Cynical Nation

Do you offer this as defense of our non-system of health care? A system where one in five has NO insurance and no regular access to health care other than through an emergency room.

I'm sorry but this is anecdotal bullshit.

This issue, and this issue alone, will bring today's conservative movement down. And if you ask me its reason enough. I won't shed a tear for the "I've got mine, fuck you" crowd!

> This issue, and this issue alone, will bring today's conservative movement down.

Bob, what in God's name does the current American health care system have to do with conservatism?

Housing, health-care, food, etc., are COMMODITIES, Bob. They are produced by some people who NEED to sell those commodities in order to earn their livings.

Anyone who considers those things “rights,” is arguing, in effect, that the producers of all those commodities could & should be enslaved for the benefit of others.

THAT is why it’s morally wrong for any American to advocate any form of government control/ownership over commerce and industry, for it is private property, in the form of both income (work wages), investments and real property (ie. real estate, etc) that are the foundation of our LIBERTY (self-ownership).

“Doing whatever I want” – THAT’S NOT FREEDOM!!! It’s, for lack of a better word, LICENSE.

Self-ownership and the ability to OWN property is FREEDOM/LIBERTY.

I’ll surrender LICENSE (“the ability to do whatever I want, so long as I don’t harm anyone else”) at a moment’s notice, but I’d kill and die for LIBERTY.

Our current Corporatist system is a lot more open than the Corporatist systems of Europe. That openess means greater opportunities and it's largely why we have an unemployment rate of 4.7% and places like France, Sweden and Germany all have double digit unemployment rates.

It also accounts for a much fairer distribution of income. Ours is virtually a Bell Curve with some 59% earning between $30,000/year and $100,000/year, 18% earning over $100,000/year and 23% earning under $30,000/year. A classic Bell Curve is a 20-60-20 split.

Upwards of 40% of those earing less than $30,000/year work in part-time and per diem jobs. Many of them stdents and the elderly looking to earn some extra income.

Almost NONE of those part-time & per diem jobs come with health care, so that's almost half of the 20% of our uninsured. Another 12 million (about 5% of our workforce) are illegal immigrants who would NOT be eligible for ANY kind of Universal Health Care due to their illegal status.

Still, if anything, our current health care system is a mess precisely (compared to what it once was) because of TOO MUCH government involvement.

Without government insurance (Medicaid & Medicare, etc) and other forms of insurance that mask the actual costs of health care, medical care would actually cost much less, minus all those layers of bureaucracy.

Moreover, a physician is a plumber, is a carpenter. An artisan (skilled tradesman) can only charge what the market will bear...more aptly, what HIS market will bear.

A “builder to the stars” may be abe to charge exorbitantly high rates, but a builder of middle class homes can only charge what the market in that given area dictates, it’s the same with doctors.

As I carefully explained to Jill earlier, "profit" is so much more than just a dirty word.

“The increasing control over American health by the "bean counters" at both the insurance companies and the HMOs have eroded the viability/PROFITABILITY of health care.

When doctors can no longer earn the remuneration their skills warrant because of increased Malpractice premiums amidst shrinking payouts from health insurers and HMOs, many simply choose to move to other career choices.

“Tens of thousands of doctors have left medicine in recent years because of just such reasons.

“Kind of puts the LIE to the "health care is a RIGHT," viewpoint, doesn't it?

“You see?

“Say person-X is a trained physician, a gifted heart surgeon, at that and the country desperately NEEDS heart surgeons, but the government over-regulates health care to such an extent that person-X can no longer make the $500,000/year (post expenses) or more for his services he used to, but now makes less than half that - what is person-X to do?

“Well, if person-X is a bright person, as anyone who gets through Medical School probably is, then person-X will most likely look for a career choice that will maintain the highest quality lifestyle that person's skills can attain. Some will move into other forms of medicine, like plastic surgery, or internal diagnostics, where Malpractice Premiums may be lower, to some form of health care consulting, or even to other fields, like finance, etc.

Now THAT'S LIBERTY/SELF-OWNERSHIP in action!

Now a person who doesn't understand what LIBERTY is and why it's so important may naively (and sarcastically) ask, "So, the "good doctor" is just going to go out and earn more money and simply leave all those who desperately need heart surgery in the lurch?"

“EXACTLY RIGHT!

“And why not?

“Person-X has an inalienable (God-given) RIGHT to do what he/she wants with his/her life.

“We, the people DON'T have A RIGHT (God-given, or otherwise) to cost-effective, quality heart surgery, or ANY other medical procedures, for that matter.

“You and I cannot have a "RIGHT" to a commodity, produced by others without first championing "the people's right," or thereby, the government's right to Chattel Slavery over the producers.

“And since we can't give to government any powers we do not ourselves possess, we cannot give the government the right to enslave others for our own benefit.

“See? Anyone who'd support a government forcing person-X into continuing to be a heart surgeon no matter what, obviously believes in Chattel Slavery, no different than those who fought for the right of some to keep black slaves, over a century ago.

“So OUR government COULD NOT force person-X to remain a heart surgeon because of that silly little thing called "The Bill of Rights" (the first Ten Amendments to the U.S. Constitution). The U.S. government could only try and make inducements or provide incentives, like, for instance, "Heart surgeons pay no federal income tax," and "The taxpayers will pay a portion of their Malpractice Insurance," things like that...BUT such things, AGAIN, only wind up masking the real price/cost of health care and provides a "benefits imbalance" that would seem to violate the right to equal protection under the law to all people, as some people (those needing heart surgery, in this instance) would benefit greatly from this added overall cost and many (all those who never need heart surgery) would not benefit at all.

“We really need is a return to some form of Market-based health care.”

>Bob, what in God's name does the current American health care system have to do with conservatism?

Come on Barry, this is the system the Right defends as the best health care system in the world.

Well, I sick of hearing it, it's total bullshit. This country has the worst health care system in the Western World. They use anecdotal examples of what's wrong with the British system and the Canadian system, etc. to defend the crap we have.

Bob, far be it for me to speak for all conservatives. I think our current system has a lot of shortcomings. So does everyone else's. I think there's much room for improvement in our system. I'm just waiting for a proposed "remedy" that won't make it worse.

Let me ask you a question. My primary objection to our system is the same objection I have to the other (mostly European) systems you're so enamored of -- lack of market forces, and insulation from the law of supply and demand.

Now I don't know how to fix it, but to me, the ideal plan should include the following proviso: Everyone should have to pay some fee, no matter how nominal, for every doctor's office visit. It's okay if it's only a buck, but patients should have to pay something out of pocket if at all possible. Moreover, their payment should be at least somewhat in proportion to services rendered.

What do you say? Could you ever sign off on a plan that contained such a provision?

JMK, I know you’re sincere in your belief that market forces will ultimately bring about the greatest good for the greatest number of people. But I also know you’re wrong. A pure market system is a system driven by nothing but greed. Oh, don’t get me wrong, it’s fine to be rich and it’s fine to make a profit, but it’s not fine to do it at the expense of the weakest among us.

Capitalism needs to be tempered by a good dose of socialism.

If we live in the richest country in the history of the world, why do we have so much poverty? If we live in the country with the best health care in the history of the world, why do so many using emergency rooms as their source of health care?

It’s stupid, it’s inefficient, and it’s just wrong.

Bob, JMK, I have a question for both of you -- where are the "market forces" in contemporary American health care? You guys seems to be arguing over their pros and cons, but frankly, I don't see them at all.

>I have a question for both of you -- where are the "market forces" in contemporary American health care? You guys seems to be arguing over their pros and cons, but frankly, I don't see them at all.

Look no further than Medicare Part D. A system designed by the big Pharms for the benefit of the big Pharms. You see the big Pharms give the Republicans big bucks in donations and they get back whatever the hell they want. Market forces at work; ain’t it beautiful?

So in other words, you don't see them either. ;-)

>So in other words, you don't see them either. ;-)

Actually what I'm saying is they don't work.

What you've described is a massive, trillion-dollar government intervention into the health care industry. Not exactly what I'd call "free market" health care, Bob.

Barry, if European health care is so bad why do they enjoy longer life expectancies and lower infant mortality? And despite what some on the Right might say I don’t see a whole lot of Europeans coming here for our health care.

I really don't think market forces alone will give us a better system.

For my part Barry, I DON'T believe there are many (if ANY) market forces at work in contemporary American health care.

As I said, "...if anything, our current health care system is a mess (compared to what it once was) precisely because of TOO MUCH government involvement.

"Without government insurance (Medicaid & Medicare, etc) and other forms of insurance that mask the actual costs of health care, medical care would actually cost much less, minus all those layers of bureaucracy.

"Moreover, a physician is a plumber, is a carpenter, in that an artisan (a skilled tradesman) can only charge what the market will bear...more aptly, what HIS market will bear.

"A “builder to the stars” may be abe to charge exorbitantly high rates, but a builder of middle class homes can only charge what the market in that given area dictates, it’s the same with doctors..."

Without the layers of expensive bureaucracy adding to the cost, our health care would cost a LOT less.

If physicians had to charge what the market would bear (sans insurance), or be left unable to make a living, then they'd be charging what their particular market would bear...no question about that.

They are, bottomline, skilled artisans with a specialized skill to sell. The AMA has been very successful at limiting the number of physicians U.S. Medical Schools graduate each year and thus limiting access to that portion of the market.

The AMA is as meanspirited a Labor Union as were the Teamsters under Jimmy Hoffa.

> Barry, if European health care is so bad why do they enjoy longer life expectancies and lower infant mortality?
We've been through all this before.

And despite what some on the Right might say I don’t see a whole lot of Europeans coming here for our health care.
It's a pretty long haul. If we shared a border with them, as with Canada, it may be a different story.

But again, you're knocking down straw men. I've repeatedly said to you that I think our health care system is hosed. You keep talking as if I'm holding it up as some kind of Platonic ideal, and I'm not.

I really don't think market forces alone will give us a better system.
Well, I think that will forever remain a completely theoretical question, Bob. Whatever my preferences may be, I've long ago acceded to the reality of significant government involvement in our health care.

Still, I think introducing *some* market forces could be very helpful in controlling costs and improving efficiency.

You never answered my question. Would you be willing to accept a system that required all but the most destitute of patients to pay a nominal, out-of-pocket fee? Even a token one?

More broadly, are you interested in trying to find a truly innovative reform for our system over here, or do you merely want to copy the European model?

"JMK, I know you’re sincere in your belief that market forces will ultimately bring about the greatest good for the greatest number of people. But I also know you’re wrong. A pure market system is a system driven by nothing but greed. Oh, don’t get me wrong, it’s fine to be rich and it’s fine to make a profit, but it’s not fine to do it at the expense of the weakest among us.

Capitalism needs to be tempered by a good dose of socialism...." (Bob)

I know you don't want to see it Bob, but it’s market forces that have brought electronics prices down, made the airline industry so much more competitive and "consumer friendly." In every sector where market forces prevail things are better for consumers and in every realm where government run enterprises deliver services, conditions, especially for the consumer, are terrible.

Virtually every "government run service" is a disaster when compared to privately run competitors. There's no comparison between the USPS and Fedex or UPS. That's why the vast majority of businesses use Fedex, UPS, or even DHL for small packages.

The old joke about the Postal Service still stands, “What’s passes for increased efficiency at the Post Office?

"No Saturday deliveries.”

Private concerns don’t think, or act that way. They increase pressure on their workers to deliver more and better service to the CUSTOMER at a better price. THAT’S why private industry not only works better, but IS better for all involved, as not all of us are “workers” (some people live entirely off their investments), but we are ALL consumers.

How bad is government run enterprise?

How about the DMV?

Or how about "public mis-Education?"

Well, what about privately held monopolies?

Well, what about them?

In actuality, they don't exist! There has NEVER been a true "monopoly" without government support and protection. In fact, an actual "monopoly" cannot exist in a truly free market, one without government intervention, because without government protection the larger, slow moving behemoth would slowly loose small shares of its empire to smaller, faster, regional competitors.

People who deride the free market generally don't understand the free market.

If you want to get an idea of a government run enterprise, think of the IRS, or think about our failing public schools...hell, think about ANY government run social program that seeks to trap its recipients in a web of lifelong dependency.

As far as the current drug plan fiasco goes, you can't blame giant pharmaceutical companies for trying to get a prescription drug program designed to benefit themselves.

The only thing that could possibly be any worse would be one designed to truly give away prescription drugs for free...one that would truly harm these great and innovative companies and cause them to lay off tens of thousands of dedicated employees who want nothing more than to create new drugs and ward of diseases...and get paid handsomely for their great efforts.

To me, the whole idea of a federalized prescription drug program is insane and anti-market, and the ONLY way such a program CAN be created is with the direct input of the drug companies.

Moreover, there is NO SUCH THING as “socialized medicine” or “universal health care” WITHOUT health care RATIONING.

It’s the only way around the all too obvious problem called “the tragedy of the commons.” When any commodity is purportedly given away for free (in actuality NOTHING is EVER FREE, as the recipients pay for their “free stuff” either via either hidden fees, or in government's case, ever higher taxation) there is always a huge upsurge in demand, since there are no upfront costs and everyone wants to get “their money’s worth – just like free beer at a picnic. It's simply human nature at work.

The inevitable result is a hard cap on demand via clear-cut rationing. Those over a certain age are no longer able to get certain kinds of procedures, which are reserved for those with a “greater return” (more statistical life left to them), or those deemed to be “lower risk.”

No one is going to deny the ineluctable fact that ALL “free stuff” is rationed any more than I expect anyone to even try and mount an argument in favor of “the efficiency and effectiveness of government enterprise.”

"I really don't think market forces alone will give us a better system." (Bob)

Based on what?!

We don't have a market based health care system here.

When doctors made house calls and America's health care was the best in the world, the first part of the 20th Century, it was because there was far less government involvement and far more market forces at work.

I'd think the evidence points to the strong likelihood that more government involvement = less efficient and effective health care.

>But again, you're knocking down straw men.

It's late and I'm tired. They're the only kind I can knock down right now.

>You never answered my question. Would you be willing to accept a system that required all but the most destitute of patients to pay a nominal, out-of-pocket fee? Even a token one?

I totally agree with you. In fact it should be more than just a token co-pay. It should be high enough to discourage abuse but low enough to allow people seek help when they really need it. No one should become bankrupt because they’re sick

>How bad is government run enterprise? How about the DMV?

How about the military?

>Moreover, there is NO SUCH THING as “socialized medicine” or “universal health care” WITHOUT health care RATIONING.

And what we have now provides us with unlimited health care? The rationing argument is s tired one.

Everything in our society is finite in one way or another. What we have now is rationing by wealth.

>"I really don't think market forces alone will give us a better system." (Bob) Based on what?!

Unfettered capitalism leads to abuse of the poor and the working class. Who will look out for them if the government won't? Market forces? Don't bet on it.

"How bad is government run enterprise? How about the DMV?" (JMK)

"How about the military?" (Bob)

The Military isn't a particularly good business model Bob. After all, killing people and breaking things ("advanced demolition") isn't much of a marketable commodity.

I'll agree that there are virtually no private enterprises that are near as good as the government when it comes to enforcement (Policing) and advanced demoltion (the Military).

When we use our Military in non-Military projects (such as "nation-building" and delivering food to ravaged areas) they aren't nearly as efficient. It's not what they're trained to do and those tend to be things that government doesn't have a particularly good track record in.

"You never answered my question. Would you be willing to accept a system that required all but the most destitute of patients to pay a nominal, out-of-pocket fee? Even a token one?" (Barry)

"I totally agree with you. In fact it should be more than just a token co-pay. It should be high enough to discourage abuse but low enough to allow people seek help when they really need it. No one should become bankrupt because they’re sick." (Bob)

The system you describe here, is still the one you've attacked here in these comments as well, Bob.

Of course any system in which we try and find that magic number that is "high enough to discourage abuse but low enough to allow people seek help when they really need it," will still "ration by wealth," in your words. As such a number will be no barrier to those with higher incomes or greater wealth and huge barriers to those with little.

You argue as though it is somehow wrong that some skills are valued and rewarded far more than others, when that can't be so, as it's the market that rewards or values some very rare and hard to master skills highly and other more common and abundant ones meagerly...and it's vital the market does that, or else we'd have a nation of doormen and secretarys, because when all skills are valued pretty close to the same, people tend to "conserve personal energy," by taking those jobs that pay well, while being less time and labor intensive.

As it stands now, you can have two people earning pretty much the same income and one may live a very good lifestyle by following certain rules, like living below ones means while young, in order to acrue more investment capital, sticking to fairly strict personal budgets and not relying on credit for much more than housing, etc.

A system that seeks to benignly "help" the more profligate of the two, unwittingly punishes the more disciplined one, the one who sacrificed and planned for a better quality of life.

The primary problem with Socialism (even more primary then "the tragedy of the commons," which can never be overcome) is that it is an ideology based on an utterly simplistic worldview that sympathizes with the profligate, the epicurean (over-indulgers)and those who do not or cannot develop competitive marketable skills, by treating them as "victims of society," rather than what they really are - parasites.

"Unfettered capitalism leads to abuse of the poor and the working class. Who will look out for them if the government won't? Market forces? Don't bet on it." (Bob)

The "unfettered capitalism" cliché is more true of "unfettered government action," in fact; I'd say it is even far more true of a would-be BENEVOLENT government, than even a tyrannical and oppressive one, as more evil has been perpetrated in the name of simplistic "good intentions" than anything else.

I believe that's why every one of America's Founders had that healthy abject fear of government action and sought to rightfully restrain it at every turn with the Bill of Rights.

Still, an "unfettered form of Capitalism" isn't what was proposed here.

I'd still begrudgingly leave the AMA in place, though a much defanged one, along with some governmental oversight. I've suggested only removing the thick and costly layers of governmental and insurance bureaucracies that run up the costs of health care and return to a more market-based pay-as-you-go" form of health care, in which physicians would NEVER seek to charge "more than what their markets would bear."

Why would they?

They NEED to make a living just as everyone else does and they could only do that, in such a system, if they priced their skills and services at market-based prices.

>The system you describe here, is still the one you've attacked here in these comments as well, Bob. (JMK)

No, you're wrong. The BIG difference is I want to make sure everyone has access to health care. Not this ER as a substitute for real care bullshit.

"No, you're wrong. The BIG difference is I want to make sure everyone has access to health care. Not this ER as a substitute for real care bullshit." (Bob)

As I said, "any system in which we try and find that magic number that is "high enough to discourage abuse but low enough to allow people seek help when they really need it," will still "ration by wealth," in your words. As such a number will be no barrier to those with higher incomes or greater wealth and huge barriers to those with little."

The only way to make sure everyone has equal access to health care without our current over-dependence on government involvement and various insurances masking the REAL costs, or worse yet, having government run/manage all health care, would be to set up some form of "sliding scale" - ie. those earning under $30,000/year pay a $25/visit, those earning between $30,000 & $50,000 paying $40/visit, those earning $100,000 to $150,000 $100/visit, and so on.

Why not charge people varying prices based on income range on EVERYTHING from a gallon of milk to their electric bills?

The problem, the error in that is that it's a reverse way of attempting to "equalize incomes" and equalizing incomes/living conditions is ALWAYS wrong and most often nefarious in intent as well.

Here's why; those who possess those skills that are more rare and harder to master must be given incentives to develop and apply those skills.

After all, if a heart surgeon could enjoy the same lifestyle without all that long, laborious education, the long hours, the intense pressure of having someone else's life in your hands and all the continuing education required to keep current in that field, by say, becoming a construction worker or an English teacher...well, any sensible person would take the easier/latter path.

On my block there is a plastic surgeon who'd bought an old Tudor styled home. When he bought it, a few years ago, it had to run close to a million bucks.

He wasn't as fortunate as I, who'd bought quite awhile ago...but his earning power seems to have more than made up for that.

He took that already large home, with lots of property (very rare on SI) and he's blown the place out to the point where I'd bet it would now have to be a $3 to $5 million home.

I've heard some people in the area complain about his "ostentation" (whatever the f&^k that is) and act as though this guy didn't have the right to do what he's done.

I really don't get that!

Does this doctor's rare skills make him more valuable than almost anyone else on that block?

Yes, in a material sense, yes they do.

Does his skills really warrant the degree of wealth that gives him access to much better housing, better cars, better food, access to better accountants, lawyers and doctors than most people can afford? In short, due largely to his rare and in high demand skill set alone, does he deserve a better quality of life - a life that will not only be more comfortable, but probably longer and healthier than most other folks?

I'd say YES. That's what the incentives built into the Capitalist system do.

Those who argue in favor of some degree of income redistribution tend, not only to be motivated by greed (jealousy over another's success), but are short-sighted as well.

Without these market-based incentives, there'd be no one who'd develop and apply rare and hard to master skills. Why would they bother?