There is of course a very fallacious thing we keep hearing from AG. He rails off that that a benevolent democracy will make decisions. This is utterly specious nonsense. No such thing will happen because no such thing is possible. To state believe otherwise is disingenuous or simply ignorant. 

In no instance is socialized medicine actually democratic. The decision to implement it in the first place may well but, but it stops there. Beyond that the actual authority is delegated to someone. Much like we don't live in an actual democracy (owing to the impracticality of such a political arrangement in large populations), we cannot make a complicated system, such as health care a democratic process. You cannot have everyone vote on each and every decision. So, you say I'm merely playing games with syntax. The elected representatives make these choices, since we live in representative democracies. Again this is false. Still health care is too complicated a system for the politicians to make the decisions on, even at the basic level of setting things up. At best they provide a broad outline and then bureaucrats will  make the actual decisions, while being prodded every soften often by politicians.

 

How to politicians work? They respond to squeaky wheels. Does anyone happen to be dumb enough to think that the sugar industry protections we have are helpful? (well maybe FJV...) Does anyone believe that the TVA still needs to exist? Politics works inefficiently because it has a twisted set of incentives. Small minorities with a great interest can often pull off political coups which are against the interest of the majority (above examples are a small number from a large set). As such, when you give more and more power to politicians, you are unlikely to really get the outcome you desire, and unintended consequences are the most likely outcome.

 

A further set of twisted incentives is for the bureaucrat. They function in a world of incentives alien to most people outside their sphere. A bureaucrat's best path is to avoid rocking the boat, play CYA, and listen to politicians, and their loud supporters. This doesn't, however, usually include providing the best service they can. It also has nothing whatsoever to do with actually being efficient.  Their job is guaranteed by law, and the people who write the laws are not the customers, but the politicians.

 

 But now that we've addressed the odd incentives I'll get back to the non-democratic nature of socialized medicine (or anything socialized for that matter). Once you have handed over control of your choices in health care to the government, you no longer have a choice. Yes, you get to vote every so often, but when the bureaucrat decides that your cancer isn't worth treating, that vote two years from now looks pretty lacking as a choice.

 

 Remember, it's that bureaucrat making the choice. He decides what gets funded and what doesn't. He decides who gets treated, and who doesn't (think politically favored classes won't get better treatment? Well I do have this bridge to sell you). He decides what medical research is worth pursuing, and how many doctors we should have, and how many diagnostic machines we should have, and etc. The buck does stop somewhere and that most likely will be with some unelected faceless government employee who is unaccountable and indifferent.

 

That's where your kind and benevolent democratic choice leaves the decision. Don't continue blowing smoke up our posteriors with the load of nonsense you are selling about democratic choice. Ultimately you have decided that you trust a bureaucrat to make our decisions for us more than us. You've decided that the common citizen is too much of a dunce, so some 'wise man' can instead make those life and death decisions for us. I

 

Well for me, I will say take your power grab and stuff it. 

As for your first sentence:  Exactly!  Hiding how much of a Fabian socialist he is is precisely the goal of his premeditated maskirovka/information operation campaign.

 

As for the rest, I didn't realize that this was a point you were trying to make.  I've already "dealt with it" decades ago.  Been there, done that, so what?  The fact that the majority of Americans demonstrated their foolishness last November does not change the truth in the slightest.  Americanism is still Americanism, regardless of how many Americans still understand or agree with it.  You "deal with it" (whatever you think that is supposed to mean).

 

 

The question that I would ask you about your cynical view of democracy is what alternative are you proposing which will work and which ensure what you consider to be freedom? A US-style constitutional republic clearly doesn't do this as demonstrated by these ongoing discussions. When a majority holds a different view from Buzzard and Warpig's "traditional americanism" its representatives just play the system to get the outcomes that they want, in effect achieving  democratic outcomes anyway but in a less efficient and more divisive manner. Short of taking up arms against these "oppressors", which despite all the bluster and putting aside the occasional fruit loop like McVeigh will never happen because American's are generally too well off to risk their lives in a civil war, there is bugger all that those who subscribe to "traditional americanism" can do other than to engage in the democratic process themselves. Isn't this acknowledge by default that a democratic process is the best way to make our decisions collective decisions, including those collective decisions to protect individual freedom?

 

The only other alternative is for a country to be led by some sort of benevolent dictator or authoritarian regime whose agenda is to use dictatorial powers to protect individual liberty. Does that sound like an oxymoron to you because it certainly does to me! Hugo, your country has a reasonably recent history of authoratarian regimes (I'm not attempting to take a cheap shot, I'm just using the facts to demonstrate the point). Was Germany's experience that those in charge were the sort of people who were principally concerned with protecting individual liberty? I don't think so. How do you think Germany is going now that it is a democracy. Better than it was perhaps?

 

I'd also strongly suggest that you gents are only looking at the potential downsides of what goes on in representative democracies. It is true that populations have a lack of knowledge about economics and government, that politicians have a short-term incentive to respond to loud interest groups and that bureaucrats have incentives to kiss arse, and ignore the real issues. I see this happening every day in my work and it frustrates the hell out of me. However, there are also instances where populations elect leaders who are willing to make the hard decisions for the long-term interests of their countries and who have the necessary skills to make this happen. I'd also have to say that despite the perverse incentives there are many very talented buereucrats whom I work with who are doing the job that they do because they want to contribute to a better outcome for Australians, and who will co-operate with inspired political leaders in order to make it happen. You don't see this from the outside, but if you think about the economic reforms that leaders like Reagan achieved you will realise that there had to be good support from their officials to succeed. This is simply because of the fact that Buzzard pointed out that politicians can't be across enough detail of implementing a policy to do it themselves.

 

Specifically with respect to Buzzard's points about government officials making your healthcare decisions for you, I'd point out that this needn't be the case in a universal healthcare system which mandates the purchase of a minimum level of insurance coverage but which allows you to choose which company you buy it from. Beyond the broad requirements of what must be included in any plan, which would be decided through the political process, the rest is between you and your health insurance company. Personally though the course of these discussions I've come to the conclusion that this form of minimalist universal healthcare policy which maximises personal choice would be the one that I would prefer in Australia, whilst acknowledging  that our current system works pretty well.

 

 Now I am confused. For a while now I've advocated the McCain plan which said the above. A minimal PRIVATE plan is required (not that I like mandates, but there's a logic here, and the mandate should only be for catastrophic insurance, which should be pretty cheap since it won't be loaded down with fluff). Though I do disagree that the political process should decide what is to be in insurance plans. That has lead to some horrible insurance situations in places like NJ and Mass where rent seekers have managed to lard up the insurance plans with all manner of specialized coverage that not everyone is likely to need. A set of minimal standards (high deductible, catastrophic coverage) would be optimal with people having the ability to buy more elaborate plans if their inclinations and means allow. 

 

Though I should make clear of my opinion of democracy:

 

 

 

He had it right. Te be quite honest, limited government is the important thing to have if freedom is the goal. The basis of the political system is in many ways less important than having a set of rules which explicitly limit the scope of government and the rule of law. If such a thing were possible or likely, a benevolent dictatorship or monarchy following the above constraints might well work nicely. However human nature is such that I doubt such a thing would occur (power corrups, etc). As such democracy tends to be the best option at that level. However it can be just as corrupt as other options when it jumps the track by ignoring the rule of law and growing government too large.

Now I am confused. For a while now I've advocated the McCain plan which said the above. A minimal PRIVATE plan is required (not that I like mandates, but there's a logic here, and the mandate should only be for catastrophic insurance, which should be pretty cheap since it won't be loaded down with fluff). Though I do disagree that the political process should decide what is to be in insurance plans. That has lead to some horrible insurance situations in places like NJ and Mass where rent seekers have managed to lard up the insurance plans with all manner of specialized coverage that not everyone is likely to need. A set of minimal standards (high deductible, catastrophic coverage) would be optimal with people having the ability to buy more elaborate plans if their inclinations and means allow. 

There are some aspects of McCain's plan that I liked, getting rid of the employer tax subsidies and leaving the purchasing decision being the chief amongst these. I thought I'd already said that somewhere amongst all these threads. The key problem with McCains plan is that it wasn't universal as it didn't involve mandatory health insurance. I've been thinking about this quite a bit and it occurred to me that while people don't like the idea of being told that they have to buy insurance, the mandatory requirement probably wouldn't affect many people in practice as most people have insurance anyway. Most of those who don't probably would if they could afford it or if they weren't covered by Medicare, so it is really just an argument against the principle of government compulsion rather than something that has a practical consequence. The only people who would be compelled to buy something when they didn't want to would be people who are wealthy enough to self insure and those who are irresponsible gamblers who would expect their sorry arses to be saved at the hospitals expense if they got badly sick or injured. The former group should be allowed to be exempt based on an income/assets test and to the later group I'd say bad luck, you are buying health insurance whether you like it or not. So in short, I'd say McCains plain would have started to look acceptable if it involved a mandatory requirement.

 

Ideally I would probably do it a bit differently though. I'd like to see a plan that mandates coverage for catastrophic, chronic, basic primary healthcare (principally regular medical checkups and proceedures like pap smears , cholesterol checks etc) and medicines, with a low priority elective proceedure feature. This would mean that the fund is only required to fund so many elective proceedures of a type per year and that people with the basic coverage would wait until a spot becomes available unless they pay extra to be treated more quickly. That gives the reasonable standard of care that they need while providing an incentive for them to reach into their own pockets for quicker elective treatment. I'd get rid of taxpayer funding altogether for everybody but people below a certain income threshold or those with a healthcare or age status which precludes affordable insurance and pay the savings back through personal tax cuts, as this would promote economic efficiency. I would definately allow funds to trade nationwide and would allow health insurers to bargain collectively with drug/equipment companies and professional cartels to redress their market power and keep prices down. I would also require that funds accept patients with pre-existing conditions, though the taxpayer subsidies for the poor/chronically sick would probably mean that this would be less of a problem for them.

 

He had it right. Te be quite honest, limited government is the important thing to have if freedom is the goal. The basis of the political system is in many ways less important than having a set of rules which explicitly limit the scope of government and the rule of law. If such a thing were possible or likely, a benevolent dictatorship or monarchy following the above constraints might well work nicely. However human nature is such that I doubt such a thing would occur (power corrups, etc). As such democracy tends to be the best option at that level. However it can be just as corrupt as other options when it jumps the track by ignoring the rule of law and growing government too large.

Yes, it was one of the better quotes in political history. Like I said before, I know democracy isn't perfect for the reasons that you state, but it has a self-correcting feature in that if everything is completely screwed up by the current government can kick them out and try something new. What's more under those circumstances they tend to be a bit more accepting of hard decisions when they are needed, than they otherwise would have be

 

ps, sorry about the couple of missing words but I think you can understand what I was saying.

Government health care has been the Holy Grail of the Democratic Party's domestic agenda since the 1930's. The desire for it has nothing to do with analysis or need. The cultural elites in this country want it like the Muslim world wanted to conquer  Rome (Constantinople at the time) from the 8th century until the 15th century when they finally got it. 

 

Employer provided health care insurance started in World War II. The war economy had strict wage and price controls. Companies could not compete with wages, but they could compete with benefits like health insurance. Sixty years later, it has become a millstone around business necks. It is regulated by an incredible warren of arcane US, state and local laws. It is hugely expensive. American business would like to be rid of it.    

The US populace, on the other hand, is generally satisfied with its health care (up to 85% expressing satisfaction with the care they are already receiving). It does not see health care as a crisis. It tends to view a health care overhaul as a hugely expensive detour from the pressing issues that the country does face. The more that Democratic Party health care initiatives are presented, the less support they have.

 

 The Democratic Party has overwhelming majorities in both Houses of Congress. As far as power is concerned, the Republican Party is only useful as a foil for the Democratic majorities; someone to blame their own difficulties on. The Democrats could pass their health care overhaul overnight, if they wanted to. The fact of the matter is: they don't want to. They know it is hugely unpopular. They know passing it will cost many of them their jobs, perhaps enough to overturn their majorities.  That is why they are twisting and squirming; trying to blame nefarious Republicans its failure, or find a plausibly deniable way of passing some vaguely defined "reform" bill.

 

And that is, "What the US healthcare debate is really about." 

 

 

 

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You're right, point taken. None of the bills the Democrats are proposing, however, is anything other than a total remake of the US health care industry. Not only that, but the Democrats have blocked bills that proposed incremental changes to address gaps in the current system.