A Matter Of Opinion

Large scale HC reform is dead

Posted by Gary at 10:20 a.m. on January 21 Comments (286)

That’s what it looks like anyway. Pelosi won’t be able to get the votes needed to pass the Senate bill. Meanwhile, the Senate bill needs 60 votes and now has 59 (at best).

Scott Brown says he’s open to working with Democrats on a bill. He supports universal coverage in Massachusetts. And Americans say they want GOP buy-in.

Questions:

1. Does the GOP want to buy in? Or would they rather ride the current wave of discontent?

2. Is there a GOP senator other than Brown who likes the Massachusetts model? Northeast Republicans are more liberal than your typical Republican and are often called RINOs (Repubicans in Name Only). How much buy-in is needed?

3. If Brown buys in, does he lose his iconic status with Republicans who are currently thrilled with his victory?

Discuss here.

286 comments on this post so far. Add yours!

nslopeofw on January 21 at 11:42 a.m.
Well, hopefully, they will ride the current national wave of discontent over incredible spending, and then taxing to pay for it.
Why, instead of a total (very expensive) re-do of the current system, didn't Obama and gang just try to insure those who: A) couldn't afford insurance, and B) Wanted insurance? Seems like that would have been WAY cheaper, and, could have been done without burning the taxpayers.
Now, they have created a mess. They have alienated themselves from the average American in their zeal to appease the special interests. I mean, c'mon, what happened to Obama's transparency? He would gain a lot of respect back, if he only had the hearings open and on CSPAN. Instead, the elitists have shown the people what they really think of them.

Personally, I don't care what Brown does. It's the message to the government that his winning shows. Back up your campaign rhetoric with action, or you are next. The people don't care about the insurance issue anywhere near as much as the economy, and jobs. Save the pet projects for later, and quit spending money we don't have.
Gary Crooks on January 21 at 12:54 p.m.
<<Why, instead of a total (very expensive) re-do of the current system, didn't Obama and gang just try to insure those who: A) couldn't afford insurance, and B) Wanted insurance? Seems like that would have been WAY cheaper, and, could have been done without burning the taxpayers.>>

How would it have been done without involving the taxpayers? How to pay for it? How would that control HC costs, which is linked to the economy and threatens all budgets, private and public?
Jeffrey_Grey on January 21 at 1:13 p.m.
nsl,

– Back up your campaign rhetoric with action, or you are next. –

Hear, hear!! Now it's up to we voters to remember that and hold our elected officials to that. If we let it slip again, if we again let ourselves be seduced into placing partisan concerns ahead of our best interests, then it's on us and not the politicians.

I swear, it's to the point that unless I see some genuine, sweeping changes in the two years preceding the next election, I don't care if the independent candidate is a blind, three-legged pig. I'll 'vote pig' just on the theory that *anything* is better than once again empowering the intransigent partisan system we currently have!

And that's not just talk. I mean it.
Jeffrey_Grey on January 21 at 1:16 p.m.
Gary,

Which raises the interesting question: didn't this all start out as an attempt to reign in out of control health-care costs? I still don't quite understand how it ultimately came to be about insurance reform.

Not that I don't think we *desperately* need insurance reform, mind you! We most certainly need that too. But isn't the cart sort of before the horse at the moment? If we were to regulate health care costs, wouldn't insurance costs at least partially take care of themselves? (And if they didn't… well …)
nslopeofw on January 21 at 1:29 p.m.
Jeffery, I'm with ya on the independent candidates. Lets bust up the party power cliques.

Gary C., I think it would have been a better start to handle the uninsured, (the ones who want insurance) then, open up the state lines, and close emergency rooms to all but emergencies. Wait a while (a couple of years) then, change as needed. I'm thinking the costs would be far less.
Gary Crooks on January 21 at 2:06 p.m.
Jeff,

It started out as both. Bring coverage to the uninsured. Help pay for it by controlling costs. Insurance reform doesn't touch a lot of spending, such as what happens in Medicare and group insurance, which is how most people are covered.

End “pre-existing conditions”? That isn't applicable in group and government coverage. It helps individuals, but if insurers can't charge them for their conditions, they will raise rates elsewhere.

OK, so then you mandate that everyone has insurance to scoop up all the healthy young people so insurers can spread costs to them.

Then “Big Government” and “freedom robbing” charges are leveled. So you back off the mandate and costs go up for the already insured.

We can still regulate health-care costs, as you say. But if the “we” is government, how does that address the complaints raised by the Massachusetts electorate?

So the cart goes before the horse and it's “insurance reform,” which will have limited affects on costs.

nslopefw,

“Handle” the uninsured how? Put them on Medicaid? Medicare? Pay for their private insurance? How to pay for it?
richard on January 21 at 2:07 p.m.
“And Americans say they want GOP buy-in.”

Isn't that a bit of a spin, Gary? The American people – to my knowledge – have not said anything of the kind. The story you linked said this:

“A 55% majority of Americans say President Obama and congressional Democrats should suspend work on the health care bill that has been on the verge of passage and consider alternatives that would draw more Republican support, a USA TODAY/Gallup Poll finds.”

The election, the polls, the mood of the country, all tell us that it is upon the Dems to pull-back, not for the Repubs to “buy-in;” unless you are using that term in a manner unfamiliar to me.

The linked story continued:

“An overwhelming 72% of those surveyed Wednesday say Brown's victory “reflects frustrations shared by many Americans, and the president and members of Congress should pay attention to it.” Just 18% say it “reflects political conditions in Massachusetts and doesn't have a larger meaning for national politics.”

and . . .

“Those surveyed also are inclined to say that the president and Democratic leaders have erred in making health care the top legislative priority for now. Forty-six percent say health care is important but there are other problems they should address first, and 19% say health care shouldn't be a major priority.

One in three say health care should be the top priority now.”

I don’t believe Obama and Gates when they implied that the people “just haven’t heard the message” and that they (Dems) have done a “poor job communicating it.” The fact of the matter is that the American people know all too well what is in that bill, and they do not want it.

It isn’t a messaging problem, it isn’t a leadership problem, it isn’t a Republican problem; it is an idea problem.

When polled by the Washington Post, 58% of Americans claimed to prefer smaller government with fewer services, with only 38% favoring larger government with more services.

So Gary, I believe it to be the time for the Democrats to pull back to a position on health care more in line with what the people want. You guys always do claim that you are “for the people,” don’t you?

If that is true, then it seems a perfect time to prove that sentiment.
Gary Crooks on January 21 at 2:08 p.m.
Correction: It will be limited “effects.”
Gary Crooks on January 21 at 2:11 p.m.
<<The election, the polls, the mood of the country, all tell us that it is upon the Dems to pull-back, not for the Repubs to “buy-in;” unless you are using that term in a manner unfamiliar to me.>>

I was just repeating the headline. By “buy-in” I mean input and acceptance.
empyrius on January 21 at 5:59 p.m.
Just legalize marijuana so I can ignore you Americans and your corrupt democrat/republican one party corporate controlled state!
Arch_Druid on January 21 at 9:26 p.m.
I am liking that scaled back plan that the S-R highlighted on the front page this morning somewhat better than the behemoth that the Dems were trying to force into passage.

Let's put it bluntly, that we can do without fining people just because the employer isn't providing health insurance. Well, duh, because it is too costly?
richard on January 21 at 9:59 p.m.
Now it is recognized as a “behemouth” that the “dems were trying to force into passage.” I have to chuckle just a little, Druid. :)

But welcome aboard, now maybe the country can see real reform in our health care system.
Arch_Druid on January 21 at 10:38 p.m.
Well, “Richard,” didn't I say from the start that I had serious questions about it? Guess you must have missed that.
nslopeofw on January 21 at 10:57 p.m.
Empyrius-

A friend with weed, is a friend, indeed.

Been hearing 'bout Mary Jane pills for chronic pain. You take 'em at night, and the next day you are pain free for the whole day. Don't see much of a down side.

Tax the weed, give health care to the poor. I like it!!
empyrius on January 21 at 11:58 p.m.
“A friend with weed, is a friend, indeed.”

Amen my brother nslopeofw!

Seriously bro! Let me smoke some pot without worrying about you alcohol drinkers (whether in uniform or not) crashing my buzz, and kill anybody in this world you please!

Kill em all bro! Just let a brother smoke a joint in peace.

Amen
gmorton on January 22 at 1:02 a.m.
“It started out as both. Bring coverage to the uninsured. Help pay for it by controlling costs.”

Those goals are contradictory. More insurance means higher costs, because the 3rd-party payer fiasco is expanded. You are increasing demand without a cost constraint. There is no limit to the tests and procedures docs will order, or that patients will demand, or that providers will charge for them, regardless how low the cost/benefit ratio is, as long as someone else is paying for them. And anything you try to mitigate that price pressure, such as mandating coverages, delivering more free lunches, etc., will only perpetuate the problem.

You cannot obtain optima in an economy by edict. Amazing how difficult it is to make that elementary fact understood. Anyone who pursues your two goals simultaneously is a believer in economic magic. You might as well invest your time and money building a perpetual motion machine.

“OK, so then you mandate that everyone has insurance to scoop up all the healthy young people so insurers can spread costs to them … Then “Big Government” and “freedom robbing” charges are leveled.”

Sure. Instead of imposing taxes to support the demanded free lunches, you finance them by forcing people to buy something they don't want and probably don't need.

I'd hoped that would pass. The Attorney General of Florida had already promised to challenge it in court, on the ground that Congress has no constitutional power to force anyone to buy anything – that the courts would never stretch the commerce power that far. T'would have been an interesting case.
Jeffrey_Grey on January 22 at 5:53 a.m.
gmorton,

Then how does manditory auto insurance work?
Jeffrey_Grey on January 22 at 6:01 a.m.
Gary,

– We can still regulate health-care costs, as you say. But if the “we” is government, how does that address the complaints raised by the Massachusetts electorate? –

Might part of the answer lie in first defining exactly what the Mass. electorate was objecting to?

How about asking the question directly? 'Would you be opposed to governmental regulation of health care costs, given the understanding that would of necessity require some limitation on just what your doctor could do for you - ie: no more 'every test and procedure under the sun', which in turn would require some tort reform to shield from malpractice claims? Would that be okay?'
Gary Crooks on January 22 at 10:04 a.m.
<<'Id hoped that would pass. The Attorney General of Florida had already promised to challenge it in court, on the ground that Congress has no constitutional power to force anyone to buy anything – that the courts would never stretch the commerce power that far. T'would have been an interesting case. >>

Seems that challenge would've occurred in Massachusetts, where there is a mandate. Or with auto insurance.

Whatever the case, the mandate wouldn't be my preferred method. It was a compromise for zapping pre-existing conditions. Given both of those stipulations, it seems like it isn't even insurance anymore.
Gary Crooks on January 22 at 10:10 a.m.
<<How about asking the question directly? 'Would you be opposed to governmental regulation of health care costs, given the understanding that would of necessity require some limitation on just what your doctor could do for you - ie: no more 'every test and procedure under the sun', which in turn would require some tort reform to shield from malpractice claims? Would that be okay?' >>

Health care has to be the most surveyed issue in history. I'm sure some such question has been posed at some point, but not at every point.

So you ask the question today. Then legislation is crafted accordingly. Then the interest groups pounce and pick it apart. Then the question is asked again just before the finish line.

And the response changes.

BTW, the bill is a “behemoth”, because there are so many measures aimed at controlling costs. So you pare the number of pages by eliminating all that, and it's no longer a behemoth.

And it no longer controls costs.
richard on January 22 at 12:40 p.m.
<<Well, “Richard,” didn't I say from the start that I had serious questions about it? Guess you must have missed that.>>

In a word … NO! I don't recall that.
gmorton on January 22 at 1:37 p.m.
Jeffrey_Grey wrote,

“Then how does manditory auto insurance work?”

It works by conditioning use of a public good upon having insurance. Hertz imposes the same requirement for use of its rental cars. A bank may require you to have some collateral before loaning you its money. Etc.
richard on January 22 at 1:39 p.m.
Jeff – auto insurance is not madatory for anyone… unless they own a car. And then it is mandated becasse driving a 3000 pound metal and glass object at high speeds is a direct threat to people and property.

It only makes sense that auto insurance is mandatory because there are so many irresponsible people out there and if they happened to hit you and they didn't havbe insurance or money or assets, you would be tough-outta luck.

It is a matter of potentially very high liability everytime someone drives down the street.

It proctects all of us equally from the bad drivers and irresponsible people.

Clearly not the same thig as health insurance.
gmorton on January 22 at 1:40 p.m.
Gary Crooks wrote,

“Seems that challenge would've occurred in Massachusetts, where there is a mandate. Or with auto insurance.”

That is a state law, subject to whatever limitations there may be in the Mass. constitution.
gmorton on January 22 at 1:46 p.m.
Richard wrote,

“Jeff – auto insurance is not madatory for anyone… unless they own a car . . .”

… and operate it on a public highway.
Jeffrey_Grey on January 22 at 2:17 p.m.
Oh. Okay.

So first off; I guess the government can in fact make you buy a privately-offered product?

Second; as a matter of public policy we ought to dictate the purchase of auto insurance because driving a car is a potentially hazardous and at least arguably voluntary act.

However, health care - being non-discretionary and indisputably hazardous (at least to go without)… that we don't mandate. Instead we just throw the *inevitable* costs of uninsured health care back onto the general population anyway.

Sure. Makes perfect sense to me.
Gary Crooks on January 22 at 2:48 p.m.
If individuals can't be compelled to buy private insurance, then make them buy social insurance. That's how seniors are covered. We're compelled to participate in Social Security, too.

We cannot opt out of the payroll tax if we are working.

In any event, there is disagreement among legal scholars on whether a mandate would be unconstitutional.

There are laws that give benefits to a married couple that people living together cannot access? Isn't the point of this coercion to get people to marry?

Supporters say, yes, because it an overall benefit fo society. That's what universal care advocates say. There is an overall benefit. If you don't get covered and get hurt, third parties end up picking up some of the costs.

I'd rather go the social insurance route, but both activities are mandates.
Gary Crooks on January 22 at 3:22 p.m.
Here is a link that has an oped saying it's unconstitutional and some rebuttals.

http://lawprofessors.typepad.com/conl…

It would be an interesting case, but it's not as simple as has been discussed here.
gmorton on January 22 at 6:16 p.m.
Jeffrey_Grey wrote,

“Second; as a matter of public policy we ought to dictate the purchase of auto insurance because driving a car is a potentially hazardous and at least arguably voluntary act.”

Hmm. Seems you missed the point. No one dictates that you must buy auto insurance. They only dictate that you buy it *if you wish to use their property in certain ways*.

When you are using someone else's property, then you are subject to whatever dictates they may impose.
gmorton on January 22 at 6:18 p.m.
Jeffrey_Grey wrote,

“Instead we just throw the *inevitable* costs of uninsured health care back onto the general population anyway.”

False dichotomy. You left out a few obvious alternatives.
gmorton on January 22 at 6:37 p.m.
Gary Crooks wrote,

“Here is a link that has an oped saying it's unconstitutional and some rebuttals. . .”

I agree the *Wickard/Gonzales* line of reasoning would be invoked. Both of those rulings should be overturned, as they are ahistoric (Wickard is one of the “Dirty Dozen”). That is not likely to happen, unless the Court, in a moment of sanity such as it just exhibited, grasps their implications for the Constitutional ideal of a free society.
richard on January 22 at 7:56 p.m.
Jeff said . . .

<<However, health care - being non-discretionary and indisputably hazardous (at least to go without)>>

But health insurance IS discretionary, Jeff – who forces you to have it? Lots of people choose not to buy it for a variety of reasons. And they should have that right, don’t you think?

Where in ther contract between government and the people does it say you can be FORCED to buy something? And if you mention auto insurance, that is a very different matter for reasons that should be clear to anyone.

One is a matter of responsibility for one self. Driving, which is a “privelege” and not a right, is regulated because it highly dangerous. If no one had insurance then the innocent would be hurt. Requiring insurance ensures the innocent will be compensated for their loss.

You argue that it is “indisputably hazerdous” not to have health insurance. No it isn't. And someone’s lack of medical insurance is not a risk or a hazard to anyone else. And that is key.
richard on January 22 at 8:19 p.m.
jeff said -

<<So first off; I guess the government can in fact make you buy a privately-offered product?>>

You left out one very important factor …only IF you own and operate a car on public roads where thousands of people also congregate. And each car is a potential killer.

If you are completely opossed to buying car insurance? Then that is your choice. Simply ride the bus, walk, ride a bike, carpool, hitchhike, etc. Just don't drive a car. Thus, we have options, whereas the health bill gave no options. Buy, or pay a fine. Either way, it costs you money.

And there is nothing consistant about that kind of government-compelled behavior, and the concept of freedom and liberty. If there is, I would certainly listen to the argument.
gmorton on January 22 at 9:04 p.m.
BTW, McConnell v. FEC, which was struck down in part by the Citizens' United ruling, was also one of the “Dirty Dozen.” So those appalling rulings are not inviolable.
Lewis on January 22 at 10:58 p.m.
I have a question. why do i have to pay 1200 dollars a year for health insurance i rarely use and only pay 400 a year on car insurance for the 2500 pound truck i drive every day?
Arch_Druid on January 23 at 12:08 a.m.
“Richard,” of course you would fail to recall when I posted my serious issues about Health Care Reform under its original format. You were too busy screaming at the “librul opposition” to pay attention! LOL!

There were worthwhile arguments at the start of this debate where those who supported the overall idea of health care reform said that the Dems should in fact work on what was doable, instead of trying to do too much. They were “lefties,” I believe. Now, some months later, and with Scott Brown as an R from Mass. The Dems may in fact have to resort to working on what's doable. A little at a time.
Jeffrey_Grey on January 23 at 5:27 a.m.
gmorton,

– When you are using someone else's property, then you are subject to whatever dictates they may impose. –

Tax revenues used to cover the medical care of those who can't afford it are someone else's property (or at least as much 'someone else's property' as are publicly held things like roads.) The increased costs we all pay for medical care required to cover unrecovered expenses incurred by uninsured recipients is 'someone else's property.'

Why can't we require people to obtain insurance to thus regulate the expense of using that property?

– False dichotomy. You left out a few obvious alternatives. –

And those alternatives are…?

Richard,

– But health insurance IS discretionary, Jeff – who forces you to have it? –

If the cost of most major medical care is no longer within my reach, if the only way I can obtain that medical care (without suffering catastrophic economic harm) is to insure the risk, then the *realistic* alternative, Richard, is 'insure or do without.' If you see that as truly discretionary, then you're genuinely clueless.

–Lots of people choose not to buy it for a variety of reasons. –

Do you perceive 'I can't possibly afford that' or 'I want it but nobody will sell it to me' as a discretionary choice? Do you understand what the word 'discretionary' means? Or 'choice', for that matter.

– You left out one very important factor …only IF you own and operate a car on public roads where thousands of people also congregate.–

You're tap-dancing around the point. You made the sweeping claim that the government can't legally force you to buy a privately-offered commodity. Clearly, that's not true. The truth is that if you choose to drive your car on a public highway, the government can force you to buy insurance. Therefore, the government can indeed legally (and properly in this instance at least) force you to buy a privately-offered commodity.
gmorton on January 23 at 4:59 p.m.
Jeffrey_Grey wrote,

“Tax revenues used to cover the medical care of those who can't afford it are someone else's property (or at least as much 'someone else's property' as are publicly held things like roads.) The increased costs we all pay for medical care required to cover unrecovered expenses incurred by uninsured recipients is 'someone else's property.'”

Sorry, Jeffrey. The decision to use tax revenues to pay my health care expenses is your decision, not mine. It is as though you have towed my car unto a public roadway, then announced, “You are using our roads. Now you must buy auto insurance.”

Nice try.

“And those alternatives are…?”

Leave charity care to private charities.
gmorton on January 23 at 5:03 p.m.
Jeffrey_Grey wrote,

“Therefore, the government can indeed legally (and properly in this instance at least) force you to buy a privately-offered commodity.”

Er, no, it can't. It can only revoke your privilege of driving on its highways, just as Hertz could withdraw its permission to use its cars if you lack insurance. Neither can force you to do anything.
gmorton on January 23 at 5:15 p.m.
It's amazing, Jeffrey, how mightily you are struggling to rationalize an egregious intrusion on your freedom, rather than simply owning up to the obvious: for you, free lunches trump freedom.
Jeffrey_Grey on January 23 at 6:21 p.m.
– The decision to use tax revenues to pay my health care expenses is your decision, not mine. –

So I have to personally agree with how every tax dollar is spent for it to be a valid expenditure? What if I don't want that new highway bridge in Tennessee to be built with my federal tax dollars? Do I get to cry 'foul!' and demand that only the people who are going to drive on it pay for it?

Damn but democracy can be terribly unfair and demanding at times, can't it?

– Leave charity care to private charities. … [F]or you, free lunches trump freedom.–

No. I think 'Free lunches' trump dumping a large segment of our nation's health care burden onto the Salvation Army.

Do you realize how *utterly absurd* 'just let charity handle it' is, given the scale of what we're talking about?

As always, gmorton - it all sounds good on paper until your Utopian dreams slam face first into the brick wall of the real world.

As for mandatory auto insurance - you're going to tap dance too? Yes; you can choose not to drive. So yes, there's that option. But if you choose to drive, the government can force you to buy insurance. Therefore the government has the power to force you.
Arch_Druid on January 23 at 6:31 p.m.
That is entirely correct, Jeff Grey. You can actually fore go insurance AND a driver's license as long as you leave that brand new car parked in your yard. But if you take it anywhere, then you MUST have both.

What GMorton and “Richard,” both argue is anarchy. That is radical leftism at its worst.
spoketucky on January 24 at 7:53 a.m.
gmorton: Two words: Atmospheric clocks.
gmorton on January 24 at 4:17 p.m.
Not a perpetual motion machine, Spoke.
gmorton on January 24 at 4:34 p.m.
Jeffrey_Grey wrote,

“But if you choose to drive, the government can force you to buy insurance. Therefore the government has the power to force you.”

No, Jeffrey. Withdrawing a permission (such as the permission to drive on someone else's property) is not “force.” Hertz doesn't “force” you either, when it conditions use of its cars on your having a valid driver's license, insurance, etc.

Force is the use or threat of bodily harm, or confiscation or destruction of another's property, to compel him to act as you command. No force will be exerted against you unless you trespass upon the State's highways without permission, in which case force is justified. You are perfectly free to drive your vehicle around your farm or ranch, with or without insurance.
Jeffrey_Grey on January 25 at 4:28 a.m.
– Withdrawing a permission (such as the permission to drive on someone else's property) is not “force.” –

Utterly empty semantics. The State has the power to 'make' you to purchase auto insurance.

– You are perfectly free to drive your vehicle around your farm or ranch, with or without insurance. –

Just as you are not 'perfectly free' to drive it on the State's highways without the requisite insurance. Therefore you're not 'free'. Therefore you're subject to… well, call it whatever you want. 'Force', 'coercion', 'regulation'. The words don't matter as much as the simple fact.

I honestly wonder if you actually believe this absurd, nonexistent distinction you're trying to bootstrap out of nothing, or if you're incapable of admitting a point that simply doesn't go your way.
Arch_Druid on January 25 at 10:18 a.m.
GMorton, the “State's highways” are YOUR highways. You pay the taxes for their building, maintenance and etc. then you have a PUBLIC access to it. BUT, to have such access you MUST have a valid driver's license and you MUST have insurance.

Now, say you want to drive around your own property. If you skid around and drive INTO your own house then what? If you commit other property damage, then what? Then why would you assume that buying car insurance is an act of coercion? After all, there are people out on those roads who behave very recklessly. Shouldn't the PRIVILEGE of driving have a cost of if you behave recklessly then you can find your driving privileges suspended? Yes, most people who don't want THEIR property damaged or their lives threatened by YOUR reckless behavior would substantially agree. That is why we have laws. You want to treat laws as “coercion” and statist, the invitation to find an uninhabited island is still open.
Gary Crooks on January 25 at 12:09 p.m.
More analysis. The comparison to minimum wage is interesting.

http://www.slate.com/id/2224258/pagen…

<<I have a question. why do i have to pay 1200 dollars a year for health insurance i rarely use and only pay 400 a year on car insurance for the 2500 pound truck i drive every day? >>

Next time you need the truck repaired, show them your auto insurance card. That might crystallize the difference for you.

As I recall, you use some of the clinics around town. Those aren't free. Other people pay for them. If you have insurance, you wouldn't be banking on them anymore.
Jeffrey_Grey on January 25 at 1:47 p.m.
Gary,

I think the analogy to auto insurance fails in this one regard: The analysis usually goes, 'You can choose not to drive a car and so avoid the mandate. But if you drive a car, then the mandate applies.'

And as that article you cite points out, that then raises the point, 'Though I can have some impact on my health, in many cases it isn't a matter of choice. For example, I don't have a lot of say in contracting a non-smoking-related cancer. That factor of choice means comparing auto insurance and health insurance is comparing apples and oranges.'

However, auto insurance isn't about choosing or not choosing to drive. It's about not saddling society with the costs of your actions should they result in financial loss - either to you or, more importantly, to others who have no say in the factors that led up to the loss. If you look at it in that light, it seems to me that auto insurance and health insurance are apples and apples.

So here's the deal: if you promise never ever to contract any illness or suffer any injury that you can't immediately pay for out of pocket and thus *guarantee* that you'll *never* pass any expenses on to the rest of society, then I suppose you shouldn't have to purchase medical insurance.
Chip Jones on January 25 at 2:35 p.m.
Good point Jeffrey. You do not have to carry auto insurance in most states, if you can post a bond that guarantees payment for the amount of insurance required by law. So, if you can guarantee that you will never ask for a “free lunch” on medical expenses, then insurance should not be required.
Do you think Scott Brown (R-Mass) will sponsor a health care bill in the U.S. Senate similar to the one he supported and voted for in Massachusetts, where all residents are required to maintain health insurance?
gmorton on January 25 at 3:30 p.m.
Jeffrey_Grey wrote,

“Just as you are not 'perfectly free' to drive it on the State's highways without the requisite insurance. Therefore you're not 'free'.”

True. No one is free to use another's property without permission (except gummint, of course). Freedom does not include the freedom to steal or trespass.

“I honestly wonder if you actually believe this absurd, nonexistent distinction you're trying to bootstrap out of nothing, or if you're incapable of admitting a point that simply doesn't go your way.”

Heh. That distinction is quite clear, Jeffrey. You are free to sleep in your bed tonight. You are not free to sleep in your neighbor's bed, or in a bed at the Davenport Hotel without the owner's permission.

That is a popular argument against freedom among the Left, however – that property rights restrict other's freedom. I.e., your property right to your bed may confer a freedom upon you to sleep in the bed, but it removes a homeless person's freedom to sleep in it. Oh, so unfair!

If you think that distinction is meaningless, no doubt you'll just scoot over, and not complain, when a homeless person crawls into your bed.
gmorton on January 25 at 3:42 p.m.
Arch_druid wrote,

“GMorton, the “State's highways” are YOUR highways. You pay the taxes for their building, maintenance and etc. then you have a PUBLIC access to it. BUT, to have such access you MUST have a valid driver's license and you MUST have insurance.”

All quite true, Arch. But, unlike Jeffey's bed, you are only a joint owner of the highways. In joint ownerships each individual owner must abide by rules of use established by all of the owners, or perhaps by a majority of them if they have adopted that method of reaching decisions. If you live in a condo, you are a joint owner of the building, and a sole owner of your unit. So you may use common areas of the building only according to the rules you and the other owners have jointly adopted.

“Then why would you assume that buying car insurance is an act of coercion?”

Er, I haven't assumed that, Arch. That has been Jeffrey's contention, not mine. I have no objections to compulsory auto insurance. Were the matter to come to a vote I'd vote for it.

You really need to read these posts more carefully.
gmorton on January 25 at 3:44 p.m.
“If you think that distinction is meaningless, no doubt you'll just scoot over, and not complain, when a homeless person crawls into your bed.”

No jokes about homeless, buxom blondes, please.
gmorton on January 25 at 4:17 p.m.
Jeffrey_Grey wrote,

“The analysis usually goes, 'You can choose not to drive a car and so avoid the mandate. But if you drive a car, then the mandate applies.'”

Nope. You are misstating the argument in order to enable you to contrive a plausible counter-argument. That is called a “straw man.”

The real argument is, “But if you drive a car *on public roads* then the mandate applies.” You may choose to drive a car wherever you wish without insurance, as long as you have the permissions of the owners of the car and the property upon which you wish to drive it.

“However, auto insurance isn't about choosing or not choosing to drive. It's about not saddling society with the costs of your actions should they result in financial loss - either to you or, more importantly, to others who have no say in the factors that led up to the loss.”

Sorry, Jeffrey. If you or your government decide to take it upon yourselves to pay my health care costs, then I have not “saddled” you with anything. You have saddled yourselves.

“… thus *guarantee* that you'll *never* pass any expenses on to the rest of society… ”

I can only guarantee what I will do, not what others do. I can guarantee that I will never submit any medical bills of mine to you for payment, or authorize anyone else to do so. If your paternalistic or authoritarian impulses compel you to insert yourself into my relationships with my health care providers, then that is your choice. But don't demand that I narrow my options in order to ease your self-imposed burden.
Jeffrey_Grey on January 25 at 4:26 p.m.
– That is a popular argument against freedom among the Left, however – that property rights restrict other's freedom –

And it's an equally popular rationalization among anarchists to assert that any regulation of freedoms - no matter how reasonable or necessary - leads inevitably to unrestrained tyranny. 'Infringe on my rights in any way and you'll abolish ALL rights!'

Once again - it's the false premise of 'all or nothing'.
Jeffrey_Grey on January 25 at 4:37 p.m.
– Sorry, Jeffrey. If you or your government decide to take it upon yourselves to pay my health care costs, then I have not “saddled” you with anything. You have saddled yourselves.–

You really don't get it, do you? What we're talking about here is the 'free lunch' of someone without health insurance foisting the unrecovered cost for their care off on others.

That free lunch is currently being served in this state at the cost of *at least* $457/year for *insured* individuals (or $917/year for *insured* families.) Better yet, the 'tab' for that free lunch is rapidly increasing.

– The cost of uncompensated care is also rising rapidly. The 2008 total of nearly $700 million, for example, represents a 20 percent increase in just two years. –

http://www.insurance.wa.gov/consumers…

For such a purported foe of free lunches, you sure seem to be on the wrong side of the fence, gmorton.
Gary Crooks on January 25 at 4:55 p.m.
<<So here's the deal: if you promise never ever to contract any illness or suffer any injury that you can't immediately pay for out of pocket and thus *guarantee* that you'll *never* pass any expenses on to the rest of society, then I suppose you shouldn't have to purchase medical insurance. >>

At which point the law that requires care at ERs — regardless of ability to pay — would be repealed because it mandates free lunches.

I'm still wondering why the payroll tax isn't deemed unconstitutional. Isn't that telling people how to spend by spending for them on future health care and retirement needs?

Must be someone who has tried — and failed — with that.
gmorton on January 25 at 5:12 p.m.
Gary Crooks wrote,

“More analysis. The comparison to minimum wage is interesting.”

While Amar is correct that takings are “paradigmatically” about “things,” they are not confined to tangible property (“things”). They can involve intangible property also.

http://www.justia.com/real-estate/emi…

He is also mistaken that the individual mandate would be a “tax.” A tax is a payment to government for services provided by government, not a payment to private parties. Unless, of course, the Court wishes to re-write 200 years of Constitutional understanding of “tax.”

But the Constitutional argument will not turn on the takings clause. It will rest on the interstate commerce clause. In 1942 (Wickard v. Filburn) the Court re-wrote that clause, expanding the power of Congress to “regulate commerce … among the several states” to include anything *affecting* commerce among the states. It relied on the Wickard reasoning to uphold the government's marijuana ban (Gonzales v. Raich, 2005). That decision was 5-4, and one of those in the majority, Scalia, wrote a concurring opinion (he did not accept the majority's reasoning).

Upholding the health insurance “individual mandate” would require the court to further expand the reach of the commerce clause, to compel persons to *engage in commerce* if their non-engagement would have an “effect” on that commerce. Given the current composition of the Court, and Scalia's concurrent opinion in *Gonzales*, which allowed that decision to squeak by, the Court is most unlikely to expand the *Wickard* doctrine any further.

That overreaching might well motivate the Court to re-examine the entire *Wickard* line of reasoning. (“If Wickard allows the government to force people to buy health insurance, what prevents it from forcing them to buy, say, automobiles if the auto industry is in trouble, or to buy broccoli if broccoli farmers are in trouble?”).

*Wickard* was a contrived, ahistorical, and idiotic ruling. Perhaps this “individual mandate” proposal will lead the Court to realize how bad it was.
gmorton on January 25 at 5:27 p.m.
BTW, minumum wage laws (and other provisions of the FLSA) apply to firms earning more than $500,000 per year (which are presumed to be engaged in interstate commerce) or which produce goods for interstate commerce. Since citizens *per se* are not engaged in commerce at all, the FLSA will supply no precedent for the “individual mandate.” The Court will have to expand the Wickard/Gonzales reasoning.
gmorton on January 25 at 5:51 p.m.
“You really don't get it, do you? What we're talking about here is the 'free lunch' of someone without health insurance foisting the unrecovered cost for their care off on others.”

Jeffrey, you are trying your best to avoid the obvious, but it is unavoidable. The person without health insurance is not “foisting” anything upon anyone. The government is foisting that cost off on you, by choosing to pay his bills. Or the hospital is, by choosing to treat him without payment, and then trying to recover those costs from you – probably because the gummint demands that it do so.

You need to face who exactly is responsible for the “foisting,” Jeffrey.
gmorton on January 25 at 5:59 p.m.
Jeffrey_Grey wrote,

“And it's an equally popular rationalization among anarchists to assert that any regulation of freedoms - no matter how reasonable or necessary - leads inevitably to unrestrained tyranny.”

Now, Jeffrey, that is another straw man. Even most anarchists would agree that a regulation which restricts your freedom to violate others' rights is not only acceptable, but necessary. Your freedom does not include the freedom to enslave others, maim or murder them, or steal or destroy their property.

You, however, wish to further restrict freedoms “reasonable and necessary” to secure a free lunch for yourself. And that is, indeed, tyranny.
gmorton on January 25 at 6:09 p.m.
Gary Crooks wrote,

“Must be someone who has tried — and failed — with that.”

Yes indeed. The Court upheld Social Security in 1937, in response to FDR's court-packing scheme (Helvering v. Davis, one of the “Dirty Dozen”). Discussion here:

http://www.lewrockwell.com/orig3/atta…
gmorton on January 25 at 6:16 p.m.
Should read,

“You, however, wish to further restrict freedoms *as* 'reasonable and necessary' to secure a free lunch for yourself.”
richard on January 25 at 9:06 p.m.
Jeff … I think it has all been said, but this all comes down to personal responsibility vs. looking for a “free lunch.”

The differences between auto and health insurance are clear and cogent: you will never be forced to purchase auto insurance because you always have other options. That does not seem to be the case with health insurance.

Quite simply, you wish to force others to buy something they have concluded is not necessary or desired - and WHICH CAUSES NO HARM AT ALL TO YOU OR ANYONE ELSE - for the simple fact that this will lower the costs for YOU.

That is called “entitlement” thinking.
spokelooneh on January 25 at 9:11 p.m.
Correct me if I'm wrong, but I don't recall the DMV requiring a person to submit evidence of liability insurance or financial responsibility in order for them to issue you a Drivers' License. Perhaps you have to swear or affirm that you do, or will, obtain such if you operate a motor vehicle on the public highways. And if stopped by a LEO for any reason, you will be required to show compliance with the financial responsibility law, if you don't, you will be charged with disregarding the law and compelled to answer that charge in a court of law.

Another scenario: Let's say you're a truck driver, don't own a vehicle, and never drive on the public roads except for your job, to which you commute to via public trans or rides from friends, or walk. You shouldn't have to procure auto insurance, as your employer is the one on the hook if your actions in a collision are deemed negligent or purposeful in causing harm to another person, right?

“Gary Crooks on January 22 at 3:22 p.m.

Here is a link that has an oped saying it's unconstitutional and some rebuttals.

http://lawprofessors.typepad.com/conl…

It would be an interesting case,
***but it's not as simple as has been discussed here.***

Now THERE'S an UNDERSTATEMENT!
spokelooneh on January 25 at 9:24 p.m.
While I can see the benefit of the individual insurance mandate in that it would likely shift costs from the most expensive place to receive health care, the ER, to clinics and doctors' offices, I can also appreciate the arguments against it, and I sure as hell don't see the current SCOTUS upholding such a mandate.

“More insurance means higher costs, because the 3rd-party payer fiasco is expanded. You are increasing demand without a cost constraint. There is no limit to the tests and procedures docs will order, or that patients will demand, or that providers will charge for them, regardless how low the cost/benefit ratio is, as long as someone else is paying for them. And anything you try to mitigate that price pressure, such as mandating coverages, delivering more free lunches, etc., will only perpetuate the problem.”
-gmorton

Except that your conclusion is not universal, in that we have numerous examples where certain health care providers/systems, though billing 3rd parties, have greatly reduced costs and better outcomes, than other providers/systems which are also billing 3rd parties.

So it's not the existence of 3rd party payers, per se, that is causing the rapidly increasing health care costs. It MAY be a contributor to the problem, but it's certainly not the ONLY contributor, nor has it been shown to be the DRIVING contributor.
gmorton on January 26 at 12:05 a.m.
Spokalooneh wrote,

“You shouldn't have to procure auto insurance, as your employer is the one on the hook if your actions in a collision are deemed negligent or purposeful in causing harm to another person, right?

The State doesn't care who buys the insurance as long as it covers the vehicle you are driving while you are driving it on State roadways.
gmorton on January 26 at 12:15 a.m.
Spokalooneh wrote,

“Except that your conclusion is not universal, in that we have numerous examples where certain health care providers/systems, though billing 3rd parties, have greatly reduced costs and better outcomes, than other providers/systems which are also billing 3rd parties.”

HMOs and similar integrated health care systems can reduce costs somewhat, via internal controls. But their costs per covered patient have grown only slightly less rapidly over the last 50 years than other forms of care delivery.

You won't see a flattening of the cost curve in health care, much less a decline, until a majority of payments are paid out-of-pocket (until they are priced in the market).

Or, of course, until government creates a single-payer system which will control costs by fiat (rationing).
spokelooneh on January 26 at 12:46 a.m.
“HMOs and similar integrated health care systems can reduce costs somewhat, via internal controls. But their costs per covered patient have grown only slightly less rapidly over the last 50 years than other forms of care delivery.”
-gmorton

You are wrongly minimizing the giant differences in costs such as in this example:

“McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost *twice the national average.*
…
Yet public-health statistics show that cardiovascular-disease rates in the county are actually lower than average, probably because its smoking rates are quite low. Rates of asthma, H.I.V., infant mortality, cancer, and injury are lower, too. El Paso County, eight hundred miles up the border, has essentially the same demographics. Both counties have a population of roughly seven hundred thousand, similar public-health statistics, and similar percentages of non-English speakers, illegal immigrants, and the unemployed. Yet in 2006 Medicare expenditures (our best approximation of over-all spending patterns) in El Paso were *$7,504 per enrollee—half as much as in McAllen.* An unhealthy population couldn’t possibly be the reason that McAllen’s health-care costs are so high.

http://www.newyorker.com/reporting/20…

The differences in health care costs among different systems are not minor as you suggest, gmorton, and are in fact quite significant. And 3rd party payers are deeply involved in any of these systems, one with much lower costs, and one with much higher costs.
gmorton on January 26 at 1:26 a.m.
Looneh,

Try comparing average HMO rates with average rates for fee-for-service (usually PPO) coverage. HMO rates run about 72% of PPO rates nationally, but PPOs score higher on customer satisfaction. The difference between them pales in comparison to the rates of increase in both since WWII.

http://www.allbusiness.com/health-car…

You miss the forest for the trees when you focus on the extremes of a distribution, Looneh.
spokelooneh on January 26 at 2:20 a.m.
“but PPOs score higher on customer satisfaction”
-gmorton

Oh? Really?

From YOUR link:
“Overall satisfaction scores were similar for HMO and PPO enrollees.”

You seem to be (big surprise) trying to change to the subject, and utterly failing in that attempt.

There ARE huge cost differences between various healthcare systems/providers. Yet 3rd party payers are involved in such systems.

You've provided NO data to support your assertion that health care costs will be reduced or contained by eliminating 3rd party payors. NONE whatsoever. Just repeating your typical dogma, with NO basis in fact or evidence.
Jeffrey_Grey on January 26 at 3:33 a.m.
No, gm - it's you who is beating your head against the painfully obvious.

– The person without health insurance is not “foisting” anything upon anyone. –

Of course they most certainly are.

If they can't pay for their own medical care - and nowadays, for the really 'big ticket' items, unless you're Bill Gates the only way to pay without wiping yourself out financially is via insurance - then those costs go unrecovered. Simple fact.

*In the real world* the only way the health care provider can deal with those unrecovered costs is to either absorb them and take the financial loss themselves, or pass them along to other consumers in the form of higher prices. Same with government funded health care initiatives. Finite resources must be allocated to cover demand. Simple fact.

Therefore it's not 'the EVIL Totalitarian State' that's creating some new chains to bind you and thus crush your freedom.

It's simple, real-world economics.

Everybody not pedaling an absurd-ist social philosophy gets that.
gmorton on January 26 at 4:20 a.m.
Spokalooneh wrote,

“From YOUR link:
'Overall satisfaction scores were similar for HMO and PPO enrollees.'”

Eeek, I missed that line. Looked only at the comparative Blue Cross HMO/PPO comparison.

Your point.

“There ARE huge cost differences between various healthcare systems/providers. Yet 3rd party payers are involved in such systems.”

The differences *among* providers are trivial compared to the increases incurred over the last 50 years for *all* providers. The *mean difference* (as opposed to the range) is even less significant.

“You've provided NO data to support your assertion that health care costs will be reduced or contained by eliminating 3rd party payors.”

Given that nearly all health care in the US today is paid for by third parties, about the only way to estimate the effects is to compare with those few procedures and subspecialties which are generally not covered by insurance, e.g., cosmetic surgery. See this:

http://www.ncpa.org/pdfs/st318.pdf

You can also compare to cost trends in related fields, such as veterinary care and dentistry, which are still largely paid for out-of-pocket. I've seen those, but not gonna look for them now. You can also note that the trend in health care costs almost exactly mirrors, inversely, the decline in the portion paid out-of-pocket.

Moreover, you can approach the question from “common sense”: What do you suppose would happen to the price of bagels if everyone had “bakery insurance,” paid for by their employers, which allowed them to obtain as many bagels, cakes, pies, eclairs, and donuts annually as they desired?
gmorton on January 26 at 4:28 a.m.
Jeffrey_Grey wrote,

“If they can't pay for their own medical care - and nowadays, for the really 'big ticket' items, unless you're Bill Gates the only way to pay without wiping yourself out financially is via insurance - then those costs go unrecovered. Simple fact.”

Er, no. If they can't pay for their care, and no charity steps forward to pay for it, then there are no costs because no treatment is delivered. Some providers may choose to provide treatment and absorb the costs. Others may try to pass it along to other patients, but since those providers have to compete in the market, that will be self-limiting.
gmorton on January 26 at 4:34 a.m.
BTW, Jeffrey, “major medical” coverage is not what is killing the system. If everyone had insurance which only kicked in after $10,000 in expenses had been incurred costs would fall quickly.
Jeffrey_Grey on January 26 at 5:58 a.m.
– …then there are no costs because no treatment is delivered.–

Absolutely, utterly FALSE!!

– Our office estimates that by 2011, Washington state's cost of uncompensated care — i.e. charity care and bad debt — will surpass $1 billion a year. –

http://www.insurance.wa.gov/consumers…

Once again, the FACTS of the real world simply refuse to conform to your Utopian dogma.
Jeffrey_Grey on January 26 at 6:10 a.m.
– If everyone had insurance which only kicked in after $10,000 in expenses had been incurred costs would fall quickly.–

**boggle**

Okay, first off: your proof of this assertion?

Second: I would be *THRILLED* to be allowed to invest in such insurance. *Please* tell me where I can sign up. I assure you that I have most-dilligently searched high and low for such insurance for the past six years at the very least. **It doesn't exist.** At least not for me.

The reason it doesn't exist is because insurance companies don't offer it. At least not to me. They apparently have decided in their discretion that to offer it to me wouldn't be a good business decision. So how is that decision to be changed? (That is; if we want me to have such insurance and thus be both responsible for my own expenses and at the same time lower the cost of care and insurance for everyone else.) Please, tell me gmorton.

Part of their decision is evidently based on the fact that the risk is too great for the current pool of insurance premium payers to support. The only way for that pool to increase is for more people to buy insurance. But the currently uninsured can't buy insurance because like me there is no insurance available. Either that, or for whatever other reason, they have also decided against buying insurance. How will that decision be changed? Please, tell me gmorton.

Are we wait for the Utopian fundamental premise of 'everybody will always do what's best and make the wisest decision' to kick in?

If that is going to happen, what's taking so long?
gmorton on January 26 at 2:24 p.m.
Jeffrey_Grey wrote,

“– Our office estimates that by 2011, Washington state's cost of uncompensated care — i.e. charity care and bad debt — will surpass $1 billion a year. –”

That's an analog to the iconic case of the kid who shot his parents, then pleaded for leniency because he was an orphan.

It is hypocritical for the State to complain of the cost of “uncompensated care” when it is commanding the delivery of that care. E.g., per EMTALA and WAC 246-320-116:

“Specialty hospitals must:

… .

(6) Participate in the medicare and medicaid programs and provide at least the same percentage of services to medicare and medicaid beneficiaries, as a percent of gross revenues, as the lowest percentage of services provided to medicare and medicaid beneficiaries by a general hospital in the same health service area. The lowest percentage of services provided to medicare and medicaid beneficiaries shall be determined by the department in consultation with the general hospitals in the health service area but shall not be the percentage of medicare and medicaid services of a hospital that serves primarily members of a particular health plan or government sponsor;

(7) Provide at least the same percentage of charity care, as a percent of gross revenues, as the lowest percentage of charity care provided by a general hospital in the same health service area. The lowest percentage of charity care shall be determined by the department in consultation with the general hospitals in the health service area but shall not be the percentage of charity care of a hospital that serves primarily members of a particular health plan or government sponsor … ”

And when the State thwarts competition among hospitals by requiring “certificates of need,” thereby insuring that facilities which, because they are run by charitable organizations or governments, provide much uncompensated care, have no competition in the market.

Most health care providers will provide some uncompensated care. How much is optimal can only be decided in a free market.
gmorton on January 26 at 2:41 p.m.
Jeffrey_Grey wrote,

“But the currently uninsured can't buy insurance because like me there is no insurance available.”

That is false, Jeffrey. Most of the uninsured are financially well able to afford insurance, and have no “uninsurable” conditions. They are uninsured by choice. We've covered this previously.

“Part of their decision is evidently based on the fact that the risk is too great for the current pool of insurance premium payers to support.”

It is due to state laws which bar them from excluding pre-existing conditions, or charging premiums sufficient to cover the expected costs. In a free market you would certainly find a carrier willing to cover you, but probably not one who would pass the additional costs of your coverage to other policy holders, since those customers would soon switch to another carrier. And if no existing carrier offered a policy which met your needs, nothing would prevent you from forming an insurance co-op with others in your risk category. You would not, however, be able to shift the costs of your care to others with lower risks.
Jeffrey_Grey on January 26 at 5:35 p.m.
Ad hominem attacks on the facts you can't dispute. Airy dogma and meaningless rhetoric.

– Most health care providers will provide some uncompensated care. How much is optimal can only be decided in a free market.–

The 'free market' should decide the optimal number of people who can get sick and thus regulate the need for service? It's like Homer Simpson's donuts. 'Ooo! Is there anything the free market can't do?'

And when the real world once again fails to conform to fringe dogma and the demand for services refuses to be guided by the laws of supply and demand, the State nevertheless insists that care be provided? How dare it!! Don't those sick and injured people know that if they can't afford medical care it's their DUTY as liberty-loving Americans to die quietly at home? (Talk about your 'death panels'!)

Turn that $1 billion/year short-fall over to charity.

Laughable but for the harm your utterly unworkable Utopian fantasy stands to do as a distraction from the search for genuine solutions.
Arch_Druid on January 27 at 12:13 a.m.
GMorton, first of all, don't abruptly foist onto others your contentions when you are challenged on them. I keep track of what gets posted and read Grey's VERY thoroughly.

AREN'T you the guy who decided that instead of public land ALL land should be privately owned? And that ANY rancher should simply work out how he will run his cattle on someone else's property?

You get challenged on all of this and abruptly you do a 180.

A hotel or motel is a BUSINESS deal. You purchase a room for a night. Because of the purchase you made you can assume TEMPORARY ownership of the property. In which case, Morton the hotel's or motel's owner in his BUSINESS deal with yourself isn't “granting permission” for your use of the room, but rather making a profit by SELLING it.

Now, for this matter of theft and coercion, if you own the home and a robber tries breaking in to steal your valuables, that is in fact theft. Coercion involves even though the first amendment gives you specific freedoms, there are special interest groups who wish to turn to gvt in order to deny them to you. Is it only “coercion” if YOUR ox is gored?

Finally, “enslavement.” Only if you are put on an auction block, GMorton, and bought for a price, THEN you are enslaved. But of course, you couldn't sit at your computer and post a bunch of balderdash either.
gmorton on January 27 at 12:14 a.m.
Jeffrey_Grey wrote,

“Ad hominem attacks on the facts you can't dispute.”

“ad hom attacks on the facts”? How does one wage an ad hom attack on a fact? Will logic texts have to add a new subchapter?

“The 'free market' should decide the optimal number of people who can get sick and thus regulate the need for service?”

No, Jeffrey, the market cannot decide “the optimal number of people who can get sick.” That is not an economic matter. What is an economic matter is how resources are allocated to that problem, given the other demands on those resources. The latter is what markets decide.

Let me refresh your memory regarding what is a “free market.” A *free market* is an aspect of a free society. A *free society* is one in which each individual is free to enter any desired relationship with any other willing individual, on any mutually agreeable terms, without interference from third parties. Insofar as those criteria are satisfied with respect to economic relationships, you have a “free market.”

So with regard to allocation of health care resources, you have two choices: either each person is free to allocate his/her own resources to that problem as he/she sees fit, or some third party allocates other people's resources, contrary to the wishes of their owners. I.e., some people are masters, others servants.

Hope this clears things up.
Arch_Druid on January 27 at 12:31 a.m.
Actually, GMorton, MARKETS operate regardless of the type of society or the type of gvt. A “free” market is a fiction. And you just did a major rebuttal of the “market.” Presumably, if the market is the first responder as to the allocation of resources, then there should be absolutely no limit as to what the market can provide.

The very fact that you do resort to declaring an allocation of resources, advises that there are such limits.

But that limit is a two way street. The market can't sell me much needed medicine for COPD if I can't afford to buy it nor can I afford the insurance. The market doesn't provide an affordable doctor. Only if that doctor, Morton CHOOSES to engage in charitable contributions, then and only then does he become affordable. The market does not provide an affordable clinic or hospital. Unless the clinic or hospital receives some kind of gvt subsidies in order to operate at a much lower cost.

So, who should then receive this limited amount of resources? Those with the wealth who can stand in line? The poor because they might be recipients of a “free lunch” can be denied? There is but one consistency in any of your arguments, Morton, the lack of morality.
gmorton on January 27 at 12:31 a.m.
Arch_druid wrote,

“GMorton, first of all, don't abruptly foist onto others your contentions when you are challenged on them.”

Hmmm. Can you cite an example of my doing that?

“AREN'T you the guy who decided that instead of public land ALL land should be privately owned?”

Nope. Never made any such argument. I did suggest that most BLM rangeland should be sold. But that is not “all land.”

“Because of the purchase you made you can assume TEMPORARY ownership of the property. In which case, Morton the hotel's or motel's owner in his BUSINESS deal with yourself isn't “granting permission” for your use of the room, but rather making a profit by SELLING it.”

I have no idea how this relates to the topic at hand, but in any case you're mistaken. You do not have a “temporary ownership.” You have a temporary *occupancy*. You might google for those terms, or buy a used econ or real estate law text at Auntie's and brush up on “occupancies,” “estates,” and “titles.”

“Coercion involves even though the first amendment gives you specific freedoms, there are special interest groups who wish to turn to gvt in order to deny them to you. Is it only “coercion” if YOUR ox is gored?”

I'm not at all sure what your point there might be, but (insofar as I understand your question) the answer is “No.” It would be coercion regardless who the victim is.
Arch_Druid on January 27 at 12:37 a.m.
GMorton, here you go nitpicking again. Ownership and occupancy is a distinction without a difference. You can hardly LEGALLY occupy a hotel room unless you have PAID for it. And therefore, it is available for your use.

Now, you want other people to read your posts more carefully? Try reading your own more carefully. And then try backing up what you say. Which to date, you have extreme difficulty even doing that. LOL!
gmorton on January 27 at 1:20 a.m.
Arch_druid wrote,

“A “free” market is a fiction.”

Ah. Are you lamenting or rejoicing that state of affairs? It is false, of course. Free markets are certainly scarce, given the endless demands of free lunchers to subvert them and the endless quests of power-hungry pols to pander to those demands, but they have existed and do exist.

But if it were a “fiction,” don't you think it desirable to make it real? Or do you prefer unfree markets, wherein bureaucrats are empowered to command your time and other resources? I.e., a slave economy?

“Presumably, if the market is the first responder as to the allocation of resources, then there should be absolutely no limit as to what the market can provide.”

Well, Arch, that is a howling *non sequitur*. I have no idea how you've arrived at that conclusion. There is no connection between the two parts of your claim.

“So, who should then receive this limited amount of resources?”

In a free market, Arch, whoever you decide should receive them, with respect to your own resources. And every other person is similarly free to make those decisions with respect to their resources. Clear enough?
gmorton on January 27 at 1:24 a.m.
Arch_druid wrote,

“Ownership and occupancy is a distinction without a difference.”

You're just digging yourself in deeper. Go to Aunties, buy some books.
Arch_Druid on January 27 at 1:32 a.m.
No GMorton, you are refuting the marketplace. I have a business. To make a profit, “I don't” decide who should receive what. The person who comes to my business seeking a particular product, IF I have that product, they will look at the condition of it and being satisfied will then buy it. If I DON'T have it, then they will turn to the competitor and see if that person has what they seek instead.

If I am not fully informative on the product I have to sell, then I can conceivably frustrate my would be customer, who will then turn to another business for the product, service, information that they need. My CUSTOMERS inform me what I should stock as to products. My CUSTOMERS let me know they would probably give me business IF I had this or that.

Your argument is, that the “marketplace” replaces the gvt in determining who has a right to this, where in fact these resources *should go* when in fact, Morton, the only business of the marketplace is for supply to meet demand. Only gvts Morton, allocate resources and decides who gets what.
Arch_Druid on January 27 at 1:36 a.m.
And by the way, nice “dig” in trying to label me ignorant. GMorton, half the time you don't even understand the basic principles about the market. Let alone anything else about this society.
gmorton on January 27 at 1:55 a.m.
Arch_druid wrote,

[1] “The person who comes to my business seeking a particular product, IF I have that product, they will look at the condition of it and being satisfied will then buy it.”

Then,

[2] “Only gvts Morton, allocate resources and decides who gets what.”

[2] contradicts [1], Arch.

Did the government make the decision in [1]? Your customer allocated some of her resources to you. Are you arguing that gummint should have made that decision for her? Perhaps dictating that she should buy some other product instead, or buy it from someone else, or perhaps seize her money and hand it over to someone whose votes it needs in the next election?
Jeffrey_Grey on January 27 at 6:02 a.m.
gmorton,

I assure you that when your only concrete solution to the problem was the patently ridiculous, 'Let charity handle it' - with respect to you and your ideas, the only thing that really mattered in the real world became *crystal* clear.

And as for:

– So with regard to allocation of health care resources, you have two choices: either each person is free to allocate his/her own resources to that problem as he/she sees fit, or some third party allocates other people's resources… [etc, etc, yatta-yatta-yatta]. –

Which might be workable in other circumstance. But you keep forgetting that here in the real world, there's a further complicating factor:

What happens when your 'free person' simply doesn't have the resources to allocate?

'Go home, die quietly and dutifully sacrifice yourself on the altar of my Utopian ideal'? 'Let charity handle the $1 billion/year load here in WA'?
spoketucky on January 27 at 9:38 a.m.
gmorton reminds me of almost every retired military member who decides to return to college after completing 20 plus years of service who has taken a political science and logic course and is now armed for everything and anything that might come along. I've seen droves of them in my decades of teaching.
Gary Crooks on January 27 at 10:28 a.m.
<<Quite simply, you wish to force others to buy something they have concluded is not necessary or desired - and WHICH CAUSES NO HARM AT ALL TO YOU OR ANYONE ELSE - for the simple fact that this will lower the costs for YOU.

That is called “entitlement” thinking. >>

Medicare is financed this way. You don't have the option of saying, “I don't want to spend part of my salary on that. I'll cover my own health care.”

And you've said you don't want to repeal Medicare. So how to finance it such that it doesn't fall victim to “entitlement thinking” or remain a health care coverage mandate?

Also, why doesn't the spreading of costs to others constitute harm?
Arch_Druid on January 27 at 11:37 a.m.
GMorton keeps wanting to create a “socialist state” to be afraid of. And you never know, he might get what he wishes for. On the other hand, GMorton wants to keep confusing health care with the marketplace.

I don't have the resources to by a 50” LCD 1080p flat screen TV. News flash here: since flat screen TVS had come out in the early 2000s, where even the smallest was near a thousand bucks to buy, NOW the most spendy TVs at over a thousand ARE those at 50” with all the bells and whistles PLUS being name brand. However, the smaller ones can now run in the lower hundreds. Overabundance? People who now have all the TVS they need can quit buying them? Or like myself, don't have the resources to pay a hefty price for a nice TV and that the lack of demand drives down the price of the product. THAT'S the marketplace.

But, for everyone who does not buy insurance, who does not get prescription medication, who does not go to a doctor—because of a lack of financial resources, DOES a lack of demand drive down the cost of insurance? No. WOULD it encourage health insurance companies to attach more bells and whistles to their products in order to encourage more people to buy their product? No. Would a doctor or dentist “reduce costs” in order to encourage more people to visit their office? No. Would Pharm companies “reduce costs” on medicines to encourage people to take them? No. Unless and until the gvt forced them to do it.

There are exceptions, without a doubt. And those exceptions have been discussed on the news.

But here in this country, for GMorton's information in particular, IF he wanted to apply marketplace rules to health care, actually health care doesn't comply with market place rules of supply and demand. Never has and never will. That is why, health care has nothing to do with the marketplace.
gmorton on January 27 at 3:06 p.m.
Arch_druid wrote,

“DOES a lack of demand drive down the cost of insurance?”

Yes, but as with all other goods, it will only drive them down to the extent:

1) There is competition in the marketplace, and

2) Prices don't fall below costs. When that happens, the price cannot fall any further, and if customers are unwilling to pay that price, the insurer goes out of business.

Throughout this health care debate (both on this blog and nationally) there has been a misguided focus on the cost of insurance, primarily due to efforts by the Left to blame the problem on “corporate greed” and insurance company “profiteering.” But the cost of insurance is only a secondary effect, as I think most of the “regulars” here now acknowledge. The culprit is the cost of care. As those costs rise, then the costs of insurance must also rise. Profits in the insurance industry average around 5% – less than most other industries, and rates of non-profit insurers, such as the Blues, are not appreciably lower than those of for-profits. Get the costs of care down and the cost of insurance will follow.

“Would a doctor or dentist “reduce costs” in order to encourage more people to visit their office?”

Not if the non-patients make up only 10% of the market, and they can charge what they please to the other 90% who are insured. They will only reduce costs – by reducing referrals, ordering fewer tests, prescribing generic or other low cost drugs, investing less in expensive equipment with marginal diagnostic value, and cease freely raising employee (and their own) salaries when patients begin to become cost-conscious. I.e., when patients begin to ask, “How much good is that $300 test gonna do?,” and when they begin to compare the prices they are asked to pay with what others are paying. As long as someone else is paying the bill, the patient will not be asking those questions.

“… actually health care doesn't comply with market place rules of supply and demand.”

Sorry, Arch, but whenever you have one or more persons able to supply a given good or service, and one or more consumers who desire that good or service, then you have a market, and “market rules” (the laws of economics) apply. And they most certainly – and obviously – are at work in the health care market. They predict that if demand is unchecked by price, because the demanders are not paying those prices, then prices will rise inexorably. And that is exactly what you are seeing.
Arch_Druid on January 27 at 9:09 p.m.
I'd have to disagree that there are market rules in health care, GMorton. Let us remind you that people who can afford to leave the U.S. for countries that produce basic but cheaper care, does not produce a “competition” within a U.S. Health Care “market,” to reduce the cost of insurance, or the cost of tests, the costs of medicine, the costs of surgery and etc. For everyone else who CAN NOT leave the country for “more affordable care,” the costs of health care continues to be prohibitive.

That's because, GMorton, it is run on a monopolistic instead of a competitive basis. Oh yeah, you can go to a local Immediate Care Center, or you can go to some local General Hospital, you can visit Dr John Doe general practitioner vs Dr. Smith general practitioner. You could even visit various specialists. BUT Morton, it would do you much good to remember to read news magazines that discuss how these doctors set up fees and etc. and that they aren't going to differ much from one office to another, from one clinic to another, or even one hospital to another. For that reason alone, competition does not exist.

And while you may look at your leisure at various health and life insurance ads, they MAY promise lower costs, they MAY offer only the coverage you desire, BUT what is the catch? You don't get competition on over all health care. You are more likely to get better competition when it comes to your car insurance. And there is only one reason, GMorton, health care is a necessity, not a luxury.
richard on January 27 at 9:16 p.m.
Good questions Gary. I thought I had answered them before - but maybe not.

The first time you asked the question you posed in this way; as I recall: Would you prefer to repeal Medicare.

My answer is quite practical; a bill of this magnitude and which has been in place for so long should have been defeated at the inception; but it wasn't.

To do so now would be just too disruptive to the economy, to the lives of those who now rely on it, and to those who have paid into it for decades but not yet become a recipient.

In addition, I am far less philosophically opposed to providing an entitlement to those who have done their work for their family, themselves and the economy. Some can call my stance contraditory - I call it nuanced.

i just believe that society - if it owes anything to any specific group or groups of people - it is the elderly and the children. (I know, call me a softy).

The presumption is that children have a parent or parents to care for them - and they have a future. The elderly don't have either. AND, they - in contrast to other groups who are given entitlements - have earned it. Theoretically they have paid into it through decades of work.

In contrast to younger segments of society, they do not have the time or strength to make changes to their lives in order to afford the high costs of medical care - especially when they are at the age when there are more medical problems.

The younger population do have the time and the strength and the potential to make positive steps to finance their own way. And those who are unable due to physical or mental disabilities would also be covered by the safety nets in society.

Every race and nationality, every political persuasion, both sexes … everyone becomes old (if they are fortunate) so protecting the elderly should not be a devisive thing as every group is included.

Of course the devil is always in the details - but you didn't ask about those.
gmorton on January 28 at 1:34 a.m.
Arch_druid wrote,

“BUT Morton, it would do you much good to remember to read news magazines that discuss how these doctors set up fees and etc. and that they aren't going to differ much from one office to another, from one clinic to another, or even one hospital to another.”

That's correct. Most of them will be charging something close to the market-clearing price. But what is market-clearing in the current market is what insurance companies and the government will pay (and what they will pay for), rather than what patients will pay. As long as most patients have a third party paying their bills, thats where the pricing will be targeted. And costs will continue to rise.
gmorton on January 28 at 1:38 a.m.
Arch_druid wrote,

“GMorton, health care is a necessity, not a luxury.”

So is food, so is housing. But the costs of both have declined steadily, as percentages of median income, since 1900, while quality, quantity, and variety have increased.
Arch_Druid on January 28 at 8:43 a.m.
Then I guess GMorton that market rules didn't exactly apply to housing since speculation and etc. in real estate caused a massive bubble before it finally burst with catastrophic results. And I will have to disagree with you about the costs of food as well. The cost of food has INCREASED from the 1960s even as quantity has diversified. And given the various food born illnesses, the QUALITY of food has deteriorated.

If the patient is indigent, then the burden of the costs of health care goes to the taxpayers. And I know of no one in any industry who would not try to recoup their losses or investments by setting a price that they expect their “customers” to pay for the products and services. Only in durable goods, GMorton would the price decline steadily if demand is light and there is an overabundance of the product. Not so in the health care professions. So in your case, when ever you try to set market rules and forces, you compare apples and oranges. No a house is not a necessity if people prefer to rent or own a trailer instead.
Jeffrey_Grey on January 28 at 10:12 a.m.
It continually strikes me as odd that on the one hand, it is asserted that the answer to all this nation's ills is to just let folks make all their own decisions, on the assumption that they will always make the best decisions because they know what's best for themselves…

… While on the hand arguing that the problems are caused by so many of those same people are all standing around with their hands out gobbling down free lunches. And who are apparently too stupid to figure out that if they let someone else pay their insurance premiums, their costs will go up. (Assuming there actually is a cause and effect relationship between 3rd party payers and costs.)

I guess it's the same problem that ultimately frustrates every Utopia. The perfect society could indeed be perfect!

…if it weren't for all the imperfect people living in it who keep screwing it up.
Jeffrey_Grey on January 28 at 10:14 a.m.
If I were to re-write that sentence in English, it would read:

“… While on the other hand arguing that the problems are caused by so many of those same people all standing around with their hands out, waiting to gobble down free lunches.”
Gary Crooks on January 28 at 10:21 a.m.
Thoughtful response, Richard. Before I get to that, I was asking those questions in the context of a healh care mandate being unconstitutional.

Would it be disruptive to overturn Medicare at this point? You bet. And thanks for pointing out the reality that theorists zoom past

But if a mandate that says you must buy insurance or be penalized were to be deemed unconstitutional, how could the Supremes carve out an exception for Medicare?

Disruptive isn't a legal argument grounded in the Constitution. Neither is “old people are special.” Or, “we've always done it that way.” And sometimes disruptions are positive. Like ending slavery.

The only contradiction I was alluding to is that. One mandate is fine. The other isn't.

That aside, would you be for universal coverage for children? They cannot improve their circumstance until they are adults. And the presumption that adults can provide for them is disproven daily.

That is the struggle with entitlements. You can say old people and children are special, but how to give kids an entitlement without helping their parents? Short of taking the kids away, it's impossible.

A program like S-CHIP is aimed at kids but it helps parents you might not find deserving because it frees up their money for other things. Take away the program and kids are harmed.

Medicare also helps families that would otherwise have to pay for Grandma's care. So we aren't only aiding the elderly with Medicare. You might find that some of those adult kids are able to help their parents or grandparents and they don't. You might find that distasteful. But you don't want to end the program.
.
You mentioned a nice benefit of Medicare. It helps the elderly who are no longer in a position to improve their financial circumstances. Plus, we all get old (hopefully). But before we get old, we pay into a system that helps the elderly that come before us. We're all givers and takers in the system. (Yes, I know the exception for the chronically unemployed).

Same would be true with a mandate to buy coverage. Insurers take the premiums from the young and healthy and use them to cover the costs of older, sicker clients.

This is what happens with group insurance now.

But few people are forever the losers or winners in such a proposition. The roles change over time.

I'd rather do it this with the social insurance model (lower admin. costs), rather than edicts that you must buy private coverage. But they're both mandates.

P.S. Aren't conversations more satisfying when dumping the “isms.”? (Fascism, communism, socialism, capitalism, etc.)
gmorton on January 28 at 5:18 p.m.
Jeffrey_Grey wrote,

” …on the assumption that they will always make the best decisions because they know what's best for themselves…

“… While on the hand arguing that the problems are caused by so many of those same people all standing around with their hands out gobbling down free lunches.”

The first premise is slightly (but importantly) incorrect. There is no presumption that anyone will make the “best” decision, only that they are in the *best position* to make decisions regarding their own welfare, i.e., that no bureaucrat is in a better position.

And there is no contradiction between your two premises. It is in each person's best interest to reduce the costs *to him* of the goods he desires as much as he is able. That will include imposing them on others if that is permitted. That leads, of course, to a “tragedy of the commons” situation – it is in each person's interest to withdraw as much from the common as possible, while returning as little as possible. In short order the common is exhausted.

So you need some “side constraints” which forbid any person from shifting the costs of his needs and desires to another, without the latter's consent. That's where rights come in.

People will always attempt to do so, however, because of the “bird in the hand” problem. People heavily discount the future. A free lunch is consumed today; the “tragedy” occurs in the indefinite future. So today''s free lunch wins.
gmorton on January 28 at 5:45 p.m.
“But if a mandate that says you must buy insurance or be penalized were to be deemed unconstitutional, how could the Supremes carve out an exception for Medicare?”

Medicare is a tax. Per US v. Butler and Helvering v. Davis, the Congress may impose taxes to “provide for the general welfare.”

http://www.law.cornell.edu/supct/html…

http://www.law.cornell.edu/socsec/cou…

Forced payments to 3rd parties are not taxes, per Butler:

“A tax, in the general understanding of the term, and as used in the Constitution, signifies an exaction for the support of the Government. The word has never been thought to connote the expropriation of money from one group for the benefit of another.”

Also per Butler, the power of Congress to “provide for the general welfare” is tied to its power to tax. It cannot provide for the general welfare by other means. So the government would have to rely on another Constitutional power to justify the individual mandate, most likely the commerce clause. But that would require a further expansion by the Court of the scope of that power.
Jeffrey_Grey on January 28 at 6:55 p.m.
Same as always, gmorton. You're trying to rationalize something out of nothing with nothing but semantics to support the attempt.

– There is no presumption that anyone will make the “best” decision, only that they are in the *best position* to make decisions regarding their own welfare, i.e., that no bureaucrat is in a better position. –

This is an attempted distinction without any real meaning.

It doesn't matter what my position is - either relative to the problem or to some other decision maker - if I still make the wrong decision. The quality of the decision I make is all that matters - at least in practical, real-world terms. And imperfect people will make imperfect, selfish, misguided decisions. Try to rationalize that simple fact away with whatever lofty philosophical jargon ('tragedy of the commons') you like.

It doesn't change the inescapable fact.

– So you need some “side constraints” which forbid any person from shifting the costs of his needs and desires to another, without the latter's consent. That's where rights come in. –

“Side constraints”? More evasive jargon. 'Side constraints' being things like laws and regulations?

And it's not where “rights come in.” Rights don't 'come in'. Rights are either there or they aren't from the outset. But by themselves, rights are only a concept. It's the *enforcement* of rights that give them tangible value in the real world. And that requires rules and regulations and a government to enforce them.
richard on January 28 at 10:38 p.m.
I guess I didn’t realize you were asking about the constitutional question about Medicare funding. I think gmorton offered some light on that, even though I have not yet read his links.

Not being a constitutional lawyer, I don’t know all the legal answers to that, but it appears that there is an immediate difference, in that the current attempt to mandate insurance requires a citizen to purchase a product – or face sanctions. I don’t know the legal arguments against that, but I can’t think of an example when government even contemplated doing that.

Medicare, on the other hand isn’t “purchased” as a product and people are “taxed” via withholdings to pay for the program. You become a recipient by attaining a certain age.

Again, not being a legal scholar, I believe the constitutional issue would arise throught the commerce clause. What kind of precedence would that create; where the Federal government requires you to purchase a product? Would other industries not try to manipuate a similar mandate for their product … all for the “common good”?

<<The only contradiction I was alluding to is that. One mandate is fine. The other isn't.>>

I don’t see it as a contradiction; for the reasons above. It seems more than a little “edgy” to me for the federal government to be requiring citizens to purchase a particular product or service. Without using an “ism,” that is crossing a line we should avoid. It conjures up all kinds of losses-of-liberty scenarios that would, I believe, even cause you to question.

<<That aside, would you be for universal coverage for children? They cannot improve their circumstance until they are adults. And the presumption that adults can provide for them is disproven daily.>>

Absolutely not. And what would be your next suggestion; required government summer camps for all children ages 5 through 16? And are you really suggesting that government assume the responsibility for parenting children whom government has deemed “unprovided for” by their parents?

Who sets those standards? I know, a government committee!

That was an easy answer. We have had S-Chip for just a short time, and now you are proposing universal coverage? And why is it again, that you scoff whenever anyone sounds an alarm about “incrementalism”?

<<That is the struggle with entitlements. You can say old people and children are special, but how to give kids an entitlement without helping their parents? Short of taking the kids away, it's impossible.>>

I guess that is just the price you have to pay for entitlements; and why it is that there could be merit to the suggestion that S-Chip not be given to families with out strings.

Require the parents to pay something. The amount is far less important than the fact that the parent is not left out of the “loop of responsibility.” It is my experience that many parents will disengage from their responsibility equal to the rate that someone else assumes responsibility. I guess some of it is just human nature.

And if it ends up helping parents who may not be deserving, you ask? Well, there are always unintended consequences when you try to “engineer” behavior or outcomes; some that are not predictable. And that is lesson #1 about government trying to create a “perfect” society. It ain't gonna happen. We can't - and shouldn't - try to protect everyone in every situation.

I believe many of the resources put into ventures of that nature could be better spent in other ways – leaving people with more liberties and more opportunities to improve their lives, which would diminish many of the social ills you are wanting to “correct” through manipulation.

It is just a difference of worldview.
richard on January 28 at 10:50 p.m.
Jeff said -
Same as always, gmorton. You're trying to rationalize something out of nothing with nothing but semantics to support the attempt.

I saw absolutely no rationalization in gmorton's remarks. Instead, they were an insightful comment on human nature and why government “systems” often overlook that dimension.

“Systems” are often designed to “fit” human behavior into the matrix of the system; rather than designeing them around human behavior.

The former will almost always have negative unintended consequences. Look at the welfare program of the 70's. It caused horendous unintended consequences mostly because it neglected human naturewhich will often take all the free lunches that are willingly being handed out. It stifles initiative and responsibility.

And that is just one example in many.
Jeffrey_Grey on January 29 at 4:02 a.m.
Richard,

The rationalization is painfully obvious upon its face.

gmorton is pedaling a Utopian ideal that says that this country would be a wonderful place if we were all just left alone without the 'interference' of government.

The problem is those comments about human nature that you find so insightful - the fact that we're flawed and perfectly capable of making the absolute worst decisions against our best interest - is the very proof of why leaving us alone without government interference is a recipe for utter disaster. (And now watch - the rejoinder will be something like, 'Why, I never said that governmental intrusion *per se* was a bad thing! We must of course have regulation.' What goes unsaid is what will happen when someone then actually proposes any kind of regulation. That's when the howls of protest and the lengthy recitations of dogma begin.)

It is that flawed human nature that is why anarchy (which is what is really being proposed under the banner of 'everyone will be allowed to govern themselves') has NEVER worked. It CAN'T work. Unalterable human nature makes that scheme of (non-) government simply untenable.

The reason gmorton and I are constantly at logger-heads is the fact that at its core, what he is pedaling is simply not a viable solution to the myriad problems we face.

Look, you and I and gmorton can all agree that when it comes to government and governmental intrusion into our lives, 'less is more.' It's the case-by-case application of that fine principle to the real world where problems arise.

Case in point: Our health care system in this country is broken. Nobody on either side of the Great Partisan Divide who expects to be taken at all seriously disputes that fact. Furthermore, the system doesn't seem capable (or perhaps inclined) to fix itself. Yet it must be fixed. Therefore someone in authority must step in and fix it.

That is why to attempt to address the very real, tangible problems with nothing more than a constant repetition of simple (and in gmorton's case; empty and unworkable) dogma is not only NOT a solution, it's worse than nothing at all because it distracts from the discussion of solutions with the potential for actually fixing something.

Notice how to date gmorton has never yet come up with anything even remotely like a workable solution to the problem when challenged point-blank to do so. 'There is no problem and even if there is, just let charity handle it. Better that than any meaningful governmental intervention!'
gmorton on January 29 at 5:23 a.m.
Jeffrey_Grey wrote,

“… the fact that we're flawed and perfectly capable of making the absolute worst decisions against our best interest - is the very proof of why leaving us alone without government interference is a recipe for utter disaster.”

Hmmm. Who do you suppose constitutes the government, if not other humans similarly error-prone?

You seem to imputing a god-like omniscience and benevolence to government, hoping it will save you from your own “flawed” decision-making powers. But of course, it has no such exalted talents, nor such noble motives. It is only a gang of humans as “flawed” as you are, and with distinct interests and motives of their own. One of those motives, moreover, is clearly to acquire, expand, and exercise power over other people, as evidenced by their having sought out the positions they occupy and the efforts they invest in maintaining those positions.

You seem to be seeking from government the same sort of escape from responsibility humans have always sought from religion – a morally superior, paternalistic, omnipotent power who can make their decisions for them, fulfill all their desires, and spare them from suffering. But what you get is the likes of Bill Clinton, Rod Blagojevich, and George Bush.

“Why, I never said that governmental intrusion *per se* was a bad thing! We must of course have regulation.' What goes unsaid is what will happen when someone then actually proposes any kind of regulation.”

Now, Jeffrey, you're either ignoring or misrepresenting what I said. I offered a clear, definitive statement of what “kind of regulation” is acceptable – i.e., those regulations aimed at preventing or redressing violations of rights, e.g., which prohibit one person from injuring others, stealing from them or defrauding them.

“Notice how to date gmorton has never yet come up with anything even remotely like a workable solution to the problem when challenged point-blank to do so.”

Well, that is false also. I offered a “fix” early on in this discussion, and have reiterated it several times since. It was:

* Repeal the tax advantage of employer- over employee-paid health insurance.

* Repeal all laws mandating coverages insurers must offer, which dictate who they must cover and what they may charge, and where they may do business;

* Repeal all laws dictating who may offer health care services, such as licensing laws, “certificates of need,” mandated charity care (such as EMTALA, state hospital regulations, etc.).

Those changes would reduce costs substantially within a few years. But you may not deem them “workable” because they would not guarantee anyone a free lunch. If that is the criterion, of course, then there are no “workable” solutions, because free lunches are economically impossible. They are always illusory.
Jeffrey_Grey on January 29 at 6:12 a.m.
– You seem to imputing a god-like omniscience and benevolence to government, hoping it will save you from your own “flawed” decision-making powers. –

NO! I'm not. Which renders all the rest of your lecture moot. This is the counter that anarchy always presents - 'You assume perfection from the state.' BUT I DON'T.

I *fully recognize* that any government - being composed of those same flawed humans - is also flawed. It will make the same mistakes as a group that the individuals composing it make as individuals.

The difference - *and the only difference that matters* - is that a representative form of government is at least theoretically subject to oversight and control by the citizens who give it power. Now yes - those citizens are still flawed and will still make mistakes with respect to that oversight.

So in effect what you get is a flawed bunch of citizens trying to exercise control over a flawed government. Now I freely grant you that's not a very desirable state of affairs, at least not when viewed from the perspective of a mythical Utopia.

But the problem is, and the thing that makes your Utopia a fantasy is; the only thing that separates that admittedly imperfect reality of a representative form of government from your unattainable Utopian dream of 'every person his own government' is that your fantasy removes the element of the citizens even trying to exercise some control over the whole.

And since you recognize that people are imperfect, you have to admit that they need that control.

“Democracy is the worst form of government - except for all other forms.”

– Now, Jeffrey, you're either ignoring or misrepresenting what I said. I offered a clear, definitive statement of what “kind of regulation” is acceptable – i.e., those regulations aimed at preventing or redressing violations of rights, e.g., which prohibit one person from injuring others, stealing from them or defrauding them. –

Again, that's a fine generalization. The problems will invariably arise when you attempt to govern a real-world society with only generalizations. Case in point that immediately springs to mind without me even having to think about it: Abortion. Apply your generalizations to that.

As to your proposed fixes:

Show me evidence that any of those will actually produce the effects you claim for them.

In particular: – Repeal all laws mandating … who they must cover.– Already the number of people denied coverage based on pre-existing conditions is reaching crisis proportions. Their unrecouped expenses constitute a large part of the 'economically impossible free lunch' every policy holder in WA state (and elsewhere) is ALREADY PAYING. Both sides of The Great Partisan Divide readily admit this FACT. Yet you would free insurance companies to deny even more people? That fixes the problem… how?

“Let charity handle it.”
Jeffrey_Grey on January 29 at 8:54 a.m.
gmorton,

In reading the new topic over on Community Comment, I realize I glossed over one of your proposed fixes with which I do, in fact, agree.

We need to abolish the artificial limits on where a reputable insurance carrier can transact their business. The ability to fairly compete in the marketplace is one of the foundations of a free market. If the free market is expected to have a hand in solving the problem, it should have access to one of its most fundamental tools.
richard on January 29 at 8:56 a.m.
<<The difference - *and the only difference that matters* - is that a representative form of government is at least theoretically subject to oversight and control by the citizens who give it power. Now yes - those citizens are still flawed and will still make mistakes with respect to that oversight.>>

And therein lies the essence: the people have spoken at Tea Parties; at townhalls; in Virginia; in New Jersey; and, most loudly, in Mass.

And yet you still want government to go above the will of the people and do the RIGHT THING! But the “right thing” involves regulations which are contrary to human nature, violate individual rights and needlessly increases the power of this benevolent power you seem to always want to fix your problems.

Would you not agree that during 19th century and the very early part of the 20th century there was a much less intrusive fed presence in this country? And would you agree that during that time this nation flourished from nothing into a world power which gave rise to the highest standard of living in history?

And would you also agree that, despite the fact there was still poverty in this nation during that period, even those in poverty were mostly living at a higher standard than the average person around the world?

If you do, you must ask yourself what it was that unleashed that kind of flourishing social order that allowed this nation to go from nothing to superpower in just few generations.

There were, of course, many factors, not the least of which was the federal government - by today's standards, and the standards you wish to impose - was much less intrusive and omnipresent. Individuals were allowed to take the necessary risks to pursue personal dreams without some bureaucrat telling them that “Regulation 236, subsection 54 disallows you from … And furthermore, if you do not purchase private health insurance a fine of $700 will be imposed upon each year until such time that you do … ”
Arch_Druid on January 29 at 9:08 a.m.
“Richard,” I'd have no idea what you may or may not accept about your own bible, but it looks like it is chock full of regulations. Now if all those “regulations on high” prohibit human freedom as you want to put it, then I guess you must be soft on crime to go along with the rest of that “libertarian think.”

Otherwise, WITH those regulations, you do have a better standard of living. You don't suffer the consequences of individuals, institutions and etc. running amok and doing you personal tremendous harm as long as they are in fact abiding by those regulations. It is only when they are “freed” of having to abide by the law, that a guy like you can get hurt.

I'll present you with Capital One, a bank that spent better than two years screwing with my accounts in billing and payments. Then AFTER I sent the Feds after them, only THEN did they acknowledge my complaints, by declaring that they upheld their current practices (of screwing with my billing/payments). A bank that doesn't think that it has to comply with the law, does some serious damage. “Richard,” that extreme “libertarianism” is okay on paper until such a time as you find what doesn't work about it in practice.
Arch_Druid on January 29 at 9:34 a.m.
And I go along with Jeff's assessment. The reason I brought out the perpetual motion machine in a now long ago thread for both “Richard's” and GMorton's benefit, is that the THEORY of the machine was that perfectly balanced wheel sitting on top of the machine that after you gave the wheel a gentle shove, then the wheel would begin rotating into perpetuity… In short, a machine manufactured without flaw. But in fact, ANYTHING made by man is inherently flawed. Therefore, MAN is inherently flawed. And flawed man isn't going to always act in his or her own best interests. And without rules, flawed man will in fact create an anarchic society. He won't “govern” himself. But even an anarchic society will be short-lived as people seek out leaders, rules, some form of gvt to rally around. Exactly what FORM of government, could be one that rules by force to one that is more democratic in nature. People by nature, could not live without seeking authority to rule over them.

I will refer both GMorton and “Richard,” to 1 Samuel. Ref: Tanakh.
Jeffrey_Grey on January 29 at 10:37 a.m.
Richard,

The people who spoke “most loudly” in Mass. did so with Brown's solemn assurance that his election would in no way jeopardize their universal health care insurance.

This is why the folks who point to Mass as the populist voice shouting out a resounding renunciation of health care reform just show me how little they understand.

And Richard, as for those glory days of yore when everything was unregulated and shining free… Read Upton Sinclair's “The Jungle” and then we'll talk again.

Now please try to understand this: **I agree with you that too much regulation and too much governmental intrusion into our lives is a very bad thing.** As a result, I'm truly jealous of my liberties and suspicious of the government bureaucrat who would seek to infringe upon them *for no good reason.* I really and truly am.

See, Richard - this is what gets me the most. Sure, I've made the point that people can be counted on to make bad decisions that are horrifically contrary to their best interests. That's just too obvious a fact to be disputed by anyone who's speaking honestly. But as dumb as people can be, *just how dumb do you think we really are?* Do you think I sit here with large, starving-orphan eyes, yearning in desperate hope for some bureaucrat to come along and beat me about the head and shoulders again?

Do you think back in those glory days of yore, people demanded the government step in and regulate things because everything was wonderful and nobody had any problems? That back then they were all standing around with large, starving orphan eyes of their own, perfectly content with their lives yet desperately waiting for the government to come along and take it all away from them?

This is the foundation of that same blindingly obvious rationalization you apparently can't see every time gmorton spoons up another helping. “We're so gullible and spineless and eager to be enslaved that the only answer is to cast ourselves entirely upon our own decision-making.”

If you can't see the stupefying-ly obvious contradiction in that…
Jeffrey_Grey on January 29 at 11:16 a.m.
Oh, and by the way - with respect to opinion polls (which I still maintain only *prove* that people have opinions, not the objective truth of those opinions) - this from a CNN poll:

– What do you think Congress should do on health care: pass a health care bill similar to the legislation that Congress has been working on for the past year, start work on an entirely new bill, or stop working on any bills that would change the country's health care system?”

Pass Similar Bill: 30%

Work On New Bill: 48%

Stop Working On Any Bill: 21%

Other: 1%

Unsure: 1%

(Polling period: 1/22-24/10) –

http://www.pollingreport.com/health.htm

Richard, tell me that 78% saying that 'something' needs to be done versus 21% saying, 'forget it' constitutes a loud shout from the populist voice denouncing at least some kind of health care reform.

Here's another poll found a little further down that page, this time from USA Today/Gallup:

– What do you think President Obama and the Democrats in Congress should do now concerning a health care reform bill? Should they continue to try and pass the health care bill now being worked out by Democrats in the House and Senate, or suspend work on the current health care bill the House and Senate are working on and consider alternative bills that can receive more Republican support?”

Try and Pass Current HealthCare Bill: 39%

Consider Alternative Bills: 55%

Stop Working On Health Care: 2%

Unsure: 5%

(Poll date: 1/20/10) –

The latest Big Lie is misrepresenting peoples' doubts about the current proposals as a rejection of *any* health care reform. That might be what the opponents of reform would like us to believe: that doubt equals rejection.

But clearly that's not the case.
richard on January 29 at 5:37 p.m.
<<“Richard,” I'd have no idea what you may or may not accept about your own bible, but it looks like it is chock full of regulations. Now if all those “regulations on high” prohibit human freedom as you want to put it, then I guess you must be soft on crime to go along with the rest of that “libertarian think.”>>

Nonsense - Druid. the bible is not government, it imposes nothing upon you that you do not choose to accept.

<<I'll present you with Capital One>>

If your bank violated your rights or took something from you illegally, then it is the proper function of government to regulate that.

That has noting to do with what I am talking about. Nothing at all.
richard on January 29 at 7:26 p.m.
<<The people who spoke “most loudly” in Mass. did so with Brown's solemn assurance that his election would in no way jeopardize their universal health care insurance.>>

Apples and oranges. He was not running for the state Senate, he was running against the national Democratic Party and their flawed version of health care. He proclaimed very loudly and very proudly that if he won, he would be the “41st vote” against the health bill. If you bury your head to avoid that obvious conclusion, then that is your problem. You are obviously getting your “news analysis” from a very pro-Democratic/Obama source.

<<This is why the folks who point to Mass as the populist voice shouting out a resounding renunciation of health care reform just show me how little they understand.>>

What is it I don’t understand, Jeff? That the anti-health bill Republican beat a very, very pro-Obama, big government Democrat in a district that had not had a Republican in over 70 years, in a state that was the most blue/liberal/Democratic state in the union. And you take those results and tell me I “how little” I understand?

I am speechless, Jeff!

<<And Richard, as for those glory days of yore when everything was unregulated and shining free… Read Upton Sinclair's “The Jungle” and then we'll talk again.>>

And somehow I knew you would make that argument, which demonstrates how you fail to actually read what I write. I said there was poverty, but poverty compared to what? By the standards of the rest of the world, those in poverty here lived better than the middle class even in Europe. And I have read Sinclair, thank you. And there was more than little exaggeration and dramatic effectation for it to be considered a “thoughtful work.” Sinclair, if you don’t know was know for his “flair” and angst.

And I am not discounting the poverty that was in this nation when it was a mere 130 to 140 years old; now compare it to other nations that had been around for centuries if not millenia. You demonstrate a lack of understanding of critical history.

And if you don’t believe me, maybe you would believe no less than Leon Trotsky, who wrote about living in New York City in 1917. He was astounded how the “working poor” lived in this nation compared to the working poor in Europe. He had no idea of the standard of living the workers had attained here. It was a shock to the communist.

It is sad how those who prescribe to the entitlement theories must always resort to diminishing this society and this nation, just so they can try to justify the need to change the fundamentals of what made this nation great. And it requires a progression of thought which always ends in offering a view of this nation’s history as “oppressive.”

And the polls you offered? Yeah, that is exactly what I said, the majority do not want the bill that Obama and the Democrats and apparently you see as so valuable.

The first bill shows 69% want something other than the current bill, which only validates that Brown’s win was not a fluke but that he represented the vast majority of Americans who don’t want the bloated, expensive, government exapnding liberal dream.

Show me one place where I said I “reject” any health care reform. I don’t know of anyone who said that. The Republicans in congress certainly did not say that. I don’t know of any pundit who said no to any reform.

It was the specific “reform” that Obama and Pelosi and Reid thought they could shove down our thoats while we were not paying attention. They found otherwise; didn’t they.

And I recall you specifically saying that New Jersey and Virginia did not indicate any repudiation of Obama and the Democrats policies. And, as you have expressed here, you still see it that way.
Arch_Druid on January 29 at 11:02 p.m.
“Richard,” the Bible WAS all about gvt. LOL! A theocratic state. You made it obvious you had no intention of reading 1 Samuel that described an institution OF gvt that the people asked of the prophet to assist them in creating. Which, by the way included taxation. As long as you are THAT prepared to dismiss such an argument, then ANYTHING ELSE you say, also lacks credibility.

So, you do have a problem.
gmorton on January 29 at 11:07 p.m.
” … your unattainable Utopian dream of 'every person his own government' is that your fantasy removes the element of the citizens even trying to exercise some control over the whole.”

Well, Jeffrey, I never said any such thing. Indeed, I said the contrary in the very comment you quoted. Hard to pursue a dialog when you ignore what was actually said and substitute strawmen instead.

“Democracy is the worst form of government - except for all other forms.”

Churchill was referring to constitutional democracy. Unconstrained democracy is among the forms even worse.

I prefer Churchill's other “democracy” quote:

“The best argument against democracy is a five-minute talk with the average voter.”

“Again, that's a fine generalization. The problems will invariably arise when you attempt to govern a real-world society with only generalizations. Case in point that immediately springs to mind without me even having to think about it: Abortion. Apply your generalizations to that.”

Er, no, that is not a generalization, although it is a general statement. It is statement of a criterion. It must be a general statement unless you prefer a listing of all acceptable laws and unacceptable ones. The criterion is quite unambiguous, however, and any given law can easily be tested against it.

You would need more to decide the abortion matter, because what is at stake there is the definition of a “person.” That is not an issue with most proposed laws.

“Show me evidence that any of those will actually produce the effects you claim for them.”

I've already done that, in the only way it can be done – by comparing cost trends in other segments of the economy with those in health care. The only segment where those trends match health care is education – another government-ridden segment. In all other segments – housing, food, clothing, technologies of all kinds, costs (as fractions of median income) have *declined* over the past century.

“Yet you would free insurance companies to deny even more people? That fixes the problem… how?”

You seem to be oscillating between two different problems. My “fixes” are aimed at health care costs. For you, the problem seems to be lack of universal, “affordable” insurance. My fixes don't address that issue, and there is no way to obtain that goal without exacerbating the cost problem.

You have to decide which “problem” you want to fix.
Arch_Druid on January 30 at 12:00 a.m.
GMorton, sometimes I can agree with you. Not a bad post this time around.
Jeffrey_Grey on January 30 at 3:39 a.m.
gmorton,

I guess it boils down to this: You're against an overly intrusive, overly regulatory government. So am I. The differences arise when we try to apply that principle on a case-by-case basis.

But that's about as far as we get when it comes to agreement.

– Er, no, that is not a generalization, although it is a general statement.–

Semantics. (A 'generalization' is a 'general statement'.)

– The criterion is quite unambiguous, however, and any given law can easily be tested against it. –

Then test it against abortion.

– You would need more to decide the abortion matter, because what is at stake there is the definition of a “person.” That is not an issue with most proposed laws –

A transparent evasion based on semantics. The question of abortion is insoluble using only your broad principles. You're right - in this case, as in most cases of laws and rights - when two arguably equal rights conflict, more is needed. The 'more' being an authoritarian decision that will promote one person's rights at the expense of another's.

– I've already done that, in the only way it can be done – by comparing cost trends in other segments of the economy with those in health care. –

An 'apples to oranges' evasion. Health care isn't education and it isn't groceries. It's health care with it's own peculiarities and issues. The point being: You stated (finally) several specific, concrete proposals. Tell me how those proposals will reduce health care costs. Refer me to economists who demonstrate how they will reduce costs. And please note: if you've got the evidence showing those proposals will reduce costs, you'll have both my interest and probably my support for them.

But if it's just another example of, 'These things are less government and so by definition they must work'…

– You seem to be oscillating between two different problems. My “fixes” are aimed at health care costs. For you, the problem seems to be lack of universal, “affordable” insurance. My fixes don't address that issue, and there is no way to obtain that goal without exacerbating the cost problem.

You have to decide which “problem” you want to fix.–

It's not two problems. It's only one. There is currently a projected $1 billion annual burden being placed on health insurance policy holders in this state. That is the problem that has to be fixed. You can fix it via 'costs' containment to the point that most individuals can afford to pay for their own health care out of pocket. That would be perfectly fine by me. (Though I suspect that kind of a fix would be impossible without recourse to truly draconian regulation.) Or, you can make health insurance both 'affordable' and as nearly universal as possible. I would think that would fix the problem as well. (Though once again I suspect that the State will have to 'intrude' and regulate, as the current legislative proposals show.)

In any event, if you see two, distinct problems then the two are inextricably linked and you have to solve them both or you haven't solved the problem.
Jeffrey_Grey on January 30 at 4:00 a.m.
Richard,

–He was not running for the state Senate, he was running against the national Democratic Party and their flawed version of health care. –

Irrelevant. The relevant fact remains that as a precondition to obtaining their vote, Brown had to promise the Mass. voters he would not take away their health care.

Tap dance around it all you want Richard, but I assure you that more and more people are coming to realize that there's something of a contradiction in the Mass. election results - at least with regard to the issue of health care reform.

But as a repudiation of the current legislative proposals… That might be a different matter. If you want to cast the Brown election as a vote against 'Obama-care' (whatever that means), then you might have something. (*Maybe* the Mass. election results were the people of Mass saying, 'We want nationally what we have locally'?)

–I am speechless, Jeff!–

Apparently not.

–…which demonstrates how you fail to actually read what I write.–

There seems to be a lot of that going around.

“Poverty compared to what?” Compared to itself. What more does it need to compare against, *if the issue is what would motivate people to demand that government step in and use its authority to address their problems*. Because *that* is what *I* was writing about, Richard.

As for the rest:

If I mis-read your sentiments, Richard - *if you agree that some health care reform is mandatory*, it's just *some* of the details of the current legislative proposals that make you balk, then I stand corrected.

I can only explain my misunderstanding by hoping you can see how lengthy diatribes about the evils of governmental regulation could be misinterperted as a preface to discussions about proposals for new governmental regulation.

Of course, if you agree that reform is necessary but you don't like the current proposals, then you have to come up with some specific alternatives that will accomplish the necessary reform.

So perhaps we should turn to that and set all the rest of this aside?
Jeffrey_Grey on January 30 at 4:04 a.m.
Richard,

In thinking about this more, I now sincerely wish I could take back that whole last post with the exception of the final sentence:

“So perhaps we should turn [to specific proposals for fixing the problem] and set all the rest of this aside?”

I retract everything else and ask that you let that be my whole reply.
Gary D Rhodes on January 30 at 10:06 a.m.
1. Give individuals equal tax treatment that “big corporations” get when buying health insurance.

2. Eliminate rules that complicate or outlaw interstate insurance purchases. End mandated coverage.

3. Malpractice reform. 'Loser pays' could be a part.

4. Bend cost curve dramatically by encouraging use of personal health accounts, coupled with catastrophic coverage.

The government has an important role in making sure contracts are enforced when insurance companies try to welch.
richard on January 30 at 12:14 p.m.
I have given many specific suggestions for “reform” Jeff; you simply do not accept them and you scoff at them. I can only conclude you scoff because my suggestions merely address issues of creating a level playing field.

And that is the essence of the differences between your position and mine. No where in the constitution does it require government to “fix” people's problems; the genuine role of government is to ensure equal access and opportunity for the individual to resolve their own issues.

And that role does not include special interest payoffs (Nebraska, Louisiana, unions, etc) as we find in the current bill. It does not mean forcing people to buy a product or service they do not wish to purchase … for the sole purpose of lowering the cost to you.

So, yeah, I have been very consistant in my criticism of the bills created by Democrats.

And this is where progressive thought always turns equal “access” - or equality - on its head. It distorts the notion to mean equal “outcomes” for everyone. It requires that the ends justify the means. It requires that if I cannot afford insurance because of MY predicament, my neighbor MUST therefore subsidize me, so I can have an “equal” outcome.

That does not resemble the concepts of freedom and liberty noted in our founding, no matter how one tries to turn into a pretzel.

And that is the fundamental difference between my position and yours. I trust the founders notion of equalityand I believe the proper role of government is to ensure equal access (such as anti-discrimination laws); while you trust the contorted view of equality which is being fronted by the progressive movement.
Jeffrey_Grey on January 30 at 3:22 p.m.
Richard,

I was going to ask you to once again lay out your proposed solutions, but I think I'll save you some typing.

Please refer to www.gop.gov. I can't provide a direct link to what I want you to see because the page isn't laid out that way, but it's not a problem. Simply click on the “Better Solutions” hyperlink near the upper left-hand corner of the page. That link will offer you a .pdf document for download.

Once you burrow down past the obligatory partisan rhetoric, there's some genuinely good reading. (Does it surprise you to hear me say something like that about a Republican document?)

The part of the document that applies directly to the discussion at hand starts down around page 10.

Why don't you give that a read and then tell me what you think.

(And no, this isn't a setup for a trick question. I'll come right out and say in front of everyone that I think some of the proposed solutions look good. Some of them look very good. Some… well, okay - I can't give away the farm entirely. I'm skeptical of some of the proposals. But I'll be willing to discuss even what I'm not too sure about.)
Jeffrey_Grey on January 30 at 4:32 p.m.
Maybe I should have read a little further in that .pdf I cited to before I posted. I'm not taking back what I just said, mind you - I'm still supportive of what's laid out in that document.

The problem is that I posted my above comment after I'd only read what I took to be a preliminary statement laying out what the G.O.P. intended to do - which as I say, I like - on the assumption that the rest of the document would then lay out the specifics of just how those intentions were to be realized.

But that didn't prove to be the case. All that document contained is what the G.O.P. intends to do, not how they specifically intend to do it. For the specifics, I guess one has to read the text of H.R. 4038.

The text of that bill is available on-line in several places. The good news is it's significantly 'lean-er' than the Democratic health care proposal. But it's still 200 plus pages of some fairly heavy reading. I've waded in, but it's going to be a while.

I might also mention that the G.O.P. previously offered an alternative to the Dem's plan back in … May? That plan was pretty much universally dismissed as I recall (and with good reason.) Since then, however, I guess the Republicans went back to the drawing board because the new H.R. 4038 text bears a November date and - if that .pdf is to be believed - apparently corrects several of the more glaring faults of the May edition.
gmorton on January 30 at 6:07 p.m.
“I guess it boils down to this: You're against an overly intrusive, overly regulatory government. So am I. The differences arise when we try to apply that principle on a case-by-case basis.”

Exactly right. I reject analyses on a case-by-case basis. That invariably leads to “selfish conservatism” – rein in the “overly intrusive, regulatory” government, except for those regulations which benefit me. I reject all free lunches, regardless of who may be the beneficiary.

“Semantics. (A 'generalization' is a 'general statement'.)”

No, it isn't. A general statement is a statement about a class of things, rather than an individual thing (“all crows are birds”). A generalization is a *conclusion* about a class of things *based on observations of only a few individual things* (“All Democrats are socialists”).

“The question of abortion is insoluble using only your broad principles.”

You're right. Those principles assume the concept of “person” is uncontroversial. Hence they hold only in those cases where that is true.

” … in this case, as in most cases of laws and rights - when two arguably equal rights conflict, more is needed. The 'more' being an authoritarian decision that will promote one person's rights at the expense of another's.”

No. The question was not settled by any “authoritarian decision” of which “conflicting rights” of different persons would be promoted. It was decided by determining that fetuses are not persons. Thus there is no conflict between rights of persons.

“Health care isn't education and it isn't groceries. It's health care with it's own peculiarities and issues.”

No, it doesn't. Or rather, none that are economically relevant. The prices of all goods and services are determined by supply and demand. The price of kidney dialysis or a hip replacement is determined in exactly the same way as the price of a haircut, a steak dinner, or a house. In the absence of government interference, of course.

“There is currently a projected $1 billion annual burden being placed on health insurance policy holders in this state. That is the problem that has to be fixed.”

I've already told you how to fix that. Repeal all state and federal laws which force insurers to cover conditions the policy holder does not want or need, which force them to extend policies to some persons below cost (which shortfall is then, of necessity, inflicted on other policy holders), and which force providers to provide care to non-paying patients. That burden would then be eliminated.

“In any event, if you see two, distinct problems then the two are inextricably linked and you have to solve them both or you haven't solved the problem.”

Yes, they are linked. The universal coverage “problem” is the source of the cost problem. Whenever you decide to offer free lunches, you pay for them in one way or another. The soaring costs of health care is that price.
spokelooneh on January 31 at 12:26 a.m.
“I've already done that, in the only way it can be done – by comparing cost trends in other segments of the economy with those in health care. The only segment where those trends match health care is education – another government-ridden segment. In all other segments – housing, food, clothing, technologies of all kinds, costs (as fractions of median income) have *declined* over the past century.”
-gmorton

The health care market does not perform in a classic elastic, constantly improving productivity market. Any example that looks at health care costs a century back are ridiculous. Just 60 years ago, the majority of people died at home. Now the majority of deaths occur in hospitals, after many days, weeks, of treatment at many thousand dollars a day, some of which is truly miraculous, but when looking at death stats over all, we see the HUGE increase in end-of-life healthcare. If this issue isn't solved, there's no hope, this country is doomed.

While the supposed power of the market and individual choice could make some small dent in rising overall health care costs.
There's no doubt that vast improvements in medicine resulted in improved outcomes, and yes, came at a high price. We have a far greater variety of courses of medical treatment that were unknown/unbelievable 50 years ago. And one thing not lacking is profits in the overall healthcare sector.

WITHOUT the supposed benefit of the “real” free market, we see vast cost discrepancy in various health care systems in the country, that have nothing to do with 3rd party payors.
Arch_Druid on January 31 at 1:50 a.m.
I had something of a chortle Friday night when watching The News Hour after work. Seems, President Obama went and had a frank discussion with the GOP in Baltimore and afterwards, The News Hour staff interviewed one GOP Congress critter. What the guy had to say (and didn't catch his name) was full of irony, and LOL! hypocrisy and even further, self-conflicting notions. In short, he could have been a repeat of any of “Richard's” posts.

So, we are opposed to “equal outcomes,” but we want portability of insurance across state lines. Whereby John Smith in Iowa could have the SAME price in health insurance that John Doe gets in Georgia. But for the *dare I say it?* equal outcome of such portability in that type of insurance, it would require an overly intrusive gvt. The GOP do not like the DEM approach, but they couldn't NOT achieve their “reform” without federal involvement. 6 of 1 and a half dozen of the other. And really, it was too funny by half.

As for the “liberal” News Hour; yeah, I'll agree. Since the Congress critter was never challenged on his assertions.
gmorton on January 31 at 2:18 a.m.
“Now the majority of deaths occur in hospitals, after many days, weeks, of treatment at many thousand dollars a day, some of which is truly miraculous, but when looking at death stats over all, we see the HUGE increase in end-of-life healthcare.”

You're absolutely right. End-of-life care is a major component of overall health care costs, and a major driver of the upward cost trend. But you ignore the role of 3rd party payers in that facet of the problem. How many of those patients would liquidate and fork over their entire estates, leaving nothing to their kids and grandkids, or worse, ask their kids to mortgage their houses and raid their own kids' college funds, to gain themselves another year or two of seriously compromised life? How many will grasp that straw if an insurer or the government is paying the bills instead?

The government cannot rationally or morally make those cost/benefit calculations, but patients can, and would.
gmorton on January 31 at 2:33 a.m.
“So, we are opposed to “equal outcomes,” but we want portability of insurance across state lines. Whereby John Smith in Iowa could have the SAME price in health insurance that John Doe gets in Georgia. But for the *dare I say it?* equal outcome of such portability in that type of insurance, it would require an overly intrusive gvt.”

Well, no, Arch. A national insurance market does not mean that customers in all states pay the same price. It has nothing to do with equal pricing. It means that a patient could buy insurance from any carrier in the country; it would not have to be licensed in his state. The rates he'd pay, however, would be determined by his actuarial class.

That change would help some, by expanding competition, but it would have much more impact if insurers were forced to comply only with state regulations in their home states, and not with those in the customer's state. Then the states would be forced to compete with their regulations, else in-state companies would lose business to insurers in states with fewer costly regulations.
Jeffrey_Grey on January 31 at 6:06 a.m.
gmorton,

– I reject analyses on a case-by-case basis.–

Which is why you're always stuck with generalizations that don't have any practical application in the real world. In the real world, it's always a case of applying dogma to specific situations. The real world is always 'case by case.'

Agree with that or don't. I don't know if you've noticed, but I'm trying to get away from arguing lofty principles and empty dogma. I've come to realize that's just a distraction. 'Is the proposed solution practical and reasonable?' That's all I'm interested in any more.

A descent into socialism or… well, whatever the great bug-a-boo fear d'jour might be… Maybe that's the road to ruin. Maybe that will be the death of America. Maybe. I don't know.

I know I no longer really care.

All the 'be very afraid!' partisan rationalizations for not doing this or not doing that *might* be the end of America. Not fixing the problems we currently face *most certainly WILL* be.

It's down to choosing between not acting based on the fear of what might be, versus acting to try and head off the certainty of what will come to be through inaction.

From now on, I'm talking nuts and bolts specifics. Philosophy and dogma will have to wait for tomorrow. And if my new course of action doesn't suit folks, if they want to stay mired in dogma and rhetoric…

Well, I no longer really care about that either.
Arch_Druid on January 31 at 10:10 a.m.
What you said GMorton is entirely correct. And you have precisely made my point. For the GOP brand of health care reform to do what is advertised given the current circumstances of state determined insurance costs: as an example, WOULD REQUIRE an utter and radical change in everything that you have stipulated and would need an overly intrusive gvt to make those guarantees. But hey, only the Dems can be “socialist,” correct?
richard on January 31 at 1:45 p.m.
<<Agree with that or don't. I don't know if you've noticed, but I'm trying to get away from arguing lofty principles and empty dogma. I've come to realize that's just a distraction. 'Is the proposed solution practical and reasonable?' That's all I'm interested in any more.>>

You scoff at “lofty” principles when those principles run counter to your interests and you instead search for “practical” solutions. Practical? For whom? Those that receive the benefit; or those that pay for it?

Using your “logic” you seem to have become a “poster child” for the “progressive” principle - government is there to create equal outcomes for all.

A “Practical” Principle: “Thou shall not steal… . except when it is practical (“beneficial”) to do so.”

I guess that explains why our children are coming out of our school system - according to studies - with a credo that the “ends justify the means.”
Jeffrey_Grey on January 31 at 1:52 p.m.
Richard,

I won't get sucked in by the rhetoric any more. If you have tangible proposals to discuss, by all means let's have a look. Otherwise…

“Whatever.”
gmorton on January 31 at 3:53 p.m.
Jeffrey_Grey wrote,

“In the real world, it's always a case of applying dogma to specific situations. The real world is always 'case by case.'”

PROSECUTOR: Your client committed rape. The evidence is unequivocal and he's confessed. I intend to prosecute him to the full extent of the law.

ATTORNEY: You're being inflexible and dogmatic. You have to approach these things on a case-by-case basis. After all, the guy is from a good family, he's a doctor, he's respected in the community. He was drunk and not thinking clearly. The victim, on the other hand, is a welfare mother, never married, a high school dropout, a barfly. Besides, her injuries were minor. Is it in society's best interests to send a productive citizen to prison for a momentary lapse of judgment?

PROSECUTOR: What is in society's best interests is a dependable rule of law. That precludes deciding whether someone should be prosecuted based on the factors you cite. The only thing the law allows me to decide on a case-by-case basis is whether the evidence indicates that the accused broke the law. A rule of law is not a rule of relative worth.
Arch_Druid on January 31 at 7:41 p.m.
“Richard” is opposed to “equal outcomes,” that is if it benefits that other guy. But his posts could easily be an “equal outcome” argument. GMorton, have you ever been in a jury trial? I have. You are trying to create a black/white situation that does not exist. Sorry guy.
Jeffrey_Grey on February 01 at 3:19 a.m.
gmorton,

What AD said. Further, the fact that there's a trial being held at all shows how the real world decides things on 'a case by case' basis.

Finally, “whatever.”

Got any good, specific ideas to discuss?
Jeffrey_Grey on February 01 at 9:47 a.m.
With respect to the G.O.P.'s alternative proposal to the Dem's health care reform initiative, here's an analysis of H.R. 4038 by Timothy Jost as published in The New Republic.

http://www.tnr.com/blog/the-treatment…

Now if the reply to the article is, 'Everybody knows that the New Republic is a piece of liberal propaganda and…' then my response would be, 'Fine. Whatever.'

However, I would be quite interested in hearing any substantive refutation of Mr. Jost's criticisms.

Any takers?

Though I remain supportive of the bill - at least in general principle - to add my own objection to 4038, I might mention that though I'm only about a quarter of the way into reading the text of the bill (as I've previously said; it's slow going), I already notice a troubling inclination by Congressional Republicans to fall back on the old familiar stand-by of, 'Let the individual state pay for it.'

Let me be clear; it's not that I'm against requiring the state to provide for its citizens. But if there is indeed a projected $1 billion cost for the uninsured that is currently being borne by premium payers in this state… And given our state's current woeful inability to meet the financial obligations it already has…

…*as a purely practical matter*, where is the money for this unfunded mandate going to come from?

(Or am I misreading the funding provisions of 4038? That's certainly a possibility.)
Gary D Rhodes on February 01 at 9:54 a.m.
In the real world, there are different types of people, with divergent attitudes. Some people make saving for retirement a priority. Some spend every penny they get.

In our current system, the person who lived large and spent every dime, could be housed in a long-term care facility paid for by the tax payers. Also living in the same facility could be another person that made a similar amount of money, but saved for a rainy day. They are now forced to use their savings.

Let's pretend there were no “third party” payment system for healthcare.

Granny has one million dollars in assets.
She can move into a nursing home and spend major money, eventually depleting the inheritance. Or,
she can be cared for at home by loving family members, leaving the inheritance intact.
Arch_Druid on February 01 at 10:45 a.m.
Gary Rhodes, I intend to agree with the vast majority of your views in principle. However, the cost of in home care as borne by the family is STILL an expensive proposition. WOULD granny's million dollar inheritance remain intact? No. Esp. if granny suffers from any kind of catastrophic health problem. Esp. if that catastrophic health problem led to her having to go to a nursing home anyway.

You aren't wrong about savers and spenders. BUT the theory as opposed to the reality is where the quality of your argument gets tested. And let us not get into the family that would rather shuffle granny off to the nursing home so that they can better get their hands on the million dollars.

Human greed can be a decided factor.
gmorton on February 01 at 3:59 p.m.
Jeffrey_Grey wrote,

“Further, the fact that there's a trial being held at all shows how the real world decides things on 'a case by case' basis.”

What is decided on a case-by-case basis is whether the accused is guilty. The analog is the decision as to whether a proposed government program or policy is another free lunch. If it is, then you reject it, just as you convict the rapist if the evidence proves him guilty. What you don't do is decide that, though the rapist may be guilty, that the rape or the free lunch is OK “in this case.”

“Let me be clear; it's not that I'm against requiring the state to provide for its citizens.”

That's very clear. And it is precisely the problem. You imagine the State to be everyone's parent, obliged to provide for its helpless brood. Which it can only do by plundering someone else's nest.
gmorton on February 01 at 4:04 p.m.
Jeffrey_Grey wrote,

“Got any good, specific ideas to discuss?”

Already listed them. But you've dismissed them since they don't provide anyone a free lunch.
richard on February 01 at 8:17 p.m.
Tort Reform

Insurance companies compete across state lines

Medical savings accounts

I have offered these simple, readily achievable strategies that no one has said would not have a positive impact on health care access and cost. They are understandable to everyone, they could be written in far fewer than 2000 pages, and I don't know there would be much opposiiton (except to the tort reform from lawyers - -

So why not pass those, with plans to revisit it later and if other good ideas surface, put them into effect incrementally?

Simple plans and solutions are almost always better than complex, herd to understand plans. Less is more.

But Jeff, you seem to never acknowledge that these ideas have been proposed over and over again. I have to conclude that you are much more comfortable with over-stuffed, multi-faceted, and incredibly complex plans, so you have no interest in these.

Or is there another reason you discount these? My guess, as gmorton said above, is that there is no free lunch in those ideas.
Arch_Druid on February 01 at 9:38 p.m.
GMorton, one word of caution when you start theorizing about trials involving rape. In far too many cases, the rapist DID get a free lunch. Meaning, that he was never convicted. Before you start spouting, you need to first do a whole lot of research.

“Richard,” Obama had a great deal to say about Tort Reform when meeting with the GOP in Baltimore. He also confirmed that tort reform didn't save a whole lot of money.

And tort reform would be rather similar to bankruptcy reform. Where credit card companies had an opportunity to exploit a new law that the GOP had carefully crafted just for them, ran amok, and when the dust had settled; had done substantial harm to people who had obtained loans, credit cards and etc. through these same banks. And even further, there were a number of banks that folded.

As with bankruptcy laws (even when abused) malpractice suits would serve as a check against dangerous and truly life threatening practices. And besides, I thought that Tort Reform had already BEEN passed by the last administration.
Jeffrey_Grey on February 02 at 3:39 a.m.
Richard, when have I ever dismissed allowing health insurers to sell across state lines? Quotations, please.

Where have I ever argued against tort reform? Quotations, please.

Where have I ever argued against medical savings plans? Quotations, please.

I'm in favor of all those things. **Always have been.** (And if you don't believe that, I can show you quotations where I have supported them.)

It's not that I'm opposed to many of the things you're proposing. It's that you've identified me as a Liberal whose only agenda is to destroy the United States and therefore *you* have opposed everything *I* have proposed (including but not limited to tort reform and deregulating cross-state insurance transactions) with a now knee-jerk reflexive howl of 'free lunch!'

In any event and far more importantly, the discussion has moved beyond the worth of these particular ideas. The question now is; it's an arguably good idea - how do we implement it?

Recognizing the need to fix the problem, the G.O.P. plan proposes to implement several of the things we apparently agree need to be implemented.

However, as I'm reading the draft legislation, it seems that many of their proposed fixes depend heavily on 'let the individual states pay for it.' To say it another way - 'unfunded mandates.'

And once more Richard, please note that it's not me saying these things need to be implemented and funded at the state level. It's not a cabal of radical liberals with the suicidal goal of demolishing the United States who are proposing 'let states pay.' It's the conservative Republican party making the proposals. (I guess when you get right down to it, nobody can resist a 'free lunch.' Or maybe it's just that when you get right down to it, once the knee stops jerking everybody recognizes the reflexive chants of dogmatic talking points like 'free lunch' don't actually fix a problem and there inevitably comes a time when you actually have to start wrestling with practicalities.)

So… now that we're down to practicalities, is it your position that unfunded mandates are the way to go? That the only rational way to address the problems that both sides now obviously agree exist is just to wait for the money to magically appear at the state level?

The answer lies in proclaiming it's not a free lunch if we just tell the restaurant to pick up the tab?

And if somebody needs to pay for lunch (pay for fixing the now universally recognized problem), which they do, but unfunded mandates aren't the way to go - **what is?**

That's where the discussion is now.
Jeffrey_Grey on February 02 at 5:58 a.m.
AD,

The common rebuttal to tort reform is that it won't save a lot of money.

It seems to me that the rebuttal to the rebuttal is two part:

1) Tort reform in and of itself might not result in a lot of savings. But *if* (perhaps big 'if') such reform also reduces the waste inherent in the practice of 'defensive medicine', then the savings could be potentially significant. (I'm starting to read arguments against tort reform with an eye to which figures they base their assertions upon. If all they talk about is the proportional impact of excessive jury awards *and that's all,* I'm skeptical. The amount of jury awards is only part of the story.)

2) Even if with all the relevant factors included - jury awards and the cost of defensive medicine, etc - the savings are still only modest, money saved is still money saved. “A billion here, a billion there… Pretty soon you're talking real money!” It would seem to me the relevant consideration then becomes, 'what's the value of what we get (in the form of money saved) as opposed to the cost of what we give (in the form of limits placed on 'the right' to scam as much out of a court as we possibly can)?

Cost / benefit analysis.
Gary D Rhodes on February 02 at 7:03 a.m.
Grey, when Obama supporters are asked about what difference a possible partial freeze of a tiny slice of the federal budget will do, they seem to defiantly state that it is a start in the right direction.

Being able to sue when malpractice happens is important and correct.
To weed-out unethical crooks like John Edwards, we need to punish those people with loser pays. When an officer of the court is the one committing perjury, they need to go away.
Gary D Rhodes on February 02 at 7:22 a.m.
By Charles Hurt
THE WASHINGTON TIMES

The American Medical Association lists North Carolina’s current health care situation as a “crisis” and blames it on medical-malpractice lawsuits such as the ones that made Democratic vice-presidential candidate Sen. John Edwards a millionaire many times over.
One of the most successful personal-injury lawyers in North Carolina history, Mr. Edwards won dozens of lawsuits against doctors and hospitals across the state that he now represents in the Senate. He won more than 50 cases with verdicts or settlements of $1 million or more, according to North Carolina Lawyers Weekly, and 31 of those were medical-malpractice suits.

During his 20 years of suing doctors and hospitals, he pioneered the art of blaming psychiatrists for patients who commit suicide and blaming doctors for delivering babies with cerebral palsy, according to doctors, fellow lawyers and legal observers who followed Mr. Edwards’ career in North Carolina.
“The John Edwards we know crushed [obstetrics, gynecology] and neurosurgery in North Carolina,” said Dr. Craig VanDerVeer, a Charlotte neurosurgeon. “As a result, thousands of patients lost their health care.”
“And all of this for the little people?” he asked, a reference to Mr. Edwards’ argument that he represented regular people against mighty foes such as prosperous doctors and big insurance companies. “How many little people do you know who will supply you with $60 million in legal fees over a couple of years?”
Through a spokeswoman, Mr. Edwards declined to comment beyond e-mailing his and John Kerry’s “real plan for medical-malpractice reform.”
The plan calls for one measure that Mr. Edwards previously had said is meaningless and does not impose caps on verdicts for economic damages or limits on attorneys’ fees.
One of his most noted victories was a $23 million settlement he got from a 1995 case — his last before joining the Senate — in which he sued the doctor, gynecological clinic, anesthesiologist and hospital involved in the birth of Bailey Griffin, who had cerebral palsy and other medical problems.
Linking complications during childbirth to cerebral palsy became a specialty for Mr. Edwards. In the courtroom, he was known to dramatize the events at birth by speaking to jurors as if he were the unborn baby, begging for help, begging to be let out of the womb.
“He was very good at it,” said Dr. John Schmitt, an obstetrician and gynecologist who used to practice in Mr. Edwards’ hometown of Raleigh. “But the science behind a lot of his arguments was flawed.”
Jeffrey_Grey on February 02 at 7:44 a.m.
– Grey, when Obama supporters are asked about what difference a possible partial freeze of a tiny slice of the federal budget will do, they seem to defiantly state that it is a start in the right direction. –

Your point being? It's not a start? We shouldn't make such a start? What?

– Being able to sue when malpractice happens is important and correct. –

Who is disputing that? How are they disputing it?

– … we need to punish those people with loser pays. –

Assignment of the cost of the litigation to the loser is already possible in our legal system, though it's at the court's discretion. Would you remove that discretion by making it a hard and fast rule?

Please understand that I'm *not* saying I'd *necessarily* disagree with that, or that I'm at all opposed to making the frivolous litigant pay the costs of the suit. I'm just saying at this point I'm skeptical of making it a hard and fast rule with no leeway. ('Skeptical', but not unwilling to be persuaded.)

(See: http://www.manhattan-institute.org/ht… for an article arguing in favor of 'loser pays.' But also see: http://blogs.wsj.com/law/2008/12/24/a… for a discussion representing both sides of the issue.)
Gary D Rhodes on February 02 at 7:48 a.m.
Some people want “caps” on damages. I am against that concept.
Jeffrey_Grey on February 02 at 9:43 a.m.
That makes me uncomfortable too.

But what are the alternatives - given the contention that out-of-control jury awards are a significant part of the problem?

A suit for five million dollars for a lost pair of pants even making it before a judge is a clear symptom of a serious problem in the system. But how do you fix the problem?

'Loser pays'? Maybe. At least worth discussing, anyway. But how do you answer the at least color-able objections raised in that second article I linked?
Gary D Rhodes on February 02 at 10:14 a.m.
I think an honest attorney would turn down an obviously bogus claim. Others would be less likely to tackle a frivolous case when they could actually lose money, rather than just being denied a big windfall when they lose the case. Right now the rewards outpace the risks.

I believe that serving on a jury when asked is one of the main responsibilities of American citizenship. We should encourage and facilitate every citizen to participate. Without a true cross section of our populace being in the jury pool, a true and fair verdict is much harder.
gmorton on February 02 at 3:55 p.m.
“I think an honest attorney would turn down an obviously bogus claim.”

Perhaps. But how many attorneys are honest? In fairness to attorneys, its hard to be honest when you don't know what counts as honesty. Most attorneys are taught that it is their job to “do the best they can for their client” (which will, of course, also mean doing the best they can for themselves). That would constitute “honesty” in their view. That would entail that they exploit the system to the maximum extent the law allows on behalf of their clients.

The only bogus claims, given this understanding of “honesty,” are those which are not winnable.
gmorton on February 02 at 4:21 p.m.
One of the commenters (Press Secretary for the Trial Lawyers) on the WSJ piece to which Jeffrey linked asked,

“Why would an attorney take a case on their own dime that’s “frivolous,” knowing they have no chance of winning, therefore sacrificing time and money?”

Note the implicit definition of “frivolous”: unwinnable. That is not, of course, what anyone else means by “frivolous.” When used by non-lawyers, it refers to cases of phantom or exaggerated injuries, cases based on junk science, or cases of displaced liability (usually cases where the plaintiff did something stupid and is trying to blame someone else). Unfortunately, many of those cases are winnable, and thus not frivolous at all, in lawyer-speak.

The most oft-cited objection to the “loser pays” rule is that it would hamper access to the courts by “the poor.” I.e., same rationale as the demand for universal health insurance coverage. And it yields the same result – tort costs which are double those in the rest of the world.
richard on February 02 at 7:32 p.m.
Jeff, at this point in time, what with clearly more pressing problems in our economy and jobs than health care, it is my opinion to shelve it for another day.

We have spent the past two years being confronted with one of the most protracted and focused campaigns to “educate” the public into believing that health care - though certainly frought with problems - was the most severe and pressing problem we face. It isn't.

It is just not the case … not when our debt is exploding beyond comprehension.

Pass the three items I mentioned, see what that does to access and cost, and then revisit it in another 5 years or so.

That is how I would propose it be dealt with. Clean up our debt before we try to fix anything else.
richard on February 02 at 7:38 p.m.
Loser-pay is fair, it is equitable and it would save billions of dollars.

I don't see a downside. Whenever confronted with an issue such as this, the Democrats can only pull-out the tired, worn argument that it adversely affects the poor. But that just is not the case, if their case they take to court is solid they will find a ggod attorney and they have afiar shot at winning.

It would not impact the poor anymore than it would the middle class. It is mostly liberal hype, using the poor-card.
richard on February 02 at 7:59 p.m.
A sleight change in the topic, but I was just listening to a report about government debt at all levels and how even the most obvious cuts or efficiencies are thwarted by what can only be called a collusion between government and unions.

This report noted that there are 200 teachers in New York city which have been charged and found guilty of sexual improrieties, gross misconduct, theft, etc but the city cannot fire them because the unions have protected them with an appeal process that makes it nearly impossible. So these teachers are sitting at home, collecting full pay and all their benefits while the district must hire someone else to teach their classes.

Some of our largest federal agancies have similar occurnaces where hudnreds if not thousands of employees are on paid “leaves” because they have committed terminable offenses but the union appeal processes will keep them on the payroll for years if not indefinately.

Multiply that all across this nation and there are easily untold millions if not billions of dollars going down a drain into the hands of of people unfit to perform their job, but who have all been taught that they are entitled to their jobs since they are “gevernment jobs.”

Might even help pay for health reform …but the Dems will never close these loopholes, so we are held hostage by these politicians, and they still have their hands out wanting more and more. It never is enough for liberals and Democrats.
Jeffrey_Grey on February 03 at 5:56 a.m.
– Jeff, at this point in time, what with clearly more pressing problems in our economy and jobs than health care, it is my opinion to shelve it for another day. –

Richard,

With deference to your civil tone, and thus a request that you interpret what follows as an attempt at equal civility but also an unavoidable vehemence…

Not just 'no!' but 'OH HELL **NO!!**

See, this is the one I was waiting for almost from the beginning of the debate. Not from any prescience on my part, but only as a result of familiarity with past history.

This is how it has always gone in the past. The opponents to health care reform obscure and obstruct, dissemble and delay… and then when it looks like meaningful reform will in fact take place, they play the ace in the hole. 'But look! Here's another problem that's much more pressing. While we agree that health care is needed … maybe … surely we must turn our attention to this much more pressing problem and return to the question of health care reform some other day.'

And the cost and accessibility of health care - **which most surely IS a CRISIS of epic proportions, equal to any other we face** - gets shifted to the back burner where it can continue to bubble and boil and build to explosion.

Look, Richard, I get it. I understand that this country is currently facing a **crisis** in the economy. Anybody with half a functioning brain and who hasn't been living in a cave for the last decade gets it. I fully and without reservation agree that the economy MUST be a top priority. A solution(s) to the problem MUST be found in the very near future.

But here are two points that - in my mind at least - utterly rebut the notion that given the crisis in the economy, health care reform must take a back seat:

1) Yes, “it's the economy, stupid!” But in this state alone, we are currently shelling out one billion with a 'b' dollars a year to cover otherwise unfunded health care costs. For Christ's sake, Richard - if a one-billion-dollar annual drag on this state's economy isn't a contributor to our local economic crisis, what is?

2) Yes, there are several crises competing for attention and resolution. I freely stipulate that as well. But you know what, Richard? I can work on more than one problem in an eight-hour work day. I bet you can too. And if our elected representatives in whom we have entrusted so much authority and responsibility *can't do* what you and I can routinely do, then I guess we seriously need to re-examine our current office holders' fitness for their position. Wouldn't you agree?
Jeffrey_Grey on February 03 at 6:02 a.m.
To both gmorton and Richard on the issue of 'loser pays',

I'm not sure what to think with respect to the validity of the 'poor card'.

So how about this as a compromise?

How about a one-year-long experiment where-in we enact 'loser pays' with a built in 'one year sunset clause' and a requirement that statistics be accurately gathered? (Together with a one-year-long suspension of the statute of limitations for civil suits that might have been brought during that period.)

Then at the end of the one-year period, we study the statistics to see if the 'poor card' is valid or not.
Arch_Druid on February 03 at 6:46 a.m.
The practice of “defensive medicine” as a response to medical malpractice suits sounds more like a band aid in which doctors or hospitals can still get a lot of money for practicing it. But, if doctors and hospitals tried to get it right the first time in the vast majority of cases then lawsuits and defensive medicine wouldn't be necessary.Only in a few cases where accidents and etc. were not avoidable THEN malpractice lawsuits WOULD become a fact.Or because of the active negligence or worse by the doctor or hospital THEN malpractice lawsuits would become a fact. But by working effectively to prevent any of the above by excellent training and standards of operation, it would reduce substantially the need for lawsuits.
richard on February 03 at 8:22 a.m.
Jeff - I must disagree. I put out three (and there are more) initiatives that would impact health care costs and make it more accessible. And it would do it without adding One Trillion (with a “T”) to the national debt over ten years.

But that counts for nothing to you, it seems, so you claim I am part of an obstructionist movement. How is making big strides to lower costs and increase access obstructionist?

And say what you will, the claims by Dems that they are only thinking of the “poor” when they discount and refuse to enact tort reform merely demonstrates their hypocrisy.

Howard Dean and other Dems have already said that the reason they won't introduce serious tort reform is because the very powerful layer lobby would withhold huge money from them. Thus they use the “poor-card”!

Trot reform is just the right thing to do. If John Edwards is not an example of the unfairness of our current malpractice system, then I don't know what is.

He won suits based on so-called scientific claims that the actions of doctors casused children to be born with Cerebral Paulsy … when there is scant evidence to support that conclusion. And he did so by playing the “poor-card” and “rich-doctor/hospital-card” and the emotional impact of the severe disabling condition of the child. He convinced the jury that SOMEONE must pay for this horror, and who better than the rich doctors?

The claims Edwards brought in his home state made him a very wealthy man, it cost the state many tens of millions of dollars and it ruined the careers of many doctors and it put a huge strain on the hospitals and the whole system.

It needs to be changed regardless of the costs it would save.

And Druid … when you claim that “if the doctors and hospitals tried to get it right the first time” it demonstrates a clear lack of understanding of medicine.

Medicine is not a science; there are very few absolutes in the “art” of medicine. And your suggestions for resolving “malpractice” by providing better training deserves zero serious consideration. No other profession requires more education and training than medicine.

Foolish ideas.
Jeffrey_Grey on February 03 at 9:47 a.m.
Richard,

You misunderstand. I'm taking exception only with the idea that health care reform is an idea that must 'wait for another day.'

That's what I categorically reject.

That evasion is the only reason I mention past dogma and rhetoric - that in the past it has always been thus; stalls and delays and endless ideological rhetoric that wears everyone down and readies them for the, 'Oh look! Another far more serious crisis to solve!' distraction.

In any event - that's in the past. I'm now only interested in substance. You say 'tort reform'. I nod in agreement, at least with the concept.

So… Since health care reform is indeed a problem that must be solved along with all the other contributors to our economic woes, the question is not if we should or shouldn't do it or if now is the time. The only question that seems relevant to me is how to best accomplish what has to be accomplished.

Returning to that question, then - would a one-year (or two-year, or whatever) experiment on 'loser pays' be a good way of determining just how valid (or invalid) the rationalization 'it will hurt the poor' actually is?
gmorton on February 03 at 6:15 p.m.
“Then at the end of the one-year period, we study the statistics to see if the 'poor card' is valid or not.”

Well, no, Jeffrey. That is your “case-by-case” approach at work again. We don't decide the question based on whether or not it would hurt the poor (by making it more difficult for them to file lawsuits). Or whether it would hurt the rich, or hurt business, or hurt unions, etc.

We adopt “loser pays” because it is the moral thing to do. It is the moral thing to do because it compels an accuser to make good the damages inflicted by an accusation when that accusation proves false.

It is entirely irrelevant whether it would or would not hurt the poor. What is relevant is whether is would help anyone, rich or poor, who is hurt by a false allegation.
richard on February 03 at 9:20 p.m.
Jeff; I understand you see health care as a vital and immediate need, but you do know that you are in the minority, don't you? A vast number of the Mass voters stated in polls that health care was way down the list of “immediate” concerns of people.

National polls have shown the same results.

Cap and Trade, One Trillion dollar health bill, these are questionable ventures in a great economy; when we are teetering on the brink of disaster - and we are - it is beyond irresponsible.

Now you can scoff if you want, but amybe you should broaden your reading of what economists are saying amongst themselves. We have not turned the corner on this recession; and many believe we have not seen the worst yet.

the two most issues right now are the economy and protecting this nation from terrrorism. We have been sleeping now for the last year for sure and we have become complacent even longer ago.

Pass something meaningful, simple and inexpensive for health care and come back to it later when the economy has turned around.

And tort reform - I will say it again (and gmorton said it very well) - is a no brainer. It is just the right thing to do even if saves no money, which anyone who has studied the issue, knows there is much room for cost savings when doctors are no longer fearful of frivolous lawsuits which cost them hundreds of thousands - and sometimes millions - of dollars to defend against.

And yet you continue to walk the tightrope on this because of misplaced guilt about how it would effect the “poor.” Just how many poor people are suing doctors anyway? Not very many.

Obama needs to gather himself and try another approach later on. Now is the wrong time.
Arch_Druid on February 03 at 11:40 p.m.
“Richard,” suggest you might not want to dismiss my above post in the most sneering fashion possible. A surgeon appearing on “The Daily Show with Jon Stewart,”(3 February 2010) confirms my previous post. Didn't catch his name but you can Google “A Checklist Manifesto.” Merely by washing one's hands, so this surgeon asserts, thousands of lives are saved. That's also, thousands of malpractice suits that never occur.

Now, how more obstructionist can a guy get than dismiss a solid statement confirmed by a DOCTOR no less and simply call it “foolish?” The definition of radical, “Richard.” Where you think you know everything and the FACTS can't get in the way of your opinion. LOL!
gmorton on February 04 at 12:43 a.m.
Arch_druid wrote,

“Merely by washing one's hands, so this surgeon asserts, thousands of lives are saved.”

Well, Arch, I didn't see the show, but I suspect you are confusing an historical illustration (of how small things can have big results) with advice for contemporary physicians. I'm sure Gawande was discussing the campaign at the turn of the last century to educate health care workers on aseptic technique – perhaps the biggest life saver in the history of medical practice.

You can be sure that aseptic technique is drilled into the skulls of all health care workers today. For most of them it is second nature, and more education (per your previous suggestion) on that topic would be redundant.

Atul Gawande, BTW, is the physician who wrote the New Yorker piece comparing health care costs in McAllen, TX with costs in El Paso, previously discussed at some length on this blog.
Jeffrey_Grey on February 04 at 3:46 a.m.
Richard,

– A vast number of the Mass voters stated in polls that health care was way down the list of “immediate” concerns of people.–

Health care reform could well be a low priority for Mass. voters **since they already have the benefit of the reforms others are seeking.** Funny how that fact constantly gets overlooked when folks cite the Mass. election results as proving anything with respect to health care reform.

– National polls have shown the same results.–

That is simply NOT TRUE. It's conflating peoples' growing skepticism over the Democratic plan with a FALSE assertion that folks are starting to turn away from health care reform in general.

http://www.pollingreport.com/health.htm

I cited those polls to you previously. The *overwhelming* majority of respondents were of the opinion that 'something' needed to be done NOW to reform health care in this nation.

– Pass something meaningful, simple and inexpensive for health care and come back to it later when the economy has turned around. –

Well and good, Richard. I'm not opposed to that, at least not in principle. But that's not 'people are no longer interested in health care, don't worry about it, now is not the time.' Maybe the first order of business is for you to decide which message you want to send. And if the message is 'pass something meaningful' statement - great.

Now, what's “meaningful, simple and inexpensive”? *It's time to get specific.* 'Meaningful is defined as these specific benefits for this percentage of the population over this span of time. Simple is defined as implementing these specific proposals in this specific manner to achieve the specific benefits previously mentioned. Inexpensive is defined as spending this sum and no more, allocated in these specific amounts to the previously mentioned specific proposals.'

Richard, you constantly throw out terse statements of principles - not that there's anything wrong with principles - but then when the discussion turns to the actual nuts and bolts of 'how to validate those principles in the real world?' you scamper back into the thicket of 'nobody is interested any more and look at all the other problems that are more pressing.'

What do we demand from our elected officials, Richard? *SPECIFICALLY*. Do we demand the implementation of the Democratic plan? Clearly you don't much care for that. So do you vote for the Republican alternative proposals? Okay. I can see some things in that plan that sound good. But there are also apparently some serious, practical objections to some of its proposals. (See the link cited above.)

How do you answer those objections?

And with respect to tort reform…

Well, here it is again. Tort reform is good as a general principle. But when you get confronted with an objection that would complicate the simplicity of just tossing out a generalization… “How many poor people sue doctors? Not a lot.”

**Do you have ANY evidence to support that allegation? ANY evidence at all to prove that it's only middle-income earners and above who file law suits?** (And thus we don't need to worry about turning the poor away from the courthouse door because there actually aren't any. Therefore you don't need to address the practical objection to your simplistic solution.)
Jeffrey_Grey on February 04 at 3:51 a.m.
gmorton,

Same comments for you as for Richard. When you get around to actually trying to apply those philosophical generalizations to the 'nuts and bolts' real world, do let me know.

Then we'll talk.

Otherwise; 'whatever.'
Gary D Rhodes on February 04 at 8:37 a.m.
That some “central planners” in DC think they can anticipate and deal with the “billions and billions” of complications and variables in such a giant arena is ludicrous.

Grey, the philosophical question is this;
What will happen to western industrialized nations when the 'ponzi scheme' of over promised entitlements hits the baby-boom fan?
Gary Crooks on February 04 at 10:54 a.m.
For those who can't see a downside to “loser pays”, read “A Civil Action.” There is a movie, too.

It isn't just the poor that would lose access to the courts. The defense attorney in that case destroyed his practice in his quest to win the case and had to file for bankruptcy. He also ended up taking a settlement, because he couldn't afford to continue.

Most attorneys would've given up long before that, and the corporation (Grace) would've gotten away with its liability in the leukemia deaths of children.

People are underestimating the ability of corporations to stretch out court cases with depositions and appeals. And guess what? They have attorneys, too. And their job is to win. Make the best case for their clients. If you have built-in thoughts about attorneys, they apply to the corporate versions, too.

When med-mal was on the ballot in Washington state, we asked for examples of “frivolous” cases. The proponents of caps on damages struggled mightily to produce examples. They did come up with one example that related to a power company accident. Had nothing to do with medicine.

Frivolous cases don't make it to trial. Lawyers would be crazy to take them, knowing the technical nature of evidence and testimony needed to win.

When med-mal cases do get to trial, juries generally side with docs.
You only hear about the cases where they lose.

It is hard to win such a case. It takes a lot of money to mount one. You need an expert witnesses to match the other side's. Good luck finding them in the same state you're suing. So you have to fly in your experts and put them up.

Then, let's say you win. Then it can be appealed. Doesn't take much to burn through $250k, which is what the cap would've been in Wash state. In Texas, lawyers don't take the cases as much anymore because of the cap.

All that aside, only like 3 percent of people that are medically harmed file lawsuits. So you pass laws that lower that number. What about the harm? What is being done to reduce the actions that led to that?

Tort reform doesn't answer that question.
gmorton on February 04 at 4:27 p.m.
“It isn't just the poor that would lose access to the courts. The defense attorney in that case destroyed his practice in his quest to win the case and had to file for bankruptcy. He also ended up taking a settlement, because he couldn't afford to continue.”

Those are indeed bonafide issues, Gary. But they have nothing to do with “loser pays.” That rule was not in effect in the cases you cite.

Nor would it cause the poor or anyone else to “lose access to the courts.” Their access would be the same as it is now. Would-be plaintiffs and their attorneys might weigh differently how and when to make use of that access, however, if they knew they would be held responsible for the costs their unsupportable accusation imposed on the accused. Holding plaintiffs responsible for the consequences of their accusations is not “denying” them anything, except a free lunch.

“Doesn't take much to burn through $250k, which is what the cap would've been in Wash state. In Texas, lawyers don't take the cases as much anymore because of the cap.”

Texas does not cap economic damages, nor attorney's fees. It only caps noneconomic damages. The noneconomic damages (“pain and suffering,” “loss of consortium,” etc.) are where the attorneys look for windfalls.

“When med-mal cases do get to trial, juries generally side with docs.”

Yes, they do. And the costs the docs incur to defend against those baseless allegations end up in your doctor bill and insurance premium.

A lot more “tort reform” is needed beyond the loser pays rule, BTW.
gmorton on February 04 at 4:32 p.m.
Jeffrey_Grey wrote,

“When you get around to actually trying to apply those philosophical generalizations to the 'nuts and bolts' real world, do let me know.”

Already explained how to apply them to the real world. Where they do not apply is to the fantasy world you prefer, i.e., the world of free lunches.
Jeffrey_Grey on February 04 at 6:28 p.m.
gmorton,

There's been so much rhetoric and so much lofty philosophy, I apparently lost the actual nuts and bolts, specific step-by-step 'how to' in the rush of everything else.

Since that really is my only concern at this point - the specific 'how to' - could you run your proposals past me again?
Arch_Druid on February 04 at 9:34 p.m.
Given the fact GMorton that “The Daily Show” presented Gawande's book only LAST NIGHT, LOL!; apparently, what's supposed to have been “drilled into the doctors” during their training so that it is second nature to them, has been forgotten. Or, Gawande wouldn't have found much occasion for writing his book.

So, hardly turn of the century thinking if the book only came out recently.
gmorton on February 04 at 10:23 p.m.
Jeffrey_Grey wrote,

“Since that really is my only concern at this point - the specific 'how to' - could you run your proposals past me again?”

Sure, Jeffrey.

1. Eliminate tax advantages of employer-paid v. individual insurance. This would instantly relieve employers of the burden of health insurance, and allow employees to individually purchase plans optimized to their particular needs and circumstances;

2. Repeal state mandates regarding what must be covered, who must be covered, and rates which may be charged. This would instantly reduce insurance costs across the board for most customers, because they would not longer be forced to pay for unneeded coverages or to finance subsidies for high-cost patients;

3. Allow customers to buy insurance from any carrier in the country. Would greatly increase competition among insurers;

4. Repeal licensing laws which restrict the supply of providers and health care facilities and compel providers to deliver free lunches.

5. Enact tort reform, including:

a) A “loser pays” rule;

b) Caps on non-economic damages, and eliminate them entirely in class action suits;

c) Adopt a strengthened Frye Rule;

d) Reinstate the contributory negligence rule;

e) Repeal joint and several liability in tort actions.
Jeffrey_Grey on February 05 at 4:17 a.m.
gmorton,

First off; a sincere thank you for repeating your concrete proposals. I mean that. Now that you lay them out again, I do remember at least some of them. (Not to say you haven't set all of them out in the past. It's just that I can honestly claim to remember only some of them. Speaking solely for myself, this is one of my objections to a lot of theory and philosophy. There's only so much room in my small mind and one thing quickly drives out another. Be that as it may…)

I'm going to pounce on one point simply because it 'lit up' the moment I started to read it. I'd like to discuss this one first, if we may.

– Repeal state mandates regarding what must be covered, who must be covered, and rates which may be charged. –

First: How does this proposal relate to the issue of denial of coverage for pre-existing conditions? Second: Would there be some minimum 'basic coverage' that would be mandated? 'If you're going to insure, you're going to cover the costs of at least the following fundamental health care items…'?
Gary Crooks on February 05 at 1:40 p.m.
Selling across state lines.

http://www.kaiserhealthnews.org/Stori…

CBO says 5 percent savings on average for people shopping for individual insurance. Most people have group insurance through employers.

Jeff,

I would imagine that the ability to deny coverage would remain under intact under a libertarian plan. Or, the cost would be raised to cover the additional risk, which would put the premiums out of reach. This form of rationing would remain. I would think it would be enhanced since fewer people would have group coverage, which currently shields many people with pre-existing conditions.

Remember, that such a plan does not have universal coverage as a goal. Once you eliminate that goal, it's easier to bring the overall price tag down. We could eliminate Medicare and costs to the government would tumble.
Gary Crooks on February 05 at 2:02 p.m.
House Republicans did have a plan. Here is CBO's scoring of it.

http://cbo.gov/ftpdocs/107xx/doc10705…

LA Times:

“The different goals and effects of the GOP bill are reflected in a preliminary analysis released Wednesday evening by the Congressional Budget Office, which put the bill's 10-year price tag at $61 billion. That is far less than the $1 trillion estimate for the Democratic bill that House leaders plan to bring to the floor as soon as this weekend.

“But the CBO analysis also concluded that under the GOP plan, 52 million nonelderly Americans would have no insurance in 2019 — even more than the 50 million in 2010. By comparison, the House Democratic bill would reduce the number of nonelderly Americans without coverage to around 18 million over the next decade.

“The GOP bill is an amalgam of market-oriented measures that would limit medical malpractice lawsuits, expand the use of tax-sheltered medical savings accounts, let people shop for insurance outside of their own states, and make it easier for small businesses and hard-to-insure people to get coverage. The ideas reflect conservatives' suspicion of sweeping new programs, federal spending and additional regulation.'”

http://articles.latimes.com/2009/nov/…

I do wonder why this GOP plan was not introduced and passed when they held power. Seems more reflexive than heartfelt.

“We have to offer something. Can't just say no.”

And, Jeff, denial for pre-existing conditions would have remained.
Jeffrey_Grey on February 05 at 2:27 p.m.
Gary C,

The good news is that in an era when both sides of the Great Partisan Divide disagree as a simple matter of reflex, at least everyone can apparently agree that any fix for the looming crisis must include prohibition against denial of coverage for pre-existing conditions if it's to be a real fix.

So I suppose the best thing to do with this particular point is to just let it go since it's a non-issue in the real world.

As for the rest of the G.O.P. proposals, make sure you distinguish the 'new and improved' plan floated in November from the old plan dated last May or so. There are apparently still serious objections. But there are also elements where the Republicans are offering to 'meet at least half-way'. I think those items at the very least should be seized upon as a first bi-partisan step in the right direction.

– Despite our differences on some important health care-related issues, we are convinced there are areas offering
potential for common ground on health care reform among Republicans and Democrats. These areas for potential agreement are evident in the similarities between some of our recently-outlined health care reform principles and yours:
• We believe we must make quality health care coverage affordable and accessible for every American, regardless of
pre-existing health conditions. You’ve called for a plan that “puts us on a clear path to cover all Americans,” and said
“no American should be denied coverage because of preexisting conditions.”
• We believe health care reform must let Americans who like their health care coverage keep it, and give all Americans
the freedom to choose the health plan that best meets their needs. You’ve said Americans “should have the option of
keeping their employer-based health plan,” and said reform “should provide Americans a choice of health plans and
physicians.”
• We believe health care reform must improve Americans lives through effective prevention, wellness, and disease
management programs, while developing new treatments and cures for life-threatening diseases. You’ve said health
care reform must address “cost drivers” in our system such as “obesity, sedentary lifestyles, and smoking.”–

The Republican Senate leadership writing in a letter to President Obama, cited in the “Better Solutions, A Compilation of G.O.P. Alternatives” document.
gmorton on February 05 at 4:08 p.m.
Jeffrey_Grey wrote,

“First: How does this proposal relate to the issue of denial of coverage for pre-existing conditions?”

It allows any carrier to offer or deny coverage to any person it wishes, to offer any scope or extent of coverage agreeable to the customer, and to charge whatever the customer is willing to pay.

“Second: Would there be some minimum 'basic coverage' that would be mandated? 'If you're going to insure, you're going to cover the costs of at least the following fundamental health care items…'?”

An insurance policy, like all other business transactions, is a bilateral contract between an insurance company and a customer. Only those two parties have any legitimate “say” in its terms. Unless those terms violate some 3rd party's rights, they are none of any 3rd party's business. The State has no business mandating anything (though it may properly require the company to demonstrate that it is sufficiently well capitalized to pay claims).

As I said above, if you're looking for free lunches, you'll need to look elsewhere than to the proposals I listed. If you're seeking to reduce health care costs, you will consider them.
gmorton on February 05 at 4:19 p.m.
Gary Crooks wrote,

“CBO says 5 percent savings on average for people shopping for individual insurance. Most people have group insurance through employers.”

That would change if the tax advantages of employer-paid insurance were eliminated.

That change would not automatically eliminate employment-based group plans, BTW. But the employees, not the employer, would be paying for them, and every employee would be able to compare the advantages and costs of participating in a group plan or buying an individual plan.
gmorton on February 05 at 4:44 p.m.
Gary Crooks wrote,

“Remember, that such a plan does not have universal coverage as a goal. Once you eliminate that goal, it's easier to bring the overall price tag down.”

Yes. That is a separate goal, and should be handled separately, through an express welfare program with a visible budget. Trying to build it into a comprehensive health care “reform” scheme hides its costs and destroys the mechanisms which would otherwise constrain costs in the market. It renders the entire market economically irrational.
richard on February 05 at 5:07 p.m.
Excellent idea Gary! Let's watch a hollywood movie based on a book about evil corporations. Give me an example of a serious movie since the 1970's which involves a corporation, and where that corporation is not “evil” or at least very bad.

You can start with … Avitar and go backwards.

So I am hearing you say, as is most every one else, that tort reform is just pl;ainly a bad idea; there is no redeeming value at all. Since neither bill contains tort reform that must be the conventional wisdom in the progressive camp.

Or can you identify any kind of tort reform that is acceptable to you and Nancy and Harry?
richard on February 05 at 6:08 p.m.
Jeff, your polls do not rank “problems” in this country and their relative weight given by the populace. I have been unable to find the poll which did that which specifically listed several “problems” and asked people to rank them according to seriousness.

The number one problem by a significant number was … the economy. It then included the following (though not necessaritly in this order): unemployment, the national debt, Afghanistan, terrorism; all of which ranked above health care.

At the bottom were: health care, global warming, immigration.
There may have been others in the ranking, but health care reform was far from the top. I will continue to look for that poll.

The polls you listed merely gave an either or question. And you will note from your polls the following:

Do you believe Obama is giving too much attention to helath care, or too little. 44% said TOO MUCH, while 16% said TOO LITTLE. That indicaters the public does not see a drastic problem that must be solved above all else.

Is Obama’s plan a GOOD idea or a BAD idea? 31% said GOOD, 46% said BAD. Same conclusion can be drwan. It is not a pressing issue.

If the current legislation becaomes law, is it a step forward, or a step backward. 44% said STEP FORWARD, while 49% said STEP BACKWARD. Same conclusion.

And, the USA Today/Gallup poll asked: Do you agree with the Dems making health care a top priority, or do you disagree? 32% said they agree it should be a TOP PRIORITY, while 46% said it should NOT BE TOP PRIOITY.

I think this shows exactly what I said … the people want other things fixed first; it is not a “critical” priority; it is down the list of importance to the people.

I don’t think you can refute that Jeff.
Jeffrey_Grey on February 05 at 6:31 p.m.
– “How important is it to you that the President and Congress deal with each of the following issues in the next year? Will it be extremely important, very important, moderately important, or not that important? . . .”

“Very Important”:

Economy: 61%
Unemployment: 58%
Terrorism: 55%
The Deficit: 46%
Health Care Reform: 43%
… –

http://www.pollingreport.com/prioriti…

So Richard, does this mean that one of the biggest hot-button issues today - solving the deficit - is only slightly more important than reforming health care? Or does it mean that reducing the deficit isn't important either?

And yes, you're right - “It's the economy, stupid!” I still get that. I also get the fact that you completely dodged the question about health care reform being an integral part of fixing the economy. $1 billion a year in this state alone. Remember? Remember how that means it's therefore not an either/or issue?
Jeffrey_Grey on February 05 at 6:40 p.m.
gmorton,

– It allows any carrier to offer or deny coverage to any person it wishes, to offer any scope or extent of coverage agreeable to the customer, and to charge whatever the customer is willing to pay. –

And this will cause insurance companies to issue more policies and thus reduce the load of unrecovered, uninsured medical expenses currently being borne by the system?

Please provide evidence based on real-world experience where this has proved to be the case. I ask for proof because it sure seems profoundly counter-intuitive to me.
Gary D Rhodes on February 05 at 7:11 p.m.
Actuaries perform this task, Jeff.

If I went to purchase life insurance at age 57, I would have to pay more tan a 30 year-old, but less than a 77 year-old for the same sized pay-out.

What Morton is trying to get through to you is the philosophy. Our nation is founded on individual liberty and limited government. Some of us would like to return to this way of governance. If you force one person to pay for someone else's needs or desires, that is not freedom.
GMorton writes;
<< Trying to build it into a comprehensive health care “reform” scheme hides its costs and destroys the mechanisms which would otherwise constrain costs in the market>>

That's exactly the object of over 2000 pages of regulations and rules. If we could make the federal government pick up the costs of forced ER care, and the chronic underpayment built into Medicare and Medicaid that is passed on to the private sector, we could see some major cost savings to that private sector.
gmorton on February 06 at 12:45 a.m.
“And this will cause insurance companies to issue more policies and thus reduce the load of unrecovered, uninsured medical expenses currently being borne by the system?”

No, Jeffrey. It will only lower costs of insurance. To “reduce the load” of costs born by third parties, you'll need to eliminate the government edicts which demand that providers bear that load (which of course they must recover from paying patients).
gmorton on February 06 at 1:08 a.m.
Gary Crooks wrote,

“Remember, that such a plan does not have universal coverage as a goal.”

Should have added this comment to previous response to this comment of yours.

All public policies which attempt to provide “universal” anything in civilized societies are misguided. That is because such societies are not constituted from “universal persons,” i.e., persons whose needs, interests, goals, and values are all the same. They are comprised instead of autonomous, *sui generis* individuals who vary widely in all those variables, many of which are incompatible. Hence any attempt to universalize a given value will enhance the welfare of some at the expense of others – they allow some to become predators and others prey.
Jeffrey_Grey on February 06 at 3:52 a.m.
gmorton,

– To “reduce the load” of costs born by third parties, you'll need to eliminate the government edicts which demand that providers bear that load (which of course they must recover from paying patients).–

And then what happens to that 'load'?

As you very well know, the costs will still be there. People will still be getting sick and injured and won't have the means to pay for their treatment. Pre-existing conditions will still be grounds for denial of coverage leaving an ever-growing 'load' - as is happening right now. The 'load' will increase as people are dumped from coverage the moment they make a claim - as is happening now. The only beneficiary will be the insurance companies who will be left free to pick and choose people least likely to ever demand a payout, a dream come true for the insurers and a nightmare for everyone else.

Your 'solution' will in fact only make the crisis that much worse that much faster.

It's not a fix worth considering. Fortunately, nobody is. As I said to Gary C, that being the case there's no point in pursuing this any further. It's not real world.

Rhodes,

You might not have been around when I announced that I'm simply no longer interested in philosophy. I'm only interested in practical solutions. The above reply to gmorton shows why.
Gary D Rhodes on February 06 at 6:45 a.m.
You seem to be interested in in practical solutions to particular cases. Why don't you get specific and site real world examples of problems with our current system, then we might be able to drill down on that specific person, and how to solve their problem.
Jeffrey_Grey on February 06 at 7:42 a.m.
Fair question.

Let's start here on the local level:

– Many of the costs of uncompensated care are quietly passed along to the insured.

In fact, our office estimates that uncollectable medical debts and charity care by hospitals and other health providers end up adding at least $917 a year to the medical bills of insured families. For individuals, that added annual cost is at least $457.

The cost of uncompensated care is also rising rapidly. The 2008 total of nearly $700 million, for example, represents a 20 percent increase in just two years.

Also in 2011, we estimate, the state will see the number of people without health insurance rise above 1 million. And in some populations, such as rural, working-age adults, the ratio of people without health coverage is rapidly approaching 1 in 4. –

http://www.insurance.wa.gov/consumers…

I would call that a specific, real-world problem that is rapidly approaching crisis proportions. (And for Richard's benefit - if that isn't a crisis directly related to the health of our state's economy, I'm hard pressed to know what is.)
Gary D Rhodes on February 06 at 8:04 a.m.
<<In fact, our office estimates that uncollectable medical debts and charity care by hospitals and other health providers end up adding at least $917 a year to the medical bills of insured families.>>
Should the cost of uninsured people be shifted to those people who have private insurance or self-pay?

Should the government pay for 100% of the costs of Medicare and Medicaid, or continue to be subsidized by the private sector?

Do you think it is a good idea to force every person in America to buy insurance from private companies?
What about the farmer who wants to pay for medical care from his own bank account?
Would you have any exemptions?
Jeffrey_Grey on February 06 at 9:32 a.m.
– Should the government pay for 100% of the costs of Medicare and Medicaid, or continue to be subsidized by the private sector? –

My personal preference would be to continue to have the private sector bear as much of the burden as practical, with the government stepping in only as necessary to cover any shortfall. Of course that assumes responsible action on the part of both and I'm pragmatic enough to know that's going to be a good trick if we can manage it. Still… you asked and that's my reply.

– Do you think it is a good idea to force every person in America to buy insurance from private companies? –

Given the current real-world reality, I don't see any other practical way to make the risk pool large enough to bear the burden.

If that statement provokes the need, please feel free to howl with the righteous fury of the offended libertarian all you want. *In this particular case*, I don't care if making people do something that is ultimately in their best interests to overcome a crisis offends dogma. If you have a *practical alternative*, by all means trot it out and let's examine it. Otherwise… 'whatever.'

– What about the farmer who wants to pay for medical care from his own bank account? –

I suppose we could certainly examine the possibility of allowing someone to post a surety analogous to the alternative to mandatory automobile insurance. (With the interest from the surety applied to insurance funding for everyone else.) It's either that, or we allow Farmer Brown to opt out with the explicit understanding that he is FOREVER waiving *ANY* medical care that he can't pay for in full out of his own pocket prior to treatment being rendered.

The latter option seems pretty draconian to me, though. I would much prefer the first option.
richard on February 06 at 12:36 p.m.
Jeff, the problem discussing an issue with you is that even when I provide clear evidence to support my position – which you challenged – you mearly morph the issue so it appears to to dispute the evidence I provided . . .

Most important issues . . .

ECONOMY 61%
UNEMPLOYMENT 58%
TERRORISM 51% (an issue Dems consider to be but a minor issue)

HEALTH CARE 43%

As I stated, health care is clearly not seen by the people as one of the most pressing problems confronting them. I understand it may be to you – and I empathize – but the nation has rejected the “dire straits” hype from Obama and the Dems.

And when you ask …
<<So Richard, does this mean that one of the biggest hot-button issues today - solving the deficit - is only slightly more important than reforming health care? Or does it mean that reducing the deficit isn't important either?>>

I can only state what the numbers reveal. You call the deficit a “hot-button” issue, but apparently it isn’t that “hot” to a majority of the people … at least relative to the Economy, Unemployment and Terrorism. I am afraid you conflate the public’s opinon of an issue, with your own subjective perception of what is most important.

Opinion does not necessarily reflect reality, at least not in an object manner.

And yes, health care is an integral part of the economy; and that is one argument for why measures should be taken to bring the costs down. Tort reform will help with that; nationwide competition between insurance companies will greatly help with that; allow buyers to purchase coverage “ala carte” to eliminate the state mandates on insurance companies which require people to buy converage they don’t want or need . . .

That would help resolve many of the issues in health care, AND the economy.

I am afraid you do not appreciate the “genius” of simple, often overlooked solutions. Time and again throughout history, it has been the simple solutions which the “experts” overlook which actually resolve pressing problems.
richard on February 06 at 1:18 p.m.
<<I don't care if making people do something that is ultimately in their best interests to overcome a crisis offends dogma. If you have a *practical alternative*, by all means trot it out and let's examine it. Otherwise… 'whatever.'>:>

That statement is quite illuminating Jeff. You “don’t care” if it is forcing people to do something … Forget the so-called “dogma” you refer to (It is funny how principle is “dogma” when it is someone else’s principle – but that is another topic), it shows arrogance, it clearly illustrates “the ends justify the means” rationalization, and it defies one of the most fundamental elements of “liberty”, as in “Life, Liberty and the pursuit of Happiness” (with apologies for being “dogmatic”).

And speaking of arrogance, how are you equipped to tell someone else that being forced to buy something is “ultimately in ther best interests”? You are mouthing the words of the progressive agenda, whether you realize it or not. And progressivism is “dogmatic.”

Maybe, Jeff, just maybe, there is no practical solution for this particular topic. And maybe the problem with government’s solution is much like “trying to pound a square peg into a round hole” which only results in something else breaking along the way; or, as is so often the case with government manipulations, there are “unintended consequences” which only replace one problem for another.

And maybe that doesn’t matter to some, as long as someone elseis burdened with the unintended consequence.
Gary D Rhodes on February 06 at 3:05 p.m.
So Jeff, you like the fact that the government only reimburses doctors and hospitals at a 70% rate. That is a great cost saving to the tax payers, but at what cost.
Some want Medicare for all in America. What unintended costs will there be?
Will the best and brightest still want to go through med school?
How many hospitals and clinics will close?
gmorton on February 06 at 4:32 p.m.
Jeffrey_Grey wrote,

“And then what happens to that 'load'?”

It is born by the patients, or by charities, or (worst case) by a specific welfare program with an explicit, visible budget.

“The only beneficiary will be the insurance companies who will be left free to pick and choose people least likely to ever demand a payout, a dream come true for the insurers and a nightmare for everyone else.”

No, Jeffrey. The beneficiaries will be everyone who buys insurance or consumes health care services, except those now receiving free lunches. They will benefit from more carriers and providers from which to choose, more choices in the scope and terms of coverage, and lower costs.

“Your 'solution' will in fact only make the crisis that much worse that much faster.”

Which “crisis”? The cost crisis, or the shortage-of-free-lunches crisis?

“I'm only interested in practical solutions.”

No. You're interested in a free lunch. That is not practical – it is in fact impossible – because it distorts the market and inflates costs. Solutions which ignore principles, such as the laws of economics, are never practical. They inevitably exacerbate the problem they're trying to solve or create new ones.
gmorton on February 06 at 4:45 p.m.
Jeffrey_Grey wrote,

“I don't care if making people do something that is ultimately in their best interests to overcome a crisis offends dogma.”

Classic example of statist arrogance there: “We statists know better than you do what is in your best interest.”

But then, its always just a rhetorical throwaway line anyway, intended to reassure the passive and gullible. It never takes much analysis to uncover whose interests are actually in play – someone seeking to score a free lunch.
Jeffrey_Grey on February 06 at 5:07 p.m.
Richard,

I'll say it one last time: health care reform IS an economic issue.

As for the rest: 'whatever'.

Rhodes,

I can no longer tell what you're arguing for. How do you answer your own questions that you posed to me?

gmorton,

– It is born by the patients, or by charities, or (worst case) by a specific welfare program with an explicit, visible budget.–

The patients would pay if they could. Clearly many can't. It's utterly unrealistic to expect this state's entire charitable donation to even begin to cover a $1 billion annual load. That leaves a “specific welfare program.” How would you propose to fund such a program?

How about mandatory health insurance? At least that way everyone who can contribute does.

As for your incessant parroting of 'free lunch' - at this point, clearly that's just rhetoric. It's just what start chanting when your solutions are shown to be empty. “Charity and welfare programs but no free lunch!”

So from now on, that's just 'whatever' too.
gmorton on February 06 at 6:46 p.m.
Jeffrey_Grey wrote,

“As for your incessant parroting of 'free lunch' - at this point, clearly that's just rhetoric.”

No, Jeffrey. It is the obvious and accurately described substance of the argument. You are looking for a benefit, and a means of forcing someone else to pay for it. That, for you, is the core of the “health care crisis.”

Yes, the welfare program would also be a free lunch (that is why it is the “worst case”). But it is preferable to other means of delivering them – such as via comprehensive health care “reform” – because its costs are visible (not concealed in prices paid by others for health care services), and it does not disrupt the cost-control mechanisms inherent in markets nor constrict the choices of consumers. A visible budget allows taxpayers to see what their forced charity program is costing them.

Private charities, BTW, are not free lunches because no one is forced to contribute to them.

I realize you don't like my constantly calling attention to your demand for a free lunch. You'd prefer that demand be tacitly accepted, left unmentioned, and the discussion focus on means of delivering it.

But it is the elephant in the room that is trampling the health care market. You may wish to ignore it, but those being trampled certainly won't.
Gary D Rhodes on February 06 at 6:52 p.m.
It's really quite simple Jeff.

The statist goal is single payer. The model, they say, is Medicare. A government program that is loved by all. This model of efficiency should be available to those 55 and older, they say, then next, Medicare for everybody.
Medicare for all!
The government pays 48% of all healthcare costs now. When it gets to 100% we will all be singing Joni Mitchell's “Big Yellow Taxi”.
As it is now, the chronic underpayment by Medicare and Medicaid is forcing the closure of hospitals where there are not enough paying customers to make up the shortfall.
Drs. are refusing to take on more of these patiens.
Add to that the staggering bill our kids will get in a few years as they try to pay off the IOU's we have left in the Social Security/Medicare “lock box”.
Then we need to worry about the massive red-ink we are facing in these entitlement programs.

Not a pretty site.
Arch_Druid on February 06 at 8:03 p.m.
The funny thing about charities, GMorton, “no one is forced to contribute to them” but the people who contribute, and further hugely, esp. to use “charitable work” as a tax shelter, is that income REdistribution is assured the moment it gets written off on form 1040.

As for the “statist” argument, bet that the “anti-statists” on this board have no problem ushering in statism when ever it serves their agenda. Opposed to abortion? Then yeah, let us introduce statism.

If it is health care that truly may serve those who can not now afford it or insurance? Then it is “statism.”

Hypocrisy instead of legitimate debate, right?
Jeffrey_Grey on February 07 at 3:24 a.m.
gmorton,

The simple fact remains that when you're finally pushed to the wall and finally have to come up with a concrete solution, you offer the worst possible example of a state created 'free lunch' - welfare - as the solution.

If 'visibility' is the rationale, both the costs and the administration of mandated health insurance would be far more 'visible' to the consumers than the hidden tax the current free market system levies against everyone.

“Charity and welfare but no free lunch!”
Jeffrey_Grey on February 07 at 6:33 a.m.
Rhodes,

You miss the most important question: *Why* is Medicare underfunded? Why are there fewer and fewer paying customers?

Is it because it's just human nature to be a deadbeat? Therefore the problem arises not because medical care is too expensive to afford without insurance and the system of providing insurance is itself fatally flawed in this country. Rather, it's because people are refusing to pay when they otherwise could and that's what's dragging the system down. That's gmorton's and Richard's fundamental thesis - everybody is standing around with their hand out expecting a free lunch.

If that's in fact true then their proposed solution - libertarian anarchy - is doomed from the start. How can a system founded on the principle of 'every man can be trusted to make the best decisions free from any control' possibly work if it's populated by a bunch of deadbeats and freeloaders? That's a glaringly obvious logical absurdity to anyone not otherwise blind to the flaws inherent in such a fatally flawed system. The very failure it points to as the ill to be fixed directly contradicts the fundamental assumption it relies on for its existence.

In any event, by now it should be patently obvious to everyone willing to stop and think about it for even a moment that gmorton's proposed fix - “Charity and welfare but no free lunch!” - is absurd on its face. (At least in the real world where the rest of us have to actually live.) That being so, again I ask you - what's the solution?

The current system clearly doesn't work.

What - *specifically* - do we replace it with?
Jeffrey_Grey on February 07 at 6:36 a.m.
AD,

I don't think it's hypocrisy so much as it is an inability to do more than repeat the slogans when it finally comes down to specifics and there's nothing else substantive to offer.
Jeffrey_Grey on February 07 at 6:42 a.m.
Lest I be accused of just asking questions and never supplying answers, here's something I stumbled across while researching the soaring price tag for uninsured healh care here in WA.

I don't know if it's the whole solution, or even a good solution for that matter. But it's certainly at least one specific proposal.

http://www.insurance.wa.gov/consumers…
Arch_Druid on February 07 at 8:56 a.m.
I tend to agree with you in principle, Jeff Grey. Slogans don't exactly argue in favor of concrete proposals. Suggest that you take a look at Gary Crooks' “Smart Bombs” this morning where he also covered GOP health care proposals. From what I could tell, the GOP would prefer to provide half loaves or quarter loaf proposals and leave the nation worse off than before in order to demonstrate their “conservative” proclivities.

But if these are “proposals” that ultimately help fewer people, then what is their worth?

But, gvt can pull out all the stops when it comes to fetuses and Terry Schiavo. So what is the worth of GOP “conservatism?”
Gary D Rhodes on February 07 at 9:05 a.m.
On December 21st, Senate Majority Leader Harry Reid said that in the time it took to make his remarks, (aprox 3:30) that two more Americans died needlessly from a preventable medical issue.
How many Americans have died since he made those remarks on the Senate floor?

Why are the Democratics and Obama so heartless?
spokelooneh on February 07 at 12:13 p.m.
Arguing about the efficacy of tort reform and reducing defensive medicine costs is akin to shuffling the deck chairs on the Titanic or putting a band-aid on a papercut while bleeding out from a gaping GSW.

The provision of health care in the US is enormously expensive and enormously profitable for the many and varied players, hence the reluctance to reform the gravy train in any meaningful way.

The rest of the industrialized world, our main competitors, have devised reasonable cost, high favorable outcome, universal coverage systems of various sorts so that THEIR citizens are not one major illness away from bankruptcy and financial ruin, and no parent has to worry that if their child gets sick or has a serious accident how they will pay for medical care.
Jeffrey_Grey on February 07 at 12:30 p.m.
Spokel,

I agree **100%** with what you have to say in the last two paragraphs of your post.

But the more I research the topic, the more I disagree with your points raised in the first paragraph. If the high cost of medical care is the logical point of attack, then reducing the cost of 'defensive medicine' is a logical avenue of approach for that attack.

Consider this from the CBO:

– CBO had previously estimated that enacting a common package of tort reform proposals would reduce federal deficits by $4 billion from 2010 to 2019, but CBO now estimates that those proposals would reduce federal deficits by about $54 billion during that period. The latest estimates are substantially larger for four principal reasons:

•The estimates include a larger effect of tort reform on medical malpractice costs;
•The estimates incorporate the effect of a gradual reduction in the utilization of health care services resulting from changes in the practice patterns of providers;
•The estimated effect on federal revenues was substantially smaller in the previous estimate (which reflected only a reduction in malpractice costs) than the estimated effect on revenues in the current estimate (which reflects the combined effects of the reduction in malpractice costs and the change in spending attributable to changes in practice patterns); and
•The reduction in utilization is projected to generate a proportionately larger reduction in federal spending on health care than in other spending on health care. –
http://cboblog.cbo.gov/?p=441
spokelooneh on February 07 at 1:06 p.m.
$54B over 10 years, eh? Wow.

Let's say a miracle happened and health care costs plateaued at the current level, $2.5T per year, over ten years, that's 25 TRILLION dollars.

$54B is the proverbial drop in the bucket.

But there is no miracle, and health care costs are rising $200B a YEAR and increasing.
gmorton on February 07 at 1:46 p.m.
Jeffrey_Grey wrote,

“The simple fact remains that when you're finally pushed to the wall and finally have to come up with a concrete solution, you offer the worst possible example of a state created 'free lunch' - welfare - as the solution.”

You apparently have short memory. I offered the welfare scheme as one solution, though not the optimum one, many weeks ago, in another thread. I also repeated it several times.

Why is the welfare scheme the “worst possible example”? “Worst” in what way?

“If 'visibility' is the rationale, both the costs and the administration of mandated health insurance would be far more 'visible' to the consumers than the hidden tax the current free market system levies against everyone.”

You're dissembling, Jeffrey. The cost of the *free lunch* is *not* visible in the mandate. It is concealed in the premium, part of which covers the cost to cover the purchaser, and part of which covers free lunches for 3rd parties. It also restricts the choices open to the purchaser, forces him to buy coverage he does not need and will not use, in order to deliver more free lunches. And it also perpetuates the the 3rd party payer fiasco, thereby assuring the cost spiral will continue.

Do you perhaps dislike the welfare proposal because, though you seek a free lunch, you don't want to be seen or labeled as a “welfare recipient”?
gmorton on February 07 at 1:50 p.m.
Jeffrey_Grey wrote,

“If that's in fact true then their proposed solution - libertarian anarchy . . .”

Huh? Who has advocated anarchy? Do you know what “anarchy” means? Or are you attempting to redefine it?
gmorton on February 07 at 2:09 p.m.
Jeffrey_Grey wrote,

“How can a system founded on the principle of 'every man can be trusted to make the best decisions free from any control' possibly work if it's populated by a bunch of deadbeats and freeloaders?”

You've attempted that distortion before. A free society is not based on the principle you cite. There is no such thing as a “best” decision, and no need for any person to trust any other to make it. In a free society the question of trust will arise only when you and I have a contractual relationship, in which case I will exercise due diligence to see whether trust is justified. If there is no contractual relationship then no trust is necessary. I will not be interested in any decision you might make. I will have no means of judging whether your decision is “best,” nor any interest in whether it is. I will assume it is best for you, and if that turns out not to be the case, it is no skin off my nose.

The world can be populated by deadbeats and freeloaders only with the assistance of government. In free societies those are not viable options.
Jeffrey_Grey on February 07 at 2:43 p.m.
gmorton,

“Whatever.” I don't even bother to read it any more knowing as I do that it's a fifteen minute shaggy dog joke with a not-at-all humorous punchline.

“Charity and welfare, but no free lunch!”

Spokel,

Doesn't it feel just a wee bit disingenuous to pooh-pooh $54 *billion* dollars?

Look, I am by no means saying that tort reform is the whole solution. It isn't. I have no illusions in that regard.

But neither does it seem reasonable to me to expect a solution if we just dismiss out of hand a sum *that* large, branding it irrelevant. It's the old Congressional truism at work again. “A billion dollars here. A billion dollars there. Pretty soon you're talking real money!”
Arch_Druid on February 07 at 5:32 p.m.
I find the Dems are so heartless line of attack as big a guffaw maker as “racism” being found among people trying to END it. GMorton, every time you post, you advocate anarchy. The idealism that people will always know and do what is best for them is LIBERALISM to the extreme. Excuse me, but we CONSERVATIVES on the board know better.
spokelooneh on February 07 at 5:46 p.m.
As I said many times before, I have no problem with reasonable tort reform and reducing the cost of defensive medicine. But to focus on it is not see the Redwood boreal forest for the saplings.

Health care costs are projected to be $30 TRILLION over the next 10 years. $54B in projected savings amounts to .18%, that's right, less than a fifth of penny on every dollar. It's idiotic to focus on it as it will do next to nothing in curbing overall spending.

REAL reform has to find and focus on the BIG cost drivers, or the system will simply collapse of its own weight.
gmorton on February 07 at 7:50 p.m.
Arch_druid wrote,

“GMorton, every time you post, you advocate anarchy.”

Can you quote an example?

“The idealism that people will always know and do what is best for them is LIBERALISM to the extreme.”

Never claimed any such thing, Arch. Only claimed that you are more likely to know what is best for you than I am, and much more likely to know that than a bureaucrat who has not even had the pleasure of trading thoughts and barbs with you.
gmorton on February 07 at 8:33 p.m.
Spokalooneh wrote,

“Let's say a miracle happened and health care costs plateaued at the current level, $2.5T per year, over ten years, that's 25 TRILLION dollars.”

What is instructive is not the per capita costs or the total costs, but the rate of increase in those costs over the last 40 years or so. Americans have higher per capita incomes than most people elsewhere, and are also highly receptive to novelty and innovation. So you can expect they might be willing to spend a larger portion of their disposable incomes on health care. But that does not explain why those costs have (roughly) tripled the inflation rate over that time period. You would expect, in fact, the opposite trend: technological innovation in every other field *reduces* costs.
richard on February 07 at 8:43 p.m.
<<The provision of health care in the US is enormously expensive and enormously profitable for the many and varied players, hence the reluctance to reform the gravy train in any meaningful way. >>

You vastly over rate your hand, Loone. ENORMOUSLY expensive? You exaggerate. ENORMOUSLY profitable? Again you exaggerate; and compared to what? And it may seem “enormous” to those who resent others who make a profit.

GRAVY TRAIN? I know people in insurance; it is profitable, but I would hardly call it a “gravy train.” Just sounds like sour grapes to me, rather than “meaningful” commentary.

There have been many proposed changes to health care which would positively effect cost … but the dwindling numbers who still see the Dems proposals as the only way are clearly in favor because it forces others to pay their way … the “progressive way.”

Free Lunch anyone?
spokelooneh on February 07 at 9:09 p.m.
Enormously expensive? The US pays the highest per capita health care costs in the world, a good 35-40% higher than anyplace else.

I'm not just talking about the profitability in the insurance companies, but the ENTIRE industry, as a whole. Pharm, durable medical devices, labs, all of it. Most industries in the US would kill to have to profitability of the medical industry.

Your tort reform arguments are laughable to the scope of the overall cost inflation problems.
gmorton on February 08 at 12:29 a.m.
Spokalooneh wrote,

“I'm not just talking about the profitability in the insurance companies, but the ENTIRE industry, as a whole.”

Looneh, you protested that tort reform was a drop in the bucket of health care costs (and I agree with you on that). The same applies to corporate profits. If you set the profits on the entire for-profit portion of the health care market at 0%, you'd see a cost reduction of < 1%. I'll let you work it out for yourself.
Jeffrey_Grey on February 08 at 6:32 a.m.
Some actual numbers regarding health care and corporate profit.

http://www.politifact.com/truth-o-met…

Spokel,

I just don't see how we can walk away from $54 billion and still claim to be working toward fixing the problem. Get obsessed about tort reform? Concentrate on that to the exclusion of all else as if the whole fix can be found there? No. Most certainly not. Tort reform to address the costs of defensive medicine is just one item in a long laundry list. Anyone who tries to sell the idea that we can fix it all with only one or two overly-simplistic solutions - including tort reform - is protecting a sacred cow and/or a political agenda.

But at $54 billion, tort reform is still an 800 pound gorilla that has to be acknowledged and dealt with.
Gary D Rhodes on February 08 at 6:36 a.m.
<<REAL reform has to find and focus on the BIG cost drivers, or the system will simply collapse of its own weight.>>

Without “death panels” brought about by the inevitable shortages that will result from a complete government takeover, and the rationing that will be their only option, how will Obamacare deal with preventable, life-style caused diseases?

Here is a real world question; How much will type 2 diabetes cost over the next ten years?
What is the plan to get these people to take better care of themselves?
spokelooneh on February 08 at 10:52 a.m.
“I just don't see how we can walk away from $54 billion and still claim to be working toward fixing the problem”
-Jeff

Show me where I said walk away from tort reform. Nevermind, you CAN'T.

Tort reform is not an 800lb gorilla. It's an insignificant gnat in the overall scheme of health care reform, as it amounts to to less than 1/5 of 1% of health care spending.
Gary Crooks on February 08 at 11:16 a.m.
<<You seem to be interested in in practical solutions to particular cases. Why don't you get specific and site real world examples of problems with our current system, then we might be able to drill down on that specific person, and how to solve their problem.>>

From an email I received.

Wife is self-employed. Husband is 60 and has Type 1 diabetes (the kind you can't prevent) and works. They get health care coverage via his employer, but that employer is dropping coverage for all employees starting March 1.

Because of his condition, they need a high-end plan. There is only one that doesn't cap expenses for diabetic supplies. They're looking at $1,300 a month just for the premium. Add $100 a month and they can get dental.

That is more than his monthly take home pay.

Discuss.
Gary Crooks on February 08 at 11:27 a.m.
<<We have had S-Chip for just a short time, and now you are proposing universal coverage? And why is it again, that you scoff whenever anyone sounds an alarm about “incrementalism”?>>

You just now figured out that I'm for universal coverage? I haven't scoffed at alarms about that. I want that.

A lot of this debate is apples and oranges, because the goals are completely different. The arguments designed to bring about universal coverage make no sense to people who don't want that. And vice-versa.

By the way, Medicare could be deemed incrementalism, but you don't want to end it. Subsidies to employers could be deemed incrementalism, too. Most employers wouldn't offer coverage without that.
Gary Crooks on February 08 at 11:38 a.m.
Medicare waste is a much higher figure than $54b. More like a 5,000 pound gorilla.

But trying to eliminate it was demagogued as taking care from the elderly. Because, you know, they want unneeded tests and procedures.

We need to address that and then spend some of the savings on fixing reimbursements.

Plus that waste is a good indicator of the amount of unneeded tests and procedures throughout the HC system. The wide variation in costs per region also show that there is much money to be saved.

Again, 3 percent of harmed patients file claims. So you zap that 3 percent or reduce it. You still have the costs associated with the harm.

Medication errors.

http://www8.nationalacademies.org/onp…

Overall errors.

http://www.nap.edu/catalog.php?record…

“Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDS—three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems.”

Even simple things like pilot checklists for surgeons have been resisted, even after wrong-limb surgeries.

So many ways to save money. Ending fee for service is another.
spokelooneh on February 08 at 11:49 a.m.
“They get health care coverage via his employer, but that employer is dropping coverage for all employees starting March 1. ”

It appears COBRA is of no help in such a situation.
Gary D Rhodes on February 08 at 12:16 p.m.
I guess you must be advocating for an end to employer based coverage.

Too bad Obama and the Democratics aren't on board.
gmorton on February 08 at 12:28 p.m.
Gary Crooks wrote,

“Because of his condition, they need a high-end plan.”

No, they don't. Insulin + supplies will cost them about $100-150/month (average). They could buy a $4000 deductible, catastrophic plan for less than $500/month (Group Health).

In a free market, where providers could offer any kind of plan the customer desired, including excluding complications from diabetes, and not subject to any state mandates, the cost would be much less.
spokelooneh on February 08 at 12:41 p.m.
“If you set the profits on the entire for-profit portion of the health care market at 0%, you'd see a cost reduction of < 1%. I'll let you work it out for yourself.”
-gmorton

According to the (admittedly snapshot) data here:
http://www.bizstats.com/drilldown_Cor…
healthcare organizations of various types average about 9.5% profit AFTER taxes.

That's a larger rate of profit than the Construction, Accommodation/Food Service, Manufacturing, and Retail Trade industries, among others.

Let's be “generous” and say that only half of total health care expenses are generated and paid in the for-profit side.

$2.5T/2 =$1.25T. times .095 would be about a $119B in profit, per year. Not chicken feed.

If you have other data sources, I'd love to take a look at them.
Gary Crooks on February 08 at 1:00 p.m.
<< I guess you must be advocating for an end to employer based coverage. Too bad Obama and the Democratics aren't on board. >>

Agree. It's one thing gmorton and I agree on. End the tax subsidies for employers.

How about you? Keep that government-funded system going? It's hundreds of billions of dollars a year.

Anyway, it's a real world example you called for.

gmorton,

How do you know the insurer would charge that or accept this couple? Wouldn't pre-existing conditions be a factor?

Anyway, I'm going to have to take their word that they need a high-end plan since they have a better handle on their situation.
Jeffrey_Grey on February 08 at 1:08 p.m.
Spokel,

Am I missing something here?

Is there some either/or imperative at work? Do we have to pick and choose which parts of the health care system we fix? For example; if we decide to address excessive profit taking as part of the solution, that precludes working on tort reform?

It strikes me that's rather like standing out on the front lawn of our burning house, arguing about whether we want to tell the fireman to put out the fire that's burning in the living room or the the fire that's burning in the kitchen. (And before you strain my analogy - the firemen brought two hoses.)
gmorton on February 08 at 1:17 p.m.
Spokalooneh wrote,

“Let's be “generous” and say that only half of total health care expenses are generated and paid in the for-profit side.”

That is overly generous. Only 18% of hospitals are for-profit. About 20% are government hospitals, where the staff are also government employees.

http://en.wikipedia.org/wiki/Non-prof…

Moreover, profits in the pharm industry are misleading. Less than half the “profits” are actually distributed to shareholders. The rest finances R&D.

So your 4.25% goes down to perhaps 2%.
gmorton on February 08 at 1:42 p.m.
Gary Crooks wrote,

“End the tax subsidies for employers.”

We may agree on the policy, but not that it is a “subsidy to employers.” For employers health insurance for employees is a deductible business expense, just as all other employee compensation costs. It is a subsidy *for the employee*, because he need not declare it as income and pay tax on it. A similar deduction for individually purchased insurance would remove that tax advantage and encourage employees to buy their own insurance.

“How do you know the insurer would charge that or accept this couple?”

I just looked it up on Group Health's rate calculator, with the info you gave.

“Wouldn't pre-existing conditions be a factor?”

Not if the insurer were free to exclude that condition.
gmorton on February 08 at 2:02 p.m.
Looneh,

Here is a more detailed profitability list. Notice that while net profit margin for pharm (Drug Manufactureres, Major) is 18.4%, dividend yield is only 4.17%.

http://biz.yahoo.com/p/sum_qpmd.html

Some other health sectors (net profit):

Medical Instruments & Supplies: 8.2%
Medical Laboratories & Research: 7.1%
Home Health Care: 7.0%
Accident & Health Insurance: 5.6%
Specialized Health Services: 4.9%
Drug Manufacturers - Other: 4.7%
Medical Appliances & Equipment: 4.5%
Health Care Plans: 3.4%
Medical Equipment Wholesale: 3.1%
Drug Related Products: 2.9%
Hospitals: 2.2%
Drug Stores: 1.3%
Drugs Wholesale: 1.1%
Medical Practitioners -3.3%
gmorton on February 08 at 2:05 p.m.
Jeffrey_Grey wrote,

” … if we decide to address excessive profit taking . . .”

Hmmm. Which profits are those?
spokelooneh on February 08 at 2:05 p.m.
“That is overly generous. Only 18% of hospitals are for-profit.”
-gmorton

“Of each dollar spent on health care in the United States 31% goes to hospital care, 21% goes to physician services, 10% to pharmaceuticals, 8% to nursing homes, 7% to administrative costs, and 23% to all other categories (diagnostic laboratory services, pharmacies, medical device manufacturers, etc.[28]”
http://en.wikipedia.org/wiki/Health_c…
(However, the referenced link, to PHRMA, is invalid”

What do you think, is 31% about the amount of total HC spending in hospitals? That means the great majority is spent elsewhere.

“Moreover, profits in the pharm industry are misleading. Less than half the “profits” are actually distributed to shareholders. The rest finances R&D.”

In the data I cited, net profitability was after ALL expenses, including taxes and R&D.

“So your 4.25% goes down to perhaps 2%.”
-gmorton

Pharma's profitability is higher than the Fortune 500, but is somewhat skewed by their R&D expenses which have more of a capital expense nature to them. Even allowing for that, their profitability is still significantly higher than the Fortune 500. Their biggest problem is that the efficacy of most (expensive) new drugs is unknown or not marginally different in comparison with existing much cheaper drugs, often generics.

http://www.cbo.gov/ftpdocs/76xx/doc76…
Gary Crooks on February 08 at 2:06 p.m.
<<The rest finances R&D. >>

And marketing, advertising, lobbying and other administrative costs.

Wiki:

“Pharmaceutical company spending on marketing far exceeds that spend on research.[2][3] In Canada, $1.7 billion was spent in 2004 to market drugs to physicians; in the United States, $21 billion was spent in 2002.[4] In 2005 money spent on pharmaceutical marketing in the US was estimated at $29.9 billion with one estimate as high as $57 billion.”
spokelooneh on February 08 at 2:17 p.m.
http://biz.yahoo.com/p/sum_qpmu.html
In that link, “Net Profit Margin % (mrg)” is undefined. Is it before or after taxes? What period of time? Appears to me it may be the last quarter's reported results, which are not illustrative.
Gary Crooks on February 08 at 2:22 p.m.
Whatever the semantics on the work subsidy, there is an enormous government cost, yet it is thought of by some people as a private system.

It is the single largest deduction in the tax code. This coverage would scarcely exist without it.
gmorton on February 08 at 2:31 p.m.
“What do you think, is 31% about the amount of total HC spending in hospitals?”

That's the figure Kaiser quotes.

http://www.kaiseredu.org/topics_im.as…

But not “in” hospitals, *to* hospitals.

“In the data I cited, net profitability was after ALL expenses, including taxes and R&D.”

R&D is not an expense. It is a capital expenditure, financed from profits.

“Their biggest problem is that the efficacy of most (expensive) new drugs is unknown or not marginally different in comparison with existing much cheaper drugs, often generics.”

I agree. That holds for many other health care expenses. Because some third party is paying, no CBA is done. And it can only be done by the patient, who asks, “Is the advantage of GeeWhizine v. generic worth $300/month *to me*?”

“Pharmaceutical company spending on marketing far exceeds that spend on research.”

That is irrelevant. Unlike R&D, marketing costs are expenses, and are reflected in the profit margins.
gmorton on February 08 at 2:56 p.m.
Spokalooneh wrote,

“Appears to me it may be the last quarter's reported results . . .”

Usually those summaries are annualized, but I agree its hard to tell.
gmorton on February 08 at 3:09 p.m.
Gary Crooks wrote,

“Whatever the semantics on the work subsidy, there is an enormous government cost, yet it is thought of by some people as a private system.”

A tax not imposed is not a “cost” to government. That is Newspeak. A cost is the price paid for a service rendered or a good received. You are assuming that all income is the property of the government, and any it elects not to collect is a “cost” to it. Government incurs costs when it purchases goods and services, not when it refrains from seizing someone else's money. That's like saying robber incurred costs because he allowed his victim to keep his shoes.
Gary Crooks on February 08 at 3:10 p.m.
Truth about drug companies.

http://www.nybooks.com/articles/17244

Most of the spending for research is on the drugs that will bring the most profit. These “me-too” drugs drive up health care costs but don't bring innovation.

As the author says, you don't need to advertise true breakthroughs in medicine. It's the other drugs that need the hype.
Gary Crooks on February 08 at 3:16 p.m.
<<A tax not imposed is not a “cost” to government. That is Newspeak. >>

Again, not the point.

Absent the deduction, fewer employers would offer coverage. Agree or disagee?

If you agree, then government got involved in health care. It put its finger on the scale and tipped it toward employers saying, “Let's offer coverage.”

That is my point.
Gary D Rhodes on February 08 at 3:23 p.m.
Gary, can you concede this point? “It is true that market forces, (elimination of third party payer) would bend the cost curve downward in all healthcare.”

If you can agree to that, then we can talk about what to do with those whom can not take care of themselves.
spokelooneh on February 08 at 5:04 p.m.
98,000 plus 1 deaths in hospitals due to errors.

RIP John Murtha.
richard on February 08 at 7:28 p.m.
What is your point Loone for the 98,000 deaths in hospitials due to “errors.”

You can't just throw that figure out without some kind of context. What are you trying to say?

That hospitals kill people; or is it that very sick and severly injured people (those that go to hospitals) are at a much higher risk of immediate death than the general population?

How does one tabulate that a death is due to an error? Sometimes the erroneous action is clearly the cause of death; most of the time it is not that simple.

So who is your target here? Doctors? Nurses? Technicians? Administrators? Who?

And what do you want done? Pay for more nurses so they can work shorter hours and thus reduce errors that are fatigue caused?

You throw out numbers like that as if to say that the numbers speak for themselves; which, of course they do not without context.
Arch_Druid on February 08 at 7:47 p.m.
GMorton, “what would be best for me,” is if in my lifetime, I actually had enough work hours, enough pay raises, to actually have been able to afford a home, a car, health and etc. insurance, hospital care, and so on. You know, actually have been a member of the middle class. BUT since that never happened, and I can claim that your much vaunted “market forces” saw to it, well; I have to roll my eyes every time you post. As for your advocacy of anarchy. Well, do you ever re read what you write?
richard on February 08 at 7:49 p.m.
<<Your tort reform arguments are laughable to the scope of the overall cost inflation problems.>>

I never said tort reform will resolve the problem. It is a start. What you guys do not understand about the mood of the country is … they don't want a HUGE, turn everything upside-down, government take over where there is little if any consideration to the unintended consequences. They don't understand it; those who wrote it don't understand it. They are fearful because they have no idea how it will effect them specifically.

That is why the slim number of people who still want it are those who forsee a “free lunch” for themsleves. That is a frieghtful way to fashion an overhaul of such magnitude.

They want it to be done incrementally where there is control and where they can understand.
Arch_Druid on February 08 at 8:03 p.m.
Well, win at all costs against the Dems, GOP had no problem muddling up the Health Care issue so that NO ONE would understand. How about blaming BOTH parties for that mess, “Richard?”
gmorton on February 08 at 8:52 p.m.
Gary Crooks wrote,

“Most of the spending for research is on the drugs that will bring the most profit.”

Surely true. So you have to ask, “Why will those drugs bring the most profit?”

The answer is, because, after they are made known to patients and docs – marketing – their marginal advantages (which might not appear so marginal to patients, e.g., fewer unpleasant side effects), there will a demand for them. In a 3rd party payment regime those advantages will not be weighed against their higher costs, and hence the demand will be unchecked.

The drug companies would love to come up with a real “silver bullet” – a pill which, taken for 7 days, cures every breast cancer. That would put the profits from GeeWhizine to shame. But to continue that search they need the profits from GeeWhizine.

“Again, not the point.”

Not THE point, perhaps, but a point nevertheless. By calling the tax advantage of employer-paid health insurance a “subsidy for employers” you are perpetuating a falsehood and parroting the “evil corporate greed” meme. It is the employee who is getting the tax break, not the employer.

“Absent the deduction, fewer employers would offer coverage. Agree or disagree?”

Which deduction do you mean? The deduction employers take for wages and benefits paid, which are business expenses, just like rent, cost of materials, etc., or the deduction *employees* receive by not having to report insurance benefits received as income?

To eliminate the former you'd need to make some fundamental changes in the IRS law, which is an *income* tax, not a gross receipts tax. Wages and benefits paid to employees are not income.

But if those benefits were made taxable to employees, or their wage equivalent was made deductible if spent on health insurance, then, yes, you'd see insurance costs begin to move away from employer to employee (where they should have been all along).
spokelooneh on February 08 at 9:09 p.m.
“richard on February 08 at 7:28 p.m.

What is your point Loone for the 98,000 deaths in hospitials due to “errors.””

Pay attention or pipe down, Richard. If your attention span is tasked beyond its capability, perhaps you should give it a rest.

Gary C.posted the following earlier:

“Overall errors.

http://www.nap.edu/catalog.php?record…

“Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDS—three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries.”

Reports are saying the surgeons who took Murtha's gall blader out, a fairly common operation with fairly low risk, nicked his intestine, and that's what killed him.
gmorton on February 08 at 9:16 p.m.
Arch_druid wrote,

“BUT since that never happened, and I can claim that your much vaunted “market forces” saw to it . . .”

Market forces can only place a value on the goods and services you bring to the market. If that price is not satisfactory to you, you have to improve the product or service you are offering, or offer a different product/service.
spokelooneh on February 08 at 9:18 p.m.
“I never said tort reform will resolve the problem. It is a start.”
-Richard

You've got an industry where costs are going up 2-3 times the average rate of inflation, over $200B a year, and yet you're vigorously promoting a “start” that will save $5.4B a year, or less than 1/5 of 1% of health care spending.

That's not a start on addressing a MONUMENTAL problem, that's about as good as doing nothing at all, except some vague feel-good action of sticking it to the trial attorneys. Fine, you want to stick it the trial attorneys, it's not MEANINGFUL health care reform, don't call it such, that's ridiculous.
gmorton on February 08 at 9:39 p.m.
Gary Crooks and Spokalooneh,

“Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDS—three causes that receive far more public attention.”

Well, *some* experts contend the rate is that high.

But that is not the interesting issue. The question which needs to be asked is, “What is the avoidable error rate?” Surgery, and medicine in general, is an inherently risky business. Errors are inevitable, and the consequences of small errors can be great. The “avoidable error rate” comprises those errors which could be avoided *had known good practices been followed*. It is not enough to show that the doc made a misdiagnosis, or that a scalpel slipped. Those are risks that every patient should be prepared to accept. He has a bonafide complaint only if the misdiagnosis occurred because the doc failed to order a test which standard practice says he should have ordered, given the symptoms, or the scalpel slipped because was joking with a nurse or showed up drunk in the operating room.

*Errors* are not necessarily *negligence*.
spokelooneh on February 08 at 10:10 p.m.
“*Errors* are not necessarily *negligence*.”
-Gmorton

No one suggested all such errors were negligence.
spokelooneh on February 09 at 1:12 p.m.
“Thank you for taking a few moments out of your day to view my story. My name is Terri Carlson. I am 45 and was born with a genetic immune disorder C-4 complement deficiency. I am currently on cobra health insurance (from my divorce, 2 years ago) but it runs out in a year. And now my current situation is that I can't buy health insurance because of my pre- existing condition.

It is not easy living with my disease and now that I have the genetic answer for my health issues, every insurance company uses the information to deny me insurance coverage. You know, I am not happy I was delt this deck of cards in my life. However, if I don't fight for myself nobody will. While the goverment fights over healthcare reform people like me suffer. I will continue on this crusade for healthcare reform.

And yes, as drastic as it sounds, I will marry for health insurance!!!

Please help my cause.”

http://www.willmarryforhealthinsuranc…
richard on February 09 at 1:41 p.m.
And I still am interested Loone whjy you feel the number 98,000 is such a compelling number.

gmorton provided the details of how I was going to respond; not every death in a hospital is due to “avoidable negligence,” which should have been self-evident to you when you posted that number … or was it Gary?

Is it just agrden-variety attack on greedy doctors? Is another pointless attack on the health care system in this country?

You must have been trying to make a point; I am just curious what it was.

Care to enlighten me?

thanks
Arch_Druid on February 09 at 8:19 p.m.
Geeze. GMorton, you finally got the picture on why health care ISN'T anything like “market forces?”

On the other side of “market forces,” GMorton; “improving the product and service” doesn't do much good if you (the consumer) don't have the money to acquire.

Something that seems to escape the notice of health insurance companies, doctors and hospitals.
gmorton on February 09 at 11:10 p.m.
Arch_druid wrote,

“On the other side of “market forces,” GMorton; “improving the product and service” doesn't do much good if you (the consumer) don't have the money to acquire.”

Eeek, another Yogi Berraism.

You're abruptly switching tracks again, Arch. You had complained that market forces had kept you out of the “middle class.” I responded that market forces merely place a value on the product or service you bring to it. The “product” at issue here is the product you produce and place on the market, not heath care. If the product or service you are offering does not produce the returns you desire, then you have to improve it or offer a different one.
spokelooneh on February 10 at 12:42 a.m.
“Care to enlighten me?

thanks”

-Richard

I don't think that's possible without invoking supernatural powers that neither I or anyone I know possesses. Fool's errand.

I would hope, Richard, that if one of your loved ones was in the hospital, you'd want the Physicians treating that person to have training that would reduce the possibility of medical error that might seriously harm, if not kill, your loved one. Certainly those who care about you would be hurt and devastated if you were the unfortunate victim of medical error.

If you'd simply taken the time to educate yourself, and click on Gary's link, you'd see it has nothing to do with blaming “greedy doctors” or any other crazy malarkey.

“To Err Is Human breaks the silence that has surrounded medical errors and their consequence—but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agenda—with state and local implications—for reducing medical errors and improving patient safety through the design of a safer health system.”

But you choose, time after time, to remain ignorant, exaggerate (self-admittedly) and spout off illogical and emotionally-charged BS, completely bereft of any objective facts.

That's why it's impossible to enlighten you. On anything. Sad, but true.

I'll continue, from time to time as I feel like it, as I said long ago, to correct your misstatements and crazy notions, not for your benefit, but for the desire to project truth in a public forum that is attempting to foster reasonable discussion on the serious issues of the day.
gmorton on February 10 at 12:56 a.m.
“Instead, this book sets forth a national agenda—with state and local implications—for reducing medical errors and improving patient safety through the design of a safer health system.”

Ah, a “national agenda.” With state and local implications, too. No doubt that means, “Hospital administrators, medical school faculties, doctors, nurses, and other medical professionals – not to mention their insurance adjusters –- are not competent to keep medical errors to a minimum. So lets turn the problem over to politicians and bureaucrats.”

Sounds like a plan.
spokelooneh on February 10 at 2:04 a.m.
“Ah, a “national agenda.”
-Gmorton

I know, SCARY. Like a National Constitution is VERY SCARY!

God forbid a comprehensive (NATIONAL, READ SOCIALIST) medical organization (collecting LOCAL information and aggregating) would attempt to clarify and quantify medical errors on a national basis in order to REDUCE such at the local level.

Guess you think all plans are evil, unconstitutional, and worse than worthless, eh Gmorton?
Gary Crooks on February 10 at 10:25 a.m.
<<No one suggested all such errors were negligence.>>

Exactly. Preventable is more like it. Nobody said greed was the driver either. There is no money to be gained from operating on the wrong limb (but much to be lost).
Gary D Rhodes on February 10 at 10:36 a.m.
Obama said doctors remove viable body parts to make money.
Arch_Druid on February 10 at 8:46 p.m.
The only person projecting Yogi Berra would be the above poster. Since I am not exactly all that conversant in who the guy was and most of anything that he may have said in his life time.

As for my “switching tracks,” excuse me, but I think the above poster does that all the time. LOL!

For all that GMorton loves to argue the value of “market forces,” and both “Richard” and Rhodes just love to agree with his theories; don't you guys just LOVE the fact that in your lifetimes you never had to want for anything? You made enough money during your time in the workforce that you can own a home, or decently rent an apartment? Afford multiple insurances including for your car? That you can readily pay for health care? That you never faced being dependent on others for food or shelter?

When those “market forces” assure that you can get a decent wage, stable work hours and etc. so that you can do all of the above, then I am quite sure that you guys wouldn't care to give a hand up to anyone for whom those same market forces did not in fact work out so well. I have to pity you that you are three guys who don't understand the first thing of which you speak.

So, I shall remind you, those market forces comprise three things. The business start up that can only come to existence because of initial investments, the product or service that can only be created and produced by employees, who receiving their paychecks then ADD to the local economy as a people who become CONSUMERS.

The attempt to cut all of that out is exactly why this nation is now economically damaged and will take a great deal of time to recover from. Any other definition of “market forces” is utterly meaningless.

It doesn't matter what “price” you set, as a business owner, to the product or service; if the people you are trying to sell it to don't have the means to acquire. Which is utterly ignored by health insurance companies and hospitals.
gmorton on February 11 at 12:08 a.m.
“God forbid a comprehensive (NATIONAL, READ SOCIALIST) medical organization (collecting LOCAL information and aggregating) would attempt to clarify and quantify medical errors on a national basis in order to REDUCE such at the local level.”

Well, if it is to be a “national medical organization” which collects and evaluates this data, then the recommendations are superfluous. Numerous medical (and insurance) organizations are already doing that, and have been for decades.

But usually talk of a “national agenda” implies a government agenda. I.e., the problem is handed over to pols who transform it from a technical problem into a political one, complete with a burgeoning bureaucracy, a few more volumes in the CFR, and a deficit-financed and ever-expanding budget. And with the usual unintended consequences.

“Guess you think all plans are evil, unconstitutional, and worse than worthless, eh Gmorton?”

No. Only plans concocted by bureaucrats for other people's time, money, property, and projects.
gmorton on February 11 at 12:22 a.m.
Arch_druid wrote,

“It doesn't matter what “price” you set, as a business owner, to the product or service; if the people you are trying to sell it to don't have the means to acquire.”

Won't fly, Arch.

We've been discussing your complaint that “market forces” had kept you out of the “middle class.” That surely would not be because your potential customers had “no means to acquire.” They did, after all, acquire numerous other things which carried those who provided those things into the middle class, and perhaps even made them rich.

Those customers are spending plenty of money, recession or not. If you are not getting your share, you need to re-evaluate your product mix.
Arch_Druid on February 11 at 9:04 p.m.
GMorton, nothing of what you said, flies. Your arguments come out as an end product, not the nuts and bolts of what gets us there. Whereas, EVERYONE ELSE discusses the nuts and bolts.

Now for something else that maybe gets you thinking, actually you ARE dependent on someone else for your food and shelter. The day someone hired you and provided you a paycheck, you DID become dependent on someone else for food and shelter. You were dependent on that weekly, biweekly or monthly paycheck for your home, car, insurance and etc. You are and were only part of the nuts and bolts that gets us from here to there. Your paycheck added to other paychecks when you made purchases. And their paychecks added to your paycheck, when they bought the products and services you produced.

The market is a GIANT collective. You don't like that? Well, too bad. But that's the way it is.

On the other hand, health care is a different critter and operates by entirely different rules. Sor-ry.
gmorton on February 12 at 12:57 a.m.
Er, Arch, can you stick to the subject? Here is the current subject:

“We've been discussing your complaint that “market forces” had kept you out of the “middle class.” That surely would not be because your potential customers had “no means to acquire.”

BTW, interdependence is not dependence, and cooperative schemes such as markets are not collectives. Gotta stick with the standard meanings of words, too.
Arch_Druid on February 12 at 8:32 a.m.
GMorton, anytime that anyone discusses what you THINK you mean about “market forces” you turn on a dime and disagree with your own assessment. It is NOT myself who has a problem keeping track of what market forces are, after all, I only described them to you. However, the only market cooperatives that I am aware of are Farmers Markets. The COLLECTIVE market on the other hand, is where various industries may in fact compete with one another, various retail businesses may compete with one another, various hospitality businesses may indeed compete with one another. But, their employees buy at their own choosing, products or services from their competitors. In short, where I worked at Beverly's Kitchen and at Tito's as a dishwasher for all of about 18 years, I was under no requirement to buy a meal at either restaurant unless I chose to. That is a collective market.

But such is your great haste to demonstrate just how much you despise such a word, that you don't even begin to realize the implications.

Do hospitals and insurance companies compete with each other? No. Then they are not a collective Or cooperative market. May they offer different services? Most certainly. As there is no question a decided difference between a general hospital and say Cancer Treatment Centers of America. A hospital dedicated to a specific specialty. BUT that still doesn't mean that they compete with one another.

Competition only exists if Super One's ads for the week show a lower price for vegetables than WalMart's ads do. You do not and never will find a “low cost” competition within health care unless those in that profession desire radical reform.
Gary D Rhodes on February 12 at 3:42 p.m.

Maybe someone can help with these 5 simple questions that went unanswered this week.

1. On December 21st, Senate Majority Leader Harry Reid said that in the time it took to make his remarks, (aprox 3:30) that two more Americans died needlessly from a preventable medical issue.
How many Americans have died since he made those remarks on the Senate floor?

Why are the Democratics and Obama so heartless?

2. Here is a real world question; How much will type 2 diabetes cost over the next ten years?
What is the plan to get these people to take better care of themselves?

3. Gary, can you concede this point? “It is true that market forces, (elimination of third party payer) would bend the cost curve downward in all healthcare.”

4. Do you think it is a good idea to force every person in America to buy insurance from private companies?
What about the farmer who wants to pay for medical care from his own bank account?
Would you have any exemptions?

5. Grey, the philosophical question is this;
What will happen to western industrialized nations when the 'ponzi scheme' of over promised entitlements hits the baby-boom fan?
Should the government pay for 100% of the costs of Medicare and Medicaid, or continue to be subsidized by the private sector?
gmorton on February 12 at 7:24 p.m.
Arch_druid wrote,

“The COLLECTIVE market on the other hand, is where various industries may in fact compete with one another . . .”

Maybe this will help:

http://dictionary.cambridge.org/defin…
Arch_Druid on February 12 at 9:42 p.m.
GMorton, you can throw out “dictionary definitions” all you want and then DISPUTE real world facts all you want. However, have you ever bothered to take a good hard look at what you tout? You obviously haven't.

What's a “collective?” Under certain real world scenarios, a collective is a group of people who say create a farm and work on it together. Such as has been done a great many times in the Democratic state of Israel. What is a “collective?” Such as has been created in Communist China having to do with a type of labor and/or housing in that country.

What is a collective market? Apparently when capitalism is described to you as a collective market—of employer and employee, to employee as consumer, of investment and lending, of regulatory acts, of lobbying for favored laws, of competition and protection from foreign competition, and so on, you go continually off the deep end and refuse to recognize the facts that are right in front of you.

Capitalism IS a collective market. And if any factor in it fails, then the whole thing collapses like a house of cards. AS WAS THE CASE by 2008.

“Collective” as you would like to see it applied, is only true for certain types of societies, those that are precisely Communist in nature. “Collective,” as applicable to the markets in the west, GMorton are a whole different ball of wax.

Now, in what way, does this “capitalism driven” collective market apply to the health care professions? It doesn't. Hospitals don't fail and are driven into bankruptcy because of a lack of “customers.” They may only shut off services that are critically needed IF they don't get say state funding, Medicaid or Medicare funding, and provide health services ONLY TO people who are best able to pay (insurance included) for the service that is provided. Nor are they going to lower the cost to make the health care services more accessible to more people. With few exceptions and those exceptions were already provided on this blog some time ago.
Arch_Druid on February 12 at 9:50 p.m.
Also for your information, GMorton, if the market wasn't a collective, then events in Greece would not cause the DOW to drop dramatically. Fears about China tightening lending laws would not cause the DOW to drop a percentage.

Now for Rhodes, why should anyone bother answering your particular questions? Why is health care reform stalled? Well, you could always talk to the GOP and the TEA Party movement about it.

As for the rest of it, you think those questions are important, go research the answers for yourself.
gmorton on February 13 at 1:53 a.m.
“What's a “collective?” Under certain real world scenarios, a collective is a group of people who say create a farm and work on it together.”

Yes, Arch. It is also any group of persons who join in pursuit of a common purpose and speak with a single voice, as it relates to that purpose. A labor union is a collective; so is a folklore society, a garden club, or a business corporation.

“Capitalism IS a collective market.”

No, Arch. “Collective market” is a contradiction in terms. The participants in a market do not have a common purpose, and do not speak with a single voice. They all have purposes of their own and speak for themselves. Some of the participants in the market may be collectives (corporations, and interest groups of all kinds) but the market *per se*, which embraces all of them, is not one. It is a term for a system of autonomous, interacting agents, all of whom are pursuing distinct and often incompatible interests and goals of their own.

“Now, in what way, does this “capitalism driven” collective market apply to the health care professions? It doesn't.”

Of course not. The health care system is not operating in a free market. It operates in accordance with government edicts. It is uncompetitive because government restricts entry, dictates the scope of services offered, and sets prices. And as a result its costs are out of control.
gmorton on February 13 at 1:57 a.m.
Maybe this analogy will help, Arch: consider a football game. The two *teams* are collectives. The *game* is a free market.
Arch_Druid on February 13 at 11:24 a.m.
GMorton, you are quite mistaken on all fronts. A sports team can be considered a collective because it works to a common purpose. But the competition between teams never has been and never well be analogous to a “free market” concept.

Did I not remind you of industries that lobby and contribute campaign monies in order to influence favorable legislation? I will now remind you of bankruptcy reform that very specifically assisted credit card companies. Now each bank and those that very specifically exist for the purpose of doing nothing but engage in assorted lending practices may compete between each other as to what they will provide in interest rates and etc. when it comes to loans, the servicing of loans in general and credit cards in particular; but lobby to a common purpose, or contribute to a common purpose any politician's war chest where they seek out favorable legislation that will further assist their specific interests. The SAME WILL BE TRUE of real estate, manufacturing, retail stores, hospitality, etc. So yes, GMorton, if you bothered reading what is public knowledge, you'd know what I meant! (Rolls eyes here.) There is no contradiction in terms when it comes to a collective market, GMorton vis a vis when it comes to gvt.

Now as for gvt regulations that “cause” an increase in prices as it would relate to health care costs. MOST of what the health care profession relies on as to equipment, cutting edge technology, etc. comes from the private sector. The private sector IS required to abide by gvt rules and regs when it involves your health and your life and your reasonable expectations of surviving a hospital stay, a visit to a doctor's office, the meds you take. If it weren't for those gvt rules and regs, wouldn't your chances of survival be greatly reduced? And what makes you think that a marketplace left to itself would better look out for your interests given the facts of new medications that have since been pulled from the market BECAUSE OF the dangers they posed to those who took them and actual DEATHS recorded because of the flaws in the meds themselves. Nonetheless, because of corruption between the FDA and the private sector, those same dangerous meds were approved. If the FDA were eliminated WOULD the cost go down? WOULD dangerous meds not enter the market? You don't know that.

So for an answer GMorton, read about the Snake Oil Salesman that made the FDA very important to begin with.