Universal Healthcare

[cat_in_the_hat]

Dee - All your examples are basically monopolies. The post office had a monopoly on letter service until the late 70s or early 80s. They have never been accused of being an efficient operation. My father worked for the postal service, so I don't have anything against them, they just aren't very efficient.

TVA is a monopoly. Most power providers are. Since they must generate and distribute in the defined service area, the local environment dictates cost more than anything else. So again, not a government organization competing well in a competitive market.

No one is saying that there are not intelligent people working in government. But government is a huge bureaucracy. It is not constructed around the idea of producing products and service. Once again, look at governments that have owned, or still own, companies that produce products. Most are very poor quality and are not competitive with private sector companies who must compete to survive.

 

[Deeeefense]

Once again, look at governments that have owned, or still own, companies that produce products. Most are very poor quality and are not competitive with private sector companies who must compete to survive.

I agree governments should not be in the consumer or industrial products and services arena - those are socialistic or quasi-socialistic based economies that are typically weak and inefficient.

A much better comparison would be to look at other countries health care systems that are primarily government based on a per capita cost basis compared to our employer based/private insurance system. You will see that countries like France and Canada provide high quality comprehensive care for half the cost. There's a lot of reasons for that which have nothing do to with government vs. private but it's illustrative of what is possible and it flys in the face of the argument that government run health care is less efficient and more expensive than the private based system we have. If it was one or two countries you could say its an anomaly but it's virtually every industrialized country in the world.

 

[cat_in_the_hat]

I agree governments should not be in the consumer or industrial products and services arena - those are socialistic or quasi-socialistic based economies that are typically weak and inefficient.

A much better comparison would be to look at other countries health care systems that are primarily government based on a per capita cost basis compared to our employer based/private insurance system. You will see that countries like France and Canada provide high quality comprehensive care for half the cost. There's a lot of reasons for that which have nothing do to with government vs. private but it's illustrative of what is possible and it flys in the face of the argument that government run health care is less efficient and more expensive than the private based system we have. If it was one or two countries you could say its an anomaly but it's virtually every industrialized country in the world.

I think that is an oversimplification of what is going on. First, those countries are more socialistic than we are. Their first priority is socializing the costs as much as possible and providing the same coverage for everyone. Fundamentally, that is a different philosophy of government than ours. So we have to ask ourselves if that philosophy is appropriate here. I don't think it is.

Second, a system like that can control costs because it can ration care. We spend more than most every country in the world because we can. Our system allows people to make decisions based on what they believe is right for them. This leads to people spending a lot of money to save their lives, perform cosmetic procedures, etc., that aren't spent in other countries that use a socialized approach. It's based on what each individual is willing to spend to get what they need or want. I don't see that as a bad thing. Canada can control what you spend, the U.S. government cannot. Many wealthy people in Canada come to the U.S. for certain medical procedures because of the relative quality and the fact that they don't have to wait a long time to receive treatment.

It is pretty well understood that we have the finest healthcare in the world in terms of quality of treatment and patient satisfaction with the care they receive. If you remember the old WHO rankings, every ranking dealt with how well a country socializes cost and provides access, so we didn't rank high in many of those rankings. The one or two parameters that actually tried to measure quality of care, the U.S. always ranked extremely high. The fundamental economics of socialization means that the quality of the product or service will suffer compared to a system that is more market driven. While our system is far from perfect, socializing medicine will result in mediocre products and services. You cannot make the marginal cost of purchasing anything close to zero and expect the quality of the product to remain high. It doesn't matter if we are talking about cars or healthcare. It's fact of economics.

 

[Bill@ModernThirst]

Who pays for insurance?
Insurance companies take money from consumers and gives it to providers...and keep a little for profit.

People seek healthcare when they NEED healthcare.

Yes, there are hypochondriacs out there that run to the doctor for every little sniffle...but the baseline is that people seek care when they need care. Actually, Americans generally wait too long to seek care resulting in higher costs. The need for healthcare is entirely inelastic in demand because when you break a bone, you need healthcare. When you have cancer, you need healthcare. When your kid falls and busts his head open with a cut that requires stiches, you need healthcare. When my wife was diagnosed with cancer in January she needed healthcare and you're damn straight that cost was the last item considered.

I suppose if your spouse or child was diagnosed with cancer...or just a broken bone, you're going to consider the cost before seeking treatment?

I'm sorry dude but this idea that there are millions of people seeking wasteful healthcare is frankly, idiotic. Most people try to avoid going to the doctor. If the insurance market went away tomorrow there would still be the same demand for healthcare. Would the same amount of healthcare be delivered? Probably not.

Apparently, you have no understanding of elasticity of demand and no understanding of demand subsidies.

Inelastic demand means no matter the cost, the demand for the service remains the same. Elastic demand would mean that as the cost rises, demand falls. Healthcare is almost entirely inelastic, because we demand the service no matter the cost. That means there is no incentive for a supplier to lower price- in fact, the incentive is to keep raising the price. The price to the consumer is basically the max deductible. The bulk of the cost is not borne by the person seeking the service, and instead by a pool of money from healthcare insurance, the consumer tends to not even care. They just pay their deductible and let insurance worry about the rest. Both situations skew the traditional supply/demand market economics and drive prices higher.

I never made a single comment about people seeking wasteful healthcare- implied or otherwise. Nice straw man.

The cost of basic healthcare is what it is. Who do you want to accept less money to administer care?

Cost is a concern for everyone. The threshold of absorbing costs, especially unexpected costs varies greatly from person to person. While we know that in the long term, preventive care pays for itself by identifying medical issues earlier when they can often be treated (relatively) inexpensively, we also know that it is basic human behavior to avoid pain (out of pocket costs) when don't see an immediate need. People will forego annual physicals if they have to pay out of pocket. They just will. The price is paid on the other end when they show up with advanced illnesses, have heart attacks, strokes, etc. The $25/mo cholesterol medication could have prevented the $250,000 stroke. Yet if has a stroke and taken to the ER...it doesn't matter if they can pay. They are going to be treated and given care...or would you prefer that they show proof of ability to pay before receiving care?

You're going off in the weeds on this. Not sure who you are arguing with, but it certainly isn't pertaining to anything I've written.

 

[Anon1640710541]

It also, in many cases, it's truly, COMPLETELY inelastic. For anyone with a traditional "copay" plan, the cost for many services is fixed, regardless of what the actual bill is. An MRI could truly cost anywhere between $400-$2000+, but their share is set at, say, $250. Can't get much more inelastic than that.


It's a crying f'ing shame there isn't a single politician in Washington that's actually concerned about lowering healthcare COST. That should be the single most important point in this entire discussion, not how to shift around who's pumping in the money into an already broken system.

 

[Bill@ModernThirst]

It also, in many cases, it's truly, COMPLETELY inelastic. For anyone with a traditional "copay" plan, the cost for many services is fixed, regardless of what the actual bill is. An MRI could truly cost anywhere between $400-$2000+, but their share is set at, say, $250. Can't get much more inelastic than that.


It's a crying f'ing shame there isn't a single politician in Washington that's actually concerned about lowering healthcare COST. That should be the single most important point in this entire discussion, not how to shift around who's pumping in the money into an already broken system.

It's become too politicized. I'm a small government conservative at heart, but what we're doing today, and have been doing for decades is the epitome of wasteful. Again, I don't know what the right answer is, but we sure as heck haven't come close it in this country.

There's something inherently wrong when we spend more public dollars per person on healthcare than a country like Germany that has universal healthcare, and yet we still have to spend our own PRIVATE dollars for the bulk of our care that costs more than any other country's healthcare, and a significant portion of our population can't afford hardly any level of care at all. We're doing it wrong.

And trying to continue to twist and pervert tools of a flawed system to act like a different system only makes it worse.

 

[Deeeefense]

Their first priority is socializing the costs as much as possible and providing the same coverage for everyone. Fundamentally, that is a different philosophy of government than ours.

Maybe we should look more towards "socializing" the costs of medical products and services as we are being ripped off right now in ways most people are unaware of. Ironically I just got an email from my brother this AM who just got back from visiting Paris a place he lived for many years. He has an arthritic knee from a torn meniscus (which I also am dealing with). Its not an uncommon condition for active people over 50. He received a treatment for this condition which is fairly widely prescribed, and one I have had myself called hyaluronic acid injections, which lubricates the joint. Here is a what he said about the costs:

I paid €140 for the doctor's visit and the injection – that's around $150--at the American Hospital of Paris. Here (Florida), the same injection was billed as follows:

Gel $1,388.80
Injection $366.00
Total $1,654.80

Of which I paid it co-pay of $167.52

In other words, my out-of-pocket co-payment was more than I paid for the entire procedure at the American Hospital of Paris!

The product he got in both places was Monovisc, I had the same treatment here with the same product at a similar price.

Our system allows people to make decisions based on what they believe is right for them.

It allows people that are fortunate enough to have employer paid insurance, or can afford to purchase it on their own to make their own decisions to a certain extent but in the end its up to the insurance company as to what they agree to cover or not cover.

Many wealthy people in Canada come to the U.S. for certain medical procedures because of the relative quality and the fact that they don't have to wait a long time to receive treatment.

I have a Canadian friend who spends 6 months in the US which I have posed this question to about "waiting lists". He's not an ignorant man, he's an attorney that works as a corporate mediation judge. He told me the "waiting list" theme that he hears here is greatly misunderstood. If you have an emergency or a life threatening situation like a need for heart surgery you get it right away in Canada. But if you need something like a knee replacement you may have to wait 3 or 4 months for it. But unlike the US 100% of their citizens will get the surgery. In this country if you don't have insurance, they'll give you a cane, and send you home. I can understand how Canadian citizen that is wealthy and wants a great knee replacement or similar procedure would come to the Mayo Clinic or Cleveland Clinic and have it done. I would too. But that's a weak criticism at best. No one flees to the US to get an emergency procedure because they can't get it in Canada - that's a myth.

The bottom line to this discussion is that we agree 100% on the efficiency and superior quality of a market based economy. Where we differ is that I believe there are certain functions of any economy that are fundamental parts of our social fabric and are the responsibility of the government which you and I own. Those include things like public safety, K1-12 education, infrastructure, national security and health care.

Every industrialized country in the world except the US accepts this general thesis. The US accepts all but health care. We don't ration education only to people that pay property taxes, we don't offer the use of state roads to only those that pay state income taxes. And I don't think health care, including preventive care should only be available to those that have it paid for by their employer or can afford it.
That's just a fundamental difference of opinion that we have, and no economic theory will ever make me think otherwise.

 

[fuzz77]

Healthcare is almost entirely inelastic, because we demand the service no matter the cost. That means there is no incentive for a supplier to lower price- in fact, the incentive is to keep raising the price. The price to the consumer is basically the max deductible. The bulk of the cost is not borne by the person seeking the service, and instead by a pool of money from healthcare insurance, the consumer tends to not even care.

I am highlighting this part of your response in which we mostly agree.

So if your statement above is true, and I believe it to be...the laws of supply and demand don't really apply. Private for-profit businesses will continue to raise prices because they can. Right?
Regardless of price, the demand will remain the same.

So for a minute let's pretend that we totally removed all governmental regulation and interference in healthcare. The result would be that we would simply reset the basis for healthcare prices and from that point they would continue to rise as they have and in time we would be right back where we are.

Addressing your last sentence above...the person seeking the service is (hopefully) contributing to that pool of money through their insurance premiums. So the upper limit on price is the aggregate ability of people to contribute to the insurance pool.
Of course the problem is that as we price people out of the ability to contribute to that pool of money, we don't totally deny them service allowing them to create cost that is borne by those who pay into the system. The more that are priced out, the higher those expenses that are recovered by raising premiums. That cycle repeats itself over and over. The only "fix" for that would be to deny service to those who cannot pay.

What a single payer system does is fix the pool of money available to the political ability tax. It's much more difficult to pass tax increases than insurance premium hikes. The costs could also be spread over all wage earners via a tax not unlike Social Security that is paid by everyone. Because the govt is the single payer it has the ability to set limits on prices forcing providers to alter their cost structures since they would no longer be able to push up pricing because they only have one customer to which they can sell. Because we all use the same healthcare system we all have an incentive to see that it is adequately funded.

The alternative solution to control healthcare cost is to deny access to those unable to pay.

There is good reason that nobody has a solution to maintain our current system, provide access to all who need it and to control pricing. It can't be done.

 

[Chuckinden]

Something need to be done differently. As Defense said, we have been doing all the wrong things with healthcare costs while other countries seem to have it better than us.

Insurance companies have politicians in their back pocket. It will always be that way as long as we have private money in politics. We are probably the worst corrupted country in the world in that regard.

 

[Bill@ModernThirst]

Countries with Universal healthcare (and they're not ALL single payer, by the way), most often control costs by constricting supply. Canada is the easiest example, and it does indeed keep their costs down a bit, but it makes it far less responsive and efficient as well. Plus, Canada isn't even completely universal or single-payer- citizens still have to buy either government or private insurance for their prescription drugs. Another way they limit costs is by combining facilities, placing caps on physicians fees, and closing hospitals. Ask a Canadian sometime what 'Summer Shutdown' is. If you're a patient waiting on surgery, you won't like it. But problems with cost cutting aren't relegated to Canada. If you're a couple in London who have had two miscarriages and you want to find out if you have fertility problems, tough luck. The UK healthcare system won't approve you for testing you until you've had four miscarriages. That's just the way it is. It's too expensive otherwise.

Now- Canada is probably the last of the "universal" systems we would want to emulate compared to France, England, etc. But those same cost cutting measures apply there as well. But Canada shares some of the same problems we would face with a universal system- namely geography. Centralized facilities those countries rely on for efficiency can only exist in a country where the entire population lives within a few hours drive of the center of the country. Centralized facilities are cheaper, and patients can reach care easily. They require fewer doctors, far lower costs, etc.

There's a problem here- we have 300+MM people spread over a continent. We'd need exponentially more facilities (and therefore doctors) to provide those services to our population with any semblance of accessibility. And it's not just proportional to the population difference either- we have so much GEOGRAPHY that delivering services to huge swaths of the population require a ton more facilities, distribution, etc. It- in very simple terms- will cost significantly more per capita to emulate what other countries do here. Otherwise, it could take days just to get a patient TO a specialized facility, or the cost of moving patients in a prudent time would be astronomical and would actually DECREASE Accessibility.

So it's not just a matter of dropping another system into our country and having it work the same. It can't.

But something has to give. The free market doesn't work with healthcare in our system. It just doesn't. The inequality of access is proof of that. We don't want to lose what our system does well- which is innovative and TIMELY care at our doctor's instruction, not the government's. What we need to find is a way to get the quality and efficiency of care we already provide to everyone who needs it rather than to those can afford insurance and the resulting copays. That has to start with some reforms that are intended to either stop the unmitigated growth of costs or even reverse it in some ways. Then we need to make that care accessible. That's why I say I don't know what the right solution is. It's not, in my mind, the system in place north of the border or in European countries. But it's also not what we have here. I have to believe that if you took politics out of it, we have some smart people who could come up with a new system that combines the best of both worlds. Whether that's single payer, government/private universal, or some other form of private, I can't say.

But every time we start trying to further bastardize insurance to do that, we make the problem worse. Unfortunately, the only thing our politicians seem to be able to do is focus on changes to insurance and claim they've fixed everything and walk away. Insurance, as it exists today, is a symptom of the problem, not the problem itself. And you don't fix a problem by treating the symptoms.

 

[Bill@ModernThirst]

No one flees to the US to get an emergency procedure because they can't get it in Canada - that's a myth.

Actually, it's not entirely a myth. Basic Diagnostic appointments average between 4.5 and 6 months in Canada from family doctor referrals. That means that while they may get the necessary procedure shortly after that diagnostic is performed, they may have had to wait upwards of 6 months to get the recommendation. The Canadian Fraser Institute estimates that between 1993 and 2009, that may have cost as many as 63,000 Canadian women their lives from delayed treatment for breast cancer alone.


One other thing that is more common is Canadians coming to the US for treatment for aggressive cancer drugs- that's because of cost. The FDA is far more thorough and efficient in testing and vetting new drugs -particularly for cancer treatment- than Canada, and that's largely because private money pays for the process in the United States.

So yeah, there's not much reason to come here for bypass surgery, but there is reason for cutting edge treatments and drugs, and it's actually somewhat common. A new trend in Canada has been people paying ungodly amounts for cancer treatments in the US, and then suing their regional medical associations in Canada for the cost of the treatments. Drugs like Erbitux have been standard treatment for colon cancer in the US for several years, but it wasn't until mid 2016, and only through a lawsuit- that Canadians could get access to it (and then only reimbursement after they came to the US for treatment with it.)


But Canada is probably a bad comparison, because they're one of the most expensive and least efficient pseudo-universal healthcare systems. We don't want to emulate theirs anyway, if that's the route we go.

 

[fuzz77]

Countries with Universal healthcare (and they're not ALL single payer, by the way), most often control costs by constricting supply. Canada is the easiest example, and it does indeed keep their costs down a bit, but it makes it far less responsive and efficient as well. Plus, Canada isn't even completely universal or single-payer- citizens still have to buy either government or private insurance for their prescription drugs. Another way they limit costs is by combining facilities, placing caps on physicians fees, and closing hospitals. Ask a Canadian sometime what 'Summer Shutdown' is. If you're a patient waiting on surgery, you won't like it. But problems with cost cutting aren't relegated to Canada. If you're a couple in London who have had two miscarriages and you want to find out if you have fertility problems, tough luck. The UK healthcare system won't approve you for testing you until you've had four miscarriages. That's just the way it is. It's too expensive otherwise.

Now- Canada is probably the last of the "universal" systems we would want to emulate compared to France, England, etc. But those same cost cutting measures apply there as well. But Canada shares some of the same problems we would face with a universal system- namely geography. Centralized facilities those countries rely on for efficiency can only exist in a country where the entire population lives within a few hours drive of the center of the country. Centralized facilities are cheaper, and patients can reach care easily. They require fewer doctors, far lower costs, etc.

There's a problem here- we have 300+MM people spread over a continent. We'd need exponentially more facilities (and therefore doctors) to provide those services to our population with any semblance of accessibility. And it's not just proportional to the population difference either- we have so much GEOGRAPHY that delivering services to huge swaths of the population require a ton more facilities, distribution, etc. It- in very simple terms- will cost significantly more per capita to emulate what other countries do here. Otherwise, it could take days just to get a patient TO a specialized facility, or the cost of moving patients in a prudent time would be astronomical and would actually DECREASE Accessibility.

So it's not just a matter of dropping another system into our country and having it work the same. It can't.

But something has to give. The free market doesn't work with healthcare in our system. It just doesn't. The inequality of access is proof of that. We don't want to lose what our system does well- which is innovative and TIMELY care at our doctor's instruction, not the government's. What we need to find is a way to get the quality and efficiency of care we already provide to everyone who needs it rather than to those can afford insurance and the resulting copays. That has to start with some reforms that are intended to either stop the unmitigated growth of costs or even reverse it in some ways. Then we need to make that care accessible. That's why I say I don't know what the right solution is. It's not, in my mind, the system in place north of the border or in European countries. But it's also not what we have here. I have to believe that if you took politics out of it, we have some smart people who could come up with a new system that combines the best of both worlds. Whether that's single payer, government/private universal, or some other form of private, I can't say.

But every time we start trying to further bastardize insurance to do that, we make the problem worse. Unfortunately, the only thing our politicians seem to be able to do is focus on changes to insurance and claim they've fixed everything and walk away. Insurance, as it exists today, is a symptom of the problem, not the problem itself. And you don't fix a problem by treating the symptoms.

Fair enough...but there are no perfect systems. They all have flaws.

You say... "There's a problem here- we have 300+MM people spread over a continent. We'd need exponentially more facilities (and therefore doctors) to provide those services to our population with any semblance of accessibility."

More facilities? why? We have more doctors and facilities per capita than any country on earth...hence part of the reason for our high costs. Facilities in rural areas have been closed because they aren't as profitable or because they lose money because a high percentage of patients seen had no insurance and could not pay for services.

We aren't going to maintain accessibility to healthcare on demand like we currently have it for those able to pay unless we are willing to pay for that amount of care. When you cut costs you make sacrifices. Priority should be given to emergency care, then preventive care followed by disease management. You may have to walk with a cane a while before getting that knee replacement. If you're 80 yrs old and require a heart transplant you should wait in line behind the 40 yr old who needs one also.

You're never going to remove politics from the issue.

While I would favor a 100% single payer system I think a reasonable compromise would be to offer Medicare to all that granted emergency and preventive and basic care to all as well as a VA type system for disease management. People would have the option of buying private insurance just like the Medicare supplement plans today that gave those with resources access to a wider range of care.

 

[cat_in_the_hat]

I know this is pointless because neither side will change the other's mind about universal healthcare. However, I think this is an important point to make about anything that is run by the Federal Government. If we have a single payer system, then government, and even the people, may feel like they have the right to place certain restrictions on lifestyle, etc., since everyone is paying the cost. I don't want the government, or the citizens, thinking that because they foot the bill, they can vote to tell people what they can eat, how much they need to exercise, what they can drink, etc. I want government involved in personal matters as little as possible because it always leads to them, or other people, trying to tell people how to live. When you consolidate power in the Federal Government, it is never a good thing for liberty. That is just a fact of life. This would be no different. And yes, I understand that we pay for those costs now.

 

[Deeeefense]

I don't want the government, or the citizens, thinking that because they foot the bill, they can vote to tell people what they can eat, how much they need to exercise, what they can drink, etc.

So far as I know neither Medicare nor the VA, attempts to tell seniors or veterans what to eat or how much to exercise. I don't think the Constitution would allow the government to order people in that manner of fashion. I mean we're talking about government insurance, not turning into Somalia. I do think, as has been mentioned by some members above, that allowing the government and/or private insurers to risk-rate premiums based on life style is desirable. Recommendations should be welcomed by all.

When you consolidate power in the Federal Government, it is never a good thing for liberty.

I don't see it as "empowering" but rather providing a service. Again I think our liberties are protected by The Constitution. What liberties do you feel you have lost or would be in jeopardy?
============================================================

I don't mean to sound disrespectful but the way you speak about the government it's as if you view it as a monster that you fear is out to take things from you. I view our government as a rock solid institution based on a well thought out Constitution and system of law that has evolved over the course of our history and has become better with time.. Our governement is made up from elected representatives of both parties that hold offices. They pass laws that we live by. If we don't like what they do we vote them out. If the laws don't pass Constitutional muster they are challenged in the courts and can be overturned. In short, while our system isn't perfect I think, for the most part it works.

 

[rudd1]

-unelected bureaucrats control the govt. not elected representatives. If a politician from either side looks to cut budget/power from said bureaucrats they are cast as america hating pacifists(defense) or racist/pawns of the 1% that wanna destroy the planet/starve old people/murder children (pretty much every bureaucracy/agency other than defense).

 

[Deeeefense]

-unelected bureaucrats control the govt. not elected representatives. If a politician from either side looks to cut budget/power from said bureaucrats they are cast as america hating pacifists(defense) or racist/pawns of the 1% that wanna destroy the planet/starve old people/murder children (pretty much every bureaucracy/agency other than defense).

The "unelected bureaucrats" are powerless to create any laws, or deny any citizen of their Constitutional liberties. Politicians have and will always be cast in a variety of ways, but that does not equate to citizens losing any liberties that are guaranteed by The Constitution.

 

[cat_in_the_hat]

So far as I know neither Medicare nor the VA, attempts to tell seniors or veterans what to eat or how much to exercise. I don't think the Constitution would allow the government to order people in that manner of fashion. I mean we're talking about government insurance, not turning into Somalia. I do think, as has been mentioned by some members above, that allowing the government and/or private insurers to risk-rate premiums based on life style is desirable. Recommendations should be welcomed by all.



I don't see it as "empowering" but rather providing a service. Again I think our liberties are protected by The Constitution. What liberties do you feel you have lost or would be in jeopardy?
============================================================

I don't mean to sound disrespectful but the way you speak about the government it's as if you view it as a monster that you fear is out to take things from you. I view our government as a rock solid institution based on a well thought out Constitution and system of law that has evolved over the course of our history and has become better with time.. Our governement is made up from elected representatives of both parties that hold offices. They pass laws that we live by. If we don't like what they do we vote them out. If the laws don't pass Constitutional muster they are challenged in the courts and can be overturned. In short, while our system isn't perfect I think, for the most part it works.

It's not really worth arguing over, but my view of government is exactly the same as our founding fathers. They viewed government as a necessary evil whose powers must be strictly limited because its very existence places some limits on liberty. You can call it providing a service all you want, but as government grows it limits liberty. You cannot have government and liberty. They do not coexist. Our founding fathers knew that and went out of their way to strictly limit it's power. For example, with national healthcare, you are limiting the liberty of everyone that is forced to pay for the healthcare of someone else. There is no way around that. Anytime government implements any kind of social program it limits the liberty of a portion of the population.

When you say "If we don't like what they do we vote them out." that, in my mind, represents a problem in how society views government. Government must be better than carrying out the will of the people. The will of the people is never 100%. Therefore, the will of the people will often limit the liberty of the minority. Government must stand up to the will of the people and uphold the Constitution. I don't really see government doing that. I see government catering to the majority in order to get elected and stay elected. I see government manipulate the Supreme Court (FDR) in order to do something that was considered unconstitutional prior to that time. The Constitution is only as good as the people who are charged with enforcing it. History shows that it is not that difficult for the people in power to insert people on the court, etc., who will find reasons why the Constitution will allow what they want to do. I do not see government as some benign helper of the people and neither did the people who created this government to begin with.

 

[Deeeefense]

You cannot have government and liberty

If you don't have government you have anarchy.
that is all.

 

[cat_in_the_hat]

If you don't have government you have anarchy.
that is all.

Nice straw man, but no one has said anything about not having any government. Are you saying our founding fathers trusted government and felt that large government was an ally of the people and protected individual liberty?

 

[Deeeefense]

Nice straw man, but no one has said anything about not having any government. Are you saying our founding fathers trusted government and felt that large government was an ally of the people and protected individual liberty?

Not a straw man. By definition Anarchy is a society of free associations without government.

I can't get into the heads of the Founders, but the Constitution including all the Amendments speak for themselves and they are the body of work which they created. :americanflag:

 

[cat_in_the_hat]

Not a straw man. By definition Anarchy is a society of free associations without government.

I can't get into the heads of the Founders, but the Constitution including all the Amendments speak for themselves and they are the body of work which they created. :americanflag:

Yes, and no one has suggested a society of free associations without government. So I'm missing your point or it is a straw man.

It's very easy to get in the heads of the founding fathers since they wrote quite a bit about what they believed and what they were trying to accomplish with the Constitution.

 

[Rex Kwon Do]

I don't think the Constitution would allow the government to order people in that manner of fashion.

Well, the government just mandated every citizen carry otherwise purchase a product just for being alive, I'd say that's a tidy pathway into doing whatever tf they want, candidly.

The federal govt forcing you to buy health insurance is one of, if not the most, disturbing federal laws to ever cross the books in US history.

 

[Deeeefense]

Yes, and no one has suggested a society of free associations without government. So I'm missing your point or it is a straw man.

It's very easy to get in the heads of the founding fathers since they wrote quite a bit about what they believed and what they were trying to accomplish with the Constitution.

you said: You cannot have government and liberty

If this is your believe, that the two are mutually exclusive, I can only interpret that to mean you don't want government, which equals anarchy.

 

[Deeeefense]

Well, the government just mandated every citizen carry otherwise purchase a product just for being alive, I'd say that's a tidy pathway into doing whatever tf they want, candidly.

The federal govt forcing you to buy health insurance is one of, if not the most, disturbing federal laws to ever cross the books in US history.

What are we all mandated now to "buy" through taxation? roads, bridges, education, law enforcement services, regulatory services like the FAA and the FCC, and retirement health care etc. If hypothetically
heath care were to become a single payer government system it would fall into the same category.

 

[cat_in_the_hat]

you said: You cannot have government and liberty

If this is your believe, that the two are mutually exclusive, I can only interpret that to mean you don't want government, which equals anarchy.

That's a pretty poor interpretation if you understand what our founding fathers believed. That's why the power of government is severely limited by the Constitution. They wanted to limit the role of government because of the fact, and it is a fact, that the very existence of government limits individual liberty.

 

[Rex Kwon Do]

What are we all mandated now to "buy" through taxation? roads, bridges, education, law enforcement services, regulatory services like the FAA and the FCC, and retirement health care etc. If hypothetically
heath care were to become a single payer government system it would fall into the same category.

[laughing]

 

[Deeeefense]

That's a pretty poor interpretation if you understand what our founding fathers believed. That's why the power of government is severely limited by the Constitution. They wanted to limit the role of government because of the fact, and it is a fact, that the very existence of government limits individual liberty.

OK - I think I'm following you. Some government results in some loss of liberty but you're OK with it so long as it's limited. I see that logic. Any time 2 or more people are sharing the same piece of real estate you're going to have some loss of liberty. We have a country of nearly 350 M people sharing a large section of a continent so it's reasonable to believe that we will have some loss of liberty by instituting a system of laws and order.

From history I recall that the founders were also interested in preserving life and the pursuit of happiness, along with liberty. I think the subject of health care squally touches the issue of life.

 

[Rex Kwon Do]

Any time 2 or more people are sharing the same piece of real estate you're going to have some loss of liberty.

Again, you're stretching. You used the word "share" purposely, who exactly is sharing a piece of real estate? Real estate is owned by someone.....person, bank, corporation, govt.....and people enter into arrangements of their own free will and accord. Liberty, in other words. Trying to act like we all "commune" our real estate so the govt should impose universal HC is =\=.

From history I recall that the founders were also interested in preserving life and the pursuit of happiness, along with liberty. I think the subject of health care squally touches the issue of life.

Again, stre......you get the point. You're talking about a statement from the Declaration of Independence and trying to justify universal HC or mandated insurance purchasing? It was declaring independence from Eng so that individuals could pursue such things, sure af not so the federal govt could pursue it or provide it for you. Had that been the case they *clearly* would have put some kind of rudimentary version of "the federal govt needs to take currr of airyone" into the Constitution......which they did not.

 

[Rex Kwon Do]

That's a pretty poor interpretation if you understand what our founding fathers believed. That's why the power of government is severely limited by the Constitution. They wanted to limit the role of government because of the fact, and it is a fact, that the very existence of government limits individual liberty.

Obama's speech well before he was elected about the Bill of Rights was extraordinarily fascinating on the topic, calling it a "charter of negative liberties". Not even clowning him. That's an incredible take, albeit one I *vehemently* disagree with but it's a window into the soul of that way of thinking. Negative liberties in that it described what the govt couldn't do to you i.e. protect you from them.

Point was he wanted the Bill of Rights to cater to what the govt HAD to do for you, i.e. health care and other entitlements. He certainly has a right to that opinion, but again it's the exact opposite view of the founders of the country.....proven by the fact that they wrote nothing within a country mile of that into the Constitution/BoR.

 

[Deeeefense]

Again, you're stretching. You used the word "share" purposely, who exactly is sharing a piece of real estate? Real estate is owned by someone.....person, bank, corporation, govt.....and people enter into arrangements of their own free will and accord.

Obviously Rex you've never been married Seriously I'm talking about public land and facilities that are owned by all of us. You can visit the Library of Congress in Washington, but you don't have the liberty to take your friends in with a case of beer and throw a party. You can drive your car on a federal highway but you don't have the liberty to drive it 120 MPH.

You're talking about a statement from the Declaration of Independence and trying to justify universal HC or mandated insurance purchasing?

The question that was posed to me was regarding the intent of the founders. Words in documents such as the DOI are germane towards addressing that IMO.

I'm not a lawyer but I recall that the insurance mandate portion of the ACA was held up by the Supreme Court to be Constitutional under challenge. The founders gave the Supreme Court the final word on all legal matters. To me that means it's settled law, not to say we can't find better ways of providing universal coverage.

 

[cat_in_the_hat]

Obviously Rex you've never been married Seriously I'm talking about public land and facilities that are owned by all of us. You can visit the Library of Congress in Washington, but you don't have the liberty to take your friends in with a case of beer and throw a party. You can drive your car on a federal highway but you don't have the liberty to drive it 120 MPH.



The question that was posed to me was regarding the intent of the founders. Words in documents such as the DOI are germane towards addressing that IMO.

I'm not a lawyer but I recall that the insurance mandate portion of the ACA was held up by the Supreme Court to be Constitutional under challenge. The founders gave the Supreme Court the final word on all legal matters. To me that means it's settled law, not to say we can't find better ways of providing universal coverage.

Dee, your logic in the context of what our founding fathers wrote is so far off base it's hard to know where to begin. Let's start with the basics, which I tried to discuss from the beginning. It is extremely important that citizens understand the difference between rights and privileges. Driving is not a right, therefore your liberty is not limited by a speed limit.

The declaration of independence was exactly that, a declaration of independence from England. It is not the best source for understanding the thinking a logic behind the Constitution. I would suggest you spend some time reading The Federalist Papers and other writings from the time when the logic behind out government was being created.

 

[Deeeefense]

Dee, your logic in the context of what our founding fathers wrote is so far off base it's hard to know where to begin. Let's start with the basics, which I tried to discuss from the beginning. It is extremely important that citizens understand the difference between rights and privileges. Driving is not a right, therefore your liberty is not limited by a speed limit.

The declaration of independence was exactly that, a declaration of independence from England. It is not the best source for understanding the thinking a logic behind the Constitution. I would suggest you spend some time reading The Federalist Papers and other writings from the time when the logic behind out government was being created.

That's interesting history but we all know that the Constitution was purposely written to be open ended and amended and it has been 25 times over the course of history because the founders knew it was impossible for them to visualize what the world would be like far into the future.

I didn't say health care was a "right" rather I think it's a fundamental ideal of our social fabric that we, as a people and as a nation will not let people die in the street like dogs. As a result laws are in place that allow those that have no other access to health care to seek treatment in emergency rooms. But the question comes up is that the most efficient and cost effective way to include all members of our society under a health care umbrella? Clearly it is not.

Health care as a system did not even exist in the 18th century most people were rural and treated illnesses with botanical and herbal products. Physicians were rare and practiced primative techniques like bleeding people that were ill. Health care was for the most part left up the family. There is no way anyone in that era could have ever imagined what health care would evolve into.

I cannot imagine that Jefferson or Madison, if were they alive today, would endorse any draconian system of health care that was based on accessibility only to those that had the resources to purchase and let others die based on some abstract notion of someone's liberties being denied. I don't think that is what they had in mind when the spoke about liberties and other matters.

It's one thing to oppose universal health care based on philosophical ideal that you believe is a component of our history but it doesn't address the question of what to do about the problem and doing nothing is not an acceptable answer IMO.

 

[fuzz77]

Yes, and no one has suggested a society of free associations without government. So I'm missing your point or it is a straw man.

It's very easy to get in the heads of the founding fathers since they wrote quite a bit about what they believed and what they were trying to accomplish with the Constitution.

The founding fathers did not come from one voice. They disagreed on many things. They consisted of Federalist and Anti-Federalist who disagreed over the role of federal government. But they were wise enough in their compromises in framing the Constitution that they left it broad in meaning. Had they not the Constitution wouldn't have survived more than a couple of generations.
Wise, learned men who have studied the Constitution and studied the founding fathers disagree over meanings. It is in fact much like the Bible in that one can find within its text justification for opposing positions on many subjects.
Add that the founding fathers were men of their time. Were they alive today would they still hold the same views? Think they would still believe that the 3/5ths Compromise was a good idea?

Perhaps if James Madison was still alive we could ask him to better define article 1, section 8. I think it is very reasonable to rationalize that a national healthcare system would provide for the general welfare of the United States.

 

[cat_in_the_hat]

That's interesting history but we all know that the Constitution was purposely written to be open ended and amended and it has been 25 times over the course of history because the founders knew it was impossible for them to visualize what the world would be like far into the future.

I didn't say health care was a "right" rather I think it's a fundamental ideal of our social fabric that we, as a people and as a nation will not let people die in the street like dogs. As a result laws are in place that allow those that have no other access to health care to seek treatment in emergency rooms. But the question comes up is that the most efficient and cost effective way to include all members of our society under a health care umbrella? Clearly it is not.

Health care as a system did not even exist in the 18th century most people were rural and treated illnesses with botanical and herbal products. Physicians were rare and practiced primative techniques like bleeding people that were ill. Health care was for the most part left up the family. There is no way anyone in that era could have ever imagined what health care would evolve into.

I cannot imagine that Jefferson or Madison, if were they alive today, would endorse any draconian system of health care that was based on accessibility only to those that had the resources to purchase and let others die based on some abstract notion of someone's liberties being denied. I don't think that is what they had in mind when the spoke about liberties and other matters.

It's one thing to oppose universal health care based on philosophical ideal that you believe is a component of our history but it doesn't address the question of what to do about the problem and doing nothing is not an acceptable answer IMO.

Actually, I have said how I think the problem should be addressed. Local, and perhaps even State governments, should be a part of providing some way to meet the healthcare needs of the poor without bankrupting them. Programs conceived and implemented locally are far more efficient, less likely to be scammed by recipients, and have the least effect on liberty because every person has a greater influence locally than nationally, and a person can move if he is offended by how the program is implemented. We also need to find ways to interject as much competition as possible in the industry. My problem has always been, and always will be, that the Federal Government should not be involved. None of these things should be done through the Federal Government.

 

[fuzz77]

Actually, I have said how I think the problem should be addressed. Local, and perhaps even State governments, should be a part of providing some way to meet the healthcare needs of the poor without bankrupting them. Programs conceived and implemented locally are far more efficient, less likely to be scammed by recipients, and have the least effect on liberty because every person has a greater influence locally than nationally, and a person can move if he is offended by how the program is implemented. We also need to find ways to interject as much competition as possible in the industry. My problem has always been, and always will be, that the Federal Government should not be involved. None of these things should be done through the Federal Government.

cat, with the great disparity in economic resources what do you think "local" healthcare in Wolfe or Owsley county (< $11K per capita) vs that in Oldham or Boone county(>$32K per capita) would look like?
You believe that the quality of your healthcare should be dictated by your address?

How does that work? If I live in the poorest county with ****** healthcare can I drive to the wealthiest county and be covered the same?

If my locality doesn't offer healthcare, can I go to a locality that does and be treated there

To claim that local programs are "more efficient" tells me that you haven't spent much time in local government. It is at best equally efficient and goes down hill from there.

 

[Deeeefense]

Actually, I have said how I think the problem should be addressed. Local, and perhaps even State governments, should be a part of providing some way to meet the healthcare needs of the poor without bankrupting them. Programs conceived and implemented locally are far more efficient, less likely to be scammed by recipients, and have the least effect on liberty because every person has a greater influence locally than nationally, and a person can move if he is offended by how the program is implemented. We also need to find ways to interject as much competition as possible in the industry. My problem has always been, and always will be, that the Federal Government should not be involved. None of these things should be done through the Federal Government.

Actually this is what we do now to some extend with Medicaid. Some funding comes from the Feds and the rest from the states, and states set up their own programs. The problem is some states do not have the resources to cover all citizens and some states have rejected the supplemental funding the Feds offered under the ACA. Where you lose me is why you think federally managed health care like Medicare or VA results in a loss of liberties, but state government run programs wouldn't. As far as local governments, in my life I have seen far more corruption, and irresponsible fiscal management on the local level then I ever have at the state of federal level. In many instances it's simply a lack of accountability and controls that opens the door wide for abuse.

Agree that competition in the insurance arena is beneficial, as discussed above I see no reason that a Medicare type offering could not be introduced to compete with private insurance to achieve a better result.

 

[cat_in_the_hat]

Actually this is what we do now to some extend with Medicaid. Some funding comes from the Feds and the rest from the states, and states set up their own programs. The problem is some states do not have the resources to cover all citizens and some states have rejected the supplemental funding the Feds offered under the ACA. Where you lose me is why you think federally managed health care like Medicare or VA results in a loss of liberties, but state government run programs wouldn't. As far as local governments, in my life I have seen far more corruption, and irresponsible fiscal management on the local level then I ever have at the state of federal level. In many instances it's simply a lack of accountability and controls that opens the door wide for abuse.

Agree that competition in the insurance arena is beneficial, as discussed above I see no reason that a Medicare type offering could not be introduced to compete with private insurance to achieve a better result.

I thought I explained that pretty well. State and local governments can do things the Federal Government should not because of several reasons. First, individual citizens have more influence in state and local government than they do nationally. Second, when the Federal Government institutes a program, there is no way to avoid it if you do not like it or feel that it is unfair. If State and Local government institutes a program, you have options to escape its impact if you don't like it or feel like it is unfair. Finally, consolidating power in one entity increases the risk of abuse and also makes it more difficult to recover from a failed system than one where there are multiple systems and the power is spread out over multiple entities.

I have made this general statement on and off over the years on this board. In reality, state and local taxes should probably be higher than federal taxes because many of the programs implemented by the federal government should have been implemented at the state and local level. State and local governments have much more latitude than the federal government by design. As I said before, our founding fathers distrusted federal governments and felt that concentrating power in them was unwise limited individual liberty. They wanted power not specifically attributed to the federal government in the Constitution to rest with the people or state and local governments. The very idea is that because government limits liberty, most governmental decision making should take place as close to the citizen as possible and not at some national level where large majorities (or population centers) can inflict their will on minorities.

 

[cat_in_the_hat]

cat, with the great disparity in economic resources what do you think "local" healthcare in Wolfe or Owsley county (< $11K per capita) vs that in Oldham or Boone county(>$32K per capita) would look like?
You believe that the quality of your healthcare should be dictated by your address?

How does that work? If I live in the poorest county with ****** healthcare can I drive to the wealthiest county and be covered the same?

If my locality doesn't offer healthcare, can I go to a locality that does and be treated there

To claim that local programs are "more efficient" tells me that you haven't spent much time in local government. It is at best equally efficient and goes down hill from there.

You are getting caught up in trying to create equal outcomes for everyone. That, in my mind, should not be the question. The question should be how do we help the poor obtain healthcare in a way that is consistent with our belief in individual liberty. Everything we do as society must be filtered through that question. If a program can't be done in the context of protecting individual liberty, then it should not be done. At some point you have to trust your fellow citizens to solve problems. Every problem is not something that should be addressed by government. A combination of charity and some local or state help is what is appropriate. The federal government forcibly taking another person's earned income and giving it to someone else should never be the fundamental approach to solving problems for a government charged with protecting liberty.

 

[shutzhund]

I tend to believe that Charlie Munger is right about almost everything, including a preference for a single payer healthcare system with the option for people to opt out if they so choose.

When everyone has the same coverage as congress and the president or, at least I do, then it will be just fine.

 

[fuzz77]

You are getting caught up in trying to create equal outcomes for everyone. That, in my mind, should not be the question. The question should be how do we help the poor obtain healthcare in a way that is consistent with our belief in individual liberty. Everything we do as society must be filtered through that question. If a program can't be done in the context of protecting individual liberty, then it should not be done. At some point you have to trust your fellow citizens to solve problems. Every problem is not something that should be addressed by government. A combination of charity and some local or state help is what is appropriate. The federal government forcibly taking another person's earned income and giving it to someone else should never be the fundamental approach to solving problems for a government charged with protecting liberty.

No, not trying to create equal outcomes, just the equal opportunity for outcomes. That kind of comes under the equal protection clause of the 14th amendment.

Article 1, Section 8 of the Constitution clearly gives the government the power to tax people to provide for the common defense and general welfare. Providing healthcare for all certainly falls under that heading IMHO.