Obamacare Going Down?

[Lemur]

Looks like the administration's lawyers are not faring well in front of the Supremes. Details (http://www.politico.com/politico44/2012/03/toobin-health-law-looks-like-its-going-to-be-struck-118811.html):

CNN's legal correspondent Jeffrey Toobin reports that the court's conservative wing appeared skeptical of the Obama administration's arguments in favor of the individual mandate provision of the Affordable Care Act.

"This was a train wreck for the Obama administration. This law looks like it's going to be struck down," Toobin said on CNN. "All of the predictions including mine that the justices would not have a problem with this law were wrong."

"The only conservative justice who looked like he might uphold the law was Chief Justice Roberts who asked hard questions of both sides, all four liberal justices tried as hard as they could to make the arguments in favor of the law, but they were -- they did not meet with their success with their colleagues," Toobin said.
This gets me wondering, if the latest attempt at universal coverage is ruled unconstitutional — if the individual mandate, which is pretty much the only method for preserving a market-based system while guaranteeing coverage for most citizens, is unenforceable — what's next? Remember, the concept of the individual mandate was initially put forward by the Heritage Foundation (http://www.forbes.com/sites/aroy/2012/02/07/the-tortuous-conservative-history-of-the-individual-mandate/) and enacted by Governor Romney (http://www.bloomberg.com/news/2012-03-26/romneycare-s-98-success-rate-defies-gripes-on-obama-law.html) in its first real-world test-drive.

So what's next? Do we really try to disentangle government from healthcare, and strike out into uncharted waters for a completely market-based approach? Do we eventually get forced into single-payer just to keep costs under control? Do we limp along with our hybrid jackalope not-market/not-universal system for the forseeable future?

What?

-edit-

Shamelessly ganking from another thread where this came up:


The NHS provides universal cover for half the cost of the US system - there are other alternatives, but the tell is that you can have private insurrence in the UK but most people don't bother.

I assume he means half the cost per head, and I also assume he wasn't being literal.

Actually, I think he understated the case, although it's hard to make head-to-head comparisons, given that different benefits apply. Still and all, a recent, rough comparison (http://www.guardian.co.uk/news/datablog/2010/mar/22/us-healthcare-bill-rest-of-world-obama).

https://img.photobucket.com/albums/v489/Lemurmania/healthcare.png

I think anyone who has run the numbers can see that the US system involves the most cash for (at best) an average outcome.

Well that's pretty damning, isn't it?

Especially seeing as you wouldnt say the UK has some fabled mediterranean diet, they drink, smoke eat too much nor do they exercise blah blah and still the life expectancy is two years better with less wonga spent.

Short version of my take: Single-payer healthcare has its ups and downs, but it appears to be the cheapest method for covering the population.

A purely market-based system of healthcare may be cheaper, depending on which economic theories you choose to believe, but it has never been tried on a national scale in a developed country. (I would be a lot more confident in the Republicans who advocate a pure market system if they could point to a single real-world example. Empiricism FTW.)

Here in the USA we've managed to take the worst aspects of single-payer and fuse them to the worst aspects of a broken market system, yielding the most expensive healthcare on Earth. Yay us.

The only upside to our system is that if you have a great deal of wealth (in the form of gold-plated insurance or good old cash), some low-percentage diseases and conditions can be treated at a much higher level of competence than in any single-payer system. So if you've got some weird variant of lymphoma, and your pockets are functionally bottomless, you can buy better treatment here.

And that's about it.

[Strike For The South]

The goal should be Maximizing care while minimizing cost. The individual mandate is a middle ground which keeps the bloat of the medical industry intact under the guise of "universial health care"

I just want an NHS, Sorry for being fiscally respobsible

[Lemur]

The individual mandate is a middle ground which keeps the bloat of the medical industry intact under the guise of "universial health care"
I think this is one of the most relevant criticisms of Obamacare (and Romneycare): yes, near-universal coverage is achieved, but no big steps are taken to rein in costs. And if you compare the year-over-year increases, our system is getting more expensive at a geometrically faster pace than other systems. Big problem.

-edit-

Not very confidence-inspiring: GOP Senate majority leader weighs in (http://www.bloomberg.com/news/2012-03-26/supreme-court-case-won-t-end-republican-obamacare-attacks.html). "[H]e doesn’t favor comprehensive legislation to replace it. 'We would want to more modestly approach this with more incremental fixes,' he told me. 'Not a massive Republican alternative.' Two ideas McConnell mentions are allowing people to purchase health insurance across state lines and reforming medical-malpractice laws."

Those old chestnuts? That's the alternative?

[Strike For The South]

I think this is one of the most relevant criticisms of Obamacare (and Romneycare): yes, near-universal coverage is achieved, but no big steps are taken to rein in costs. And if you compare the year-over-year increases, our system is getting more expensive at a geometrically faster pace than other systems. Big problem.

Obamacare was rushed through and hamstrung by all the worst parts of the art of compromise. To tout what will become law in 2014 as universal health care is putting lipstick on a pig. The end result will most likely be higher rates, more red tape, and a crushing effect on small buisnesses. Obama gave up to much in order to get the thing passed, quite the phyrric victory.

As you allude to in the op a purley based market system may in fact be better but it is not a practical reality unless we accept the fact the uninsured will die becuase their is no saftey net for them. I do not mean to be hyperbolic but my larger point is the American people will not stand for a pure market becuase no one is going to turn away the uninsured at the ER (nor should they). Guess who ends up paying for that?

People wait until the last possible second for medical care percisely becuase they lack or have inadequte coverage. Then everyone ends up paying more becuase they waited so long to take care of their medical issues.

I would be remiss if I didn't mention that an NHS would require a tax hike. But that's a small hurdle compared to the elephant in the room. An NHS would eliminate allot of jobs. A price I am more than willing to bear, of course I don't work in health care.

[rory_20_uk]

A nice graph of comparative costs, courtesy of McKinsey.

http://www.alacrastore.com/blog//wp-content/uploads/2008/12/mckinsey-healthcare.gif

Those will be some of the most well heeled lobbyists in the land, and faced with a potentially life or death struggle.

Perversely, in the UK the PM has a lot more power than the President does - as evidenced by the first challenges occurring 12 minutes after the bill was passed where here changes can be more effectively deployed (whether the changes themselves are effective is a different matter).

I did some work for a friend who was looking into getting involved in preventative medicine in the USA for Diabetes. In a cohort study of the staff of one company, the ROI was under 5 years - and this for a long term illness.

I really don't know how the USA is going to sort this out. Although oft said, it can't go on - spending 20, 30, 40 percent of GDP on healthcare is insane, but based on current trends is going to happen.

~:smoking:

[Rhyfelwyr]

What I like about the NHS is that not only does it provide a better value service than what people currently have in America, I think it strengthens British society.

From what I've seen the levels of care poor people get in America is shocking, it's bordering on third-world levels. Meanwhile the rich get the best of the best.

That doesn't happen in the UK. Rich or poor, most people will use the NHS (of course some will still go private). It's something we all have in common regardless of class, creed, colour etc.

This obviously means that there is less of a disconnect and less resentment between the rich and poor. If we are going to live together as a society then we have to have things in common. Shared institutions like the NHS, BBC, Royal Mail etc are all good examples of that.

No death panels. No communism. Just a decent level of health care for everyone.

Somtimes I wonder if the lack of these things in America is what makes politics so polarised there.

Of course the social, political, and even geographic make-up of the USA is completely different to that of Britain, so I can't presume that what works here will work there.

[Lemur]

Of course the social, political, and even geographic make-up of the USA is completely different to that of Britain, so I can't presume that what works here will work there.
Given that the USA is the only industrialized nation without some form of universal healthcare, I think that's a dodge. If it can work for a nations as racially and physically diverse as India and Singapore, it could work here. That's ignoring the baggage we bring to the table by having invested so much for so long in our jackalope hybrid system, however.

More legal analysis (http://www.newyorker.com/online/blogs/comment/2012/03/health-care-supreme-court.html):

In weighing how the contemporary Supreme Court behaves, there’s a relevant precedent here. In the Citizens United case, the Supreme Court not only rejected a major piece of legislation but created a constitutional standard that makes any meaningful campaign-finance legislation next to impossible to pass.

The question is whether they will do the same with health-care reform.

[rory_20_uk]

Death panels? Oh, we are up with the Media Hype.

Until healthcare is infinite there will always be rationing. Who gets organs is decided by a panel of experts, and yes, those who don't get them have an increased chance of dying.

People are increasingly demanding of the NHS. A cough for 2 weeks - quick, off to the GP!

I am not advocating this as the "good old days" but one elderly patient informed me that pre-NHS, seeing the GP would be the pay for a day or so - not something taken lightly. I personally think that a nominal charge attending both A&E and one's GP. In France, people are expected to bring all their medical records to their doctor and this is considered normal, so I don't think paying a small payment isn't unreasonable, and would help preserve the system for the future.

~:smoking:

[Strike For The South]

That's worrisome, to block the government from healthcare will only continue us down an untennable role.

Granted considering Uncle Sam already foots a large part of the bill I don't know how they would word it. Granted I don't put it past them either

[drone]

My understanding is that the main Constitutional challenge is the requirement to purchase insurance. This need to be struck down or else the commerce clause pretty much overrides everything in this country. Forcing people to buy something is not a power I want the federal government to have. We are already becoming a corporatist nation, no need to accelerate it further.

The best solution is for an NHS-style system (payed for by taxes/deductibles). Through that, get health costs down through tort-reform, neutering Big Pharma, and preventative medicine.

[a completely inoffensive name]

I can't wait until someone tries to tell me that only through adhering to a laissez-faire free market, can we achieve maximum efficiency in rationing medical supplies by having our money go into the coffers of insurance companies that are trying to maximize profit, not coverage.

[a completely inoffensive name]

Also, I can't wait to hear everyone cry when SCOTUS takes out the individual mandate and suddenly their state government can't force people to buy car insurance anymore.

[Rhyfelwyr]

Since I forgot to say it earlier, I offer a +1 to GC's above post. The free market is great but it is just not appropriate for peoples' physical suffering to be the source of profit for an organisation.

IMO this is another example of protecting the vulnerable, and it is the government's duty to do so.

Although, as Drone's post has made clear to me, the way they are going about this reform is sillly.

idk but would conservatives be happy with NHS style reforms being made at the state (as opposed to federal) level? Could that work?

[rory_20_uk]

Even if things were directed at a federal level, things would have to be done at state / county level. Again, similarities to the NHS where the structure is nationwide, but the implementation is far more local. Some trusts are good, others are dangerously bad.

~:smoking:

[PanzerJaeger]

I can't wait until someone tries to tell me that only through adhering to a laissez-faire free market, can we achieve maximum efficiency in rationing medical supplies by having our money go into the coffers of insurance companies that are trying to maximize profit, not coverage.

Do you know what the average profit margin for the health insurance industry is?

[a completely inoffensive name]

Do you know what the average profit margin for the health insurance industry is?

Not great, but still too high. My philosophy is that all money should be going back to providing health care. The stuff is just too dang expensive, it doesn't make sense to have a system that automatically takes a chunk of your money and does nothing for your health with it. The free market is supposed to provide a better product in return of being able to have profits, but the free market incentives for health care are completely out of wack. It just doesn't work. The incentive is only to cover healthy people and deny sick people, which is the exact opposite of what we want because healthy 20 year olds don't need insurance and the elderly/sick do.

It's not a failure of free market principles to admit that they just don't work for providing health care. It's just admitting that health care is a unique product with certain problems in its distribution.

EDIT: I am not asking for government control of hospitals and doctor's pay, I just want a government insurance agency that applies to everyone that is able to bring down costs by being able to negotiate with hospitals with its leverage.

[drone]

Also, I can't wait to hear everyone cry when SCOTUS takes out the individual mandate and suddenly their state government can't force people to buy car insurance anymore.
Bad counterargument.

Obamacare relies on a twisted interpretation of the commerce clause to be constitutional. The commerce clause covers interstate commerce. What state governments do within their borders is (theoretically) their own business.
Driving or owning a car is not mandatory. You can make the choice not to have a license. Obamacare does not give you a choice.

[econ21]

I did some work for a friend who was looking into getting involved in preventative medicine in the USA for Diabetes. In a cohort study of the staff of one company, the ROI was under 5 years - and this for a long term illness.

Rory, can you spell this out a bit? For example, what's a ROI? Can you explain this study and what you infer from your work in layman's terms? It sounds interesting.

[rvg]

Driving or owning a car is not mandatory. You can make the choice not to have a license.

Precisely. You don't need car insurance if you don't drive. All you need to be obligated to buy Obamacare is a pulse.

[a completely inoffensive name]

Bad counterargument.

Obamacare relies on a twisted interpretation of the commerce clause to be constitutional. The commerce clause covers interstate commerce. What state governments do within their borders is (theoretically) their own business.
Driving or owning a car is not mandatory. You can make the choice not to have a license. Obamacare does not give you a choice.


Point of car insurance is to make sure costs that people produce when using the infrastructure are not offset onto someone else. The logic still applies to health insurance. Only difference being that everyone is allowed to use the infrastructure at any time, so of course the mandate is going to apply as long as you live. One reason why health care is so expensive is because people who can't pay have their costs dumped on others who can pay and/or have insurance, which is why just like we make sure every car has insurance, every body should have insurance.

[rory_20_uk]

Rory, can you spell this out a bit? For example, what's a ROI? Can you explain this study and what you infer from your work in layman's terms? It sounds interesting.

Link (https://docs.google.com/open?id=0B1Am4117z183dnNYOVF4ZzBTYnlDVzNyWXhTSzdvZw) this is the document that I created. It was for internal review, and yes, is gleaned from others and there was no time to properly reference it. Rest assured it was all plagiarised from online sources.

ROI - Return On Investment - this was being prepared for the basis of starting a company, but savings are equally important if it was a non-profit.

~:smoking:

[drone]

Point of car insurance is to make sure costs that people produce when using the infrastructure are not offset onto someone else. The logic still applies to health insurance. Only difference being that everyone is allowed to use the infrastructure at any time, so of course the mandate is going to apply as long as you live. One reason why health care is so expensive is because people who can't pay have their costs dumped on others who can pay and/or have insurance, which is why just like we make sure every car has insurance, every body should have insurance.
But the problem with your analogy is that people can opt out of using automobiles. Forcing people to purchase goods/services from private entities just for being alive is a bad precedent to make, especially considering the corporate influence over our current government. SCOTUS needs to kill Obamacare for this reason. Try again with a single-payer system.

[Lemur]

Driving or owning a car is not mandatory. You can make the choice not to have a license. Obamacare does not give you a choice.
Fair point, but you can also go from cradle to grave without owning a car, should you choose. Hard to picture the same for healthcare.

I think it's more like paying for the army. Whether you want it, like it or approve of it, a nation's gonna have an army. We all have to pay for it. We can argue about how big that army should be, what it should be doing in its spare time, whether they need the latest and greatest death robots, but the fact remains that it must exist and we must pay for it.

We are all going to use healthcare at some point. (In fact, for most people 90% of their healthcare dollars will be spent in the last three months of their lives.) The question is how we pay for it, and ration it, since the appetite for healthcare is infinite and the supply is finite. Right now we ration it via paperwork and insurance bureaucrats. I would actually rather we debated it in public and made it an issue of elections. That would be vastly more transparent than our current hybrid system.


Try again with a single-payer system.
Yeah, it's starting to look like that will be the only workable option.

[PanzerJaeger]

EDIT: I am not asking for government control of hospitals and doctor's pay, I just want a government insurance agency that applies to everyone that is able to bring down costs by being able to negotiate with hospitals with its leverage.

This, like eliminating insurance industry profits, digitizing medical records, tort reform, and selling insurance across state lines, would amount to only negligible savings. Even adding all of those together and assuming maximum efficiencies, they would still only make a dent in the significant cost overruns the American system experiences in comparison to other developed nations.

The truth is that the vast majority of healthcare spending in the US is end of life care. It is incredibly expensive to keep people alive who should be dead. The Left is afraid to admit that Sarah Palin was essentially correct. To truly bring America's healthcare costs in line with other nations in a government run system, some higher authority (i.e. death panels) will have to step in and make decisions about what is and is not appropriate end of life care. Left up to families and/or individuals, most people will opt to live as long as possible, especially if insurance is footing the bill.

Now, of course, Palin was trying to invoke an Orwellian emotional reaction for political gain. It would be nice, though, if politicians would acknowledge the essential fact that under a socialized system people's lives would necessarily have to be weighed against a budget instead of acting like the healthcare issue can be solved through the elimination of waste, fraud, and abuse.

[Lemur]

The truth is that the vast majority of healthcare spending in the US is end of life care.
And a really shocking amount is spent on administrative overhead, both with care providers and insurers. A light touch (http://www.nejm.org/doi/full/10.1056/NEJMsa022033) on that subject:

In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States [...] The gap between U.S. and Canadian spending on health care administration has grown to $752 per capita. A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system.
So yeah, between end-of-life care and exploding administrative costs, there you have it. Those are the two big drivers of cost, so far as I can see.

[HoreTore]

Old people has to die, regardless of whether its paid for privately or through taxes.

It might sound cold, but it really isn't. We need to stop thinking about wrenching the last bit of life out of an old and tired body as a positive thing, and instead see a dignified and natural death as a positive.

Keeping terminally ill people alive for a couple of extra months is NOT saving lives. Cancer isn't the deadliest disease, poverty is what kills most people in all countries. Keeping people who are going to die alive costs a heck of a lot of resources, resources which could instead be used on the production economy to create a means of subsistance for a lot more people. Whether healthcare is privately or publicly funded has no meaning on that debate.

All that said, however, we are still doing the same over here with our NHS-thingies, so I believe it's fair to say that public healthcare still saves quite a lot of money. Oh, and of course suing doctors is a candidate for the Dumbest Idea in History-award. Doctors are people, and like all people, they make mistakes in their jobs. Its part of real life, and demanding money when it happens is nonsense.

[Lemur]

Another update, apparently one of the lawyers representing the government's side of the case is doing an unusually awful job (http://motherjones.com/mojo/2012/03/obamacare-supreme-court-disaster). Maybe not as epically bad as the defenders of Prop 8 in California, but bad nonetheless.

Stepping up to the podium, Verrilli stammered as he began his argument. He coughed, he cleared his throat, he took a drink of water. And that was before he even finished the first part of his argument. Sounding less like a world-class lawyer and more like a teenager giving an oral presentation for the first time, Verrilli delivered a rambling, apprehensive legal defense of liberalism's biggest domestic accomplishment since the 1960s—and one that may well have doubled as its eulogy.

"What is left?" Justice Antonin Scalia demanded of Verrilli, "if the government can do this, what can it not do?" Verrilli's response to this basic and most predictable of questions was to rattle off a few legal precedents.

Justice Samuel Alito asked the same question later. "Could you just—before you move on, could you express your limiting principle as succinctly as you possibly can?" Verrilli turned to precedent again. "It's very much like Wickard in that respect, it's very much like Raich in that respect," Verrilli said, pointing to two previous Supreme Court opinions liberals have held up to defend the individual mandate. Where the lawyers challenging the mandate invoked the Federalist Papers and the framers of the Constitution, Verrilli offered jargon and political talking points. [...]

The months leading up to the arguments made it clear that the government would face this obvious question. The law's defenders knew that they had to find a simple way of answering it so that its argument didn't leave the federal government with unlimited power. That is, Obamacare defenders would have to explain to the justices why allowing the government to compel individuals to buy insurance did not mean that the government could make individuals buy anything—(say, broccoli or health club memberships, both of which Scalia mentioned). Verrilli was unable to do so concisely, leaving the Democratic appointees on the court to throw him life lines, all of which a flailing Verrilli failed to grasp. -edit-

And a good summation of public opinion (http://www.theatlantic.com/politics/archive/2012/03/a-majority-wants-the-supreme-court-to-rule-against-obamacare/255075/):

Americans want all the freedom of a market-based health insurance system, all the security of a system heavily regulated by government, and the option to put off purchasing this guaranteed insurance until it's needed. And all for no more than they're paying now. It seems whoever is in power will be doomed to disappoint.

[econ21]

The truth is that the vast majority of healthcare spending in the US is end of life care. It is incredibly expensive to keep people alive who should be dead. The Left is afraid to admit that Sarah Palin was essentially correct. To truly bring America's healthcare costs in line with other nations in a government run system, some higher authority (i.e. death panels) will have to step in and make decisions about what is and is not appropriate end of life care. Left up to families and/or individuals, most people will opt to live as long as possible, especially if insurance is footing the bill.

I don't think that is a truth. End of life care (i.e. care in the last year of life) is maybe 27-30% of medicare spending and there is more to health care spending in the US than medicare. There's not much data on it but one study suggests spending on end of life care takes a similar proportion of total health care spending in the US and some other countries like Holland:

http://stevereads.com/papers_to_read/demographic_and_social_characteristics_and_spending_at_the_end_of_life_.pdf

I think your final rider about insurance may be more to the point. The US system may have less incentive to restrain costs across the board, not just at the end of life.

Interestingly studies seem to contest the commonsense view that increasing life expectancy will inevitably inflate health care costs per person per year. Controlling for time to death, extra years of age among the elderly reduce health care costs at the end of life - perhaps because they are less likely to want to be hospitalised. The share of spending on end of life care has not risen markedly over the last two decades. The point seems to be that it's not being old that raises health care costs - it's being close to death (i.e. in the last year of life).


Now, of course, Palin was trying to invoke an Orwellian emotional reaction for political gain. It would be nice, though, if politicians would acknowledge the essential fact that under a socialized system people's lives would necessarily have to be weighed against a budget instead of acting like the healthcare issue can be solved through the elimination of waste, fraud, and abuse.

There's always a budget constraint, whether the budget is private or public. The argument for the socialised system is that it will pay for those whose private budget wouldn't run to it. Those with higher incomes can always use their own private budget (including via private insurance) to get more health care if they choose. If the socialised system is decent enough, they won't. I suspect it's not just "death panels" that see the futility of extending the life of people who "ought to be dead". If the extra bit of time you could eke out is miserable, people may think it's not worth squandering what they have accumulated to pass on to the next generations.

[Xiahou]

Whether it's a good bill or not (I think not) isn't at issue here. Whether we need single-payer or market based healthcare is also not at issue. The issue is does the federal government have the authority to compel people to buy health insurance?

Case law presents us with several twisted and strained abuses of the Commerce Clause (Wickard v. Filburn), but Obamacare, if upheld, would outdo them all. It would not prevent you from taking a certain action- it would compel you to take action under the guise of regulating interstate commerce. To paraphrase Justice Kennedy, it would be forcing you into a market so that the government can regulate you. This is frightening stuff. If the court were to uphold this, what could the government not force you to do under the fig leaf of the commerce clause?

Luckily for us, early indications are that this will be overturned. I welcome such a decision and hope it's just a beginning step in rolling back the power of the commerce clause to that which it was originally intended. :yes:

[Lemur]

Whether it's a good bill or not (I think not) isn't at issue here. Whether we need single-payer or market based healthcare is also not at issue. The issue is does the federal government have the authority to compel people to buy health insurance?
I think it's kind of strange to walk into this conversation and tell everyone what the issue is or isn't. Nor do I see how it's illegitimate to discuss the long-term ramifications if the law gets struck down.

The USA's system of healthcare is problematic, as most anyone would agree. The Obama administration tried to apply a fix, which now looks to be nullified. All we're hearing from the GOP is the same small-ball. Surely, beyond the legal question of the Commerce Clause, there is a legitimate conversation to be had about what we do next, yes? I do believe that was posited as the central question of my OP, yes?

[PanzerJaeger]

I don't think that is a truth.

You are correct. I meant to imply that end of life care takes up the vast majority of the differential between our system and comparable ones in comparison to the other factors often listed as reasons for that differential, which is based on my reading of sources such as this (http://www.medicaring.org/whitepaper/).


Changes in the way Americans die are mirrored in health care cost patterns. The overwhelming preponderance of U.S. health care costs now arise in the final years of life. Indeed, if one were to estimate costs across a life span, the shape of the expenditures reflects the new health and demographic circumstances. Figure 1 presents a rough estimate of health care costs distributed across the average American's lifetime. The final phase of life, when living with eventually fatal chronic illnesses, has the most intense costs and treatments. A similar curve for the U.S. population in 1900 would have been flatter, both because serious illness was more common throughout life and because death often occurred suddenly. Neither clinical services delivery nor Medicare has kept pace with the changes in the pattern of needs that underlie these costs.

https://i4.photobucket.com/albums/y104/panzerjaeger/fig1.gif

Of course such statements take into account the actual care plus the administrative and other related costs which, as Lemur pointed out, can be very costly. Thanks for pointing that out.

On the subject, here is a good article about our society's distorted view of end of life care. Without changes to that view and the way end of life care is handled, the popular fixes politicians from both sides of the aisle like to proscribe will only be peripheral. Nobody wants to tell the elderly (voters) or their doctors that they should not attempt to defy natural law on the public dime.


This is the moment in Sara’s story that poses a fundamental question for everyone living in the era of modern medicine: What do we want Sara and her doctors to do now? Or, to put it another way, if you were the one who had metastatic cancer—or, for that matter, a similarly advanced case of emphysema or congestive heart failure—what would you want your doctors to do?

The issue has become pressing, in recent years, for reasons of expense. The soaring cost of health care is the greatest threat to the country’s long-term solvency, and the terminally ill account for a lot of it. Twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.

Spending on a disease like cancer tends to follow a particular pattern. There are high initial costs as the cancer is treated, and then, if all goes well, these costs taper off. Medical spending for a breast-cancer survivor, for instance, averaged an estimated fifty-four thousand dollars in 2003, the vast majority of it for the initial diagnostic testing, surgery, and, where necessary, radiation and chemotherapy. For a patient with a fatal version of the disease, though, the cost curve is U-shaped, rising again toward the end—to an average of sixty-three thousand dollars during the last six months of life with an incurable breast cancer. Our medical system is excellent at trying to stave off death with eight-thousand-dollar-a-month chemotherapy, three-thousand-dollar-a-day intensive care, five-thousand-dollar-an-hour surgery. But, ultimately, death comes, and no one is good at knowing when to stop.

The subject seems to reach national awareness mainly as a question of who should “win” when the expensive decisions are made: the insurers and the taxpayers footing the bill or the patient battling for his or her life. Budget hawks urge us to face the fact that we can’t afford everything. Demagogues shout about rationing and death panels. Market purists blame the existence of insurance: if patients and families paid the bills themselves, those expensive therapies would all come down in price. But they’re debating the wrong question. The failure of our system of medical care for people facing the end of their life runs much deeper. To see this, you have to get close enough to grapple with the way decisions about care are actually made.

Recently, while seeing a patient in an intensive-care unit at my hospital, I stopped to talk with the critical-care physician on duty, someone I’d known since college. “I’m running a warehouse for the dying,” she said bleakly. Out of the ten patients in her unit, she said, only two were likely to leave the hospital for any length of time. More typical was an almost eighty-year-old woman at the end of her life, with irreversible congestive heart failure, who was in the I.C.U. for the second time in three weeks, drugged to oblivion and tubed in most natural orifices and a few artificial ones. Or the seventy-year-old with a cancer that had metastasized to her lungs and bone, and a fungal pneumonia that arises only in the final phase of the illness. She had chosen to forgo treatment, but her oncologist pushed her to change her mind, and she was put on a ventilator and antibiotics. Another woman, in her eighties, with end-stage respiratory and kidney failure, had been in the unit for two weeks. Her husband had died after a long illness, with a feeding tube and a tracheotomy, and she had mentioned that she didn’t want to die that way. But her children couldn’t let her go, and asked to proceed with the placement of various devices: a permanent tracheotomy, a feeding tube, and a dialysis catheter. So now she just lay there tethered to her pumps, drifting in and out of consciousness.

Almost all these patients had known, for some time, that they had a terminal condition. Yet they—along with their families and doctors—were unprepared for the final stage. “We are having more conversation now about what patients want for the end of their life, by far, than they have had in all their lives to this point,” my friend said. “The problem is that’s way too late.” In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.”


Read more http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande#ixzz1qNy5IemW

[Graphic]

The goal should be Maximizing care while minimizing cost. The individual mandate is a middle ground which keeps the bloat of the medical industry intact under the guise of "universial health care"

I just want an NHS, Sorry for being fiscally respobsible

NHS vote from me too. Obama's health reform is fundamentally flawed because it goes out of its way to preserve the private system for no other reason than "just because." It has no point other than to perpetuate its existence, working around it or within its framework can't help but be inefficient and costly.

[a completely inoffensive name]

Whatever. My logic is flawed but it looks like this will be a win-win for me anyway. If it is upheld Obama wins, if it fails we are that much closer to single payer.

[econ21]

The issue is does the federal government have the authority to compel people to buy health insurance?

I agree that seems to be the issue. I just find it strange to accept that the federal government has the authority to compel people indirectly to buy services - for example, to pay taxes to buy defence, welfare, medicare, etc - but to challenge its authority to compel people to buy them directly.

A mandate is potentially[1] a more efficient system than a purely public (NHS type) system. It should require less taxation and avoids public sector provision. It gives people more freedom around the edges, e.g. to buy more than the mandated amount or vary the quality bought, to shop around different providers etc. I would have thought as a market friendly solution to the health care problem, it might have appealed in America. It did to Romney.

To Scalia's question "where does the authority stop?" I think an answer would be along the lines of Rawls's "primary goods" - things that are so important we think everyone should have a decent amount of them. That would mainly consist of security (defence, law enforcement), education and health care but might include a few others. Mandating people to buy Fall of the Samurai is clearly silly; mandating them to send their kids to school is common sense.




[1]In reality, market failures in health care might mean the NHS type system is better, but it is not cut and dried. In the UK, there are constant initiatives to try to improve quality and choice as public provision alone does not guarantee those.

[Papewaio]

Sounds like too much cost is going into decreasing quality of death rather then increasing quality of life.

If you gave grandparents the choice of a quick painless death and increased health care for their grandchildren OR a long drawn out death rattle that draws down on the pool of money that can be used for their grandchildren... I think most of us would make a good choice for our genes.

However make it a case of having the amorphous government pay and most of us see it as a blank check.

[CountArach]

The goal should be Maximizing care while minimizing cost. The individual mandate is a middle ground which keeps the bloat of the medical industry intact under the guise of "universial health care"

I just want an NHS, Sorry for being fiscally respobsible
That's pretty much the best summary I've seen of the individual mandate.

It is interesting to me that some of the people supporting an NHS-style system are also some of the people talking up Ron Paul in the nomination thread :inquisitive:

[gaelic cowboy]

I think it's kind of strange to walk into this conversation and tell everyone what the issue is or isn't. Nor do I see how it's illegitimate to discuss the long-term ramifications if the law gets struck down.

The USA's system of healthcare is problematic, as most anyone would agree. The Obama administration tried to apply a fix, which now looks to be nullified. All we're hearing from the GOP is the same small-ball. Surely, beyond the legal question of the Commerce Clause, there is a legitimate conversation to be had about what we do next, yes? I do believe that was posited as the central question of my OP, yes?

That would be admiting that the "market" doesnt always work properly, reality is the market often needs to be hammered into insensibility with a 10lb sledge hammer.

When we say were in favour of free markets were making a political not an economic statement, we know this cos no one has a real free markets except places like somalia.

GOP needs to man up and admit there in favour of poorer voters dieing from easily treatable ailments.

We will see then if ye want the current system of death due to insurance company small print or some kind of A.N.H.S.

We all know there is flaws in NHS style medicine were not eejits but there very small beer compared american healthcare.

[Lemur]

Ganked from the GOP thread:


I am aware of the relative strengths (cost, coverage) and weaknesses (care (http://www.guardian.co.uk/society/2012/jan/19/patients-missing-nhs-waiting-time-target)) of the NHS. Why would we want to replace our own mediocre system with another mediocre system? As I said, there are much better models to choose from.
This is interesting—to which models are you referring? I'd like to read up a bit more on the alternatives. (Since we're all history nerds to greater or lesser degrees: Here's the original Heritage Foundation rollout for their conservative proposal of an "individual mandate." (http://www.scribd.com/doc/86911670/1989-Assuring-Affordable-Health-Care-for-All-Americans) Wheels in the sky, keep on turnin' ...)

-edit-

An eassayist sums up my worries about the GOP's lack of anything resembling a plan (http://www.thedailybeast.com/articles/2012/03/27/after-the-supreme-court-rules.html). I would only add that if the Supremes invalidate Obamacare, the Republicans will also need a plan. Not for campaigning; they can get many miles per gallon by railing against Obamacare/Romneycare. But for governing? Yeah, they're going to need to belly up to the bar and put something down.

Make no mistake: If Republicans lose in the Supreme Court, they'll need an answer. "Repeal" may excite a Republican primary electorate that doesn't need to worry about health insurance because it's overwhelmingly over 65 and happily enjoying its government-mandated and taxpayer-subsidized single-payer Medicare system. But the general-election electorate doesn't have the benefit of government medicine. It relies on the collapsing system of employer-directed care. It's frightened, and it wants answers.

"Unconstitutional" was an answer of a kind. But if the ACA is not rejected as "unconstitutional," the question will resurface: if you guys don't want this, want do you want instead?

In that case, Republicans will need a Plan B. Unfortunately, they wasted the past three years that might have developed one. If the Supreme Court doesn't rescue them from themselves, they'll be heading into this election season arguing, in effect, Our plan is to take away the government-mandated insurance of millions of people under age 65, and replace it with nothing. And we're doing this so as to better protect the government-mandated insurance of people over 65—until we begin to phase out that insurance, too, for everybody now under 55.

That's a different version of "all or nothing"—and one that invites the voters to answer: "nothing."

[Philippus Flavius Homovallumus]

Death panels? Oh, we are up with the Media Hype.

Until healthcare is infinite there will always be rationing. Who gets organs is decided by a panel of experts, and yes, those who don't get them have an increased chance of dying.

People are increasingly demanding of the NHS. A cough for 2 weeks - quick, off to the GP!

I am not advocating this as the "good old days" but one elderly patient informed me that pre-NHS, seeing the GP would be the pay for a day or so - not something taken lightly. I personally think that a nominal charge attending both A&E and one's GP. In France, people are expected to bring all their medical records to their doctor and this is considered normal, so I don't think paying a small payment isn't unreasonable, and would help preserve the system for the future.

~:smoking:

The poor will always try to save costs. While I sympathise with your motivation the result would be to discourage certain socio-economic groups from using the NHS - that violates it's basic principle.


But the problem with your analogy is that people can opt out of using automobiles. Forcing people to purchase goods/services from private entities just for being alive is a bad precedent to make, especially considering the corporate influence over our current government. SCOTUS needs to kill Obamacare for this reason. Try again with a single-payer system.


Whether it's a good bill or not (I think not) isn't at issue here. Whether we need single-payer or market based healthcare is also not at issue. The issue is does the federal government have the authority to compel people to buy health insurance?

Case law presents us with several twisted and strained abuses of the Commerce Clause (Wickard v. Filburn), but Obamacare, if upheld, would outdo them all. It would not prevent you from taking a certain action- it would compel you to take action under the guise of regulating interstate commerce. To paraphrase Justice Kennedy, it would be forcing you into a market so that the government can regulate you. This is frightening stuff. If the court were to uphold this, what could the government not force you to do under the fig leaf of the commerce clause?

Luckily for us, early indications are that this will be overturned. I welcome such a decision and hope it's just a beginning step in rolling back the power of the commerce clause to that which it was originally intended. :yes:


Ganked from the GOP thread:


This is interesting—to which models are you referring? I'd like to read up a bit more on the alternatives. (Since we're all history nerds to greater or lesser degrees: Here's the original Heritage Foundation rollout for their conservative proposal of an "individual mandate." (http://www.scribd.com/doc/86911670/1989-Assuring-Affordable-Health-Care-for-All-Americans) Wheels in the sky, keep on turnin' ...)

-edit-

An eassayist sums up my worries about the GOP's lack of anything resembling a plan (http://www.thedailybeast.com/articles/2012/03/27/after-the-supreme-court-rules.html). I would only add that if the Supremes invalidate Obamacare, the Republicans will also need a plan. Not for campaigning; they can get many miles per gallon by railing against Obamacare/Romneycare. But for governing? Yeah, they're going to need to belly up to the bar and put something down.

Make no mistake: If Republicans lose in the Supreme Court, they'll need an answer. "Repeal" may excite a Republican primary electorate that doesn't need to worry about health insurance because it's overwhelmingly over 65 and happily enjoying its government-mandated and taxpayer-subsidized single-payer Medicare system. But the general-election electorate doesn't have the benefit of government medicine. It relies on the collapsing system of employer-directed care. It's frightened, and it wants answers.

"Unconstitutional" was an answer of a kind. But if the ACA is not rejected as "unconstitutional," the question will resurface: if you guys don't want this, want do you want instead?

In that case, Republicans will need a Plan B. Unfortunately, they wasted the past three years that might have developed one. If the Supreme Court doesn't rescue them from themselves, they'll be heading into this election season arguing, in effect, Our plan is to take away the government-mandated insurance of millions of people under age 65, and replace it with nothing. And we're doing this so as to better protect the government-mandated insurance of people over 65—until we begin to phase out that insurance, too, for everybody now under 55.

That's a different version of "all or nothing"—and one that invites the voters to answer: "nothing."

The thing I take away from all your posts is this:

The law is probably unconstitutional, and that is because your constitution doesn't allow for or permit government providing services for the common good. This explains why their are parts of the US where there are no Police, only sheriffs, and no fire service at all. This obvioulsy intentional, but while it may have been appropriate to a rapidly expanding pioneer nations, where government intervention was neither practical nor desiable, it is not appropriate to a modern developed state.

Your constitution needs ammending.

[Lemur]

The law is probably unconstitutional, and that is because your constitution doesn't allow for or permit government providing services for the common good.
No, that's not the case. Taxing the population to pay for the military would be unconstitutional if that interpretation held. What's problematic with the Heritage Foundation's Mitt Romney's Obama's proposal of an individual mandate is that the government is demanding citizens enter into a business arrangement with a private company. That's the stumbling block. (Interestingly, Paul Ryan's proposal to privatize Social Security would contain the exact same requirement. So the death knell of Obamacare will also, necessarily, be the death rattle of privatizing Social Security.)

That's why many of us are looking at the looming wreckage and concluding that some sort of single-payer program may be the only workable solution, long-term. If the government does not have the power to force you into buying health insurance (and that's a legitimate interpretation, BTW), then we may just have to call a tax a tax and get it over with.

[rvg]

The law is probably unconstitutional, and that is because your constitution doesn't allow for or permit government providing services for the common good. This explains why their are parts of the US where there are no Police, only sheriffs, and no fire service at all. This obvioulsy intentional, but while it may have been appropriate to a rapidly expanding pioneer nations, where government intervention was neither practical nor desiable, it is not appropriate to a modern developed state.

Your constitution needs ammending.

It most certainly does not need amending. Obamacare's individual mandate provision is an abomination that needs to be struck down. If that results in the rest of the Obamacare going down, then so be it. I will not sacrifice my liberty so that the feds have an easier time balancing their books, there has to be another way. Obamacare does have a few good aspects, but those are totally overshadowed by the monstrosity of the individual mandate. It is wrong, it is unamerican, I can only hope that the SCOTUS does the right thing and strikes it down.

[ICantSpellDawg]

I want to see the court reject the federal governments ability to abuse the commerce clause without limit.im in favore of a mandate, but at the state level. I want to see a weakened federal government, but im not sure that the idea of some sort of mandate would be unconstitutional. Put a mandatory lein on paychecks for failure to pay medical bills if you are uninsured, but let the states work out what ismost effective.

Id rather the court decide that the enumeration of powers allows questions of authority to default to states than have them reject a mandate out of hand

[Lemur]

let the states work out what ismost effective.
The states have had well over fifty years to work out what's most effective. You know what works for most of them? Turning around and demanding that the Feds subsidize their Medicare, Medicaid and child health programs. That's what they like.* I'm sorry, but the fifty states have pretty much dropped the ball and walked away on this one.



* Yes, I know it's more complicated than that, but I'm exaggerating for effect, and you know you love it.

[gaelic cowboy]

I was just struck by something that made me chuckle if the law gets stopped and you have to create an ANHS is that not more socialist than the thing there roaring about stoping. It's nearly like that apocryphal quote about saving the village required destroying it


Far as I can see this is all based on some spurious notion that Obamacare and Obama himself is gubmint socialism/communism/facism <insert your favoured meme here> and not actually on how to help people get better when there sick.

To tell you the truth there is votes in sick people so I never cannot understand why you have waited until now for even this half hearted attempt.

It must have summit to do with young people mainly working for older people cos they have assets, if younger people are less burdened due to an ANHS then older people lose a source of revenue.

[gaelic cowboy]

I want to see the court reject the federal governments ability to abuse the commerce clause without limit.im in favore of a mandate, but at the state level. I want to see a weakened federal government, but im not sure that the idea of some sort of mandate would be unconstitutional. Put a mandatory lein on paychecks for failure to pay medical bills if you are uninsured, but let the states work out what ismost effective.

Id rather the court decide that the enumeration of powers allows questions of authority to default to states than have them reject a mandate out of hand

That makes no sense how can it be legal to force people to buy/use this mandate at state level and if it's found to be illegal at federal level.

[drone]

It is interesting to me that some of the people supporting an NHS-style system are also some of the people talking up Ron Paul in the nomination thread :inquisitive:
A lot of us Ron Paul types support him for his libertarian social views. But there are just too many conflicts of interest with market based health care. When a person is seen as a customer instead of a patient, it's not going to end well.


That makes no sense how can it be legal to force people to buy/use this mandate at state level and if it's found to be illegal at federal level.
10th Amendment.

[Lemur]

That makes no sense how can it be legal to force people to buy/use this mandate at state level and if it's found to be illegal at federal level.
Tenth amendment of our constitution. (http://en.wikipedia.org/wiki/Tenth_Amendment_to_the_United_States_Constitution)

[gaelic cowboy]

It most certainly does not need amending.

Of course it does rvg sure people ammend there constitutions all the time and thats including Americans. (http://en.wikipedia.org/wiki/List_of_amendments_to_the_United_States_Constitution)

In fact here is a list of amendments currently going through the process now of being put into your constitution. (http://en.wikipedia.org/wiki/List_of_proposed_amendments_to_the_United_States_Constitution#21st_century)

In fact I am gonna lay a tenner in Paddy Power that the USA will ammend it's constitution several times in this century. I bet the odds will be terrible like say 1-1000 or something.

[Philippus Flavius Homovallumus]

It most certainly does not need amending. Obamacare's individual mandate provision is an abomination that needs to be struck down. If that results in the rest of the Obamacare going down, then so be it. I will not sacrifice my liberty so that the feds have an easier time balancing their books, there has to be another way. Obamacare does have a few good aspects, but those are totally overshadowed by the monstrosity of the individual mandate. It is wrong, it is unamerican, I can only hope that the SCOTUS does the right thing and strikes it down.

YAY! It's unAmerican!

How about, letting citizens die of perfectly treatable conditions just because they're poor is unAmerican.

Try reading my post again. You are in this mess because your government can't force the States to provide essential services (like healthcare), so instead they try to get around it by forcing citizens to buy healthcare.

If the US Constitions contained a clause such as, "The Federal Government has both a duty and a right to enact legislation for the provision of essetial services to citizens, either directly or by delegation to the States" you would have ANHS already.

Instead, some of your politicians call basic civil provision "unAmerican" and you get unset, so it hasn't been passed.

If you want a really intructive lesson I suggest you look at what the Right was saying over here about the NHS Bill when it was going through parliament, and what doctors were saying, popular it was not. It was rammed through because the Labour Government of the day understood it was necessary and refused to back down.

[gaelic cowboy]

Nice conjob there lads they can blame the federal gubmint for Obamacare and as a result harvest votes, then they can bring in Perrycare which ends up being the same anyway.

naturally the cost then most likely ends up becoming a federal one which they can also rail against as unfair taxes resulting in more votes.

I am intrigued by this tenth amendment if it's found illegal at federal is it not by definition something the federal government should proscribe at state level.

[drone]

I am intrigued by this tenth amendment if it's found illegal at federal is it not by definition something the federal government should proscribe at state level.
The Constitution is meant to outline the limits of federal power, the 10th amendment specifies this clearly. If the Constitution does not give a power to the feds, that power belongs to either the states or the people.

There are many ways the federal government has gotten around this, usually through a combination of the interstate commerce clause and the necessary and proper clause. Social Security is an example of this, and if we are going to be forced into national health care I'd prefer that to be the model we follow.

I would prefer a country without universal health care to one where the federal government can force me to buy stuff. Corporations are already helping themselves to the treasury, this would just cut out the middle man.

[gaelic cowboy]

The Constitution is meant to outline the limits of federal power, the 10th amendment specifies this clearly. If the Constitution does not give a power to the feds, that power belongs to either the states or the people.


The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

What does that mean nor prohibited by it to the states does this mean the Feds decide if it's applicable at state level? it certainly seems that way when I read it.

How does the Federal government decide to proscribe something then, surely if it is unconstitutional then it is bad form to allow states to provide a federally unconstitutional whatever.

Reading it a second time nor prohibited by it to the States seems to say if it's illegal in the constitution then it's prohibited at state too.

I must say it's very confusing to an ordinary 5/8 on the street.

[rvg]

Of course it does rvg sure people ammend there constitutions all the time and thats including Americans. (http://en.wikipedia.org/wiki/List_of_amendments_to_the_United_States_Constitution)

In fact here is a list of amendments currently going through the process now of being put into your constitution. (http://en.wikipedia.org/wiki/List_of_proposed_amendments_to_the_United_States_Constitution#21st_century)

In fact I am gonna lay a tenner in Paddy Power that the USA will ammend it's constitution several times in this century. I bet the odds will be terrible like say 1-1000 or something.

Ummmm...yes. I'm well aware of the fact that our constitution has been amended in the past. That doesn't mean we have to amend it so that Obamacare can be shoehorned into it.

[Lemur]

What does that mean nor prohibited by it to the states does this mean the Feds decide if it's applicable at state level?
I believe that means powers specifically given to the Fed cannot be usurped by the states. In other words, Alabama cannot declare war on Serbia, because the power to declare war is given to Congress by the constitution. And so on and so forth.

[rvg]

YAY! It's unAmerican!
How about, letting citizens die of perfectly treatable conditions just because they're poor is unAmerican.


Nobody lets them die. They still go to the emergency rooms and get treatment just like anyone else would.



Try reading my post again. You are in this mess because your government can't force the States to provide essential services (like healthcare), so instead they try to get around it by forcing citizens to buy healthcare.

And I don't appreciate being forced by Uncle Sam to buy things.



If the US Constitions contained a clause such as, "The Federal Government has both a duty and a right to enact legislation for the provision of essetial services to citizens, either directly or by delegation to the States" you would have ANHS already.

If...



Instead, some of your politicians call basic civil provision "unAmerican" and you get unset, so it hasn't been passed.

If you want a really intructive lesson I suggest you look at what the Right was saying over here about the NHS Bill when it was going through parliament, and what doctors were saying, popular it was not. It was rammed through because the Labour Government of the day understood it was necessary and refused to back down.
I did listen to what they said and I quite honestly do not care. I have no desire to sacrifice my liberty to federal beancounters.

[Lemur]

Nobody lets them die. They still go to the emergency rooms and get treatment just like anyone else would.
Which means we are forcing the hospitals into a business arrangement with dying people. Which is a strange and un-libertarian way to do things, if you think about it.


I have no desire to sacrifice my liberty to federal beancounters.
Try to get your way with your own health insurer, then tell me about how your liberty would be so much worse off. Again, a finite resource has infinite demand. Rationing has, does, and will occur. It's just a question of method.

[rvg]

Which means we are forcing the hospitals into a business arrangement with dying people. Which is a strange and un-libertarian way to do things, if you think about it.

Something's gotta give. To me individual liberty comes before anything else.



Try to get your way with your own health insurer, then tell me about how your liberty would be so much worse off. Again, a finite resource has infinite demand. Rationing has, does, and will occur. It's just a question of method.

If they don't play nice, I'll hire a competent ambulance chaser to go after them. They'll change their tune in a hurry.

[gaelic cowboy]

Something's gotta give. To me individual liberty comes before anything else.

So I have the liberty to dump toxic waste in my backgarden and therefore kill all my neighbours kids.

naturally no one thinks they have that right so the common good obviously comes before individual liberty (or at least were so used to it now we no longer SEE it as a common good infringing on individual liberties)

As I said earlier when we say something like I favour free market or individual liberty these are really political statements of how much common good we will bear not how much liberty we want.

[Lemur]

no one thinks they have that right so the common good obviously comes before individual liberty
Actually, balancing common good with individual liberty is a work-in-progress in most western nations. There's no 100% right way to do it.

That said, healthcare will probably wind up being more common good than individual liberty when this all shakes out. If my little boy lemur turns blue and cannot breathe, I'm not going to shop around for the best price on an ER, or the best deal for a respiratory specialist. I just need him to start breathing again. I could go deeper into this, but suffice it to say that I do not believe healthcare can be made into a functioning market system, any more than national defense can.

And I've yet to see any real-world example of healthcare functioning as a market, which is the most damning evidence of all. Theories, slogans and hypotheticals are all well and good, but show me empirical examples, please. You would think that would be the "conservative" position, were we using that word to mean what it means.

[rvg]

So I have the liberty to dump toxic waste in my backgarden and therefore kill all my neighbours kids.

naturally no one thinks they have that right so the common good obviously comes before individual liberty (or at least were so used to it now we no longer SEE it as a common good infringing on individual liberties)

As I said earlier when we say something like I favour free market or individual liberty these are really political statements of how much common good we will bear not how much liberty we want.

Your liberty stops where my liberty begins. Specifically, my liberty to breathe clean air trumps your liberty to dump toxic waste in your backyard. Same reason why driving drunk is an infraction: it interferes with my liberty to drive in safe conditions.

[gaelic cowboy]

Your liberty stops where my liberty begins. Specifically, my liberty to breathe clean air trumps your liberty to dump toxic waste in your backyard. Same reason why driving drunk is an infraction: it interferes with my liberty to drive in safe conditions.

So where does health sit in this then?? why does you liberty to oppose healthcare trump your neighbours demand for self same right.

I dont see that you do have the right to oppose someone elses getting healthcare since it would be a common good like Drink Drive laws.

[Lemur]

why does you liberty to oppose healthcare trump your neighbours demand for self same right.
I think using the idea of a "right" confuses the issue. Healthcare is not about rights, it's about a common good and a resource which every single one of us will use at some point. Roads, for example, are not a right, but they're an obvious common good, so we all agree to pay for them.

Citizens who are needlessly crippled, too ill to work, or preventably dead are a drain on our whole society. And we do wind up paying for them, one way or another. So it's a self-evident common good for us to work out a fair, equitable and cost-conscious way to distribute and pay for the common good.

[rvg]

So where does health sit in this then?? why does you liberty to oppose healthcare trump your neighbours demand for self same right.

Because healthcare is not a right.



I dont see that you do have the right to oppose someone elses getting healthcare since it would be a common good like Drink Drive laws.

I have no less of a right to oppose it than you have to support it.


Citizens who are needlessly crippled, too ill to work, or dead are a drain on our whole society. And we do wind up paying for them, one way or another. So it's a self-evident common good for us to work out a fair, equitable and cost-conscious way to distribute and pay for the common good.

Couldn't agree more. Now let's do it without making a mockery of the basic American principles of freedom.

[gaelic cowboy]

I think using the idea of a "right" confuses the issue. Healthcare is not about rights, it's about a common good and a resource which every single one of us will use at some point. Roads, for example, are not a right, but they're an obvious common good, so we all agree to pay for them.

Citizens who are needlessly crippled, too ill to work, or dead are a drain on our whole society. And we do wind up paying for them, one way or another. So it's a self-evident common good for us to work out a fair, equitable and cost-conscious way to distribute and pay for the common good.

Indeed common good is more what I am thinking about but where does individual liberty cross swords with common good.

RVG claims his liberty mine ends where his begins and vice versa to be honest I find this to be a wishy washy at best.

How much liberty does each individual get, if I live in Alaska do I have more than someone in Manhattan, RVG would say yes but me I say no just because my actions affect less people in Alaska does not allow me such freedom as to stripmine the whole place.

[rvg]

How much liberty does each individual get, if I live in Alaska do I have more than someone in Manhattan, RVG would say yes but me I say no just because my actions affect less people in Alaska does not allow me such freedom as to stripmine the whole place.

I would appreciate if you let me speak for myself. Okay? Thanks.

[gaelic cowboy]

Because healthcare is not a right.

But here is the nub your constitution enshrines say the right to life or the right to happiness etc etc sickness infringes these rights.

Your obliged by your constitution to provide these self same services in an effort to attempt to address these failings.

If you choose to call it rights, entitlements or benefits is really of no consequence and rather misses the point that when an Irish or UK person says right they mean common good generally.

[rvg]

But here is the nub your constitution enshrines say the right to life or the right to happiness etc etc sickness infringes these rights.

Your obliged by your constitution to provide these self same services in an effort to attempt to address these failings.

If you choose to call it rights, entitlements or benefits is really of no consequence and rather misses the point that when an Irish or UK person says right they mean common good generally.

There is no right to happiness, only the right to pursue happiness.

[gaelic cowboy]

I would appreciate if you let me speak for myself. Okay? Thanks.

Well how much liberty do you get who decides? does anybody

[Lemur]

But here is the nub your constitution enshrines say the right to life or the right to happiness etc etc sickness infringes these rights.
You're thinking of the Declaration of Independence (http://en.wikipedia.org/wiki/Life,_liberty_and_the_pursuit_of_happiness), which has no standing in law, even though it's wicked cool.

[rvg]

Well??

Well what?

[gaelic cowboy]

Well what?

How much liberty do you want or need to get.











On an related point but not aimed at yourself RVG to be honest I find a lot of this individual liberty stuff to be pure guff, if you ask me most the people who are saying it are not actually libertarians at all.

Usually it's some GOP reactionary/plutocrat who goes about using there individual liberty as a cover to protect X.

A farmer in Iowa thinks his subsidy is reward for self reliance and protection of X so he calls himself libertarian. Thats all well and good till he goes out and votes to prevent or curb welfare for poor people in the nation as a whole how is that libertarian.

Incidently who was the .ORG member that said they copped the GOP is not actually libertarian and really use the term to fool libertarian voters into givin em the tick.

[rvg]

How much liberty do you want or need to get.
You gotta be more specific.




On an related point but not aimed at yourself RVG to be honest I find a lot of this individual liberty stuff to be pure guff, if you ask me most the people who are saying it are not actually libertarians at all.

Usually it's some GOP reactionary/plutocrat who goes about using there individual liberty as a cover to protect X.

A farmer in Iowa thinks his subsidy is reward for self reliance and protection of X so he calls himself libertarian. Thats all well and good till he goes out and votes to prevent or curb welfare for poor people in the nation as a whole how is that libertarian.

Incidently who was the .ORG member that said they copped the GOP is not actually libertarian and really use the term to fool libertarian voters into givin em the tick.

I do not consider myself a libertarian nor do I belong to the GOP. I oppose Obamacare not out of some partisan reasons but purely based on the reasons discussed earlier in this thread.

[gaelic cowboy]

You gotta be more specific.

Exactly how can you be specific on this issue if liberty is decided by the individual only. Thats why even our liberty is decided by common good so that were all of us protected even if we dont want it.





I do not consider myself a libertarian nor do I belong to the GOP.

By the way I didnt say you were a GOP supporter nor a libertarian.

however you have to admit you have being framing your answers through the ideal of individual liberty so I feel I gotta ask you what you believe that really means for healthcare.

Usually people fire an exocet of healthcare is not a right and think this finishes the argument like a sunk Belgrano.

Me I dont see it that way at all you dont have the right to limit peoples access to healthcare just because you dont want to pay for a common good. If we all started deciding what common goods were willing to allow how long till there coming for the army or police too.

[rvg]

Exactly how can you be specific on this issue if liberty is decided by the individual only. Thats why even our liberty is decided by common good so that were all of us protected even if we dont want it.
If you want a general answer, then I only want one specific freedom: freedom to live my life as I see fit without needless interference from the government. That is all.


Me I dont see it that way at all you dont have the right to limit peoples access to healthcare just because you dont want to pay for a common good. If we all started deciding what common goods were willing to allow how long till there coming for the army or police too.
I'm not limiting anyone's access to anything. It's the government that is trying to force me to buy stuff. That is what I resent. Want health insurance? Okay, go ahead and buy it. Don't want it? Fine by me, it is none of my business. What I do not appreciate is Uncle Sam obligating me to buy something.

[Lemur]

Want health insurance? Okay, go ahead and buy it. Don't want it? Fine by me, it is none of my business.
Except that it is your business, obviously, because you and I are on the hook for both the uninsured care given in emergencies and the overall lost productivity when treatable conditions remain untreated.

It's all of our business, hence the way I keep referring back to the "common good."

The only way we could really divorce ourselves from healthcare for others would be if we, as a society, decided it was fine for the uninsured to die in the streets and so forth. And I do not believe even the staunchest libertarian has the heart for that. We are not going to go to the necessary extreme to allow a market-based/Social Darwinism system to work. We, as a society, want certain decent minimums met in terms of healthcare. So this inevitably falls into the common good realm, much like roads and national defense.

[rvg]

Except that it is your business, obviously, because you and I are on the hook for both the uninsured care given in emergencies and the overall lost productivity when treatable conditions remain untreated.
My taxes go to cover some of that, yes. I consider that to be a lesser evil.

[PanzerJaeger]

Ganked from the GOP thread:


This is interesting—to which models are you referring? I'd like to read up a bit more on the alternatives. (Since we're all history nerds to greater or lesser degrees: Here's the original Heritage Foundation rollout for their conservative proposal of an "individual mandate." (http://www.scribd.com/doc/86911670/1989-Assuring-Affordable-Health-Care-for-All-Americans) Wheels in the sky, keep on turnin' ...)



Switzerland (http://www.nytimes.com/2009/10/01/health/policy/01swiss.html?pagewanted=all)
Taiwan (http://www.npr.org/templates/story/story.php?storyId=89651916)
Germany (http://economix.blogs.nytimes.com/2009/04/17/health-reform-without-a-public-plan-the-german-model/)
Netherlands (http://content.healthaffairs.org/content/27/3/771.full.pdf+html?ijkey=DsTX9syExLZLc&keytype=ref&siteid=healthaff)
France (http://www.businessweek.com/magazine/content/07_28/b4042070.htm)
Japan (http://www.npr.org/templates/story/story.php?storyId=89626309) (although the government probably spends too little)


The NHS is a mediocre, and in many ways antiquated, single payer system with distorted priorities. It's only really good at cutting costs quickly when funding levels are changed, but quality (http://www.guardian.co.uk/commentisfree/2012/mar/22/nurses-unhappy-nhs-staff-budget-cuts) suffers (http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-waiting-for-patients-to-die-or-go-private-to-save-money-2328055.html) accordingly (http://www.independent.co.uk/life-style/health-and-families/health-news/crackdown-launched-on-hidden-nhs-waiting-lists-6263433.html).

Many Americans in favor of reform pine for the NHS because it is the most familiar single payer system most are aware of. However, whether one prefers to replace our current system with a mandate plus private insurance scheme such as Obamacare or a pure single payer scheme, there are far superior models to choose from.

[Philippus Flavius Homovallumus]

My taxes go to cover some of that, yes. I consider that to be a lesser evil.


Lets just hope you never have to use your own healthcare system, eh?

Just tell God you can't afford to have cancer, I'm sure he'll give you a miracle.

[rvg]

Lets just hope you never have to use your own healthcare system, eh?

Just tell God you can't afford to have cancer, I'm sure he'll give you a miracle.

I have health insurance, TYVM. No need to worry for me.

[Philippus Flavius Homovallumus]

I have health insurance, TYVM. No need to worry for me.

And it will cover everything. Pretty sure only the Army and the Fed get fully comp. What if you get that obscure kind of bowl cancer, or your daughter is born with that deformity in her feet that only affects about 100 people in the entire world?

Will you still be so happy?

What if you get laid off?

[Papewaio]

Liberty is not anarchy or absolute freedom, it is freedom under the laws of the land.

My freedoms, my liberty, my ability to pursue freedom, my access to free speech are all enhanced by having a healthy life. As a member of society, my abilities are all enhanced by my societies abilities.

My health is an intrinsic part of my liberty and happiness. I feel happier around healthy people, my health is safer around healthy people. We on the whole find healthy people more attractive.

I take public transport on the double decker trains in Sydney. My quality of health is greatly enhanced knowing that my fellow travelers are not carrying an easily transmitted airborne disease. Sure I do get the common cold, but I can easily access flu shots if I ever feel the need to enhance my immune system.

Australia has a federally funded Medicare system. Those who are on the equivalent to social security get most of their meds at a vastly subsidized rate. Those too ill to work get a pension.

All workers pay Medicare at 1.5%, those over a threshold must either choose a private health care fund or pay an extra 1% to Medicare. Even with payment of private health you can still mix and match with public options. As an individual you have a choice, as a rich one you are encouraged but not made to pay your own way.

States provide the public hospitals and staff. Rebates for Medicare expenses are payed to individuals by the federal government. If I go to a GP or a specialist, some if not all of that cost will be covered and it can be deposited electronically into my account.

[HoreTore]

Some way up, someone claimed that health care is not a right. I direct you to the declaration of human rights, article 25:

http://www.un.org/en/documents/udhr/index.shtml#a25

Healthcare IS a right. And the declaration of human rights stands above any and all constitutions, period.

[Tuuvi]

Some way up, someone claimed that health care is not a right. I direct you to the declaration of human rights, article 25:

http://www.un.org/en/documents/udhr/index.shtml#a25

Healthcare IS a right. And the declaration of human rights stands above any and all constitutions, period.

The declaration of human rights is all fine and dandy, but who voted for it? I'd prefer it was democratic before it trumps any and all constitutions.


I see that some of you are equating being against the individual mandate to being against universal healthcare. The problem with the individual mandate is that it forces people to buy insurance from private companies. I can't speak for rvg, but as for myself I'm against the individual mandate but I want universal healthcare. I'd rather pay higher taxes to the government, which is supposed to exist for my benefit, to receive healthcare than to be forced to buy insurance for someone else's profit.

[Lemur]

I can't speak for rvg, but as for myself I'm against the individual mandate but I want universal healthcare. I'd rather pay higher taxes to the government, which is supposed to exist for my benefit, to receive healthcare than to be forced to buy insurance for someone else's profit.
Actually, if you take a gander through the thread, that's where a lot of us are ending up.

[Philippus Flavius Homovallumus]

The declaration of human rights is all fine and dandy, but who voted for it? I'd prefer it was democratic before it trumps any and all constitutions.


I see that some of you are equating being against the individual mandate to being against universal healthcare. The problem with the individual mandate is that it forces people to buy insurance from private companies. I can't speak for rvg, but as for myself I'm against the individual mandate but I want universal healthcare. I'd rather pay higher taxes to the government, which is supposed to exist for my benefit, to receive healthcare than to be forced to buy insurance for someone else's profit.

If memory serves, the "Individual Mandate" is the result of Republicans refusing to allow a public option - which would have driven most private health insurers out od business in a few decades, if not sooner.

[Lemur]

Yeah, that's right, the public option was a vain attempt to get Republicans onboard, since they objected so vehemently to the public option. The (naive) thinking was that since the mandate derived from the Heritage Foundation and Romneycare, they wouldn't fight it like hell. Which was obviously incorrect.

I'm getting the impression that GOP leadership really doesn't have a plan. They're cool with the status quo ante, even if it's financially unsustainable. But you know the economics saying — things that cannot continue indefinitely ... don't. Best to think ahead.

[Xiahou]

I agree that seems to be the issue. I just find it strange to accept that the federal government has the authority to compel people indirectly to buy services - for example, to pay taxes to buy defence, welfare, medicare, etc - but to challenge its authority to compel people to buy them directly.Our federal government has enumerated powers- they are not without limit. The fig leaf of authority for the health insurance mandate is something called the commerce clause which simply states: [The Congress shall have Power] To regulate Commerce with foreign Nations, and among the several States, and with the Indian tribes;

I think that's a bit of a stretch to apply it so.... Actually, I think the founding fathers would be spinning in their graves if they knew how the clause was being abused.

[Greyblades]

At this point if you attached a generator to ben franklin's coffin he'd power your entire eastern seaboard.

[rvg]

Healthcare IS a right. And the declaration of human rights stands above any and all constitutions, period.

*channels the spirit of Tribesman*

:laugh4::laugh4::laugh4::laugh4::laugh4::laugh4::laugh4::laugh4::laugh4::laugh4:

bollocks

[econ21]

Our federal government has enumerated powers- they are not without limit.

So this is an issue of federal power rather than about the individual freedom vs general government interference? It's fine for Massachuetts to mandate you to buy brocoli but not for the federal government? (That's not a rhetorical question.)

[rvg]

So this is an issue of federal power rather than about the individual freedom vs general government interference? It's fine for Massachuetts to mandate you to buy brocoli but not for the federal government? (That's not a rhetorical question.)

Legally there is nothing preventing the individual states from following the example of Massachusetts. Still this measure has little more than a snowball's chance in hell of passing in any red state and most blue states for that matter.

[Lemur]

So this is an issue of federal power rather than about the individual freedom vs general government interference? It's fine for Massachuetts to mandate you to buy brocoli but not for the federal government? (That's not a rhetorical question.)
Your example is silly, but not incorrect. The Federal Guvmint has certain powers reserved for it in the constitution (power to declare war, power to sign treaties, etc.), and the tenth amendment says that any powers not specifically ascribed to the Feds are reserved for the states and the people. There are no boundaries or limits put on state power, except that it cannot usurp or replace Federal powers (and "people" power is supposed to be just as potent, although we tend to overlook that clause).

So there are all sorts of things a state can legally do which the Feds cannot. Claro?

-edit-

More thoughts on the implications (http://www.forbes.com/sites/joshbarro/2012/03/28/how-obamacares-rejection-would-lead-to-single-payer/):

I think conservatives have an idea that, if they fight hard enough on this issue, liberals will get tired and move on to something else. You see that in knocks against the president for spending so much time on health care in 2009 and 2010. But liberals see universal health coverage as the crown jewel in a completed social safety net, one that was well worth spending time and political capital on. This isn’t an issue they’re likely to go quietly on—which is why they’ve gotten some sort of universal coverage enacted in every other wealthy country.

Conservatives also often say they favor universal coverage. But the only ways to achieve universal coverage are to give coverage to everyone, which costs money, or induce everyone to buy it, which also costs money. Republicans haven’t been able to coalesce behind a workable and enactable plan for universal coverage, probably because any such plan would cost a lot of money.

Strike down Obamacare, and only the Left will have a viable plan for universal coverage, and it will be one even less palatable to conservatives than the one that was enacted in 2010. Absent another viable proposal, they will eventually get their way, and Medicare For All will become a reality.
And furthermore (http://andrewsullivan.thedailybeast.com/2012/03/day-three-reax-can-obamacare-survive-without-the-mandate.html):

What we have here is an attempt at a middle way on healthcare: universal coverage within a private system that bars discrimination based on pre-existing conditions. If that cannot be done constitutionally with a private-public partnership, and cannot be done at all with an entirely private market, then ... we logically end up with single payer.

Which would be quite a resolution, wouldn't it?

[HoreTore]

The declaration of human rights is all fine and dandy, but who voted for it? I'd prefer it was democratic before it trumps any and all constitutions.

Who voted for it? Assuming you are over 18, you did.

Membership in the UN means accepting that the human rights trumps any of your own laws. Any country is of course free to leave the UN, and since the US is a democracy, you are of course free to start a "leave the UN"-party.

[rvg]

Membership in the UN means accepting that the human rights trumps any of your own laws.

Says who?

[gaelic cowboy]

Says who?

America does every time they use UN rules to invade a place or pressure say the government of Myanmar or put sanctions on Iran the list goes on and on.

[rvg]

America does every time they use UN rules to invade a place.
Your statement begs the question. Give me an example.

[gaelic cowboy]

Your statement begs the question. Give me an example.

Do I really need to google every resolution for proof or can we just leave it at Iraq 2003

[rvg]

Do I really need to google every resolution for proof or can we just leave it at Iraq 2003
And how exactly is the invasion of Iraq tied to the U.N. declaration of human rights?

[Lemur]

Oh you two, get a room! gaelic is suggesting that by requesting, voting for and acting on UN resolutions we are implicitly accepting UN supra-national authority, a debatable point. rvg is saying "nuh-uh."

[HoreTore]

Says who?

Not sure which part you ask about, so I'll answer both:

Who decides that being a member in the UN means accepting he UNHCR? The UN does. If you don't sccept, you can't be a member.

Who decides that the UNHCR is above any other law? The UNHCR does. The preamble, article 2 and article 30 says where, when and to whom it applies.

[HoreTore]

Oh you two, get a room! gaelic is suggesting that by requesting, voting for and acting on UN resolutions we are implicitly accepting UN supra-national authority, a debatable point. rvg is saying "nuh-uh."

No, you accepted UN supra-national authority when you decided to become a member.

[Lemur]

No, you accepted UN supra-national authority when you decided to become a member.
As I said, that's a highly debatable perspective. Deserves its own thread, really.

[HoreTore]

As I said, that's a highly debatable perspective. Deserves its own thread, really.

It most certainly is not. And its not a perspective, those are the rules for being admitted to the UN.

[rvg]

Not sure which part you ask about, so I'll answer both:

Who decides that being a member in the UN means accepting he UNHCR? The UN does. If you don't sccept, you can't be a member.

Who decides that the UNHCR is above any other law? The UNHCR does. The preamble, article 2 and article 30 says where, when and to whom it applies.

Interesting... Let's take a look at the point #7 of the Article 2, Chapter 1:



Nothing contained in the present Charter shall authorize the United Nations to intervene in matters which are essentially within the domestic jurisdiction of any state or shall require the Members to submit such matters to settlement under the present Charter; but this principle shall not prejudice the application of enforcement measures under Chapter Vll.[1]


i.e. it's none of the UN's damn business.

[HoreTore]

Interesting... Let's take a look at the point #7 of the Article 2, Chapter 1:



i.e. it's none of the UN's damn business.

I see little future for you as a lawyer.

Edit: nor do I see a future for myself as alanguage teacher, but I already knew that. Where the abbreviation "unhcr" came from, I will never know. I was, of course, referring to the declaration of human rights, UDHR. I may have been thinking "un human rights commission" or something, but I blame it on the coke.

[rvg]

I see little future for you as a lawyer.
Rest easy, I'm not a lawyer. Nonetheless, my point stands.

[HoreTore]

Rest easy, I'm not a lawyer. Nonetheless, my point stands.

If your point stands, I suggest you visit China's embassy. I'm quite sure they're interested in knowing how to argue that the human rights does not apply to them. Should earn a living on that.

[drone]

Some way up, someone claimed that health care is not a right. I direct you to the declaration of human rights, article 25:

http://www.un.org/en/documents/udhr/index.shtml#a25

Healthcare IS a right. And the declaration of human rights stands above any and all constitutions, period.
Looks at entire list of universal human rights. Looks at membership list of UN. Goes into full Tribesman mode.

[rvg]

If your point stands, I suggest you visit China's embassy. I'm quite sure they're interested in knowing how to argue that the human rights does not apply to them. Should earn a living on that.

Would you be so kind as to point to any U.N. resolution condemning China's human rights record?

[Productivity]

I think that's a bit of a stretch to apply it so.... Actually, I think the founding fathers would be spinning in their graves if they knew how the clause was being abused.

I agree, that it's a stretch. It's an interstate commerce clause to regulate general commerce, not a specific tool to surgically enforce bits of policy. However, if it couldn't be used in the way it is, the founding fathers would probably be equally spinning in their grave that a rich, developed and democratic nation doesn't have the policy framework to address real issues (be it healthcare or others).

[HoreTore]

Would you be so kind as to point to any U.N. resolution condemning China's human rights record?

Why would that matter?

Does speed limits only apply when I'm caught and punished?

And China is, of course, a veto-member. But they're always on the look-out for ways to improve their propaganda.

Edit: the policy towards african-americans in the 50's was of course a gross violation of their human rights. And of course the human rights applied even though there was no condemnation from the UN about it.

[rvg]

Why would that matter?


Because there are rules and rules matter. If one rule doesn't matter, then why follow any of them?

[HoreTore]

Because there are rules and rules matter. If one rule doesn't matter, then why follow any of them?

Enforcement of the human rights is of course a sketchy matter, and in the case of the non-eu veto-members, next to impossible.

[rvg]

Enforcement of the human rights is of course a sketchy matter, and in the case of the non-eu veto-members, next to impossible.

Which leaves persuasion by individual countries on one-to-one basis, which is what the U.S. does. Not in any official U.N. capacity of course. Anyhow, the point being, we can use the U.N. Human Rights Declaration as toilet paper and still be compliant with the UN regulations. The declaration doesn't say anything specific about healthcare either, but that's beside the point and largely irrelevant even if there was something in it.

[Lemur]

As I stated earlier in the thread, I think talk of "rights" serves only to confuse the issue. Much more logical to approach this from a "common good" or "common harm" perspective. Here's a very good essay (http://www.thedailybeast.com/articles/2012/03/28/michael-tomasky-asks-did-liberals-screw-obamacare.html) on why this is the case:

In my previous column, I briefly discussed John Stuart Mill and the harm principle as a way for Democrats and liberals to justify the idea of the individual mandate. [...] [I]n Mill’s words: “The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.” Get that. The only purpose. That is, our natural wills guide us toward being left alone, not being part of community. And that’s just fine—until our actions harm others. Then, governmental power is justified. [...]

Millions of people in this system don’t pay insurance premiums. They are bringing direct and obvious harm to the many more millions who do pay premiums. They make our premiums higher. When they get in a car wreck or have a stroke, they’re amassing medical bills that they can’t possibly pay. The rest of us pay for them.

And that is why the harm principle applies here. The government, under Mill’s definition, has the right and duty to step in to prevent harm to others—by making the free-riders pay. It’s exactly a Millian case of harm to others. And just as it explains why the mandate is valid in this case, it also explains why this kind of government action is limited to health care and can’t be extended to the purchase of broccoli or Chevy Volts or funeral plans or whatever else the conservative justices came up with Tuesday. If you don’t eat broccoli, you cause me no harm. Some would say, well, you increase your odds of colon cancer if you don’t eat broccoli, you might harm me if you don’t have insurance, but that’s speculative and very indirect and frankly pedantic. I can’t seriously claim injury based on your diet. Or whether you drive a Chevy or a Volvo. Or whether you are buried or cremated. These are not systems in which we’re all participants, either paying or nonpaying. Following Mill’s harm principle ensures that this kind of governmental activity is limited to cases in which person or Group A’s action directly harms person or Group B. That limits this to health care, answers the broccoli question, and shuts down that entire line of attack.

[gaelic cowboy]

So this would mean Obamacare stays


So no ANHS then for you.

[rvg]

As I stated earlier in the thread, I think talk of "rights" serves only to confuse the issue. Much more logical to approach this from a "common good" or "common harm" perspective. Here's a very good essay (http://www.thedailybeast.com/articles/2012/03/28/michael-tomasky-asks-did-liberals-screw-obamacare.html) on why this is the case:

In my previous column, I briefly discussed John Stuart Mill and the harm principle as a way for Democrats and liberals to justify the idea of the individual mandate. [...] [I]n Mill’s words: “The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.” Get that. The only purpose. That is, our natural wills guide us toward being left alone, not being part of community. And that’s just fine—until our actions harm others. Then, governmental power is justified. [...]

Millions of people in this system don’t pay insurance premiums. They are bringing direct and obvious harm to the many more millions who do pay premiums. They make our premiums higher. When they get in a car wreck or have a stroke, they’re amassing medical bills that they can’t possibly pay. The rest of us pay for them.

And that is why the harm principle applies here. The government, under Mill’s definition, has the right and duty to step in to prevent harm to others—by making the free-riders pay. It’s exactly a Millian case of harm to others. And just as it explains why the mandate is valid in this case, it also explains why this kind of government action is limited to health care and can’t be extended to the purchase of broccoli or Chevy Volts or funeral plans or whatever else the conservative justices came up with Tuesday. If you don’t eat broccoli, you cause me no harm. Some would say, well, you increase your odds of colon cancer if you don’t eat broccoli, you might harm me if you don’t have insurance, but that’s speculative and very indirect and frankly pedantic. I can’t seriously claim injury based on your diet. Or whether you drive a Chevy or a Volvo. Or whether you are buried or cremated. These are not systems in which we’re all participants, either paying or nonpaying. Following Mill’s harm principle ensures that this kind of governmental activity is limited to cases in which person or Group A’s action directly harms person or Group B. That limits this to health care, answers the broccoli question, and shuts down that entire line of attack.

If the author were to Mill's logic, then the obvious solution would be to turn away the uninsured at the ER, rather than buying into the mandate mumbo-jumbo.

[Lemur]

So this would mean Obamacare stays

So no ANHS then for you.
Not necessarily. If the individual mandate is ruled unconstitutional, we will have a situation very similar to New Jersey, which tried to implement universal coverage without a mandate, and is in the quick and predictable process of imploding (http://www.tnr.com/blog/jonathan-cohn/101948/supreme-court-mandate-new-jersey-insurance-reform). This is a concept referred to as "adverse selection" and/or "the death spiral."

The New Jersey effort began in the late 1980s, when rising health care costs were getting the attention of business and political leaders across the country. And a big worry then, as now, was what to do about people who couldn't get insurance from a large employer. When those people tried to get coverage in the individual or small-group market, they underwent scrutiny from insurers, who were wary of taking on big medical risks. "Insurance companies make their money not by being efficient, or managing care, but by weeding out the sick and insuring only the healthy," a frustrated Jim Florio, then governor of New Jersey, said in 1992. [...]

The plan went into effect in late 1993, not long before President Bill Clinton's efforts to reform health insurance nationally started foundering. And, for a while, it looked like Florio and his advisers had done what Clinton and his advisors could not. Nobody believed New Jersey's plan would bring universal coverage to the state. But "people thought this would have a significant impact," says Bruce Siegel, who was the state health commissioner and is now president of the National Association of Public Hospitals. "They thought it would … change the situation for the uninsured."

An early assessment of the program, by researchers at Harvard and sponsored by the Robert Wood Johnson Foundation, declared the experiment a success. But, by 1996, enrollment in the regulated plans started to slide after peaking at about 186,000. By 2001, it was down to about 85,000. Not coincidentally, the mix of people left in the program changed dramatically. According to a study published in Health Affairs, the median age for enrollees jumped from 41.9 years to 48.4 years in just five years, and premiums rose by between 48 percent and 155 percent, depending on the plan.

These were the tell-tale signs of adverse-selection death spiral: An exodus of healthy people from the insurance pool, leaving behind a population of ever-sicker people whose high health costs keep driving up prices. [...]

New Jersey's experience hardly seems unusual. Kentucky, New York and Vermont all tried to reform their insurance markets without a mandate. All ended up with higher premiums, lower enrollment in insurance or some combination of the two.
If the author were to Mill's logic, then the obvious solution would be to turn away the uninsured at the ER, rather than buying into the mandate mumbo-jumbo.
Raise your hand if you think the public really has the stomach and fortitude to watch people die in the streets. Ain't gonna happen. Two or three well-publicized cases of sweet little girls and innocent grandmas keeling over from preventable causes and we'd be in some form of NHS faster than you can say social darwinism (http://en.wikipedia.org/wiki/Social_Darwinism).

[gaelic cowboy]

If the author were to Mill's logic, then the obvious solution would be to turn away the uninsured at the ER, rather than buying into the mandate mumbo-jumbo.

No because that would harm society by allowing tens of thousands to die for want of treatment.

[rvg]

No because that would harm society by allowing tens of thousands to die for want of treatment.

People die every day. It doesn't harm the society one bit.

[Lemur]

People die every day. It doesn't harm the society one bit.
So the future of American healthcare would look something like this?


https://www.youtube.com/watch?v=Sh8mNjeuyV4

[rvg]

So the future of American healthcare would look something like this?


https://www.youtube.com/watch?v=Sh8mNjeuyV4

Cute. As if health service rationing is any different. Either way somebody's gonna get the short end of the stick. Might as well set this up without giving up even more of our freedom to Uncle Sam. Life isn't fair. It never has been and never will be. Obamacare isn't gonna change that, it's just shifting the stink around.

[gaelic cowboy]

Not necessarily. If the individual mandate is ruled unconstitutional, we will have a situation very similar to New Jersey, which tried to implement universal coverage without a mandate, and is in the quick and predictable process of imploding (http://www.tnr.com/blog/jonathan-cohn/101948/supreme-court-mandate-new-jersey-insurance-reform). This is a concept referred to as "adverse selection" and/or "the death spiral."

The New Jersey effort began in the late 1980s, when rising health care costs were getting the attention of business and political leaders across the country. And a big worry then, as now, was what to do about people who couldn't get insurance from a large employer. When those people tried to get coverage in the individual or small-group market, they underwent scrutiny from insurers, who were wary of taking on big medical risks. "Insurance companies make their money not by being efficient, or managing care, but by weeding out the sick and insuring only the healthy," a frustrated Jim Florio, then governor of New Jersey, said in 1992. [...]

The plan went into effect in late 1993, not long before President Bill Clinton's efforts to reform health insurance nationally started foundering. And, for a while, it looked like Florio and his advisers had done what Clinton and his advisors could not. Nobody believed New Jersey's plan would bring universal coverage to the state. But "people thought this would have a significant impact," says Bruce Siegel, who was the state health commissioner and is now president of the National Association of Public Hospitals. "They thought it would … change the situation for the uninsured."

An early assessment of the program, by researchers at Harvard and sponsored by the Robert Wood Johnson Foundation, declared the experiment a success. But, by 1996, enrollment in the regulated plans started to slide after peaking at about 186,000. By 2001, it was down to about 85,000. Not coincidentally, the mix of people left in the program changed dramatically. According to a study published in Health Affairs, the median age for enrollees jumped from 41.9 years to 48.4 years in just five years, and premiums rose by between 48 percent and 155 percent, depending on the plan.

These were the tell-tale signs of adverse-selection death spiral: An exodus of healthy people from the insurance pool, leaving behind a population of ever-sicker people whose high health costs keep driving up prices. [...]

New Jersey's experience hardly seems unusual. Kentucky, New York and Vermont all tried to reform their insurance markets without a mandate. All ended up with higher premiums, lower enrollment in insurance or some combination of the two.
Raise your hand if you think the public really has the stomach and fortitude to watch people die in the streets. Ain't gonna happen.

So the lesson is whatever you do you make sure to prevent insurance companies selecting who they will ensure.

In Ireland our government actually charges newer companies in the health insurance market and gives the money to older companies to prevent same.

[Lemur]

As if health service rationing is any different.
I don't understand this statement. Rationing occurs no matter the system, no matter the plan. The demand for healthcare is infinite, and the supply is finite. Hell, a marketplace can be viewed as a form of rationing. It's not as though any plan put forward by anyone will mean that everyone gets as much doctor time, drugs and end-of-life care as they please.

I really don't understand the use of the word "rationing" in this context.

[gaelic cowboy]

People die every day. It doesn't harm the society one bit.

There is a differ between passing on with some dignity in your own bed or in a hospital ward and government allowing people to die for want of medicine.



Cute. As if health service rationing is any different. Either way somebody's gonna get the short end of the stick. Might as well set this up without giving up even more of our freedom to Uncle Sam. Life isn't fair. It never has been and never will be. Obamacare isn't gonna change that, it's just shifting the stink around.

Life is not fair no nor is it cheap so thats why we decided that we would rather use the idea of a hospital waiting list than just say stuff ye yis are all poor anyway. Just cos it's rationed is not the same as outright denial of access, eventually you will get seen too.

Naturally people die on waiting list but then thats usually a very serious ailment to begin with and hardly treated better in the USA if your poor. In other words people here might get the short end but in the US your not even given a stick.

[rvg]

I don't understand this statement. Rationing occurs no matter the system, no matter the plan. The demand for healthcare is infinite, and the supply is finite. Hell, a marketplace can be viewed as a form of rationing. It's not as though any plan put forward by anyone will mean that everyone gets as much doctor time, drugs and end-of-life care as they please.

I really don't understand the use of the word "rationing" in this context.

What I mean is that we're replacing a giant douche with a turd sandwich and trumpeting it as some sort of achievement and breakthrough. It is not. In fact, all it achieves in the process is taking away one of our few precious liberties.



There is a differ between passing on with some dignity in your own bed or in a hospital ward and government allowing people to die for want of medicine.

So, the people who will die while on the waiting list will somehow die in a more dignified manner?





Life is not fair no nor is it cheap so thats why we decided that we would rather use the idea of a hospital waiting list than just say stuff ye yis are all poor anyway. Just cos it's rationed is not the same as outright denial of access, eventually you will get seen too.


Who is "we"?



Naturally people die on waiting list but then thats usually a very serious ailment to begin with and hardly treated better in the USA if your poor. In other words people here might get the short end but in the US your not even given a stick.

I said it before and I'll say it again. As of this moment, if a hobo stumbles into the ER, he will receive treatment. This is the way things are right now.

[gaelic cowboy]

In fact, all it achieves in the process is taking away one of our few precious liberties.

What one would that be then?? really I am intrigued here do you think healthcare is actually an attack on your liberty.

[rvg]

What one would that be then?? really I am intrigued here do you think healthcare is actually an attack on your liberty.

Forcing me to buy health insurance is an attack on my liberty.

[Lemur]

Well, to be accurate, since you have already stated that you have employer-funded health insurance, the mandate would actually force the freeloaders you and I currently pay for to buy health insurance. Slight difference.

[rvg]

Well, to be accurate, since you have already stated that you have employer-funded health insurance, the mandate would actually force the freeloaders you and I currently pay for to buy health insurance. Slight difference.

And that is what bothers me. I don't want the feds forcing people to buy stuff even if it means more money for me. More than money is at stake here.

[gaelic cowboy]

So, the people who will die while on the waiting list will somehow die in a more dignified manner?

Yes generally its called palliative care



Who is "we"?

The Irish people who elected governments to provide us with what we call the HSE Health Servcie Executive.



I said it before and I'll say it again. As of this moment, if a hobo stumbles into the ER, he will receive treatment. This is the way things are right now.

Because then your rewarding someone with no income and ignoring the far larger coping classes in the middle.

[gaelic cowboy]

Forcing me to buy health insurance is an attack on my liberty.

Do you own a car cos you need insurance to drive, forcing people to buy same is no differ but I dont see mass movements against it.

[Lemur]

As of this moment, if a hobo stumbles into the ER, he will receive treatment. This is the way things are right now.
File that contention under "not necessarily." See a term called hospital dumping (http://www.usatoday.com/news/nation/2007-02-15-skid-row_x.htm). (Shock, surprise, when we force hospitals into servicing people who cannot possibly pay, they try to get rid of them! Sometimes they succeed! In other news, water wet, fire hot.)

[rvg]

Yes
How?




The Irish people who elected governments to provide us with what we call the HSE Health Servcie Executive.


Good for you! This isn't Ireland though.




Because then your rewarding someone with no income and ignoring the far larger coping classes in the middle.


Like I said, life's a bitch.



File that contention under "not necessarily." See a term called hospital dumping (http://www.usatoday.com/news/nation/2007-02-15-skid-row_x.htm). (Shock, surprise, when we force hospitals into servicing people who cannot possibly pay, they try to get rid of them! Sometimes they succeed! In other news, water wet, fire hot.)

What? An organization trying to evade the law??!!!! Have you called CNN yet?

[gaelic cowboy]

Just cos your on a waiting list RVG does not mean you are not seen by medical staff.

[rvg]

Just cos your on a waiting list RVG does not mean you are not seen by medical staff.

Oh? So waiting list means that people actually get treated while on it. Then why is it called a waiting list and not, say, "Treatment List"?


Do you own a car cos you need insurance to drive, forcing people to buy same is no differ but I dont see mass movements against it.

This has been addressed before: I am not required to buy car insurance if I choose not to drive. The only way to get out of health insurance mandate is to choose not to live. A slightly more drastic choice imho.

[Lemur]

What? An organization trying to evade the law??!!!! Have you called CNN yet?
Right, of course, but it points to a perverse set of incentives that we create by not having comprehensive coverage. If hospitals had a reasonable expectation of getting some sort of payment for treating the indigent, they would not have to dump.

[rvg]

Right, of course, but it points to a perverse set of incentives that we create by not having comprehensive coverage. If hospitals had a reasonable expectation of getting some sort of payment for treating the indigent, they would not have to dump.

True, but if forcing hospitals to spend money they otherwise wouldn't is wrong, then how can forcing the individuals to do the same be okay?

[Strike For The South]

People die every day. It doesn't harm the society one bit.

This is patently false.

[Ironside]

Forcing me to buy health insurance is an attack on my liberty.


In your opinion, does paying taxes (reducing your financial freedom) on police, schools etc increase the total freedom in society or not?

[rvg]

In your opinion, does paying taxes (reducing your financial freedom) on police, schools etc increase the total freedom in society or not?

I'm not sure what you mean by total freedom in society. As for paying taxes, you'll either be paying to a government or to a local crime lord. Government is a better option imho.

[Lemur]

you'll either be paying to a government or to a local crime lord.
Lord Humungus 2012! (https://www.facebook.com/pages/Lord-Humungus-Wez-2012/353502577551)

[rvg]

Lord Humungus 2012! (https://www.facebook.com/pages/Lord-Humungus-Wez-2012/353502577551)

'xactly.

[Lemur]

A good perspective on the constitutionality question (http://theincidentaleconomist.com/wordpress/this-is-still-not-a-game/):

I really wish people would stop acting so darn sure about whether the mandate is constitutional or no. You know what? I’m not sure. I think it seems reasonable, but I don’t profess to know it as truth. But you know what’s crazy? The Supreme Court justices can’t agree! That means the people who are actually in charge don’t even “know” if it’s constutitional. We have to wait until we can poll them and get a consensus before we “know”. And you know what will happen right after that? Half the country will start crowing about how they were “right” and treat the other half as if they were crazy.

Am I the only one who thinks that’s insane? If it’s 5-4 then even though 44% of the Supreme Court justices felt the opposite, they are “wrong”. And so is everyone who agreed.

Can we all develop a little humility here?

[drone]

In all fairness, the Lord Humungus would probably repeal the "Stand Your Ground" laws. ~;)

[Ironside]

I'm not sure what you mean by total freedom in society. As for paying taxes, you'll either be paying to a government or to a local crime lord. Government is a better option imho.

To use an Indian example. If the goverment is taking half your money for a year to get 4 casteless into a normal life, then the total freedom would increase, even if the goverment is taking money from you. You got a decreased number of options and they got an increased number of options.

And here I was thinking schools as my primary point. Not many crime lords running those, even if there probably is few. Fire department?

And the local crime lord usually weren't the maintainer of public order, even before the police got organised.

[rvg]

To use an Indian example. If the goverment is taking half your money for a year to get 4 casteless into a normal life, then the total freedom would increase...

Ahh, I see what you mean by total freedom. Yeah, about that.... screw the casteless. Not my problem.

As far as paying for public schools, police and fire, I do not oppose them. In fact, when a millage increase vote comes around (for police, schools or fire departments) I usually vote in favor.

[Tuuvi]

Who voted for it? Assuming you are over 18, you did.

Membership in the UN means accepting that the human rights trumps any of your own laws. Any country is of course free to leave the UN, and since the US is a democracy, you are of course free to start a "leave the UN"-party.

IIRC, the constitution of the US was put to the popular vote in order to be ratified. Before the declaration of human rights, or any other document for that matter, can be held in higher authority than the constitution it needs to put to the popular vote as well, in my opinion.

[Papewaio]

OT the UN is a place for countries to air differences, to unite on objectives.

However the UN has no ability to force the US or any other UN permanent security council member to do anything. UN cannot enforce any UN laws on any of these as the ability to veto any security decision trumps any enforcement action. Just look at Syria and the fact that the UN is blocked from action by two such vetoes: Russia and China.

Essentially the only time that a nation will get spanked by the UN is when all five agree or one of the big five abstains from attending in protest. For instance Russia abstained from attending the UN allowing the four security perms to fight North Korea... This was back when the five were US, UK, USSR, France and "Taiwan".

=][=
As for liberty I prefer the postive variant which espouses eglatarian values and strengthening social fabric. To me it is about creating stronger, better societies. Negative liberty is focused too much on tooth and claw gene ideas where it is survival of the rugged individualist. Romantic but it misses the point that with all bar a few exceptions we live in a society, and those societies have worked well on all the cultural memes of repriocity. Money is a tangible form of a social reciprocity. It is an idea that only works in groups.

[Xiahou]

So this is an issue of federal power rather than about the individual freedom vs general government interference? It's fine for Massachuetts to mandate you to buy brocoli but not for the federal government? (That's not a rhetorical question.)Well, that states all have their constitutions as well- so the brocoli mandate would vary by state.


The demand for healthcare is infinite, and the supply is finite.You keep saying that- but that doesn't mean its true. Sure, the demand for pretty much anything is infinite if the cost is free. In our current system healthcare costs are far divorced from most consumers of healthcare service, but there's no reason to think that demand wouldn't slacken if people better felt the costs.

Point is, 'the demand for healthcare is infinite' is hardly a known fact.

[ICantSpellDawg]

Congress needs to pass a 2/3 majority with the 50 State legislatures and amend the constitution if it wants to run health care in the manner described. I'm not against this, but the proper channels need to be followed. The current law is an unconstitutional Federal power grab and an abuse of the commerce clause regarding a matter that must be resolved by the people or the States respectively. I would support a vote to amend the constitution, but the constant assault on the separation of powers by many administrations needs to end. It degrades the legal legitimacy of the nation and supporters of the law need to check themselves.

Remember when Congress amended the Constitution to allow a Federal income tax? That is a simple line that was put into the document enumerating a new power. We need to do it again and get back on track for a sustainable separation of powers. You must recognize that there is no limit to Federal abuses that use the commerce clause. The definition being used allows the Federal government to regulate and decide everything under the sun.

[rvg]

I can definitely get behind this line of thought. A constitutional amendment would get around all the liberty issues while also solving the problem in the most direct and powerful way imaginable.

Except that it ain't happening. Newt's moonbase has a more realistic chance of happening than a healthcare amendment.

[Goofball]

I don't understand why Obama didn't just take all of the insurance companies out of the picture and institute socialized medicine. That way it's a tax. Everyone pays into it. Nobody is forced to purchase anything. Everyone has health care whenever they need it. It lifts the incredibly crushing handicap U.S. businesses face when competing against companies from every other modern nation, and cuts out all of the money that has to go to insurance company and HMO profit. And the price is reasonable. In my province monthly rates are $64.00 for one person, $116.00 for a family of two and $128.00 for a family of three or more. If you are employed, many employers will pay 50% of your monthly premium for you. And those premiums only apply to people earning > $30,000/year. For those making less than that, premium assistance is provided on an upward sliding scale as income declines, to the income level of $22,000/year, at which point your premiums are 100% subsidized. Quite civilized really. Not a threat to liberty at all.

[rvg]

I don't understand why Obama didn't just take all of the insurance companies out of the picture and institute socialized medicine. That way it's a tax. Everyone pays into it. Nobody is forced to purchase anything. Everyone has health care whenever they need it. It lifts the incredibly crushing handicap U.S. businesses face when competing against companies from every other modern nation, and cuts out all of the money that has to go to insurance company and HMO profit. And the price is reasonable. In my province monthly rates are $64.00 for one person, $116.00 for a family of two and $128.00 for a family of three or more. If you are employed, many employers will pay 50% of your monthly premium for you. And those premiums only apply to people earning > $30,000/year. For those making less than that, premium assistance is provided on an upward sliding scale as income declines, to the income level of $22,000/year, at which point your premiums are 100% subsidized. Quite civilized really. Not a threat to liberty at all.

Because it would be a hugely unpopular measure.

[Goofball]

It wouldn't have been any more unpopular than what he did (at least initially, the numbers I've been seeing lately put public opinion at around 50-50 on Obamacare), and there would not have been any of this SCOTUS kafuffle you're going through right now, as the federal government is within its rights to levy taxes.

[rvg]

It wouldn't have been any more unpopular than what he did (at least initially, the numbers I've been seeing lately put public opinion at around 50-50 on Obamacare), and there would not have been any of this SCOTUS kafuffle you're going through right now, as the federal government is within its rights to levy taxes.

imho a president that introduces a healthcare tax in his first term is guaranteed to be a one term president.

[Goofball]

I don't disagree. But it looks like that's what is going to happen anyway. At least if he'd done it the other way it wouldn't have been thrown out by the SC and he might have left a lasting legacy.

[Philippus Flavius Homovallumus]

Because it would be a hugely unpopular measure.

I'm of a mind with ta' Dawg. Obamacare was an attempt to do the right thing but a half arsed one.

As to your comment, socialised medicin is ALWAYS unpopular among the chattering classes on the right, but it's blummen well popular among the poor and after a generation no one would dare get rid of it.

I don't know though, maybe America missed the moment to do this after the war. Every other country instituted socialised medicine, America opted for just socialising the care of it's soldiers and veterans instead.

[a completely inoffensive name]

I am in favor of total free market health care. No government whatsoever. The only way to teach America is to let the libertarian utopia bring about total havok and death so we can finally eradicate these silly notions from our marketplace of ideas.

[Lemur]

Interesting discussion here about why low-end innovation doesn't happen (http://www.usnews.com/opinion/blogs/scott-galupo/2012/03/29/the-perversity-of-the-american-healthcare-market) under our system.

Frum asks, "Where is the Sam Walton of American healthcare?"

We don't have the finest food or handicrafts. You go to Europe for things like that, Frum notes. "The genius of American business," he continues, "is the ability to produce a good-enough product at a fabulous price and make it available to everybody—to unleash a remorseless seeking after efficiency."

But in the healthcare arena, he says, America is like French cuisine: We have the best of the best care—and at gob-smackingly high prices.

Kaus—no fan of Obamacare or President Obama himself—replies that if it were possible for the Sam Walton (or Murray Lender) of healthcare to ever emerge, he would have done so already. That's because the healthcare market is ... unique:

"If you provide better services, you get penalized for it. If you give more and better care to people, sick people will flock to your company, and a vicious cycle will take place where they will drive up your costs and you will lose money.

"It's one of the few businesses—schools are another one—where your profits depend on the class of customers you get as opposed to the service you provide. That is a perversity that the market has not overcome."

[a completely inoffensive name]

Why attack Libertarian ideals?
Because they are presented as a cure to problems in the same way Coca Cola was originally presented as a cure for dyspepsia.



It makes no more sense than attacking communist ideals on the other side of the argument.
There are no communist ideals in America. Single payer is not communist.



We have a system that costs 3 times as much to maintain for the same results. Whether you're cutting the free market out or cutting the government out you're helping to save the healthcare system from loopholes, pork, bad legislation, bad financial management, and congressional stonewalling to prevent progress. Attack corruption and porky loop-hole-filled (and thus extroardinarily expensive) legislation, not some stupid notion of a libertarian conspiracy.
No, pushing for free market reforms in a market that many in these thread have already shown be to "unique" or "special" is simply asking for the incentives of the current scenario to be taken to the extreme. Health care only for the impeccably healthy, no health care for the poor and sick. The exact opposite of what any sane person would be looking for in a system.

[Papewaio]

"It's one of the few businesses—schools are another one—where your profits depend on the class of customers you get as opposed to the service you provide. That is a perversity that the market has not overcome."

On the surface this looks correct. It also points to why the basic no frills version should be state provided.

However no company has ever gone broke because its market share increased as long as they had no loss leads.

If an insurance company properly calibrates its risk:reward it can both make a profit and serve more customers.

Problem is that you cannot just outsource all if the building blocks of a health system overseas. You also cannot take a selective approach to modern medicine as a product in isolation. All the factors of ones lifestyle add into ones health profile. What you eat, how much you exercise, type of work, hours of sleep.

Most health systems are setup to deal with the end results of a lifetime of good and bad choices. Preventative health care and individual responsibility are tacked on too late into the equation.

Need to take a more holistic approach on individual lives. So how does a health care provider do that?

Buy there own fitness centers and give discounts too health care based on results?

The thing is your lifestyle is your choice. To make it health insurance viable for a lot of profit motivated companies will require your lifestyle to be their choice.

[gaelic cowboy]

There are no communist ideals in America.

Abrakedbra alakazam ta da bah dum bish (http://en.wikipedia.org/wiki/National_Football_League_Draft)

[rory_20_uk]

Need to take a more holistic approach on individual lives. So how does a health care provider do that?

Buy there own fitness centers and give discounts too health care based on results?

The thing is your lifestyle is your choice. To make it health insurance viable for a lot of profit motivated companies will require your lifestyle to be their choice.

A healthcare provider, be it private or state can have discounts to existing gyms. Not rocket science.
They can also tailor premiums to lifestyle. Here in the UK some providers give subsidised gym membership and also reduced premiums the more times you use it. One could also measure things such as carbon monoxide levels in the blood for smoking.

Making people healthier can make money. I posted a link to a document that describes exactly this in the case of diabetes.

~:smoking:

[Goofball]

Interesting article:

http://www.cnn.com/2012/04/02/opinion/frum-government-health-care/index.html?hpt=hp_bn7

Most of it seems plausible to me. Can anyone poke any holes in it?

[ICantSpellDawg]

I've just had a lively discussion with my mom about this very topic. I was arguing a number of different angles to the same problem.

Namely,

The current pre-PPACA system is non-competitive and non-capitalistic and should not be defended as such. The argument can be made that it shouldn't be held to that standard; sales under duress are mostly banned in other competitive industries, prices are posted in other competitive industries, Choice does not truly exist for non-elective health care and lay people cannot be required to understand the intricacies or make well reasoned decisions in emergency situations.
The current system is unsustainable and will eat every penny of growth that we will see for the foreseeable future.
The new Affordable Health Care Law could help lower cost in the short term due to its mandate that those outside of the adverse selecting pool must carry some level of insurance.

But the law is unconstitutional by my adolescent but eager understanding of the Constitution; the power should be enumerated through an amendment as other expansive federal power grabs have been required to be (ie income tax, abolition of slavery, etc)
But the current law is an abuse of the commerce clause and usurps the protected constitutional authority of the States, or the people.
But the States have mostly failed to protect the interests of the people in this regard
But it could be constitutional if we enumerated it to be so.

The federal government could pass laws requiring some action be taken by States which meet some minimum standard of citizen protection.
The appropriate governmental entity could separate elective health care requirements from non-elective health care requirements (similarly to how assigned risk auto is broken down in my state - mandatory BI, non-mandatory collision)

Etc, Etc. I've been told that one sign of intelligence is the ability to push for various opposing arguments simultaneously, so I try to do that as objectively as possible. People tend to fundamentally mis-understand the new law and think it is a single payer system. These people need to be educated to hate it for what it is, not what it isn't and find wisdom where it exists in the law.

[Xiahou]

Today Obama cautioned conservatives (http://content.usatoday.com/communities/theoval/post/2012/04/live-obama-news-conference-with-leaders-of-mexico-canada/1?csp=34news) against getting too excited over Obamacare's overturn:


"I'd just remind conservative commentators that for years what we've heard is the biggest problem on the bench was judicial activism, or a lack of judicial restraint,"
Obama seems to be a little confused about the term "judicial activism". Judicial activism is when judges base decisions on their own biases or views. Making a decision based on the Constitution or stare decisis wouldn't be activism. You can think a judge made the wrong decision- but just because you don't agree with it doesn't mean it's activism.

Further, it's very unbecoming of the office to the president to try to call out the SCOTUS on the eve of a decision because he's worried it might not go his way. It almost smacks of intimidation. I guess at least he's not threatening to pack the court.....

[ICantSpellDawg]

In a conspiratorial world, some would say that private insurance companies only came to consensus over inclusion of the mandate promise and that a distinguished constitutional law professor may have known that it would be considered unconstitutional. He would have had all of the concessions, none of the compromise. This could garner a social demand for single payer when health insurance companies are legally required to provide the service for an unconscionable price.

[a completely inoffensive name]

In a conspiratorial world, some would say that private insurance companies only came to consensus over inclusion of the mandate promise and that a distinguished constitutional law professor may have known that it would be considered unconstitutional. He would have had all of the concessions, none of the compromise. This could garner a social demand for single payer when health insurance companies are legally required to provide the service for an unconscionable price.

Exactly, Obama played this perfectly.

[a completely inoffensive name]

Abrakedbra alakazam ta da bah dum bish (http://en.wikipedia.org/wiki/National_Football_League_Draft)

Private companies engaging in mutually agreed upon contracts? Sure....

[gaelic cowboy]

Private companies engaging in mutually agreed upon contracts? Sure....

Is the specific ordering of the picking not even a tiny bit commie.

[drone]

Further, it's very unbecoming of the office to the president to try to call out the SCOTUS on the eve of a decision because he's worried it might not go his way. It almost smacks of intimidation. I guess at least he's not threatening to pack the court.....
Obama started this fight with his 2010 State of the Union address. The Supremes aren't going to do him any favors.

[a completely inoffensive name]

Is the specific ordering of the picking not even a tiny bit commie.

I don't think so. Purpose of the system is to make sure that the playing field is more even for all teams which prevents a select few from dominating all the time (AKA the Yankees syndrome) which gets an overall greater population in the US interested in the sport. In other words: Profit!

[Sasaki Kojiro]

If the nfl was communist they would just award the super bowl trophy to each team in turn (in theory, in actuality the washington redskins would "win" every year) :mellow:

[drone]

The NFL is sort of like Norway economically. Heavy on the socialism, but even the crappy teams print money because of the natural resources that are TV contracts. The draft and salary caps are meant to induce parity on the playing field only, and bad management can drop the ball with these. But it would take some serious incompetence to financially hurt an NFL franchise.

[Xiahou]

Hardly unbecoming. Every president who's had to tangle with the Supreme Court has done so under nasty circumstances, from Lincoln to FDR to Bush to Obama.No, I don't really think so. Feel free to prove me wrong with some examples, but the last president that comes to mind who was this confrontational with the SCOTUS was FDR- FDR was truly beyond the pale.

[a completely inoffensive name]

No, I don't really think so. Feel free to prove me wrong with some examples, but the last president that comes to mind who was this confrontational with the SCOTUS was FDR- FDR was truly beyond the pale.

You are right Xiahou. Presidents after FDR learned to stop fighting the SCOTUS and just try to rig it. Eisenhower if I remember correctly regretted his appointment of Warren but never said anything publicly about that.

[Tsar Alexsandr]

I'm not a fan of the bill. The fact that it is required is disturbing to me. If it's required that means US citizens will be forced to live a certain life style. Which is bad because people who could otherwise get by have to pay for something they may not want or plan on using. People have a right to use traditional medicines and lifestyles.

e.g. Nomads? It basically outlaws a nomadic lifestyle. Which might not sound like a big deal, but I think it is. As an environmentalist I am concerned with reducing my carbon footprint, and I can do that. Cheaply, but if you add expenses to my simplistic life style, it starts to become difficult to afford. I simply do not make enough money as an artist to pay for anything besides my basic human needs. I live in Michigan too, so we're expected to pay insurance on cars as a law. I don't own a car. If I did I couldn't afford it, nor could I afford gas.

I simply want my right to live as I choose. It's not hurting anyone else or our nation. In fact, I think it's helping the nation, but if the bill passes, I might not be able to live how I choose to live.

[Sasaki Kojiro]

Since FDR the SCOTUS has become partisan and almost croney-ish. I understand that's a subjective thing to say, but it seems founded when you can look at SCOTUS and know beforehand that they'll split among partisan lines instead of being a separate body of wisdom. It undermines the checks and balances, IMO. I'd prefer open political brawls to having a bunch of justices that are only too eager to please the party that appointed them. Then again, maybe they were appointed because the politicians knew beforehand that they were predictable (Roberts).

You might find this interesting:

http://www.scotusblog.com/2010/06/everything-you-read-about-the-supreme-court-is-wrong/


Start with the Court's ideological divide. Although some cases are decided five to four, that’s less than twenty percent of the cases this Term. Roughly half the decisions are nine to zero. Only slightly more than one in ten cases involved the narrow liberal-conservative divide (fewer, if we don't include cases in which we presume Justice Sotomayor would have voted with the left had she not been recused).

Though the Term ended (as it often does) with decisions decided along ideological lines, other five-to-four decisions that intuitively might have been decided on an ideological basis during the course of the Term were instead resolved by totally unpredictable alignments. For example, the Court in Dolan v. United States broadly read judges' power to order restitution (a "conservative" outcome) by a majority of Thomas, Ginsburg, Breyer, Alito, and Sotomayor, over the dissent of Roberts, Stevens, Scalia, and Kennedy. (This was the exceptionally rare case of the five most junior Justices joining together against all their senior colleagues.) Then Magwood v. Patterson broadly permitted a habeas corpus petitioner who prevails in a habeas petition to bring a new challenge to his subsequent sentence (a "liberal" result) in an opinion by Thomas (!) joined by Scalia, Stevens, Breyer, and Sotomayor, over the dissent of Roberts, Kennedy, Ginsburg, and Alito. Thomas also wrote the defendant-favoring opinion construing the Speedy Trial Act in Bloate v. United States, over the dissent of Justices Alito and Breyer. In Shady Grove Orthopedic Associates v. Allstate Insurance Co., the Court held that state law cannot block federal class actions (a pro-plaintiff result) in an opinion by Justice Scalia (!) joined by Roberts, Stevens, Thomas, and Sotomayor, over the dissent of Kennedy, Ginsburg, Breyer, and Alito.

And anyway, if there is a "conservative vs liberal" split involving how to interpret the constitution (orginalism etc), the problem is not "partisanship" but one side being wrong about how to interpret the constitution.

[a completely inoffensive name]

And anyway, if there is a "conservative vs liberal" split involving how to interpret the constitution (orginalism etc), the problem is not "partisanship" but one side being wrong about how to interpret the constitution.

How is any side wrong in how to interpret the Constitution? It's a pretty fluid and vague document.

[Sasaki Kojiro]

How is any side wrong in how to interpret the Constitution? It's a pretty fluid and vague document.

Originalism vs living, they can't both be right.

[a completely inoffensive name]

Originalism vs living, they can't both be right.

Why not? Why can't we accept a degree of validity from both and simply pick from either side what is most prudent at the time?

[Sasaki Kojiro]

Why not? Why can't we accept a degree of validity from both and simply pick from either side what is most prudent at the time?

You aren't arguing for both you're arguing for living.

edit: which means I contradicted myself...your way of doing things would allow for being partisan, unlike strict originalism would would require the judge to stick to his method even if he didn't like the results politically.

[a completely inoffensive name]

You aren't arguing for both you're arguing for living.

Then living is correct.

[CountArach]

I'm not a fan of the bill. The fact that it is required is disturbing to me. If it's required that means US citizens will be forced to live a certain life style. Which is bad because people who could otherwise get by have to pay for something they may not want or plan on using. People have a right to use traditional medicines and lifestyles.

e.g. Nomads? It basically outlaws a nomadic lifestyle. Which might not sound like a big deal, but I think it is. As an environmentalist I am concerned with reducing my carbon footprint, and I can do that. Cheaply, but if you add expenses to my simplistic life style, it starts to become difficult to afford. I simply do not make enough money as an artist to pay for anything besides my basic human needs. I live in Michigan too, so we're expected to pay insurance on cars as a law. I don't own a car. If I did I couldn't afford it, nor could I afford gas.

I simply want my right to live as I choose. It's not hurting anyone else or our nation. In fact, I think it's helping the nation, but if the bill passes, I might not be able to live how I choose to live.
Out of curiosity would you support a single-payer healthcare scheme?

[gaelic cowboy]

I'm not a fan of the bill. The fact that it is required is disturbing to me. If it's required that means US citizens will be forced to live a certain life style. Which is bad because people who could otherwise get by have to pay for something they may not want or plan on using. People have a right to use traditional medicines and lifestyles.

e.g. Nomads? It basically outlaws a nomadic lifestyle. Which might not sound like a big deal, but I think it is. As an environmentalist I am concerned with reducing my carbon footprint, and I can do that. Cheaply, but if you add expenses to my simplistic life style, it starts to become difficult to afford. I simply do not make enough money as an artist to pay for anything besides my basic human needs. I live in Michigan too, so we're expected to pay insurance on cars as a law. I don't own a car. If I did I couldn't afford it, nor could I afford gas.

I simply want my right to live as I choose. It's not hurting anyone else or our nation. In fact, I think it's helping the nation, but if the bill passes, I might not be able to live how I choose to live.

:thinking: eh nomadism has never been exactly very enviromental now has it, the nomad uses up all the local resources and moves on.
Nomadism is merely about allowing the enviroment time to recover from humanities destructive practices.

I very much doubt Obama is coming to take away your ayahuasca.

Stating you will be prevented from literally living how you want strikes me as alarmism in the extreme, if a person were that poor they could just go to the same clicic as all the homeless people go to.

[a completely inoffensive name]

I wasn't talking about the split on constitutional interpretation, I was referring to a pattern of croney-ism that follows party lines predictably (for example, Roberts was outrageously given the Chief Justice spot by Bush and he's been very loyal to the neo-con agenda). Maybe its not new, maybe its just under-reported throughout history. Either way, I feel it undermines what should be the "purest" of the branches.

But the article just showed that the judges 80% of the time do not strictly follow party lines, including Roberts.

[rvg]

But the article just showed that the judges 80% of the time do not strictly follow party lines, including Roberts.

Most of them kinda do. Scalia, Thomas and Alito are the conservative wing. Ginsburg, Kagan and The Wise Latina are the die hard libs. Roberts is mostly conservo, Breyer is mostly liberal, and Kennedy ends up making all the decisions.

[a completely inoffensive name]

Most of them kinda do. Scalia, Thomas and Alito are the conservative wing. Ginsburg, Kagan and The Wise Latina are the die hard libs. Roberts is mostly conservo, Breyer is mostly liberal, and Kennedy ends up making all the decisions.

Of course. But looking at the results as a whole​, it would be dishonest to claim that we have the equivalent of puppets on the SCOTUS who simply follow their ideological masters. What we have are nine judges who have strong convictions about Constitutional law backed by logical rationale who nevertheless do make decisions as they themselves see fit from such rationale. Such strong convictions skew the way they vote into somewhat dividable lines of "conservative" and "liberal" but these terms shown by the article are not very accurate and thus show a weakness in the argument of them being stooges of the president who put them there.

And as Sasaki has just enlightened me, it is quite obvious that when you subscribe to the originalist strain of thought, there is no fluidity to what is the correct decision in a case, it is right there, shown through the intentions of the author from his/her writings. So of course you would at least have a natural block of "conservatives" that all vote along similar lines. But this in no way indicates any sketchyness but simply that these originalist judges are all starting from common axioms they consider true and are all following the implications of these axioms to the reach the same conclusions.

[CountArach]

*Then again, I'd like to be wrong. If they shoot down the individual mandate and admit that individual freedom is THAT important, and that the government REALLY SHOULD stay out of your business, then that's a fantastic precedent to set. We could close down gitmo on that precedent. We could repeal the Patriot Act on that precedent. We could keep the feds out of state-legal Medical Marijuana programs with that precedent. We could do a lot of good with it. But unfortunately, I think they'll just shoot down the bill with specific wording, so nothing will change and no decent precedent will be set unless this Healthcare bill is the only thing on the table you feel is worth talking about, as far as the government being able to make you do things goes.
There's a lot of good that it could do, yes, but at the same time the implicatins of that sort of precedent are huge. All it takes is some nutjob to say that the Federal Emergency Services (or some other equivalent which just can't be done properly at state level) infringe on his liberty and should be a state responsibility and suddenly he has a potential precedent to draw upon. I don't like the individual mandate, but I think that there should be some way to get rid of it without the Supreme Court getting involved.

As for how liberal/conservative the supreme court is, one metric has found that this is the most conservative bench ever (http://fivethirtyeight.blogs.nytimes.com/2012/03/29/supreme-court-may-be-most-conservative-in-modern-history/).

[rvg]

There's a lot of good that it could do, yes, but at the same time the implicatins of that sort of precedent are huge. All it takes is some nutjob to say that the Federal Emergency Services (or some other equivalent which just can't be done properly at state level) infringe on his liberty and should be a state responsibility and suddenly he has a potential precedent to draw upon.

Not really. His case would likely be totally different as in he'll get spanked by the lower courts and SCOTUS would refuse to hear the case.


I don't like the individual mandate, but I think that there should be some way to get rid of it without the Supreme Court getting involved.

It's too late for that now.



As for how liberal/conservative the supreme court is, one metric has found that this is the most conservative bench ever (http://fivethirtyeight.blogs.nytimes.com/2012/03/29/supreme-court-may-be-most-conservative-in-modern-history/).

It's been like this since Renquist, but it's getting more liberal: at least David Souter and Sandra D. O'Connor were somewhat centrist. Elena Kagan and The Wise Latina both are outspoken liberals.

[Tsar Alexsandr]

The Native Americans were mostly nomadic or semi-nomadic and they seemed to do a good job of not making a mess of things. But the modern government very much desires stability in it's populace. They're easier to watch and control that way.

I'm still pretty young so yeah, I kind of am a nomad. I intend to settle down someday but when I do I want to live in a sustainable way. Growing my own food, not contributing to pollution, etc. But as I only make money from selling art, my funds are pretty limited. I am looking for what people might call "a real job" but no one has ever given me one. I live in Michigan and our economy here is horrible.

Well... single payer healthcare? No I don't think I would. Is healthcare really important? I don't want it. I can't afford it. But what is government for? Is it to govern matters of state or line our pockets? To support our every need? I don't think so. And I don't want to pay for services I don't use.

On a final note, I literally can't afford to pay it.

[gaelic cowboy]

Well... single payer healthcare? No I don't think I would. Is healthcare really important? I don't want it. I can't afford it. But what is government for? Is it to govern matters of state or line our pockets? To support our every need? I don't think so. And I don't want to pay for services I don't use.

There is a bit of an inconsistency here though have you ever had the occasion to use the millitary, police or judicury.

If you dont use any of those services or at least use the less than most should you be exempt from paying for them an all.

[Tsar Alexsandr]

There is a bit of an inconsistency here though have you ever had the occasion to use the millitary, police or judicury.

If you dont use any of those services or at least use the less than most should you be exempt from paying for them an all.

I've used the bare minimum of services from the government, but that's not the key to my argument either. I'm not arguing for an end to taxes for example. I'll pay taxes. I just don't want to be told I have to buy something if I don't want it. Isn't that an American right?

In Michigan we're required to pay for car insurance as well, and that's a horrible system. Lets say you pay the bare minimum state mandated insurance. Well if you get into an accident caused by a drunk driver but the drunk driver has better insurance, you owe him money. Even if you're hurt so bad you have to go to the hospital. If you get in any accident with the bare minimum insurance, you will be the one who pays. If you caused the accident or were the victim. So in my state at least, people pay for something that might as well not even exist. Except if you get into an accident without the minimum insurance here there is a very nasty penalty for that, naturally. It's like paying to not have insurance though, or worthless insurance anyhow.

I'd prefer that the healthcare bill didn't pass or wasn't mandatory.

[rvg]

I've used the bare minimum of services from the government, but that's not the key to my argument either. I'm not arguing for an end to taxes for example. I'll pay taxes. I just don't want to be told I have to buy something if I don't want it. Isn't that an American right?

In Michigan we're required to pay for car insurance as well, and that's a horrible system. Lets say you pay the bare minimum state mandated insurance. Well if you get into an accident caused by a drunk driver but the drunk driver has better insurance, you owe him money. Even if you're hurt so bad you have to go to the hospital. If you get in any accident with the bare minimum insurance, you will be the one who pays. If you caused the accident or were the victim. So in my state at least, people pay for something that might as well not even exist. Except if you get into an accident without the minimum insurance here there is a very nasty penalty for that, naturally. It's like paying to not have insurance though, or worthless insurance anyhow.

I'd prefer that the healthcare bill didn't pass or wasn't mandatory.

The purpose of no-fault insurance is not to cover you, but your potential victim. If you put someone in a wheelchair as a result of an accident, the no-fault insurance will cover that.

[Tsar Alexsandr]

The purpose of no-fault insurance is not to cover you, but your potential victim. If you put someone in a wheelchair as a result of an accident, the no-fault insurance will cover that.

Not everybody can easily afford that though.

[rvg]

Not everybody can easily afford that though.

So what? Nobody's required to drive either.

[rvg]

Orly? Not having a liscense can prohibit you from many jobs that simply won't hire you if you don't have your own transportation. In many cities the public transportation is simply not good enough to meet the needs of a busy and productive citizen--El Paso springs to mind.

The entire Auto industry and Auto Insurance industry is a giant profiteering nightmare (one that has come back to bite the industry in the ass--but that's okay, WE GOT BAILOUTS! lolz). There's no good reason for everything to be as expensive as it is, other than to make the beaurocracy happy.

*I mean, for crissakes, I own my car. Flat out, I own it. But I can't afford to pay $300/month for insurance that won't even fix a ding in my door. I understand insurance is necesarry for public safety, but if its a public issue then surely its idealogically hypocritical to allow people to profiteer from it, right? I own my car, but because its a sports car and because I'm under 25, the rate is adjusted ridiculously high. I can't drive something that I own, because I can't afford to pay the protection racket. Its a screwy system, and this poor economy highlights its flaws.

If you can't afford to put gas into your car, you won't be driving it either. Insurance is no different.

[Strike For The South]

The Native Americans were mostly nomadic or semi-nomadic and they seemed to do a good job of not making a mess of things. But the modern government very much desires stability in it's populace. They're easier to watch and control that way.
.


False, before the introduction of the horse most Indian tribes were fairly stable and we're not nomads anymore becuase that's no way to conduct buisness. Not becuase big brother is keeping an eye on us.

Kids these days.,.....

[rvg]

Gas does not cost anywhere near $300/month...

Soon it will. Then what?

[rvg]

Then all us poor people watch and laugh while everyone else gets a taste of what its like to not be able to meet your basic needs in spite of your best efforts.

I doubt the poor will be laughing.

[Tsar Alexsandr]

False, before the introduction of the horse most Indian tribes were fairly stable and we're not nomads anymore becuase that's no way to conduct buisness. Not becuase big brother is keeping an eye on us.

Kids these days.,.....

I'm not really protesting for the rights of nomads. But if I were, what would be wrong with that?

Indian tribes often moved north or south to avoid weather changes. I would call that semi-nomadic.

I agree it's not a good way to conduct business but there's more to life than money yes? Oh wait I'm poor. I forget that money is the be-all and end-all of America these days. But with more government involvement there is more of a paper trail to watch us with. Now if I was paranoid about that I'd probably avoid the internet, but I like the internet so I'm not going to do that. I also have nothing to hide. And I'm not afraid to say I'm not a fan of governmental control gaining more power, that's not a crime yet.

But it's not about governmental control either. It's about an added expense that I don't want.

It is about governmental control in the sense it's another mandated law requiring us to pay for more things. And I don't think that's their right. Someone might tell me to get out if I don't like it. Well maybe I will.

[Tsar Alexsandr]

So what? Nobody's required to drive either.

No they're not. But try getting a job without a car. Try making money without a car.

I live in a small town and I am an artist. I have to sell things in the nearest city, a half hour from where I live. (By car. It's a day away from me by bike.) I make enough off it to cover some expenses, but obviously I'm not swimming in cash. I'm looking for permanent work while going to school. Things are pretty tight.

The fact is poor people like me have to fight hard to make it. Add an expense I don't want or need and the government could effectively undo all my hard work. The government keeps poor people down and people who are better off forget about the poor, they're told to forget them. Or perhaps it helps them sleep at night to pretend poor people don't exist. I don't blame them. If I was part of the system that made life worse for the poor I'd worry about my health and safety.

Gelatinous Cube, I'm glad to see another sensible person in this thread. Best of luck to you.

[rvg]

The bitter spiteful kind, not the cheerful kind. :whip:

But I was late with this edit in my earlier post, you may not have seen it:

Plus with Gas, you pay as you go. You got $20 for gas, you're good for awhile. You try to do that with insurance and they hike your rates even higher for being unreliable with your payments. Its a joke, and poor people are the only ones not laughing.

You can't compare gas and insurance. One is a commodity, the other is a rigged system.

Okay, then stop being poor, I guess. Or stop driving. Or keep driving and keep complaining, which is okay as long as you keep paying the premiums. We've all gone through the penniless college student phase. Paying more for insurance because of the age and not having enough money in general. Later on the situation reverses as you pay less (due to age) while making more moolah. Then you start paying more again, then you stop paying and stop driving and not long afterwards you die. C'est la vie.

[Strike For The South]

I'm not really protesting for the rights of nomads. But if I were, what would be wrong with that?

Indian tribes often moved north or south to avoid weather changes. I would call that semi-nomadic.

Which Indians? The most advanced tribes were also the ones that stayed put. Even the proverbial plains Indian stayed put the majority of the time until the horse was introduced.


I agree it's not a good way to conduct business but there's more to life than money yes? Oh wait I'm poor. I forget that money is the be-all and end-all of America these days. But with more government involvement there is more of a paper trail to watch us with. Now if I was paranoid about that I'd probably avoid the internet, but I like the internet so I'm not going to do that. I also have nothing to hide. And I'm not afraid to say I'm not a fan of governmental control gaining more power, that's not a crime yet.


Another college kid groaning about the evils of money. Spare me. Money is certainly not the be all end all, but at the risk of go off on a tangent I'll say this. Everything you see around you is due to the movement and accumulation of capitial and stable property rights. Two things which are anathema in a nomadic socitey. There are limits on a nomadic society much like there are limits on a society which relys on the passing of information through oral history.




But it's not about governmental control either. It's about an added expense that I don't want.

It is about governmental control in the sense it's another mandated law requiring us to pay for more things. And I don't think that's their right. Someone might tell me to get out if I don't like it. Well maybe I will.

Was this about roads? The roads a publicly funded good

Also if you "get out" where would you go? The US is the most right wing, least socialist country anywhere within the realm of post industrial living standards, mostly due to a vast population and natural rescources.

I feel there is a lesson there.

[rvg]

No, no, no. Don't tell me to work harder. That's a cowardly way out of this discussion, and pretty close to ad hominem.
I didn't tell you to work harder. I told you to stop being poor.


Auto Insurance Companies may as well be designed to keep the poor off the road. Do you dispute this?
I sure do. They want the poor driving and paying since the poor are their meal ticket.


Do you think the way it is conducted is just fine? Do you really so no contradiction between the assertion that it's a public safety issue and the fact that its handled by profit-mongering corporations?
Why, do you want the government to do it instead? You think they would do a better job?


This is exactly the kind of thing the Individual Mandate discussion should be making you think about.

Totally different. Millions of people in this country don't drive and thus don't need car insurance. Individual health mandate is all inclusive, which is why it is so abhorrent to me.

[rvg]

You'd be singing a different tune if the only thing keeping you off the road was unfair rates.
The "tune" you're referring to is very familiar to me. I've been there myself: young age+low income+crappy car=high insurance rates. It's just a fact of life. As you add on a few more years, a few more pounds, a few more benjamins in every paycheck and get a better car, the rates will become very reasonable.

Life's a bitch.

[rvg]

There's no reason for car insurance to cost as much as it does, but because it can be gotten away with it gets gotten away with.
Business is business. Anything other than a paltry sum is likely to be judged as unfair. If businesses aren't allowed to set their own prices, they might stop offering the service altogether. That's definitely not a good scenario.

[rvg]

A paltry sum is already too much to force someone to pay.

Nobody is required to pay as nobody is required to drive.

[Tsar Alexsandr]

Business is business. But what about moral and civic obligations?

With the current laws and business practices it is very hard to get ahead for the countries poorer citizens. The thing is, there are people who are very poor. I know lots of people who are worse off than me and other people I know.

[rvg]

Honestly, I'm tired of your replies. "Stop being poor" and "So, don't drive." are just really bad answers.

I wanna drive a Lamborghini, but the prices for that car are absolutely ridiculous. Are those blasted Italians waging class warfare against me?

[rvg]

Not even close.
No? You don't understand the pain I go through every time I see a Lamborghini pass me by.

[Greyblades]

Please tell me that was a joke.

[rvg]

We're not talking about giving cars away. We're talking about a purely man-made and contrived system that forces you to partake in what amounts to a protection racket in order to drive something you already own on roads that your tax dollars already pay for. Think about it.

The system is there to protect the public from you. It's as simple as that. If you choose to buy more insurance it'll protect you as well as it protects the public. If you drive a good car, if you have a good driving record, if your job isn't more than 25 miles away from your home, all of that earns you a discount. Insurance companies rip off those whom they consider a risk. I see nothing wrong with that.

[rvg]

...Miss a couple payments and tell me how fair those rates are...

There's your problem.

[ajaxfetish]

The Native Americans were mostly nomadic or semi-nomadic and they seemed to do a good job of not making a mess of things. But the modern government very much desires stability in it's populace. They're easier to watch and control that way.

The idea that the native tribes were in some kind of mystical harmony with nature is a recent myth, perhaps part of a sort of cultural atonement for the centuries of ridicule and persecution that preceded it. Natives were responsible for extensive and regular burning of forests (http://en.wikipedia.org/wiki/Native_American_use_of_fire), and the standard means of hunting bison (http://en.wikipedia.org/wiki/American_bison) before the introduction of the horse was very wasteful. The primary reason Native Americans didn't make more of a mess of things was numbers. Try to pack over 300 million Indians into the U.S., and their lifestyle wouldn't be any more sustainable than ours.

Ajax

[Papewaio]

Modern cities are far more efficient per capita and combined with dedicated farming tracts has a much smaller land area footprint per person than nomadic lifestyles.

The carrying capacity of Earth is far larger due to modern inventions. Nitrogen fixing for instance uses around 6% of the worlds energy and helps provide 2/3s of the worlds food that wouldn't be possible without it.

=][=

As for health insurance.

"Give us your destitute, your weak, your sick, your poor."

And then what? Leave them like that?

End result in the US is a very lopsided expensive medical system whose results don't look any better than Universal Health Care in other societies and is more expensive too.

Modern societies made health care universal to increase carrying capacities of their societies. UHA is in the same basket as progressive tax based on income level, police, firemen, army and other services.

UHA is part of a social contract. It doesn't mean you can't top it up with your own resources, it just means everyone will be treated at a minimum level.

[Tsar Alexsandr]

The idea that the native tribes were in some kind of mystical harmony with nature is a recent myth, perhaps part of a sort of cultural atonement for the centuries of ridicule and persecution that preceded it. Natives were responsible for extensive and regular burning of forests (http://en.wikipedia.org/wiki/Native_American_use_of_fire), and the standard means of hunting bison (http://en.wikipedia.org/wiki/American_bison) before the introduction of the horse was very wasteful. The primary reason Native Americans didn't make more of a mess of things was numbers. Try to pack over 300 million Indians into the U.S., and their lifestyle wouldn't be any more sustainable than ours.

Ajax

I think you re-evaluation of the recent myth is a recent myth.

They did burn forests, yes. So did all of our ancestors who started agriculture in their societies. Slash and burn agriculture was the beginning of agriculture. I live in Michigan where the local natives made a large clearing in the great woods here. It was pretty sizable. But a small dent compared to the stress and strain of a small American city.

[rvg]

So in order to drive you should be able to commit to a long-term plan, and be penalized to the point of exclusion for not being able to make the payments? What does that have to do with your driving risk?

Its a poor-trap.

To the insurance company you're a non-paying customer, i.e. a risk. Furthermore, not paying bills usually wrecks your credit rating which might also factor into additional price hikes and such. It's not a matter of being poor really, as anyone who misses payments and has bad credit will have to pay through the nose for insurance.

[Greyblades]

Maybe but in an ideal society compensation should only cost more if the risk of accident is higher not if you are too poor to pay a monthly fee.

[rvg]

Maybe but in an ideal society compensation should only cost more if the risk of accident is higher not if you are too poor to pay a monthly fee.

We do not live in an ideal society. In the real world businesses reward good customers and punish bad customers.

[Greyblades]

Indeed, but an ideal society is one we should aspire to seeing this society is not ideal. It is rather unfair that people aren't allowed to drive vehicals they themselves own, not from risk to themselves or others but because they cant afford a fee and that should change. Saying blanket statements like "that's life" and "stop being poor" to avoid proper discussion is niether considerate nor helpful.

[rvg]

Indeed, but an ideal society is one we should aspire to seeing this society is not ideal. It is rather unfair that people aren't allowed to drive vehicals they themselves own, not from risk to themselves or others but because they cant afford a fee and that should change.
The system works as it is. Millions of poor people have cars and car insurance.


Saying blanket statements like "that's life" and "stop being poor" to avoid proper discussion is niether considerate nor helpful.
Facts of life aren't always warm and fuzzy.

[Greyblades]

The system works as it is. Millions of poor people have cars and car insurance.Just because it works does not mean that it is right or even the most effective way.

Facts of life aren't always warm and fuzzy. Thank you for making my point I don't believe I have to say more.

[rvg]

Just because it works does not mean that it is right or even the most effective way.
If it ain't broke, don't fix it.


Thank you for making my point I don't believe I have to say more.
No problem.

[drone]

Gelatinous Cube : Not to take this off-topic, but don't you qualify for USAA?

[Greyblades]

If it ain't broke, don't fix it.


That's just... Ugh that statement is so dumb, its like the person who made it hadn't come across the term "neccissary matenance to avoid failure". Besides, when a construct fails to do what it's supposed to it is by definition broken and when a system dedicated to keeping drivers licenses out of the hands of unsafe drivers is operating in a world with a mulitude of car accidents caused by drunk driving and criminal negligence, yet punishes and keeps licenses out of the hands of those who's only issue is being too poor to pay fees, it is broken.

[rvg]

Besides, when a construct fails to do what it's supposed to it is by definition broken and when a system dedicated to keeping drivers licenses out of the hands of unsafe drivers is operating in a world with a mulitude of car accidents caused by drunk driving and criminal negligence, yet punishes and keeps licenses out of the hands of those who's only issue is being too poor to pay fees, it is broken.

It's not broken, it's operating as a business, which is how it was meant to operate. If it were a charity, you could call it broken. It is not a charity.

[Greyblades]

Yeah but thats not a valid excuse, they are a service who's main point is to keep dangerous drivers away from the steering wheel, but they are keeping people who are most likely fine drivers on public transport because they cant pay fees while the future committers of vehicular homocide get by because they have extra spending money. It's patently ridiculous for a safety based service to base any of decisions on how deep your wallet is. It's like having a monthly fee to not take away your seatbelt.

[rvg]

Yeah but thats not the point, they are a service who's main point is to keep dangerous drivers away from the steering wheel, but they are keeping people who are most likely excellent drivers on public transport because they cant pay fees while the future committers of vehicular homocide who arent poor get by. It's patently ridiculous for a safety based service to base any of decisions on how deep your wallet is. It's like a car delalership charging extra for seatbelts.

No, they are a business whose main purpose is to make money. Car insurance isn't there to prevent accidents, it's there as a financial safety net for when the accidents occur. That costs money. Thus they charge whatever they charge based on the risks they are taking as a business. A deadbeat customer is a business risk. End of story.

[Greyblades]

End of story but not end of problem, its unfair. Personally I think it should be a government based service to avoid this money grubbing but whatever.

[rvg]

its unfair. Personally I think it should be a government based service.

Yes, life is unfair. Governments make rather terrible businessmen, very wasteful and inefficient. A government based service means that those who can afford to pay for insurance will be paying for themselves and for those who can't afford to pay. That's something that is highly unlikely to pass in America.

[Greyblades]

And... What, we're supposed to stop talking because lifes unfair? To stop complaining when someone says thats how it is? This is the backroom!

[rvg]

And... What, we're supposed to stop talking because lifes unfair? This is the backroom!
That's what we've been doing so far.

[Strike For The South]

Everyone already pays, way to much

[Papewaio]

Yes, life is unfair. Governments make rather terrible businessmen, very wasteful and inefficient. A government based service means that those who can afford to pay for insurance will be paying for themselves and for those who can't afford to pay. That's something that is highly unlikely to pass in America.

So please explain how government run UHA in first world countries do it much cheaper than the US with a better end outcome ie longer lifetimes, longer independent lifespan, etc

So somehow other western nations which have a universal health care system run by government. Per capita cost is factors (x2, x3, x 4) less in cost ... So many different governments somehow do it more efficiently than purely private sector.

Australia has UHA and private health funds. We have poor lifespans for some immigrant groups, a lot of Aboroginal groups also do poorly. Obesity is on par or in excess to the US. Yet we still have lifespans on average three years longer than the US.

Invention and improvement helped make US great. Why not incorporate lessons learned in other countries?

[rvg]

So please explain how government run UHA in first world countries do it much cheaper than the US with a better end outcome ie longer lifetimes, longer independent lifespan, etc

I'm not talking about UHA, I'm talking about car insurance.

[Papewaio]

Considering how cheap cars and gas are in the US I suspect that the insurance is relatively low.

Driving a car is not a right, it is just a tool. Third party should be compulsory but regulated strongly to make sure it is not being rorted... Flip side is any non compulsory insurance should be at the buyer and sellers discretion of what value it is

The general thrust of this thread has been health and access to health care. Ones life and liberty are intertwined with ones health. Just look at how well we function when sick. Health system and it's basics should be provided by a government as part of its mandate. Optional extras should be down to the user pays system.

What is the basic level of health care? Well that is going to be determined by balancing other items such as education, military, tax rate, age demographics of the population. End of the day we live in a society so we should be able as individuals do as we please and please as we do.

What we shouldn't setup though is systems that are inefficient, and that isn't always the big is bad as assumed. Cities are large but per capita they are cheaper to setup electricity, fibre, hospitals and police for. Also companies become just as inefficient as government at large scales... Anyone who has worked with privately run telcos, software companies or hardware manufacturers will have seen meeting after meeting for little or no gain.

There is an assumption that a corporation is always more efficient. This is only true when they are made to compete and when failure is a loss in funding or worse collapse of the company. Health sector either private or public should be held accountable and be transparent on where the costs are going.

[Lemur]

Yeah, I don't understand the car analogy as dismissal of healthcare. Roads are heavily subsidized. Oil production is subsidized. We bail out automakers every now and then. Clearly we see roads and cars as a national asset, and treat them as such. But health? Pshaw.

[Papewaio]

Why not Neo-libertarian?

The best set of ideas often come when we look at combining end goals from opposite points of view.

[a completely inoffensive name]

Lol at RVG being "Dad" in this thread. Teach me more life lessons, Jedi master.

[a completely inoffensive name]

http://www.tnr.com/article/politics/102620/individual-mandate-history-affordable-care-act

Found an interesting article, Professor at Harvard Law School claims that several mandates authorized by Founding Fathers in the early Congressional sessions supports the notion that the health care mandate falls under the scope of the Constitution.

[Banquo's Ghost]

Their rates aren't that much lower than anyone else. In my case, a 23-year-old with an RX-8 (which I got used, for cash--good deal), the rates are about the same. That said, USAA is one of the few banks I trust not to screw me over with debit card fees--they re-fund all the pithy little $2 ATM fees from using non-USAA ATMs each month, which is awesome.

The RX-8 is, I think, a moderately capable mid-range sports coupé. 23 year old men as a group have a documented track record of wrapping such cars around trees, motorway barriers and pedestrians. Insurance is consequently high.

On the other hand, small engined Fords, for example, have low fuel consumption, decent reliability and running costs and low insurance costs even for 23 year old men. This allows the build up of no-claims bonuses (one assumes you have similar discounts in the US) so eventually, one has enough discount to afford to drive a powerful car.

Perhaps if you chose a car more suited to your budget, you could afford the insurance and therefore to drive? Your argument about people being priced out of the insurance market may have some validity, but is rather undermined by your choice of car.

[Banquo's Ghost]

It was used, and contains all the modern safety features found in, say, a Nissan Versa. Its also an Automatic, and far from the most sporty version on the road. The fact that I got it cheap and used throws the budget accusation out the window, although I can absolutely understand where you're coming from.

But this isn't about me. I'm a Veteran with service-connected injuries, and eventually the VA will get off its lazy hump and process my claims. I'm more or less taken care of for life, and nobody should worry about my well-being in the long-term. Its people who don't have such a leg-up that we should worry about.

Fair enough (though my note about budget was meant to highlight that the cost of a car is not just the headline price, but the whole running cost - something people often forget when purchasing). Certainly insurance is a significant barrier to many on this side of the pond too, so your point stands.

[Strike For The South]

It comes down to the fact that taxes are levied for nonsense all the time. So to say that a bit of a bite out of your paycheck for healthcare is any less constitutional than a federal grant for research on the sperm of autistic urban males between the ages of 35-38 is simply empty rhetoric.

As far as I'm concerned these people who never want to raise taxes or feel comprehensive health care is a death kneel have no place in society.

I just want to get to the point where we can start haggiling.

[Tsar Alexsandr]

Society should follow natural laws.

[Strike For The South]

And which one of the enumerable defintions would that be?

You kids need to step your game up

That statement means nothing.

[Lemur]

Interesting historical perspective (http://www.tnr.com/article/politics/102620/individual-mandate-history-affordable-care-act). Certainly shows that the founders faced the same quandaries and problems we do.

The founding fathers, it turns out, passed several mandates of their own. In 1790, the very first Congress—which incidentally included 20 framers—passed a law that included a mandate: namely, a requirement that ship owners buy medical insurance for their seamen. This law was then signed by another framer: President George Washington. That’s right, the father of our country had no difficulty imposing a health insurance mandate.

That’s not all. In 1792, a Congress with 17 framers passed another statute that required all able-bodied men to buy firearms. Yes, we used to have not only a right to bear arms, but a federal duty to buy them. Four framers voted against this bill, but the others did not, and it was also signed by Washington. Some tried to repeal this gun purchase mandate on the grounds it was too onerous, but only one framer voted to repeal it.

Six years later, in 1798, Congress addressed the problem that the employer mandate to buy medical insurance for seamen covered drugs and physician services but not hospital stays. And you know what this Congress, with five framers serving in it, did? It enacted a federal law requiring the seamen to buy hospital insurance for themselves. That’s right, Congress enacted an individual mandate requiring the purchase of health insurance. And this act was signed by another founder, President John Adams.

[Vladimir]

So we should ensure our semen and reinstitute slavery? I'll vote for that.

[Lemur]

So we should ensure our ***** and reinstitute slavery? I'll vote for that.
Yes, obviously that's what I was referencing. Yawn.

Note that the Founders instituted not one but two individual mandates. Damn them for not knowing the constitution.