodes on August 26 at 9:52 a.m.
Equity was only achieved through improvements to the founders’ work. So that is a good thing, right Gary?

As ML King taught, people should be judged on the content of their character.

The government should not see groups of people, only individuals. That is how the founders wanted it to work. If it has taken some time to get it right, at least we have gotten it right. Many parts of the world do not have the same chance for all people to rise to the top.

Look at President Obama.
Abandoned by his father, his mother leaving him to be reared by his grandparents of modest means, never-the-less was able to attend elite private schools.

Now Obama puts his rich kids into expensive private school, while taking away the vouchers in DC that would allow other kids without Obama’s wealth, to do the same.
garyc on August 26 at 9:56 a.m.
<<the only=”” thing=”” the=”” government=”” should=”” do=”” is=”” make=”” sure=”” contracts=”” between=”” individuals=”” are=”“ honored.=”“>>

Later you seem to advocate tax credits for MSA/HSAs. Which is it? Keep government out or get government involved?

What these competition schemes will do is set off competition among insurers for healthy people. They will get lower rates. No question. But they won’t be young forever.

Group insurance works based on pooling people with a variety of risk factors. If government controls are lifted, why would an insurer take on someone with a chronic condition or a family history of some ailment? Why would an insurer get involved in a high-risk pool?

We’d have tiered insurance. The young and healthy get a low rate. And rates for up from there, with the sick facing exorbitant premiums or flat-out denial of coverage.

This would be true whether it were an HSA or traditional plan.

Then what? This is why there’s Medicare to begin with. Insurers didn’t see profits in that population.

So what is the free market solution?
Gary D Rhodes on August 26 at 10:13 a.m.
You missed a lot of the debate obviously.

What I said, in my perfect world, there would be no income tax, people would be free to spend their money on health insurance, a speed boat, or give their money freely to their favorite charity.

As Gmorton so eloquently stated, insurance is a business, they should not be forced to take on sure money losers.

These people should have gotten a policy that agreed they would be covered for as long as they paid their premiums. Those who neglected their responsibilities would then become charity cases.

You are free to donate your money to help these people.
spokelooneh on August 26 at 1:41 p.m.
“The government should not see groups of people, only individuals. That is how the founders wanted it to work. If it has taken some time to get it right, at least we have gotten it right.”

No, it’s not right, yet. GLBT individuals do not have full civil rights.

Insurance is a business that maximizes its profit by doing whatever it can to make the business side of providers of health care frustrated, and utilize every arrow in its quiver to delay, deny, or reduce payments to the providers that provide the care to the people who need, such providers NOT having a fiduciary duty to maximize profit, but a sworn Hippocratic Oath to provide such health care to the best of their abilities, and in keeping with the rights and wishes of their patients.

The problem with yours and gmortorn’s belief system is that you assume in any transaction, each individual is ALWAYS out to better themselves financially, because they are ALWAYS driven by pure greed, and that all individuals are inherently selfish, ALL OF THE TIME, and that the entire system will collapse unless EVERYBODY thinks and ACTS like this EVERY time.
Jeffrey_Grey on August 26 at 1:53 p.m.
“As Gmorton so eloquently stated, insurance is a business, they should not be forced to take on sure money losers.”

Okay, Rhodes. You just bought a piece of the answer that so far has generated a resounding *silence* from all the other people who heretofore had so much to say.

Barbara Waggoner.

What’s your take on her? How does ‘Do no harm’ and ‘Honor contracts’ fix her problem? What clause of the Constitution remedies her situation? No vague generalities. No lofty ideals. The scale has contracted down from broad, sweeping vistas to one woman with a real problem. Barbara Waggoner can’t afford her medication and her life is going to get cut short if an answer isn’t found.

Go ahead. Tell her that the answer is she’s a burned down house and she’s on her own.
garyc on August 26 at 1:59 p.m.
<<what i=”” said,=”” in=”” my=”” perfect=”” world,=”” there=”” would=”” be=”” no=”” income=”” tax,=”” people=”” would=”” be=”” free=”” to=”” spend=”” their=”” money=”” on=”” health=”” insurance,=”” a=”” speed=”” boat,=”” or=”” give=”” their=”” money=”” freely=”” to=”” their=”” favorite=”“ charity.=”“>>

You never said anything about HSAs and favorable tax laws to make those available to more people?

Yes, insurance is a business. That is precisely the point. Why deliver everyday health care via insurance?

Once they are mandated to cover everyone, then it ceases to be insurance, so why run it through insurance companies?. So the people who couldn’t get insurance if they were treated as individualw — and we’re talking about millions of people with chronic conditions — would count on the kindness of strangers?

So no income tax. Kindness of strangers. And you think that is a real world solution. Wow.

How did that work before Medicare? It didn’t, which is why it was adopted.
Jeffrey_Grey on August 26 at 2:00 p.m.
Spokel,

The greatest irony is that some people can pronounce someone a ‘burned down house’ in one breath. (Right after their ideological opponents have said there might have to be sacrifices if the less than profitable among us are to get insurance coverage too)…

And in the very next breath, they will howl with self-righteous indignation that ‘the burned down house’ isn’t getting every needed treatment and resource. (Right after their ideological opponents have admitted that even with a genuinely best effort to make finite resources stretch as far as possible, the best that they can achieve is a possibly more equitable distribution than what we currently have.)
garyc on August 26 at 2:03 p.m.
<<equity was=”” only=”” achieved=”” through=”” improvements=”” to=”” the=”” founders’=”” work.=”” so=”” that=”” is=”” a=”” good=”” thing,=”” right=”“ gary?=”“>>

You harkened to the founders and limited government when invoking equity. I merely pointed out the gross inequity at the time and how more government solved it.
Gary D Rhodes on August 26 at 2:39 p.m.
Gary, what inequities were written into the Constitution?

<you never=”” said=”” anything=”” about=”” hsas=”” and=”” favorable=”” tax=”” laws=”” to=”” make=”” those=”” available=”” to=”” more=”” people?=”“>
I said in a perfect world people would be reared to take care of themselves. Knowing how people have been led to believe “big brother” will take care of them, we will have to incent people to do the right thing.
<so no=”” income=”” tax.=”” kindness=”” of=”” strangers.=”” and=”” you=”” think=”” that=”” is=”” a=”” real=”” world=”” solution.=”“ wow.=”“>

I believe in volunteerism and helping those in need. I have donated over 7,000 hours of my time, plus money out of my pocket, volunteering in the past ten years.
How about you Gary?
garyc on August 26 at 3:20 p.m.
I believe in not bragging.
Gary D Rhodes on August 26 at 3:28 p.m.
< And you think that is a real world solution. Wow.>

Not unless strangers kick in and help.
In my opinion, they will.

Can you understand the difference between giving time and money to a Salvation Army soup kitchen, and the feds coming to your door to force you to give money to the needy?
garyc on August 26 at 3:30 p.m.
<<gary, what=”” inequities=”” were=”” written=”” into=”” the=”“ constitution?=”“>>

Thought you had in memorized.

“Representatives and direct Taxes shall be apportioned among the several States which may be included within this Union, according to their respective Numbers, which shall be determined by adding to the whole Number of free Persons, including those bound to Service for a Term of Years, and excluding Indians not taxed, three fifths of all other Persons.”

Free persons = 1.
Non-free persons = three-fifths

Sound equitable?

13th Amendment needed to abolish slavery.
14th Amendment needed to overrule “separate but equal” and begin the process of dismantling segregation.
19th Amendment needed so states couldn’t bar women from voting.
garyc on August 26 at 3:32 p.m.
<<can you=”” understand=”” the=”” difference=”” between=”” giving=”” time=”” and=”” money=”” to=”” a=”” salvation=”” army=”” soup=”” kitchen,=”” and=”” the=”” feds=”” coming=”” to=”” your=”” door=”” to=”” force=”” you=”” to=”” give=”” money=”” to=”” the=”“ needy?=”“>>

Sure, the former isn’t enough. Sure didn’t get health care for the elderly before Medicare. Why would it work now?
Gary D Rhodes on August 26 at 3:36 p.m.
<sure didn’t=”” get=”” health=”” care=”” for=”” the=”” elderly=”” before=”” medicare.=”” why=”” would=”” it=”” work=”“ now?=”“>

Could you show me these statistics please?

We don’t live in a perfect world, but I think the US has done a pretty good job of trying to get it right.
garyc on August 26 at 3:42 p.m.
The elderly were the poorest demographic before Social Security and Medicare. We turned that around … with government.

I’ll look for some numbers. In the meantime, can you search for the amount given for charity care before Medicare?
garyc on August 26 at 3:51 p.m.
http://www.emaxhealth.com/72/1272.html

“A national survey found that only 56 percent of those 65 years of age or older had health insurance. President John F. Kennedy pressed legislators for health insurance for the aged. However, it wasn’t until 1965 that President Lyndon B. Johnson signed H.R. 6675 (The Social Security Act of 1965; PL 89-97) to provide health insurance for the elderly and the poor.”

56 percent. Plus a much higher percentage of the elderly were at the poverty level back then.

If their fellow men and women were caring for them, there would’ve never been the need for Medicare.
spokelooneh on August 26 at 5:02 p.m.
Jeffrey_Grey on August 26 at 2:00 p.m.

Spokel,

The greatest irony is that some people can pronounce someone a ‘burned down house’ in one breath. (Right after their ideological opponents have said there might have to be sacrifices if the less than profitable among us are to get insurance coverage too)…”

I knew you wouldn’t a straight answer out of them. They laid they’re own trap, and you called them on it.

Basically, the broad theory is Social Darwinism, survival of the fittest.

If you didn’t, or couldn’t provide for yourself.
And no family member would/could, no friend, no charitable organization, then that’s it then. You’re dead. The government absolutely must not step in, that causes everyone to instantly lose their work ethic, and the entire system will break down, because everybody’s naturally lazy. Gotta keep the whip handy.
spokelooneh on August 26 at 5:11 p.m.
Superman says:

Hop on the WELFARE WAGON!

And Public Health Care too!

http://www.comicmix.com/news/2009/08/25/superman-supports-health-care-and-welfare/
gmorton on August 26 at 7:58 p.m.
Gary Crooks wrote,

“You need to read “Overtreated.” Doctors themselves are mistaken or misled about the efficacy of various treatments and drugs. You’d be surprised at how many procedures are done despite the lack of evidence that outcomes warrant the expense. But patients themselves will know this?

“Not going to happen.”

Oh, I agree. If most docs don’t know whether a particular diagnostic method or treatment method is effective, then neither will patients. And neither will bureaucrats. It always amazes me how many people assume politicians and bureaucrats are in possession of information and wisdom beyond the reach of ordinary mortals, including those who ply a particular trade on a daily basis, and are also paragons of integrity, despite the ample evidence to the contrary.

There is another dimension to this also. Different people assess risks differently. Some are risk-averse, some are risk-tolerant. Most of the dubious tests and procedures cited in the New Yorker piece are not worthless; they just have marginal value in many of the situations where they’re ordered. But some people are willing to pay for the added assurance a particular test may yield, marginal though it may be, and will obtain some degree of peace-of-mind from that information. There is nothing wrong with that, as long as they are paying for the test themselves.

Insurance companies (and the government) pay for these tests because they do have some value in some situations, for some patients. And of course they have no way of knowing whether the claim in front of them involves one of those patients or situations. Only the patient and the doc know that.
gmorton on August 26 at 9:33 p.m.
Jeffrey_Grey wrote,

“So… Let’s get down to brass tacks. No long-winded philosophy lecture, please. No doctoral thesis on the roots of dogma. Here’s Ms. Waggoner who can’t pay $45,000 a year for her medication. What do you tell her? What’s the specific answer for her specific situation?”

That is a fair question. I’ll offer three answers, representing three different respondents.

The government answer:
–––––-
Dear Ms. Waggoner,

I’m sorry, but paying the health care expenses of individual citizens is not among the responsibilities of your government. It is not responsible for your food, housing, clothing, heating, or transportation expenses either. It was created to serve a few specific purposes in society, primarily, protecting your individual rights from other humans who would violate them, such as muggers, burglars, rapists, murderers, and foreign invaders. It is also responsible for managing such natural commons as public waterways, and public goods such as roads. Those are the purposes for which it was organized, and to which it is limited by the Constitution. The government, you must realize, has no funds of its own with which to meet your health care or other personal needs. The only funds it has are those other citizens have given to it for the purposes above. It could only obtain the funds to meet your needs by seizing them from other citizens by force, and of course, that would violate the very reason for its existence.

I suggest you appeal to your friends, family, and perhaps advise the public at large of your situation. Some of them are very likely to step forward and help you.

Sincerely,

THE GOVERNMENT
–––––-

The United Way answer (which could also suffice as the answer from any member of the public at large):
–––––-
Dear Ms. Waggoner,

We’re in receipt of your request for assistance with your medication costs. While we would very much like to help you, you must realize that, like all other charitable organizations, the needs we face exceed our limited funds by hundreds of times. As we understand it, the drug you need will extend your life by a few months at most. With the $45,000 annually you are requesting we could feed 20 children in Haiti for a year, or build shelters for 5 families left homeless by the tsunami in India. I’m sure you can appreciate what granting your request would cost those children and families, and thus why we cannot grant your request. Is there some relative who could perhaps help you?

Best wishes,

UNITED WAY
–––––-

The relative’s answer:
–––––-
Dear Mom,

Jack and I have discussed how to pay for this drug you need. I’ve also discussed it with the other kids. Danny, as you know, has no money, still being in college and with only a part-time job at the school cafeteria. Laura’s husband said no, and apparently was adamant about it. He said, “I like your mother, but … ” –well, you don’t want to know what he said.

Jack and I think we have enough equity in our house to raise most of the $45,000. We can also close Nathan’s college fund, which will give us most of the rest. You should know that the additional mortgage payment will mean we won’t be able to keep Sarah in the gifted school. Since you were the one who convinced us to transfer her there, I thought you’d want to know that. Please let us know if you want us to proceed.

Love,

Patty
gmorton on August 26 at 11:23 p.m.
Spokelooneh wrote,

“Public roads and bridges were not in the commons. They were res publicae.”

Egads. Spare us the pedantry, huh? I gave the generic meaning of “commons” in “Roman and English law.” It can refer to either a natural or manmade good which is a common property, e.g., the Boston Common or common roads.

http://www.infibeam.com/Books/info/Alexander-James-Wallis-Tayler/Motor-Cars-or-Power-Carriages-for-Common/054882665X.html

What the term does *not* denote is some sort of collective consciousness or a “social organism”” or a “General Will” distinct from the wills of actual individuals – which are all distinct from each other and often incompatible.

“Sorry, no, it does not have to be a decision each one of us makes ourselves. It CAN be, does not HAVE to be. We ALREADY decided that our elder’s health care problems are MINE and YOURS, as we pay into the system that funds their care.”

No, Spokalooneh. “We” made no such decision. Certain Congresscritters made it. Some citizens supported it, others did not. Those who supported it were sufficently numerous to impose it on those who did not – at gunpoint, if they did not submit quietly. Try to pay attention to the reality, not the mythology.

“And in the rest of the civilized world, the one with better health care systems, lower costs, and superior outcomes, and based upon their faith traditions, mutual social contract to help one another, the people, as a whole, have decided to institute that social compact, and take care of one another in providing some sort of government managed health care system.”

Don’t want to give that myth up, do you? There is no such contract, Spokelooneh. Or if there is, I challenge you to produce it. Be sure it bears the signatures of everyone you claim is bound by its terms. Nor would you be able to produce any example of legislation agreed to by any people “as a whole.”

BTW, there is no common “faith” or “faith tradition” either. And even if there were, contracts do not spring into existence by faith, any more than Tinker Bell will live if only children believe strongly enough in fairies.
spokelooneh on August 27 at 2:55 a.m.
Gmorton, that you choose to ignore and deny the reality that exists, like the reality when you lied about the Health Insurance company profits, does not make you points any more lucid, nor valid.

You think because of your ultra narrow view, that the valid laws of these United States, and other countries, enacted by our democratic/republican form of government, tested and approved, or not approved by the highest courts in the land, are simply not valid, because YOU (and your narrow minded ilk anti-Government) believe such laws not to be Constitutional.

As I told you before, the spirit of commonality, shared responsibility, and governmental control over the commons, WEALTH DISTRIBUTION, and welfare have been duly enacted according to our system laws, with its checks and balances, and are the well-settled law of the land.

You John Bircher/Libertarian types have been braying about this for decades, but you haven’t gotten but a smidgeon of support from the populace to elect legislators, to enact legislation you seek nor have you been able to elect judges that share your extremist beliefs.

Sorry bub, we’re not repealing the trans-formative laws of the New Deal, nor are we going back to thepre- Income-Tax, pre-Anti-Trust era of the aptly named Robber Barons. And no amount of pontificating on this blog or any other will help you to achieve your reactionary goals, unless, as I said you can actually put people in office to make the changes you seek.

Since the economic and governing policies of the dominant parties would not share even 10% at best, of what you believe in, you’ll have to work extra specially hard and get at least a couple of hundred members elected to the House, and 60 to the Senate. That is the only way it will ever happen, especially because you folks operate in a distasteful “my way or the highway” fashion. You’re incapable of making allies, because you are always right, and they are always wrong, in your warped view. The only way that sort of view of governance works is via a coup, or taking over the Legislative branch, and the Exec (ludicrous), and doing what you what through the existing processes in place.
(continues)
spokelooneh on August 27 at 3:47 a.m.
part 2 of 3

The two central tenets of most Western religious faith traditions are rather simple and rather ubiquotous among non-believers as well. They are love your neighbor as you love your self (and your God, maybe), and do unto others as you would have them do unto you. And there are reams of poetical and allegorical language that put all that into a bunch of real pretty pictures that many people believe in, and try to practice.

Now your position will be that that is all well and good, until you get a third party involved, namely the goverment. Of course we should all try and help each other out as best we can, but we can never enact a 3rd party system to essentially manage that process in the form that have chosen to by our duly elected and constituted government.

Unfortunately for you, the overwhelming majority of the people do not believe that. They believe a system can be setup that broadly achieves the social justice goals they wish to achieve in the giving and taking of resources and management thereof. You obviously disagree, but you haven’t a leg to stand on besides mindlessly repeating that the Constitution does not permit this, while the broad majority of people have said, and done, otherwise. You cling to an outdated value system which largely no longer exists in the real world, except only in the minds of far-outlying, narrow-minded theoreticians.

Even the most cursory look at the Founding Documents allows for the establishment of the type of social contract that I’m talking about, and that is in fact, going on today and has been for quite some time.

The biggest part of the problem with health care has nothing to do with who pays for annual exams. It’s the complicated diagnosis, and often complicated treatment regimens that EVEN IF every paid out of pocket, does not lend itself to the comparison shopping model.

To paraphrase what our once (chain-smoking, gambleholic) Drug Czar and later self-proclaimed Morals Chief said once, if you wanted to save money, if that was your sole purpose, you’d be shipping 10’s of thousands of patients needing expensive surgeries and hip-replacements, overseas. These procedures can be had for 1/10 to 1/4 of the cost here in the States. And there are many private pay patients and some insurance company patients who are doing that right now. There would be enormous social degradation involved. Is that something we want to encourage, or do you think we might just have hundreds of BILLIONS that can be rung out of the system here, starting with why do MRI’s cost $200 in Japan, but $1400 here?

Why you continue to refer to things as myths, when they are already operatinng, both here and elsewhere, is baffling unless you so far detached from reality that all you have left is stubborness. We have an establish Medicare system And a Medicad System. WE have DECIDED to do this and it’s NOT against the Constitution. Kapiche? YOU don’t get to decide what’s Constitutional or not. The Court has already DECIDED. Take it up the to the next level. Oh, wait, there isn’t one. Tough luck, better get working on attracting candidates to run then. Grass roots organizing.

(continues)
spokelooneh on August 27 at 3:48 a.m.
part 3 of 3
Also your assertion that the only reason certain laws are in place that you don’t like, apparently everything in past 150 years, is that assent for such was extorted from the people at the point of the gun.
Go ahead and try and explain that, if you wish, because at this point it looks like sheer lunacy.

You think you can get away with not abiding by the laws of the country, because YOU don’t think they’re Constitutional. “I wasn’t around when that passed” “I didn’t tell my Rep to vote that way” “Nobody asked for MY permission on that vote”

Please. It’s completely childish. We live under a system of laws, not men, and while it doesn’t ALWAYS work that way, we all have to abide by the laws as duly passed or face the consequences. To suggest otherwise is in itself Unconstitutional, irrational, and anarchistic.

The Southerners thought they didn’t have to live by the Brown vs. Board SCOTUS decision, and could still assert their “States Rights” to mistreat our fellow black citizens. Ike sent the 101st Airborne and put a stop to that sick, racist nonsense in Arkansas. A few other of those racist crackers didn’t learn that lesson, and had to get thumped by a federal show of power as well. So did Weaver, and the child raping Koresh in Waco. Think you’re beyond the reach of federal laws you don’t believe are Constitutional? Look at all the tax protestors in prison. And then there’s the criminal Fed over-reaction like Kent State. In any case.good luck going up against the Feds arsenal. Sure they make mistakes, all law enforcement does, (don’t we know it here-RIP poor Otto) and it has to be held accountable, but if you’re a profligate scofflaw, fuhgehtabout it, you’re goin’ in one way or the other. And your pleas will fall on mostly deaf ears, except for you tiny reactionary fringe.
spokelooneh on August 27 at 5:02 a.m.
“The government answer:
–––––-
Dear Ms. Waggoner,

I’m sorry, but paying the health care expenses of individual citizens is not among the responsibilities of your government. It is not responsible for your food, housing, clothing, heating, or transportation expenses either.”

Not responsible for, yet exists today, and has existed for decades, all means tested except transportation.
Food: USDA Food Stamps
Housing: Many Federal and state subsidized programs Section 8.
Heating: Federal Low Income energy assistance program.
Transportation: Public Transportation heavily subsidized including by direct election sales tax set asides
Medicare/Medicare direct government funded operations.

Gmorton would have you believe that such programs do not exist. He lives in a fantasy world where laws that are passed and pass Constitutional muster, are not actually valid, well, according to him and his interpretation of the Constitution that not 2% of the population believes.

Gmorton is further delusional in thinking that because the Government has done something HE doesn’t think is legal, he doesn’t have to abide by it.

Gmorton has judged that those with little or nor means should simply live on the street, back alley, beg for food and money, die from an ear infection, or preferrably, just die, cause the charity care places are completely overwhelmed.

Strange world you live in there gmorton. You do understand these agencies actually exist right. You’ve seen a DSHS officer before? These are real places. They help real people. Oh, to use how your term them, leaches, not people.

Reality check.
It’s called anarchy folks.
Jeffrey_Grey on August 27 at 5:04 a.m.
gmorton,

The Government: “Oh, and by the way - we’ll be canceling your Social Security, Medicare and Medicaid tomorrow since we’ve suddenly realized that the welfare of the elderly and infirm are ‘not our problem’ either. Same for the V.A. Same for Aid to Dependent Children. Hey, it’s not like the United States is one of those backward European nations that have this odd idea that ensuring the health of their citizens is in their nation’s best interest. So, anyway. Good luck with it. Now if you’ll excuse me, it’s time for my annual physical and I don’t want to be late. Indeed, it’s a sad thing you couldn’t get yourself elected to public office since it *is* in the government’s best interest to ensure that the rule-makers do have health care provided for them.”

The Charity: -shrug- What can I say? You’re absolutely right. So I guess maybe, “Let the charities handle it” isn’t a workable solution after all. We’ll just strike that proposed solution from the list since both of us agree it’s not viable.

The Family: From the tone of that letter, I take it you agree that an alternate solution would be preferable? Or do you assert that this nation’s best course of action would be to wipe out the financial stability and future dreams of families in the event of catastrophic medical costs? Again - the Europeans (and Canadians) have thought that’s not a good idea and have apparently found an at least somewhat workable solution.

Last but not least, you presented only three replies.

The Free Market apparently had nothing whatsoever to say on the matter? Maybe if they just stay quiet, nobody will notice them and they can duck the issue completely?
Jeffrey_Grey on August 27 at 7:18 a.m.
Spokel,

The fundamental flaw underlying all the Libertarian dogma is that it presupposes a Utopia where all men always act in their best interests. To support the believability of this Utopia, the beautiful dreamers always insist on keeping the discussion at a lofty, vague and generalized level.

“Do no harm.” “Honor contracts.” That’s all you need. Just follow that and everything will be fine because everyone will always first interpret those two sweeping generalities in such a way as to make every solution come out well. And of course, once the perfect solution is found (assuming such perfection was in fact possible - which it never is), the citizens of Utopia will always willingly adhere to the best possible interpretation.

The ultimate failing of this simplistic fantasy is two-fold:

1) Sweeping generalities are fine, until they collide with nuts and bolts reality. “Do no harm.” My favorite question to pose in rebuttal is, “How does this generalization answer the thorny, vexing question of abortion? How do you resolve all the issues that arise in that context and still ‘do no harm’?” Or in the case at hand: “Honor contracts.” “Okay - we have total resources in the form of $10,000. *That’s the best we can do.* Wishful thinking and lofty ideals won’t increase the resources available by even a penny. The problem is that our expenses total in excess of $20,000. How do we solve the dilemma? Maybe we could squeeze some more out of the corporation’s profits. But the moment we try, they howl that they’re being harmed because we’re abridging their right to enter into contracts without interference.”

2) The second fundamental problem is the same problem that always ultimately defeats every Utopian ideal.

No matter how perfect your vision for the ideal society is, you still have to populate that society with imperfect humans. And their petty, spiteful, greedy and ignorant human nature will defeat your perfection every time - to the point that your ideal free society will always wind up being forced to make rules out of the simple basic need for self-preservation from itself.

Always.
Arch_Druid on August 27 at 8:19 a.m.
Gmorton, I don’t go to a doctor to pay for his nice car, luxury condo, vacation trip to Hawaii, etc. I go to a doctor because he is supposed to be a health practitioner. If all he can think of is sending his kids to Harvard when I walk into the door of his office, then WHY WOULD I BOTHER?

To put it bluntly, I can’t afford sending his kids to Harvard, I can’t afford his vacation trip to Hawaii. Therefore, I guess I won’t be visiting a doctor any time soon even if I could be facing a terminal illness. Which is possible that I am.

But you sure did manage to provide a good excuse for why the health care system is now broken. And why people die needlessly because of it. Greed.
Gary D Rhodes on August 27 at 8:43 a.m.
I think you touched a nerve, gmorton.
Arch_Druid on August 27 at 8:58 a.m.
Geeze Rhodes, tell me all about it when you stop breathing for a few seconds during a coughing attack. Oh and, the doctors at the immediate care center declared that it was “post nasal drip.”

Don’t applaud the fellow for failing to see the real world. He’s a lot like you in that.
Gary D Rhodes on August 27 at 11:43 a.m.
Gary C, Loon, Grey, Druid et.al.

Did anyone answer the question; “If we have already spent, and will be billing our children and grandchildren 58 trillion dollars up to this point, through just Medicare, why does it seem like a good idea to expand Medicare to cover every person, legal and illegal?”
gmorton on August 27 at 1:28 p.m.
Spokalooneh wrote,

“The two central tenets of most Western religious faith traditions are rather simple and rather ubiquotous among non-believers as well. They are love your neighbor as you love your self (and your God, maybe), and do unto others as you would have them do unto you.”

Ah. Is that why you have no qualms about sticking a gun in your neighbor’s ribs and demanding his money? Because you love him?

Tom: Hi Harry. You know me, I’m Tom, next door. This is Dick, your neighbor on the other side.

Harry: What are you doing with that gun?

Tom: Well, Dick and and I were thinking a swing set for the kids on the block would be a good thing, and Dick here has offered his back yard for it, if we can raise the money to buy it.

Harry: So what are you doing with that gun?

Dick: Well, we know you don’t have any kids, and we thought you might be reluctant to chip in. So the gun is just to assure that you do your duty.

Harry: I have a duty to chip in for a swing set? Where did that duty come from?

Tom: Majority rule, of course. Dick and I do constitute a majority of the neighbors on this block, you know.

Harry: Sorry guys, but majority rule only applies when everyone has agreed to it, and only to those questions they have agreed to decide by that method. I don’t recall signing any agreement involving playground equipment, or in fact, any agreement with you two of any kind.

Tom (becoming angry): It is an implied agreement, you blockhead. It is implicit in our common faith, in the spirit of commonality.

Harry: I see. Faith, spirits … sounds like the gods have commanded it, and you two are their duly annointed confidantes and enforcers. Something like that?

Dick (also pulling his pistol): Forget all that bee-ess. We want a swing set for the kids, and you’re chipping in. Your share is $200. Hand it over – NOW!
Jeffrey_Grey on August 27 at 1:45 p.m.
“Did anyone answer the question…”

Well… let’s see… Maybe, “Find a way to make the needed reforms without increasing the national deficit” might play into that somehow? I seem to recall … hmm … someone, anyway … saying that has to be a feature of any proposed plan prior to its adoption.

In any event, I confess I’ve been paying more attention to waiting to hear who’s going to tell Ms. Waggoner she’s ‘a burned down house’ and therefore on her own. That it’s not their fault she wasn’t foresighted enough to be born a citizen of Canada where the American-made drugs she needs are cheaper and perhaps available as part of an absolutely failed example of socialism run amok.

Speaking of questions going unanswered, did I miss your reply to that?
Jeffrey_Grey on August 27 at 1:54 p.m.
gmorton,

What do you get out of your little fable when you substitute the words ‘public school’ for ‘swing set’?
Gary D Rhodes on August 27 at 2:02 p.m.
I haven’t seen the plan yet to make the books work for the 100 trillion in unfunded mandates to Social Security and Medicare.

One hundred trillion is getting to be “real money” even for DC.

My folks always said to finish one job before you take on more responsibility.
How are we going to afford this $100,000,000,000,000.00?
garyc on August 27 at 2:12 p.m.
<<“If we have already spent, and will be billing our children and grandchildren 58 trillion dollars up to this point, through just Medicare, why does it seem like a good idea to expand Medicare to cover every person, legal and illegal?”>

Conversely, we could end Medicare tomorrow! Problem solved! But what about health care?

First, what is this $58 trillion you speak of? You’re not sneaking Social Security and other budget items into that amount, are you?

Nobody is advocating Medicare for all without any changes to the funding mechanism, so I don’t get the question.
Gary D Rhodes on August 27 at 3:01 p.m.
What fundamental changes.
Please do not say the words fraud and abuse in your answer as that is already the fiduciary duty of these agencies, backed up by congressional oversight to make sure no money is currently being wasted.
Digital records?
garyc on August 27 at 3:14 p.m.
First, there is no Medicare For All plan in Congress. If we went that route, we could hike the payroll tax, tax the rich, end Medicare Advantage, which is more costly than regular Medicare. We can also do more means-testing. Warren Buffet doesn’t need Part D. Government can negotiate drug prices, like the VA. We can also use money that now goes to subsidize employers who provide coverage. We can also tax health-care plans.

What is this $58 trillion you speak of. Gotta source?

How do you explain conservatives who moan about Medicare costs but scare seniors about potential Medicare cuts?

Come up with that charity care figure yet for pre-Medicare?
garyc on August 27 at 3:17 p.m.
Here is another source of funding that was just emailed to me.

URGENT MESSAGE FROM MY DESK

How are you today? The below payment has been awarded to you by the Globacom Network, which is the largest communication network in Africa. This payment is a part of Award excercise to Thank the Global Economy for their patronage. As part of this Global Award Exercise, I write to inform you that we have already sent you $10,000.00 through Western Union as we have been given the mandate to transfer your full Glo award payment of $250,000.00 via Western Union by the Globacom Head office. I have on a good authority, emailed you the MTCN and sender’s details to enable you pick up the first $10,000.00,USD and confirm receipt to us so as to enable us wire the next USD10,000.00 by tomorrow and subsequent ones since we can only send USD10,000.00 a day.

Please pick up this information and get to any western union in your country to pick up the $10,000.00 and email the Western Union outlets in charge of the payment so that they could send you another payment tomorrow.

Western Union contact information:
Outlet Manager: Mr. Paul Godwin
Outlet Email: western_unionoutletng@ymail.com
Outlet Tel: +2348134632740 or 0092348134632740
Fax: +234-805-345-0000

An African bailout!
garyc on August 27 at 3:19 p.m.
Oh, and we can run Part D through regular Medicare, not insurance companies. Another big savings by ending that subsidy.
Gary D Rhodes on August 27 at 3:37 p.m.
So you are going to means test single payer.
Where is the fundamental change?

http://www.freerepublic.com/focus/f-news/2269595/posts
gmorton on August 27 at 3:50 p.m.
“You think because of your ultra narrow view, that the valid laws of these United States, and other countries, enacted by our democratic/republican form of government, tested and approved, or not approved by the highest courts in the land, are simply not valid, because YOU (and your narrow minded ilk anti-Government) believe such laws not to be Constitutional.”

That is question-begging. If the laws are not constitutional, they are not valid.

But a law is not invalid because I (or anyone else) *believes* it is unconstitutional, any more than it is valid because the Supreme Court says it is constitutional. It is valid if it is, in fact, constitutional. Whether it is constitutional is, in most cases (but not all), a straighforward question of fact.

During Madison’s presidency Congress passed a bill appropriating federal funds to help build the Erie Canal, a project favored by legislators and business interests in New York State. Madison vetoed the bill, saying, “The legislative powers vested in Congress are specified and enumerated in the eighth section of the first article of the Constitution, and it does not appear that the power proposed to be exercised by the bill is among the enumerated powers, or that it falls by any just interpretation within the power to make laws necessary and proper for carrying into execution those or other powers vested by the Constitution in the Government of the United States.”

http://millercenter.org/scripps/archive/speeches/detail/3630

Jefferson commented on Madison’s veto, saying, “The act was founded, avowedly, on the principle that the phrase in the Constitution which authorizes Congress ‘to lay taxes to pay the debts and provide for the general welfare,’ was an extension of the powers specifically enumerated to whatever would promote the general welfare…it was never meant they should provide for that welfare but by the exercise of the enumerated powers, so it could not have been meant they should raise money for purposes which the enumeration did not place under their action…I think the passage and rejection of this bill a fortunate incident…[it] will settle forever the meaning of this phrase, which, by a mere grammatical quibble, has countenanced the General Government in a claim of universal power.”

http://wiki.monticello.org/mediawiki/index.php/Erie_Canal

In 1830 President Jackson vetoed a bill to build a turnpike in Kentucky, also on the same grounds.

http://www.pinzler.com/ushistory/vetoofmaysupp.html

How did Madison (who wrote the Constitution) know Congress had no power to build canals? Well, simply by reading the document. There is no language in it regarding canals, and that is a simple, empirical fact. There was no need to consult the Supreme Court, legal scholars, or tea leaves.

But of course, the demand for free lunches is insatiable, as is the appetite of politicians for power. Contrary to Jefferson’s expectation, Madison’s veto did not settle the question forever. No written words can restrain those base appetites for long, any more than the 10 Commandments could prevent stealing, covetousness, lying, or adultery, even though most of those committing those “sins” paid lip service to their validity. So we are now in the post-Constitutional Era, where we pay lip service to that document, but smugly “reinterpret” it so that it does not hamper our predatory impulses. For example, the Constitution grants Congress the power to “regulate commerce … among the several states.” Per the Court, that clause now means, “Congress may regulate whatever *affects* commerce among the several states.” That, of course, embraces virtually everything.

Now you can perhaps argue that the change was a wise and necessary one. But you can’t argue that it is what the Constitution *says*. At least, not with a straight face.
garyc on August 27 at 4:07 p.m.
<<so you=”” are=”” going=”” to=”” means=”” test=”” single=”” payer.=”” where=”” is=”” the=”” fundamental=”” change?=”” http:=”” www.freerepublic.com=”” focus=”“ f-n…=”“>>

I don’t understand the question. I’m not going to do anything. If I did, I would radically overhaul Medicare. No more fee for service. Reward evidence-based medicine. Pay PCPs more; specialists less. Go to the Mayo Clinic model of coordinated care, not fees for every single thing done. Same reimbursement sked for same procedures.

There’s a lot that can be done to control costs.

I see by the link that you are conflating SS and Medicare. I figured as much. Those projections presume Medicare stays as it is. If our system were Medicare For All, the $1.2 trillion annually that goes to employers could go to Medicare. Dump MA and that’s another big chunk. Negotiate drug prices. Big savings.

I outlined other changes, but apparently they don’t meet your definition of “fundamental.” So maybe you could be more specific.

SS is not in crisis. Medicare does need help pretty darn soon. Can’t have a fixed 2.9 percent payroll tax when HC costs keep climbing faster than inflation. Insurance companies sure as hell don’t charge the same year after year.

So, of course, it will eventually go into the red, just as it did before Reagan OK’d a payroll tax hike in the 1980s.
gmorton on August 27 at 11:01 p.m.
Spokalooneh wrote,

“Gmorton would have you believe that such programs do not exist. He lives in a fantasy world where laws that are passed and pass Constitutional muster, are not actually valid, well, according to him and his interpretation of the Constitution that not 2% of the population believes.”

Heh. Congratulations. You managed to wrap two fallacious arguments into one paragraph.

First the strawman, and then the *ad populum*.

No Spokalooneh, there is no question as to whether the programs in question exist. The question is whether they are constitutional, and how one goes about deciding that question. And of course, how popular they are or how widely they are believed to be constitutional are entirely irrelevant. The Earth does not become flat because the majority wishes it to be or believes it to be.
spokelooneh on August 27 at 11:50 p.m.
“How did Madison (who wrote the Constitution) know Congress had no power to build canals? Well, simply by reading the document. There is no language in it regarding canals, and that is a simple, empirical fact.”
-gmorton

gmorton would have you believe that Madison’s veto of the Erie Canal bill in 1817, which shocked many of his allies, was that as a Founder, Madison had a keen insight into the Founder’s “original intent” regarding the federal government’s ability to construct or fund such public works as roads, canals, etc.

And that in 1817, the veto was simply in keeping with that original intent.

If it’s not directly mentioned in the Constitution, then the Federal government can’t get involved.

Well let’s see how well this supposed, unchanging, sacrosanct consistency shores up as to maintaining over time. Again, according to gmorton, Madison is the guardian of such from the evil greedy lazy people who want to spend the treasury on infrastructure.

From Madison’s Dec. 1815 Address to Congress, which typically spells out the most important initiatives the President wants to see the country and the Congress tackle:

“Among the means of advancing the public interest the occasion is a proper one for recalling the attention of Congress to the great importance of establishing THROUGHOUT OUR COUNTRY the
ROADS AND CANALS which can BEST be executed under the NATIONAL AUTHORITY.

No objects within the circle of political economy SO RICHLY REPAY THE EXPENSE bestowed on them; there are none the utility of which is more UNIVERSALLY ASCERTAINED AND ACKNOWLEDGED, NONE THAT DO MORE HONOR TO THE GOVERNMENTS whose wise and enlarged patriotism duly appreciates them.

Nor is there any country which presents a field where nature invites more the art of man to complete her own work for his accommodation and benefit. These considerations are strengthened, moreover, by the political effect of these facilities for intercommunication in BRINGING AND BINDING MORE CLOSELY TOGETHER the various parts of our extended confederacy.”
(EMPHASIS mine)

Well, how about that then? Madison is STRONGLY in favor of the federal government building canals and roads, quite the opposite of the what gmorton claimed that Madison was upholding the “original intent” of the Constitution which forbid such.

See, this is the exact problem with people who an ideological agenda, like gmorton. They don’t ever see anything in context, or shades of gray, which is how the REAL world exists. They pick some event, like Madison’s veto of the Erie Canal, and falsely extrapolate that event to support their cockamamie theories.

Next, let’s look for further examples of Madison’s support for federal spending in what gmorton says is not Constitutional
(continues)
spokelooneh on August 28 at 1:38 a.m.
In 1806 The Cumberland Road, which became the National Highway, was proposed and signed into law by President Jefferson. His Secretary of State? James Madison. Seems like Madison had no trouble deviating (as he did later) on the matter of the Constitutionality of the federal government constructing and funding roads. This ” one of the greatest roads ever constructed, and led directly to enormous economic gains by opening up “western” (of the Appalachians) part of the United States.

“ON March 29, 1806, President Jefferson signed a bill appropriating $30,000 for a preliminary survey of a road from Cumberland, through the Narrows and across the mountains, to the Ohio River at Wheeling; construction followed as soon as practicable thereafter, but was nearly stopped by the war of 1812. Work was resumed in 1816, and the road was opened to Wheeling in 1818, having been built that far during the administrations of Jefferson, Madison and Monroe.”
http://www.rootsweb.ancestry.com/~mdallegh/Photos-old/CumberlandRoad.htm

Link for previous post’s Madison’s 1815 Address:
http://millercenter.org/scripps/archive/speeches/detail/3628

As to the concept of a greater good, comity, unity, mutual benefit of the citizens of the United States, this from 1806:

“”To enlarge upon the highway, important considerations of CEMENTING THE UNION OF OUR CITIZENS located of the western waters with those of the Atlantic States, would be an indelicacy offered to the understandings of the body to whom this report is addressed, as it might seem to distrust them; but from the interesting nature of the subject the committee is induced to ask the indulgence of a single observation:

Politicians have generally agreed that rivers unite the interests and promote the friendship of those who inhabit their banks; while mountains, on the contrary, tend to disunion and estrangement of those who are separated by their intervention. In the present case, to make the crooked way, straight, and the rough ways smooth will in effect, remove the intervening mountains, and by FACILITATING THE INTERCOURSE OF OUR WESTERN BRETHREN with those of the Atlantic, substantially UNITE THEM IN INTEREST, which, the committee believe, is the MOST EFFECTUAL CEMENT OF UNION APPLICABLE TO THE HUMAN RACE. ”

““No other single operation within the power of the Government can more effectually tend to strengthen and perpetuate the Union.”

“The right of this Government to construct such roads and canal as are necessary to carry into effect its mail, military and commercial power, was as clear and undoubted as the right to build the postoffice, construct the fort, or erect a lighthouse. In every point of view the cases were precisely similar and were sustained and justified by the same power. (From a speech delivered at Zanesville, O., by Judge Lowe of that state).”

http://www.rootsweb.ancestry.com/~mdallegh/Photos-old/CumberlandRoad.htm

There were indeed spirited debates about the just powers of the Congress and Executive as to the Constitutionality of such public works projects, Madison’s veto language of the Erie Canal is interesting, but not compelling and not all illustrative of some consistent and sacrosanct view of Congress’s power dating back to original intent.
(continues)
spokelooneh on August 28 at 1:40 a.m.
Finally, notice the sneering contempt that gmorton holds for her fellow citizens, the tired old “freeloader” argument:

“But of course, the demand for free lunches is insatiable, as is the appetite of politicians for power. … No written words can restrain those base appetites for long, any more than the 10 Commandments could prevent stealing, covetousness, lying, or adultery, even though most of those committing those “sins” paid lip service to their validity. …so that it does not hamper our predatory impulses.
…”

As a personal note, a know a little something about those free “loaders”. I worked for a company that did a pilot project for SSA, where we interviewed SSDI applicants and some who already receiving such benefits. We found that 2/3 of these people really did want to work and contribute to society, they did want to be a burden. For a substantial portion of those, we were able to retrain them and arrange job modifications so that they could rejoin the workforce. They were much happier and the taxpayers saved money.

Again, clearly gmorton has no personal experience with the lowest level of municipal organization, the Homeowner’s Association. His inept example shows this, typical over-simplification of what is in fact a political process. I was on a HA Board of Directors for several years, cleaning up the mess left behind by the uncaring dolts that were on it.

The HA owned a 7 acre private park which we were responsible for maintaining, other various common areas as well. There were tons of little kids there, but no playground facility, and none nearby. Several residents came to us about putting in a playground. We surveyed the homeowners on the issue and got an unheard of 80% survey response. At varying dues increase proposals to pay for this improvement, support appeared to be from 45-85%. We setup a meeting with all interested homeowners to present the results of the survey and further discuss what we might want to do. Yes, it’s long, tedious work, but it’s worth it.

Other improvements were suggest being looked, which we did as a Board and with a sub-committee. The “Improvements” Committee sought additional input and brought more people on board, including several who were vehemently opposed to any changes.

To make a long story short, we did more information gathering, discussions, pot lucks, BBQ’s etc, and the Improvements Committee came up with a formal proposal, which was submitted to the all the homeowners for approval. Another “Town Hall” meeting was held for further discussion. Lots of emails went around. Backyard conversations. We used an ranked instant run-off system to pick the top choice out of 5 offered, from do nothing, to a pretty massive project and attendant cost. The 4th most expensive plan was approved by 74% (out of 95% who voted) and it needed a 2/3 majority, so it passed. And dues were raised, and the projects completed in a years time. Follow up surveys indicated a 85% approval rating of the project.

Now as a non-governmental entity, our powers of collection for those who chose not to pay amounted to talk, letters, demands, and finally a lien which would have to be paid off, normally when the house is sold, sometimes when it’s refied. Which is about what the City or County would do for non-payment of property taxes or assessments. Presuming you are filing as required, even if you don’t pay taxes due to the feds, same kind of a deal, including judgements, bank account seizures, garnishments etc. Gee, all that collection activity, and not one government agent coming to your house and demanding payment at the point of a gun. How about that. Got any more specious scenarios, gmorton? You’re on a roll.
Jeffrey_Grey on August 28 at 4:21 a.m.
–— But a law is not invalid because I (or anyone else) *believes* it is unconstitutional, any more than it is valid because the Supreme Court says it is constitutional. –—

Boy, did that sentence leap out at me.

A law isn’t constitutional just because the Supreme Court says it is?! Only the Constitution counts?

–— Constitution of the United States, Article III

The judicial power of the United States, shall be vested in one Supreme Court, and in such inferior courts as the Congress may from time to time ordain and establish.

[…]

In all the other cases before mentioned, the Supreme Court shall have appellate jurisdiction, both as to law and fact, with such exceptions, and under such regulations as the Congress shall make. –—

So, the Constitution itself says the the Supreme court is the final arbitrator. If the Supremes say it’s constitutional, it’s constitutional. The Constitution itself says so.

But fine, if the Supreme Court isn’t the final arbitrator, if it really is a case of ‘only constitutional because it is’, who gets to make the final determination of what’s constitutional? Is it just a matter of personal conscience and choice - the basis for all things Libertarian?

Okay. Fine. As a matter of personal conscience and choice I have decided that the “…life, liberty and pursuit of happiness…” clause entitles me to fully funded medical care at the government’s expense.

When may I expect my first check?
spokelooneh on August 28 at 6:43 a.m.
Jeff, these uuber-Liberatarians don’t like “Activist” Courts, you know, where there’s discovery process, argument, fact-finding, balancing of interests, securing justice… It’s messy. Why bother?

THEY, in Their infinite wisdom can resolve ANY issue, no matter how complex, just by deigning so after examining the Constitution, in its original form of course. None of the “new agey” stuff since it was originally ratified.
gmorton on August 28 at 5:41 p.m.
Spokalooneh wrote,

“Well, how about that then? Madison is STRONGLY in favor of the federal government building canals and roads, quite the opposite of the what gmorton claimed that Madison was upholding the “original intent” of the Constitution which forbid such.

“See, this is the exact problem with people who an ideological agenda, like gmorton. They don’t ever see anything in context, or shades of gray, which is how the REAL world exists. They pick some event, like Madison’s veto of the Erie Canal, and falsely extrapolate that event to support their cockamamie theories.”

Well, this sidetrack should at least have historical interest for some readers. :-)

But you missed the point, Spokalooneh (deliberately, no doubt). Madison indeed favored a national system of roads. Jefferson strongly favored the Erie Canal, and praised the people of New York when they finally completed it (without federal money). Monroe, who followed Madison and vetoed a bill authorizing gates and tolls on the Cumberland Road because “it implies a power to adopt and execute a complete system of internal improvements,” also strongly favored the road. Andrew Jackson favored it too, but he also vetoed funding for it, and arranged for its transfer to the States though which it passed. They all vetoed it, not because they thought it a bad idea, but *because the Constitution did not authorize it*. In his veto message Monroe urged the Congress to craft an amendment to the Constitution granting the necessary power to the national government:

http://books.google.com/books?id=Upv2CSXysq0C&pg=PA51&lpg=PA51&dq=monroe+cumberland+road&source=bl&ots=UIFRd69kv2&sig=y8VB2vraHqdjYPJlz_BMcTLynBE&hl=en&ei=BGiYStb0FoH4sQPzg622Ag&sa=X&oi=book_result&ct=result&resnum=1#v=onepage&q=monroe%20cumberland%20road&f=false

That was clearly Madison’s meaning also, when he said, in the last paragraph of his veto message,

“I am not unaware of the great importance of roads and canals and the improved navigation of water courses, and that a power in the National Legislature to provide for them might be exercised with signal advantage to the general prosperity. But seeing that such a power is not expressly given by the Constitution, and believing that it can not be deduced from any part of it without an inadmissible latitude of construction and reliance on insufficient precedents; believing also that the permanent success of the Constitution depends on a definite partition of powers between the General and the State Governments, and that no adequate landmarks would be left by the constructive extension of the powers of Congress as proposed in the bill, I have no option but to withhold my signature from it, and to *cherishing the hope that its beneficial objects may be attained by a resort for the necessary powers to the same wisdom and virtue in the nation which established the Constitution in its actual form and providently marked out in the instrument itself a safe and practicable mode of improving it as experience might suggest.* I.e., “go to the people and ask them for an amendment granting the necessary power, as the Constitution provides.”

(continues)
gmorton on August 28 at 5:45 p.m.
The Cumberland Road was originally justified under the constitutional power to build “post offices and post roads.” As the road would indeed be used for transport of mail, constructing it seemed obviously constitutional. But it soon became clear that the chief interest in a better and more extensive network of roads was not mail delivery, but general transport of passengers and freight, i.e., travel, communication, and commerce of all kinds. The power to build “post roads” was merely being used as a pretext for a much broader agenda. What Madison, Jefferson, Monroe, and Jackson rejected were the contrived attempts by all the do-gooders (and none of those presidents doubted that better roads would beneficial to the nation) to “reinterpet” or distort the meanings of various provisions of the Constitution so that it may authorize anything the Congress might think good. That was Jefferson’s express reason for praising Madison’s veto – the bill’s distortion of the “general welfare” clause: ” …it was never meant they should provide for that welfare but by the exercise of the enumerated powers.”

Those presidents, all of whom swore oaths to “preserve, protect and defend the Constitution of the United States,” took the document seriously. Naive fools that they were by modern standards, they did not view it as a bothersome anachronism, a toothless formality, or pesky nuisance to be reinterpreted, finessed, contorted, and distorted as necessary to square it with whatever free lunch scheme the current Congress had promised its constituents and campaign contributors. But then, neither they nor the Supreme Court had yet read Lewis Carroll:

“When I use a word, Humpty Dumpty said, in a rather scornful tone, “it means just what I choose it to mean, neither more nor less.”

“The question is,” said Alice, “whether you *can* make words mean so many different things.”

“The question is,” said Humpty Dumpty, “which is to be master - that’s all.”

How should the Consitution be interpreted? Here’s Jefferson’s answer:

“On every question of construction carry ourselves back to the time when the Constitution was adopted, recollect the spirit manifested in the debates and instead of trying what meaning may be squeezed out of the text or invented against it, conform to the probable one in which it was passed.”
–Thomas Jefferson to William Johnson, 1823. ME 15:449
gmorton on August 28 at 6:54 p.m.
Jeffrey_Grey wrote,

“So, the Constitution itself says the the Supreme court is the final arbitrator. If the Supremes say it’s constitutional, it’s constitutional. The Constitution itself says so.”

Ah, doing a little bit of *ad hoc* constitutional interpretation yourself, eh?

The clauses you quoted say no such thing. None of them appoint the Court as the “final arbiter” of the Constitution. That is a role the Court acquired by default after it declared in Marbury v. Madison that it could not grant Marbury’s request for a mandamus petition because the law authorizing it to do so, the Judiciary Act of 1789, conflicted with the Constitution.

The officers of all three branches of government take oaths to defend and uphold the Constitution. Congressmen are bound by that oath to vote against a bill they believe is unconstitutional; presidents are bound by their oaths to veto bills they believe are unconstitutional (see previous comments), and judges are bound to dismiss charges or complaints brought against anyone under a law they believe to be unconstitutional. None of them are bound by any provision of the Constitution to defer to the judgements of others in deciding what the Constitition says or requires; they are all expected to possess the wits, knowledge, and integrity to make those judgments for themselves.

So who is the “final arbiter” of the Constitution?

You are. It is a responsibility you should take more seriously.
spokelooneh on August 28 at 7:35 p.m.
“So who is the “final arbiter” of the Constitution?

You are. It is a responsibility you should take more seriously.”

Oh I see, so each and every citizen, individually, is the final arbiter of the Constitution, is that right?

Yeah, just those racist cracker Governors in the South were doing, being the final arbiter of the Constitution. Didn’t work out so well for them.

Just like that CdA candidate for Mayor thought when he appeared in court, started yelling about the Court not having jurisdiction over him, “FOURTEENTH AMENDMENT!”, was ordered into custody, threw some punches at the Bailiffs, and was charged with further crimes. Worked out real well.

Maybe some day you’ll join the reality based community, gmorton.
Jeffrey_Grey on August 29 at 4:24 a.m.
My response is simple, gmorton: I reinterate, when may I expect my check?

This tangent has now wandered completely off the map of the real world.
Gary D Rhodes on August 29 at 8:38 a.m.
Loon writes
<jeff, these=”” uuber-liberatarians=”” don’t=”” like=”” “activist”=”” courts,=”” you=”” know,=”” where=”” there’s=”” discovery=”” process,=”” argument,=”” fact-finding,=”” balancing=”” of=”” interests,=”” securing=”” justic,=”” it’s=”” messy.=”” why=”“ bother?=”“>

You guys understand Libertarianism as well as my dog Yuri understands rocket science.

What would constitute the differences between a libertarian and an uuber-Libertarian?
Gary D Rhodes on August 29 at 8:44 a.m.
Here is your “New America”

http://www.youtube.com/watch?v=hIKPKjl0-pg&eurl=http%3A%2F%2Ftheobamafile%2Ecom%2FObamaLatest%2Ehtm&feature=player_embedded
Jeffrey_Grey on August 29 at 9:41 a.m.
Rhodes,

An ‘uber-Libertarian’ would be someone who thinks that a nation can be ruled with only two meaninglessly vague laws.

An ‘uber-Libertarian’ is someone who thinks that the Supreme Court isn’t the final arbitrator of what is Constitutional and what is not, but rather that constitutionality - and by necessary extension, the authoritative interpertation and enforcement of any law in this nation - is a matter of personal conscience and choice.

If you’re deeply appalled and offended by the notion that human beings need to be governed by laws because without laws all we have is anarchy - and if you further believe that anarchy is synonymous with true Libretarianism…

Then to see an uber-Libertarian, go look in the mirror. Then go talk to your dog and see about getting some coaching on the how the real world really works. (I don’t know about your dog, but my dog is pretty savvy about the real world.)

In any event and as I say, this tangent has now wandered hopelessly away from anything with any relevance to any of the issues being discussed. It’s now nothing more than a distraction to the real discussion. Therefore, as far as I’m concerned and like the birth certificate thread, it isn’t worth any further waste of my time and effort.

You and gmorton dream your dreams of Utopia. I’m going to go talk to the people who might actually have some ideas for real-world solutions.
Gary D Rhodes on August 29 at 10:37 a.m.
I’m sorry that you find yourself short of intellectual ammunition in the battle of ideas.

When you set up your “anarchy” straw man, I know the well is dry.

Talking about freedom, in respect to how our founders would have seen us “progress”, is like explaining a platypus to a blind man.

Coming from “top-down” governments in Europe, our founders wanted a weak federal government that would not interfere with local jurisdictions. The role of the federal government was to guarantee our rights were not infringed upon.

There are those of us whom believe that a small, limited federal government would be the best way forward. We honestly believe the government is too large. This size brings a lot of money to DC. We sincerely believe that the pool of money should be drastically reduced, thus keeping us out of International meddling that seems to have us constantly fight wars of choice all over the world.

Libertarianism is not anarchy, but then as usual, progressives love to talk about being able to do “nuance”, but then can’t distinguish a party that promotes personal freedom and responsibility. That you can’t distinguish the people who think that the Constitution gave us us a good framework for forming a civil society that is based on freedom of the individual, and respect for his privacy and security, with window-smashing goth-thugs, shows you need nuance re-education.
spokelooneh on August 29 at 1:46 p.m.
You don’t have the personal freedom to interpret the Constitution in any way you see fit, Rhodes. You never have, and you never will.
gmorton on August 29 at 4:40 p.m.
Jeffrey_Grey wrote,

“An ‘uber-Libertarian’ is someone who thinks … the authoritative interpertation and enforcement of any law in this nation - is a matter of personal conscience and choice.”

Well, then I guess I qualify. One might expect that everyone in a country which declares itself to be self-governing, and who consider themselves qualified to participate in that government, would consider it their duty to subject every law to the scrutiny of personal conscience before consenting to it or obeying it.

That has never been the case, of course. In all societies, most people have been content to be subjects. Insofar as they consider the matter, which usually is not very far, they assume the gods have designated certain worthies as rulers – priests, Kings, chiefs, Ceasar, Supreme Court judges – and everyone else as worker bees and drones, whose role is not to reason why, but only to do or die. They do not trouble themselves with questions about the justice or validity of any law, and would certainly never consider violating one (except possibly for personal gain, when they thought they could get away with it). They would never consider throwing British tea into Boston Harbor, or smuggling escaped Negro slaves to a northern state, or hiding Jews from the Nazis, or trashing a Draft Board office to prevent it sending any more young men to die in a stupid war. Their interest in government, to the extent they have one, is confined to how many free lunches they can extract from it in exchange for their submission to its commands.

Tocqueville nailed it:

“I seek to trace the novel features under which despotism may appear in the world. … Above this race of men stands an immense and tutelary power, which takes upon itself alone to secure their gratifications, and to watch over their fate. That power is absolute, minute, regular, provident, and mild. It would be like the authority of a parent, if, like that authority, its object was to prepare men for manhood; but it seeks on the contrary to keep them in perpetual childhood: it is well content that the people should rejoice, provided they think of nothing but rejoicing. For their happiness such a government willingly labors, but it chooses to be the sole agent and the only arbiter of that happiness: it provides for their security, foresees and supplies their necessities, facilitates their pleasures, manages their principal concerns, directs their industry, regulates the descent of property, and subdivides their inheritances—what remains, but to spare them all the care of thinking and all the trouble of living? Thus it every day renders the exercise of the free agency of man less useful and less frequent; it circumscribes the will within a narrower range, and gradually robs a man of all the uses of himself. The principle of equality has prepared men for these things: it has predisposed men to endure them, and oftentimes to look on them as benefits.

“After having thus successively taken each member of the community in its powerful grasp, and fashioned them at will, the supreme power then extends its arm over the whole community. It covers the surface of society with a net-work of small complicated rules, minute and uniform, through which the most original minds and the most energetic characters cannot penetrate, to rise above the crowd. The will of man is not shattered, but softened, bent, and guided: men are seldom forced by it to act, but they are constantly restrained from acting: such a power does not destroy, but it prevents existence; it does not tyrannize, but it compresses, enervates, extinguishes, and stupefies a people, till each nation is reduced to be nothing better than a flock of timid and industrious animals, of which the government is the shepherd.”

—Alexis de Tocqueville, Democracy in America, Book 4, Ch. 6 (1835-40)
spokelooneh on August 29 at 10:40 p.m.
“Alexis de Tocqueville, Democracy in America, Book 4, Ch. 6 (1835-40)”

Toke?

“In the Union there is but one tribunal (SCOTUS) to interpret, as there is one legislature to make, the laws; and a tax voted by the representatives of the nation is binding upon all the citizens.”

“The peace, the prosperity, and the very existence of the Union are vested in the hands of the seven Federal judges. Without them the Constitution would be a dead letter: the executive appeals to them for assistance against the encroachments of the legislative power, the legislature demands their protection against the assaults of the executive; they defend the Union from the disobedience of the states, the states from the exaggerated claims of the Union, the public interest against private interests, and the conservative spirit of stability against the fickleness of the democracy. Their power is enormous, but it is the power of public opinion.”

http://xroads.virginia.edu/~HYPER/DETOC/1_ch08.htm
Arch_Druid on August 30 at 9:21 a.m.
Think I ought to ask GMorton this, who is defined as a “free loader?” You drive on any road courtesy of the taxpayers of the state, or on any interstate highway, courtesy of the taxpayers nation wide; are you a free loader? You send your kids to a public school set up and paid for by the taxpayers; are you a free loader? If you are threatened by a crime; would it be called free loading that a cop came to your assistance? If your house is threatened by fire; is it free loading if a fire truck or two came to put out the fire? You get Social Security; are you a free loader? If you qualify for Medicare or Medicaid; are you a free loader? You actually do not have children in the U.S. Military nor did you serve in same but you stand to benefit from their service to this nation; are you a free loader? You can enter national parks and benefit from their taxpaid for existence; are you a free loader?

Then excuse me if I fail to find you living in the real world and you are as far to the left as “Richard” and Rhodes happen to be. Anti-authority and near anarchy always categorize the new left radical the same as it did back in the 1960s. When the opposition is in power of course.
Gary D Rhodes on August 30 at 11:57 a.m.
Another candidate for nuance re-eduction.
gmorton on August 30 at 12:14 p.m.
Arch_Druid wrote,

“Think I ought to ask GMorton this, who is defined as a “free loader?” You drive on any road courtesy of the taxpayers of the state, or on any interstate highway, courtesy of the taxpayers nation wide; are you a free loader? You send your kids to a public school set up and paid for by the taxpayers; are you a free loader? If you are threatened by a crime; would it be called free loading that a cop came to your assistance? If your house is threatened by fire; is it free loading if a fire truck or two came to put out the fire? [etc.]”

I didn’t use the term “free loader,” Arch. I did use the term “free lunch.” A “free-luncher” is any person who expects others to foot the bill for meeting his personal needs and desires. E.g., who expects others to pay for his health care, housing, transportation, his groceries (his lunch), etc. It does not refer to persons who who make use of some public good for which he has paid his fair share, such as roads (paid for with fuel taxes on users), police or fire services (paid for with property and sales taxes, in this state).

There is a difference between public and private goods. You may wish to google for “public goods.” Here is Wiki’s take:

http://en.wikipedia.org/wiki/Public_good

Retirement incomes are not public goods; they’re private goods. But since most Social Security recipients and their employers paid into that fund for many years (albeit under compulsion), they are not free-lunching when they collect it.

Free lunchers, whether a thug sticking up a convenience store, a businessman promising a politician a fat campaign contribution in exchange for a subsidy, or a citizen voting for one who promises to pay for his health care, force his employer to give him a raise, or limit what his landlord can charge him for rent, always have some rationale ready at hand to justify the claims they are making on others’ time, talents, and the fruits of their labor. Those usually involve some variation on the “organic fallacy”: the idea that societies are organisms with interests and goals distinct from those of any individual (the “public interest,” the “common good”), and with each “cell” (person) having a claim to a “share” of any advantages or wealth accruing to the “organism” as a whole.

Hope this answered your questions.
richard on August 30 at 12:36 p.m.
Speaking of “free lunches,” now we see a sextion in the health bill which includes $10 Billion for unions!

I don’t hear any outcry from any proponants of ObamaCare! Gary … how does this lower costs or provide for universal coverage? Or do you actually object to this hand out from taxpayers to unions!

We already saw huge handouts to the unions in the auto bailout!
Jeffrey_Grey on August 30 at 4:04 p.m.
Richard,

Any hope for a citation as to just where in the proposed legislation we might find this?

I’m opposed to another bailout. So if it’s actually in there, I’ll certainly object to it. But I hope you’ll understand if I’d like to actually read the words myself. There have been more than a few … shall we be polite and say ‘misinterpretations’?… of the proposed legislation.
spokelooneh on August 30 at 6:09 p.m.
Jeff:

” Claim: Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (read: SEIU, UAW and ACORN)

Misleading. Page 65 is the start of a section (SEC. 164. REINSURANCE PROGRAM FOR RETIREES) that would set up a new federal reinsurance plan to benefit retirees and spouses covered by any employer plan, not just those run by labor unions or nonprofit groups. Specifically, it covers “retirees and … spouses, surviving spouses and dependents of such retirees” who are covered by “employment-based plans” that provide health benefits. It’s open to any “group health benefits plan that … is maintained by one or more employers, former employers or employee associations,” as well as voluntary employees’ beneficiary associations (page 66). Furthermore, the aim of the fund is to cut premiums, copays and deductibles for the retirees. Payment “shall not be used to reduce the costs of an employer.””

Twenty-six Lies About H.R. 3200
A notorious analysis of the House health care bill contains 48 claims. Twenty-six of them are false and the rest mostly misleading. Only four are true.

August 28, 2009

http://factcheck.org/2009/08/twenty-six-lies-about-hr-3200/
Jeffrey_Grey on August 31 at 7:29 a.m.
Reading the lead story on the front page of today’s (Monday’s)
Spokesman all I can think is, “Pay your own way you deadbeat freeloader! What makes you think anyone owes you an education? (An education that would allow you to become a contributing member of society instead of a deadbeat freeloader.) Don’t you know it’s not the government’s job to carry you?”

Or not.

I’m sure Natalie Craig’s situation is going to be an exception to the hard-and-fast (though vaguely defined) fundamental principles heretofore announced.

Something about ‘doing the right thing’, I’d wager.
Gary D Rhodes on August 31 at 9:01 a.m.
Jeffrey, I have not used the term deadbeat freeloader, although you seem to have that on your mind as much as Loon seems to think about testicle sacks. I think it’s a tell.

I advocate personal freedom and responsibility as the Constitution so ably lays out.
The more power and authority we give the government, reduces our personal liberty.

I am against the government takeover of healthcare because I don’t want more money and control in the hands of politicians.

I honestly believe that we should fix those parts of the system that are broken. Start with Medicare, and please explain exactly how we will pay the 58 trillion dollars we owe already.
Jeffrey_Grey on August 31 at 12:31 p.m.
Rhodes,

We’ve plowed this field before, but I’ll give it one more go.

You say you advocate for personal freedom and responsibility. You’re suspicious of granting the government ever more power to intrude into our personal lives and our decisions.

Well, you know what? So do I. So do most people who have any basic grasp on reality. It’s not that the general principles are flawed.

It’s that they’re only general principles.

They’re not specific solutions to specific problems.

“Honor the constitution.” Okay. Again - that’s a good generalization. Indeed, it’s pretty much at the heart of our social contract as Americans. But what does it mean in *practical terms* when it confronts a *specific* issue?

You say Medicare is 58 trillion in debt. Granting that for the sake of argument, how does saying, ‘Follow the Constitution’ actually decrease that sum? How does it illuminate a *specific path of action* to follow? Where in the Constitution does it say, ‘In the event that a government program becomes deeply indebted, Congress shall levy a proportionate tax in the amount of…’

Barbara Waggoner is living on a fixed income and simply can’t afford $4,000 a month in medical expenses. Which Amendment *specifically* solves her problem? Where’s the language that says, ‘Should any citizen of the United States or any of the several states be unable to afford his or her medical treatment, Congress shall…’?

You say one of the ways to address health care reform is to regulate the way our judicial system handles tort claims. ‘Make the loser pay’, right? Show me in the Constitution where it says we should do that. (Indeed, show me where in the Constitution it even says we can.) Point to the language.

See, Rhodes? You make a few sweeping generalizations that don’t really amount to anything tangible and then you fold your arms and stare at us as if you’ve answered all the problems and it’s we who are too stupid to see the light.

In my opinion, that’s really where this whole thing has bogged down. People are mouthing empty slogans and chanting dogma that’s so vague and generalized that it doesn’t amount to anything, and then demanding that the other side capitulate because, ‘The TRUTH! has now been made clear! We hath spoken it!’
Gary D Rhodes on August 31 at 12:51 p.m.
Jeff states < Medicare is 58 trillion in debt. Granting that for the sake of argument, how does saying, ‘Follow the Constitution’ actually decrease that sum? >

I’m not the one who is advocating putting everyone in America (legal or illegal) on a “medicare” system. That, my friend, is the progressives. I believe we should be able to see a very clear prescription of how that sum will be raised before we use the same (or very similar) model to a far greater extent.

The problem, in my opinion, should be handled through the free market.

When government gets involved, it crowds out competing groups that would voluntarily help feed and clothe the hungry, and help the sick.
That we automatically look to the government to fix all of our problems is a problem.

Healthcare reform. Start bypicking all the low hanging fruit, including getting rid of the laws and regulations that impede a free health care market.
Then we’ll talk.
Jeffrey_Grey on August 31 at 2:17 p.m.
We easily agree on the need to see hard dollars and cents facts before we implement any program. That is something we *absolutely must insist upon* as a precondition. So yes - we agree.

“The problem, in my opinion, should be handled through the free market.”

On the other hand, here is one of the major points of our disagreement. You distrust the government. And heaven knows, you have more than enough evidence to back up that suspicion. But I have every bit as much hard evidence to back up my suspicion of the free market. So we’re stuck between the proverbial Rock (untrustworthy Big Government) on the one hand and The Hard Place (equally untrustworthy Big Business) on the other.

What to do?

Well, how about seeing to it via our powers (and responsibilities) as informed voters that Big Government gets to exert only *reasonable and necessary* regulatory authority over Big Business - just enough to curb the really objectionable excesses, but not enough to stifle the competition that we again easily agree is needed. How to define ‘reasonable and necessary’? Well, let’s have Washington put something concrete and specific on the table, we’ll discuss it and then put it to a vote.

“When government gets involved, it crowds out competing groups that would voluntarily help feed and clothe the hungry, and help the sick.
That we automatically look to the government to fix all of our problems is a problem.”

Suffice it to say I reject both premises. Government is involved in our daily lives and yet charities manage to do their good work. Those people who are willing to give will find a way to do so whether or not the government is involved. And besides, which is more important? Fulfilling peoples’ needs no matter if it’s government or charity that does it? Or making sure your dreams of a libertarian utopia are achieved and to hell with the people who might have otherwise benefited from government aid? I choose the former. And if we disagree, then we disagree.

And to say that we are by nature too shiftless and weak to stand on our own if the government offers us a crutch is to undercut all your libertarian ideals. Ideals that of necessity assume Man will always aspire to freedom and independence if given the choice.

As for approaching the problem piece-meal: that’s already been tried. Tort reform here. Insurance reform there. The end result is the very crazy-quilt of regulations you object to. It’s time for a fundamental redesign.

Put a comprehensive plan on the table and then we’ll talk.
gmorton on August 31 at 10:09 p.m.
Jeffrey_Grey wrote,

“Barbara Waggoner is living on a fixed income and simply can’t afford $4,000 a month in medical expenses. Which Amendment *specifically* solves her problem? Where’s the language that says, ‘Should any citizen of the United States or any of the several states be unable to afford his or her medical treatment, Congress shall…’?”

Well, that is precisely the point, Jeffrey. There is no such provision in the Constitution. That is because Ms. Waggoner’s health care needs, nor yours nor mine, fall within the role of government as that was understood by the Constitution’s drafters or by most of the citizens who concurred its ratification.

Somehow you have acquired the notion that government is the Universal Problem Solver, or everyone’s Perpetual Parent, to whom everyone is entitled to rely for meeting their various personal needs and desires. I said “somehow” you have acquired that notion, but its origin is actually quite clear: you’ve been raised and educated in the post-Constitutional Era, a period during which that concept of government was vigorously promoted by politicians seeking to expand the scope of their power, and eagerly embraced by everyone seeking a free lunch. That development was predicted by Tocqueville in 1835, if you read my earlier post quoting him.

Let me try to explain why the role you impute to government is erroneous – indeed, immoral – and therefore not contemplated in the Consitution. An old quote of unknown origin (but often mistakenly attributed to George Washington) goes, “Government is not reason, it is not eloquence. It is force, and like fire, it makes a dangerous servant and a fearsome master.”

Government is force. The only means it has for providing you or Ms. Waggoner with health care services, or indeed, any kind of service to anyone, is by forcing someone else to provide those services, or by seizing the means to pay a provider from someone else by force. But the range of circumstances in which one person – one moral agent – is entitled to exercise force against another moral agent is very narrow; it is limited, in fact, to defense of self and others against force being exerted by another moral agent (who is thus acting immorally) or to redress force previously exerted against oneself or another. Since no person is entitled to exercise force against another person for any other reason, and since government is nothing more than the agent of the individual persons (moral agents all) who have erected it, it cannot be justified in using force in any other circumstances either. It is no more entitled to resort to theft or slavery to satisfy the demands of its constituents than those constituents are to employ those methods themselves.

Sorry, Jeffrey, but your health problems and Ms Waggoner’s do not entitle either of you to stick a gun in someone else’s ribs and demand he provide whatever care you may need or pay for it, any more than it entitles a homeless person to stick a gun in your ribs and force you put him up, or a hungry man to seize your wallet at gunpoint to buy food. I.e., you are not entitled to solve your problems by foisting them off onto someone else; you are not entitled to save your own life by threatening someone else’s.

Everyone is free to ask others for help when they need it. No one is entitled to force other to help them, either personally or by proxy, and whoever does so not only forfeits any claim to consideration he might otherwise have had, but becomes an outlaw, relieving others of their obligation to respect his own rights.
richard on August 31 at 10:14 p.m.
The problem, as I read your post Jeff, is that in your analysis you say you don’t trust “big business.” That is fine; I certainly don’t trust, unilaterally, big business either. But you put the emphasis in the wrong place, as I see it.

I don’t know if you ever studied what was happening in Italy and Germany during the 1930’s, but corporations gained tremendous power through coalitions with government, meaning that when one industry was more important to government than another, government secured an even tighter “partnership” with the “more important” industry.

Ironically, these (more important) industries were the most regulated businesses in the country. While government allowed these companies to profit, government exerted great control through regulation. In this situation, government got what it want and the companies pretty much got what they wanted. It was the consumer and the people who were the losers, as they had virtually no say in the marketplace.

And this brings me to my point. When you say you distrust big business, that is not the same as saying you distrust free markets. And while you may believe that free markets are untrustworthy, I would argue that a truly free market place is the most trustworthy. It is when governments place regulations - or controls - on markets, that the resulting prices are “fixed;” sometimes to the benefit of the consumer, sometimes to the benefit of the producers, but most often to the benefit of … government. And this is all determined by politics … and you have very, very little say in the matter if you haven’t noticed.

So the question becomes; when you try to make the dichotomy between big government and big business, I believe it should actually be: big government vs. free markets.

In our current health system we certainly do not have insurance companies competing in a free marketplace. Actually the insurance business is one of the most highly regulated businesses - if not the most regulated. Regulation does not always less profits for an industry … sometimes it means more profits. So the question becomes, who and why has the insurance marketplace become so controlled that it no longer functions as a marketplace.

The answer is easy. Politicians do this and politicians almost always want government tot have more power - not less -even when they call themselves Republicans.

So I as you to step back and ask yourself; is it really the “greed” of insurance companies that causes huge profits, or is it the rules they are allowed to function under? And, would they be making the same big profits if true competition were achievable?

I believe that any profits they would make would be what the market would bare. In that situation, no one, especially not politicians, have control over it.

Politicians have pre-determined who will gain and who will lose whenever a regulation is put in place. You can blame the Republicans more than the Democrats … while I would argue that Democrats have installed more regulation; but it really doesn’t matter. They are all politicians and it is in their nature to wield power by controlling things and making deals.

And that is the nature of government, despite all the idealistic speeches and the noble gestures … they all want control over whatever there is to control.
Jeffrey_Grey on September 01 at 4:53 a.m.
And still Ms. Waggoner can’t pay her $4,000 a month medical bill.

You’ve tap-danced all around this issue Richard. Everyone has. Now speak directly to her and tell her it’s nobody’s problem but her own. If she can’t pay for it she must do without - which in all likelihood means her death.

Come right out and say it, Ricard. I dare you.

I dare you to tell her that’s what the framers of the Constitution intended: that impoverished American citizens who can’t afford medical care must die because the welfare of its citizens is not the government’s concern.

I dare you to tell her that’s representative of true American values.

Step down from your ivory tower of socio-economic philosophy and address this one, tangible issue. Put the theory to work. Solve this one problem - and lets see if the solution actually works out to be, ‘Sorry. You’re on your own. Go somewhere where we don’t have to watch and die quietly, please.’

And if you really can do that, if you really can justify that completely twisted vision of America to yourself, then I’m reminded of that wonderful quote from the Vietnam era. “I guess the poor, dumb bastard would rather be alive than free.”

As for your long treatise on the dichotomy between Big Business and The Free Market - fine, for the moment and the sake of argument I’ll stipulate to all your theories. Now, convince me that the reality isn’t that in America, Big Business wouldn’t become the whole market without at least some regulation and restraint. Libertarian dogma shouts that left unchecked, Big Government will use its unrestrained power to quickly over-run everything. Why doesn’t the same theory hold true for Big Business?

In any event, lots of blatantly slanted theory and vague generalizations spiced with the occasional, ‘Be afraid!’ that we’ve come to expect. But not a lot of tangible answers.
Jeffrey_Grey on September 01 at 6:22 a.m.
I’ve thought about this a little more.

“So I [ask] you to step back and ask yourself; is it really the “greed” of insurance companies that causes huge profits…”

Yes. **Absolutely!** And you’ll have to produce one-hundred-times as much actual evidence as you’ve managed to produce - which to date consists of, ‘Trust me! It’s not true!’ and not much more - before I’ll believe corporate greed isn’t to blame for a big part of the problems we face.

Come on Richard, do you really contend that increased profits are tied to increased regulation? That files squarely in the face of every sanctimonious pronouncement we hear coming ad-nauseum from corporate American whenever new regulations are proposed. “You’ll kill our profits!”

If corporations are governed by a fiduciary duty to their stockholders to increase profits (but they’re not driven by a profit motive as a result - yeah, right), if your contention is correct, shouldn’t they be clamoring for MORE regulation, not less?

This whole ‘regulations drives up profits’ smoke-screen is *blatantly absurd* on its face. I don’t buy it for a moment, Richard.

Turning to another point: You and Rhodes and gmorton all rant and rave about how anyone who is demanding health care reform is in fact just looking for a free ride from the government.

To phrase it in a way you might understand: THAT IS SIMPLY NOT TRUE.

I will say again what I have said many times now, and have been ignored every time I’ve said it because it’s inconvenient and contradicts The TRUTH! you have all wrapped yourselves in. **I am not now nor have I ever been looking for a free ride.** I DON’T EXPECT THE GOVERNMENT TO PAY FOR MY HEALTH CARE. Okay? Did that finally get through?

All I have ever wanted, all I ask for, is sufficient government oversight of the system to ensure that I have at least some chance to pull my own weight and to pay as much of my fair share as I possibly can should the unthinkable occur and I incur a catastrophic medical expense.

And I really don’t think that granting that request will directly result in a totalitarian, socialistic state or the utter ruination of the free market system.

I just don’t.

And to-date, nobody has come close to convincing me that it will.
Gary D Rhodes on September 01 at 8:04 a.m.
< Rhodes and gmorton rant and rave about how anyone who is demanding health care reform is in fact just looking for a free ride from the government.>

I don’t believe I rant or rave. (Although Raves are fab)

I simply believe that profits would be controlled with more competition. More competition could be realized by getting rid of regulations that cause some insures to look for greener pastures, leaving a couple of behemoths to do as they and their lobbyists please.
Jeffrey_Grey on September 01 at 8:23 a.m.
Rhodes,

If competition is such a mighty force in the land, why do regulations inhibit it?

Seriously… Here’s another one that doesn’t really make a lot of sense when you stop and think about it. If the regulations, no matter how burdensome, are applied equally across the board, how does that stifle competition?

Let’s take one regulation that seems to be a favorite whipping boy. Let’s examine the regulation that says you have to qualify with a state in order to sell insurance there. Let’s say State X currently has Insurers 1, 2 and 3 qualified and no others. If I’m insurer 4 and I want to sell insurance in State X, why don’t I just jump through the necessary hoops and qualify? Insurers 1 2 and 3 managed to do it. Why don’t I? That is if I’m really and truly as keen on competing as you claim I must be - being the paragon of the free market system that I am, that is.

Could it possibly be that the potential for profits don’t look so good if I try to butt heads with the already established 1, 2 and 3 and so I’ll just stick with my own little carved out turf in State Y since I am making money just fine there? Could it be that once again it’s profits and not regulation that are driving my decision?

If competition will always prevail, why aren’t there hundreds of car makers in the U.S.? Why are there only the Big Three? (Ford, GM and Chrysler) If competition is king, how did GM manage to become ‘too big to fail’? Does the government drive all the little upstarts out of business before they even get started with a ton of regulations that nobody (except curiously the Big Three) could ever hope to comply with?

Okay, sure. Maybe that is indeed part of the problem. I’ll grant you that. So maybe we need to make sure that regulations aren’t so burdensome that they stifle competition completely.

But then, I think I’ve already said that.

On the other hand, is it your contention that if regulation is removed completely, the large entities that already exist - the Big Three auto makers and all the conglomerate insurance companies for example - wouldn’t use that unrestrained freedom to crush the competition far more efficiently than evenly applied regulation ever could?

Do you really expect anyone to believe something that contradictory to the plain evidence we can see all around us?

If competition will always prevail if given the chance, why do we have anti-trust laws? Why would we need them?
Arch_Druid on September 15 at 7:28 a.m.
Whether one gets called a “free luncher,” GMorton or a free loader, it is nitpicking 6 of one and a half dozen of the other. It is the same thing. At some point, if you are on Social Security, SOMEONE pays your way.

As to Jeff Grey’s point, we have anti-trust laws to ASSURE competition. Those anti-trust laws did far more to guarantee the existence of the free market than prohibit them. When anti-trust laws came under attack by the GOP who front for THOSE business interests that opposed them as “anti-business regulations;” it is because those corporations were opposed to the businesses that benefited most from anti-trust laws. IE would have been competitive.

Which brings to mind just what sort of radical left turn the GOP were really going the route of since the 1980s.