I really think most of this debate is evading the question of principle, which is, "What right does 1 person or a group of people, no matter how large, have to force another person to do anything against his will?" If you say something like "well society has to bear the cost" (I reject that, people choose to bear the costs) or "well we live in a democratic republic" do you acknowledge the slippery slope to totalitarianism you're on? Are you content to just try and keep running up that slope for eternity? Does it bother you to slide toward the bottom at all? If your answer to the question of principle I posed is "none" then to solve the problems in health care in America or anywhere else, just apply that principle. For example, agreements between insurance companies and actual individuals would be much more common had the government not implemented wage caps during WW2 forcing other companies to provide it to stay competitive. They violated the principle I mentioned. Meaning they forced companies to do things against their will. There are lots of other examples. Bring on the "What are you an insane anarchist?!" rep comments!
"Many forms of Government have been tried, and will be tried in this world of sin and woe. No one pretends that democracy is perfect or all-wise. Indeed, it has been said that democracy is the worst form of government except all those other forms that have been tried from time to time." I'm going to take Winston Churchill's side on this. I think there is a good historical basis for trusting the government with some amount of one's resources with the hope that those resources will be used for things that benefit the common good. I've used public education, I've used hospitals, and I've used freeways, and I've been protected by the police. I haven't had enough time in my life to pay into these systems as much as I have been able to take out of them, and I'm willing to pay taxes towards these things later on as a wage earner because I have already benefited from them. While not every use of government dollars goes towards something that I can enjoy, the benefits I reap still outweigh the cost I pay for them. Saying that the government should not set rules for corporations to follow seems to me like a slippery slope the other direction. I, for one, am glad for anti-trust laws, FDA regulations, waste dumping laws, and so on. That life would be worse without the government "forcing another person to do something against their will" in these cases would be demonstrably true. I'm also glad that companies are held to having a modicum of truth in their advertising, must follow written warranties and return policies, and must reward their shareholders with agreed upon dividends based on honest reporting of profits. To use "nobody can force anybody to do anything else" as the only premise in an argument for one thing seems to suggest that it is all that is need to dissolve all of the regulations mentioned in this paragraph, where I would say that this is not the case. And just as much as the government "forces" us to do things, we can "force" the government similarly through the casting of votes. They can tell us not to kidnap children? We can tell them what to do through ballot measures and the election of officials, as well as through protests, strikes, or eventual revolution.
You're confusing the word Democracy with the word Freedom. Don't. Democracy is just a measure in how we can screw each other out of everything everyone owns. It is only the freedom to choose how to do so.
The entire issue with Health Care in the US makes depressed - the whole political system strikes me as being fucked. Hell, when a former vice-presidential candidate goes on record saying that the current president should start a war just to win the next election it shows how fucked things are. Oceania v Eurasia v Eastasia, big brother is watching you fucked; going broke yet throwing money away fucked. Prison rape fucked. If the country can't even properly do something which the rest of the first world has done (ensure health care for all citizens), than any hope for improving the nation's other problems are just flying out the window. Social mobility, the great aspirational carrot which has driven the US success story, is dying.
Man that was some long catch up reading. I made my opinion about the public option fairly clear in the last thread but I am much more for this bill because it cut back on a few things the first version had. There is however one thing that is bothering me about this whole thing. According to politicians this bill will: 1. Cover most Americans. 2. The deficit will not increase. 3. Taxes will not go up for most Americans. (I feel bad for the owners of the company I intern at as they are saints) 4. You will still get high quality, accessible healthcare. I am sorry but at that point you may as well promise me a space-faring unicorn that poops cotton candy. I honestly wish for one politician to just come out and say that we can pay for this if we raise taxes. Even if I am against this bill if one person says it I will vote for him or her for president and support this thing fully. I have no problem paying more in taxes if I get something out of it but please just be straight with me about it. Still I honestly think this is going to turn into one giant mess at the rate it is going.
It's not really an opinion. It's more a rule. The more money is available, the more the price of things goes up. The govt moved massive piles of money into the system with Medicare, which distorted price structures. And the insurers and Medicare paying nickels to quarters on the dollar for the services rendered only made it worse. To make up for the loss, health care focused on providing more units for Medicare and insurers to pay for, and jacked the price of them up to levels they'd never reach in a real fee for service world to offset the reimbursement discount. You couldn't put a worse set of factors together than what we have in the system now. It's like someone created the least effective model imaginable. But the answer isn't more federal involvement. The answer is bringing it back to a direct purchase system. People paying out of pocket for ALL preventative care will look for value. People who think it's all free, or ought to be, will throw their insurance card on the table and run up all sorts of bills that will never be paid. What do they care if the insurer refuses it because it's preventative? They just throw out the doctor's bill when it comes. And that need to inject personal responsibility into the equation is the fundamental issue that makes this such an emotional topic. This bill, under the guise of creating cost savings, will first, foremost and possibly only, deliver an unaffordable subsidy for the health care of a sector of society made up of a large percentage of unproductive people, at cost to productive people. There's much whining from the Left about fairness, but the Right, and the middle and upper middle class who will pay for this bill, have an equal right to be aggrieved. How long can the 60% of this country that produces in the private sector drag the other 40% along while also supporting outrageous pay packages for armies of govt employees who work in agencies and programs we neither need nor were anticipated in our Constitution? Milton Friedman was not wrong. The only way for a country to "progress" economically is to allow people, individually, to experience either success or "creative destruction." The dual "protection" of Main Street from its own bad choices and infantilism, and bailout of Wall St for its criminal stupidity, is a recipe for long term stagnation. Oh, and one last thing... I've heard a lot of politicians and pundits saying through this debate, "The measure of a society is how it treats its weakest." That's inaccurate. The measure of a society is how effectively it allows its best minds to maximize their potential. They're not mutually exclusive concepts, but in a contraction like the one we're experiencing, there is a need to elevate one above the other. The latter's preferable. The former's a slow, painful road to the European welfare state. End rant there.
It ultimately comes down to values. It would seem you value an individuals ability to become very rich more than the welfare of your common man. That's an acceptable position to have, but don't put it forward as fact. The problem with your argument is it ultimately depends upon the idea that the European welfare state is a bad thing. I disagree, in the UK virtually no-one is forced to live in a mobile home or raise kids in such an environment. We have better schools, better health services and a better safety net. Whilst the rich minority of Americans have have superior services, we have superiority when it comes down to how many people have access to high quality public services.
Yes because living in a trailer park is infinitely worse than some of the fine housing provided throughout Britain. <a class="postlink" href="http://www.skyscrapercity.com/showthread.php?p=5390732#post5390732" onclick="window.open(this.href);return false;">http://www.skyscrapercity.com/showthrea ... ost5390732</a> "high quality public services"... Really? We must have a very different meaning for the words "high quality" in the US.
I agree with all your points above, and I also wanted to ad a bit extra pertaining to those that are against mandatory health care. It's think it's mostly true everywhere about racking up bills on an ER visit and then having ridiculously low monthly payments. But what type of treatment would an individual receive if something serious came up? Like being diagnosed with MS or a form of Cancer. Without insurance the individual probably won't have access to the better treatments. They might even have treatments postponed to a later date, or if all goes well, they will be screwed with hospital bills for life. I think insurance should be mandatory because it will help with those extremes. Even if someone has to get that shitty $50.00 insurance plan per month with high deductibles, at least there will be a maximum per year the person has to pay in case something life changing happen. So mandatory insurance should help curb some of the debts individuals receive, and the lost revenue the Hospital loses out on too. It's sort of like the mandatory seat belt rule. A lot of people are against it because it violates their rights. But the fact is a seat-belt has a good chance at reducing the costs that are associated with a larger collision. *cost to government, insurance companies, hospitals, and individuals involved.
Well this is as good a time as any to re-engage with this community here. I’ve worked for a group insurance broker for the past 7 years and that’s put me in the middle of nearly every perspective of the health care industry – we help employers negotiate and implement their health insurance coverage. This thread is awesome just like the last one, but there are a few outstanding things that should be covered. You’re correct that these are all forms of socialism – which isn’t a bad word for me. Those programs do a lot of good and I don’t want 8 different train tracks all going in the same direction run by 8 different private companies. But there’s a big difference to all of those things and health care: Social Security – you have to be old or disabled. Medicare – you have to be old or disabled. Medicaid – you have to be poor. Public Schooling – you have to be young. Health Care – you have to be going to a doctor or hospital. In other words, everyone is eligible. This is why it sucks to have health insurance tied in with employment, it makes the loss of a job that much more devastating. And there’s a decision the employer has to make every year between health coverage costs and wage increases or cuts. Are you talking about a person paying completely out of pocket versus someone who has insurance? In general the person paying out of pocket is giving the doctor more money. The insurance company contracts with a provider and pays maybe 40% what the doctor would charge an uninsured schmuck/rich man off the street. This is exactly the incentive being created. Nearly all Americans will be content to pay the fine versus buying coverage since they can buy without pre-ex. Mark my words, in 2014 there will be enrollment forms in doctor’s offices, emergency rooms, and even ambulances for people to sign up as they are about to punch up a claim. Of course there will still be worry warts and unthinking idiots buying out of habit. But far worse is the incentive for employers to pay a modest fine of $3,000 (taking the higher one) versus anywhere from $3,600 per year for a modest Single coverage to upwards of $24,000 for very good Family coverage. What CFO isn’t going to pay the fine and leave their workers on their own? This provision is going to devastate the group brokerage industry. Last week we had a conference call with an insurance lobbyist who stated “Brokers are needed more than ever… Well employers don’t have a mandate to offer coverage now.” I just had it with bullshit. Once the call was done I proceeded to rant in front of my boss, coworkers and company executives that the 2 reasons employers offer health insurance is because something like 95% of employers offer it, even small ones with 2-50 employees. The second reason is there isn’t really a bona fide individual market out there. Now that there is one being created with this bill, there’s the incentive for a company to pay the fine and then only 90% of employers will offer health insurance as a benefit, then the next year only 85%, the year after only 70%. Our business model was over within the decade unless there are changes to the bill passed. And for those looking for suggested reading: Everything by Marburg on this thread. The best article written in the past year about this issue out of the 500+ I’ve read is this. <a class="postlink" href="http://www.theatlantic.com/magazine/print/2009/09/how-american-health-care-killed-my-father/7617/" onclick="window.open(this.href);return false;">http://www.theatlantic.com/magazine/pri ... ther/7617/</a> I’m going to re-pimp the conversation Philalawyer and I had. <a class="postlink" href="http://philalawyer.net/2009/08/collectivists-or-capitalists/" onclick="window.open(this.href);return false;">http://philalawyer.net/2009/08/collecti ... pitalists/</a> Read the comments afterward that go on longer than the discussion. Savage Henry has a lot of insight from the front lines of actually caring for patients and the bills involved. He gives the reason why we can’t have preventive care paid for out of pocket like we should. Because these stubborn providers won’t tell us what the motherfucking services actually cost!
This is a great reason to end socialized medicine (and everything else), not do the opposite! If you want to pay for other people's shit, do so out of your own pocket and leave me the hell alone. Your assumption of reducing cost is also baseless and illogical. It ignores the unseen costs. If you take your logic to its conclusion, you end up with a total state and 0 freedom. It's the ultimate slippery slope.
<a class="postlink" href="http://www.kff.org/uninsured/upload/7809.pdf" onclick="window.open(this.href);return false;">http://www.kff.org/uninsured/upload/7809.pdf</a> In order to justify this bill to the insured among us, we were told that ER visits for the uninsured are a drain on our economy. It's only 2.2% health care spending. Just one important facet of this debate. And the best post so far has been Philalawyer's.
I should have put a clearer wall between the first two and the rest of the paragraphs I wrote. The "fact" I was referring to was the inflation in pricing created by the Fed Govt getting involved in paying for care, and in doing so funneling mountains of money and new billing events into the system. The rest of my point, you correctly note, is my opinion. But you have to admit, it's quite difficult for anyone to argue Americans, or any consumer of health care in any nation, should not be as educated on their purchasing as possible. The only way to achieve that is by making people more responsible for their health care choices, and the only way to do that is to move back toward a direct purchaser structure. People will only demand value from health care when they are the ones buying it. And the added bonus in moving back toward something like that is it would also create more transparency in billing (providers would have to give people set fees up front) and the prices would drop because the individual, unlike the insurer, would not be paying 22 cents on the dollar charged. The notion we can't move back toward something like that seems incredibly cynical to me. Unfortunately, it's also a very practical observation. The New Deal was needed, and perhaps so was the Great Society, but they've left us with a tremendous amount of psychological wreckage. Huge swaths of American society - and no, I don't mean the poor primarily, as this is more of a middle and even upper class thing - believe our Govt serves as an omnipotent fixer... a source of "magical" money that'll keep us at our fantastic and unrealistic aggregate standard of living indefinitely. It's all bullshit. Hayek is right in the long run, which is why Keynes' most famous quote is, "In the long run, we're all dead." And that's really what it means to be a Keynesian these days. Sure, we need a stimulus. And maybe we need more health care to keep more of us alive. But who's paying for it? They could slap a 70% income tax on every hedge fund employee and it wouldn't cover a month of our spending. We're not a responsible or even sensible culture. We're kicking the can down the road, and everybody's got exactly the same mentality: "Get what you can and get out. Hope you're done before the shithouse goes up in flames." And that's what gets you things like this health care bill. Nobody cares about 2035 because, as they say on Wall Street, "I'll be gone; You'll be gone." It's a shit bill - the product of a zero sum political game where the Dems had no choice but to succeed, however empty and detrimental the "victory" might be. "Don't worry people. Be it a drug benefit or health care entitlement monstrosity, 'Nanny' will make you feel safe in exchange for your vote." Fuck it... Pete Peterson has my proxy on this stuff. Check this out and scare yourself silly: <a class="postlink" href="http://www.iousathemovie.com" onclick="window.open(this.href);return false;">http://www.iousathemovie.com</a>
Off topic somewhat, but continuing with Philalawyer's theme. Public employee unions bankrupting our states. <a class="postlink" href="http://online.wsj.com/article/SB10001424052748704281204575003101210295246.html?mod=WSJ_hpp_sections_opinion" onclick="window.open(this.href);return false;">http://online.wsj.com/article/SB1000142 ... ns_opinion</a> Spoiler It turns out there really is growing inequality in America. It's the 45% premium in pay and benefits that government workers receive over the poor saps who create wealth in the private economy. And the gap is growing. According to the U.S. Bureau of Labor Statistics (BLS), from 1998 to 2008 public employee compensation grew by 28.6%, compared with 19.3% for private workers. In the recession year of 2009, with almost no inflation and record budget deficits, more than half the states awarded pay raises to their employees. Even as deficits in state capitals widen and are forcing cuts in services, few politicians are willing to eliminate these pay inequities that enrich the few who wield political power. Let's walk through the math. In 2008 almost half of all state and local government expenditures, or an estimated $1.1 trillion, went toward the pay and benefits of public workers. According to the BLS, in 2009 the average state or local public employee received $39.66 in total compensation per hour versus $27.42 for private workers. This means that for every $1 in pay and benefits a private employee earned, a state or local government worker received $1.45. The BLS study breaks down where that 45% premium comes from. It turns out that public employees earn salaries that are about one-third higher on average than what is provided to private workers per hour worked. But the real windfall for government workers is in benefits. Those are 70% higher than what standard private employers offer, as shown in the nearby table. Government health benefits are twice as generous as what workers employed by private employees earn. By the way, nearly this entire benefits gap is accounted for by unionized public employees. Nonunion public employees are paid roughly what private workers receive. What if government workers earned the average of what private workers earn? States and localities would save $339 billion a year from their more than $2.1 trillion budgets. These savings are larger than the combined estimated deficits for 2010 and 2011 of every state in America. In a separate survey, the federal Bureau of Economic Analysis compares the compensation of public versus private workers in each of the 50 states. Perhaps not coincidentally, the pay gap is widest in states that have the biggest budget deficits, such as New Jersey, Nevada and Hawaii. Of the 40 states that have a budget deficit so far this year, 28 would have a balanced budget were it not for the windfall to government workers. But these current fiscal problems are a picnic compared to the long-term benefit commitments that state and local politicians have made to public retirees. A 2009 study by economists Robert Novy-Marx and Joshua Rauh, published in the Journal of Economic Perspectives, estimated that these government pensions are underfunded by $3.2 trillion, or $27,000 for every American household. The Orange County Register reports that California has 3,000 retired teachers and school administrators, who stopped working as early as age 55, collecting at least $100,000 a year in pensions for the rest of their lives. Illinois's pension obligations are so costly the state had to issue $3.5 billion of bonds merely to meet its mandatory contribution to the worker retirement program, which faces $85 billion, or three years of state tax revenues, in unfunded liabilities. Near-bankrupt New Jersey would have to pay $7 billion a year if it properly accounted for its pension and health benefits. California, Nevada New Jersey and Ohio all allow double dipping, which lets government workers retire in their 50s and then work another full-time job while collecting retirement checks. In Ohio, police, firefighters and teachers can retire after 30 years on the job, collect a full benefit each year and go back to work full-time doing the same job. This is called retire and rehire. As the Columbus Dispatch reported last year: "Across the state, Ohio's State Teachers Retirement System paid out more than $741 million in pension benefits last school year to 15,857 faculty and staff members who were still working for school systems and building up a second retirement plan." Some teachers can earn nearly $200,000 a year in pensions and salaries. The union response is that government workers deserve all this because they are more educated and highly skilled. That may account for some of the pay differential but not the blowout benefits. The unions also neglect one of the greatest perks of government employment: job security. Short of shooting up a Post Office, government workers rarely get fired or laid off. If government workers were underpaid, we'd expect high attrition rates, as they pursued better private opportunities. The reality is the opposite. Cato Institute economist Chris Edwards has analyzed Department of Labor statistics and found that private workers are three times more likely to quit their jobs than are government workers. So if your state is broke, this is a major reason. Eventually, governors, state legislators and city council members are going to have to decide whether protecting America's privileged class of government workers is a higher priority than funding such core functions of government as public safety. Something has to give. It's time to close the biggest pay gap in America.
Ok, they don't control ALL drug prices, but a single government agency has control of all prices on patented drugs. And that's not monopsony power how? (I'm not saying it's a pure monopsony where they control EVERYTHING, but it has far more negotiating power than any U.S. entity.) I never said that the money they earn goes directly into research, I said that knowing they can get that cash once they've developed the technology/drug/etc. is what creates a stronger incentive to innovate in the first place. Money incentivizes research. The incentive derived from a U.S. citizen is stronger than the incentive from a non-U.S. citizen, though in the end they each get the same technology. Thus it's a subsidy. Whether it's a massive company like Pfizer or a small startup doesn't really matter. We're talking about incentive derived from market demand, which has nothing to do whatsoever with the nature of the producer unless he happens to be immune to market demand (which I assume isn't your argument).