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Subject: What the US Healthcare debate is really about
Aussiegunneragain    9/14/2009 6:05:16 AM
Dreading getting sick not healthy Andrew Sullivan | September 14, 2009 Article from: The Australian THERE are many valid criticisms to be made of US healthcare, but let me tell a story that helps explain its strengths. Only 15 years ago, the retrovirus HIV was killing thousands in the US - six times as many young Americans have died of AIDS as died in Vietnam -- and researchers had never found a way to stop such a sophisticated and constantly evolving organism from burying itself in people's immune systems and slowly destroying them. I was told in 1993 that I had a few years to live. I write this 16 years later with a stronger immune system than I have ever measured before. The US's much-maligned healthcare system did this. Without this vast and free market in medical care and pharmaceuticals, without the potential for making large amounts of money from affluent and insured patients, the innovation of treatments would never have occurred at the pace it did. Yes, publicly funded research was also vital - but it is rightly restricted to basic science, not finessing drugs for humans. Now we have dozens of anti-HIV drugs, from private companies competing with each other, and my life is saved. How do I put a price on that? Here's the catch. This miraculous process was possible for me only because I had insurance through my employer. When I quit my job editing The New Republic, in part to grapple with HIV's toll, my employer compassionately allowed me to stay on staff at a low salary solely to protect me from going without insurance at all. You see: once without insurance in America, I would never have been able to get it again. I would have had a "pre-existing condition" and no insurance company would have accepted me. An uninsured freelancer with HIV had one option if he were to survive - heading fast into personal bankruptcy. If I had finally lost everything, I would then have been able to apply for public assistance. Losing everything you have ever had to prevent your own death was nearly my fate. It is the fate of many in the US - not the very poor, who are helped, however badly and expensively, in hospital emergency rooms - but the working middle classes who lose their healthcare soon after they lose their job. It is this that is at the centre of Barack Obama's proposals for reform. Yes, finding a way to control soaring costs is essential, and Obama's final compromise bill, especially if it is without an option for an affordable publicly provided plan, doesn't do nearly enough. Nonetheless, what the President was really selling last week was a little more middle-class security. And that was why it was more politically lethal, I suspect, than the pundit class has yet to absorb. Some see the potency of this move. Back in 1993, when the Clintons proposed a much more ambitious plan, Republican strategist Bill Kristol wrote a famous memo arguing that the Right should not negotiate or propose an alternative but should simply do all it could to kill the bill. In it, he shrewdly homed in on the danger as he saw it: "The long-term political effects of a successful Clinton healthcare bill will be even worse - much worse (than its medical consequences). It will re-legitimise middle-class dependency for 'security' on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government." I understand this sentiment and, given my libertarian leanings, tend to resist government intervention when it is unnecessary. I opposed the Clinton plan as too centrally dictated and bureaucratic. In an ideal world, I'd like to scrap the US system entirely, sever the connection between employment and health insurance, allow individuals to buy insurance from competing healthcare exchanges, and leave the rest to fee-for-service medicine. But it is a political fact that this won't happen in America. Obama's speech last week was therefore directed at people like me: suspicious of change and government, but aware the system is both inefficient and at some point cruel, even immoral. He played the Burkean card: "I believe it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch." He dangled the prospect of relief: "As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick, or water it down when you need it most." And here's the best pitch for universal healthcare to conservatives in a long time: "That large-heartedness - that concern and regard for the plight of others - is not a partisan feeling. It is not a Republican or a Democratic feeling. It, too, is part of the American character." This patriotic appeal was the real import o
 
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xylene       9/19/2009 10:19:12 PM
I am starting to actively oppose Obama's health care reform but for different reasons than others. What I am deeply disturbed by is the mandatory coverage requirement. I find this to be unprecidented for two reasons. One without government option it would be a legal requirement to purchase a service from a private company. That goes beyond facsim in that even under facists all the businesses may be party owned but citizens are not required to buy under penalty of fines or imprisonment. The 2nd issue is even if a government option is available, this would essentially be a tax for being alive. Some equate it to car insurance, that is wrong. It is not legal requirement to own a car. In Obama's plan the only way not to be subject to this "tax" would be to commit suicide.
 
 
 
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CJH       9/19/2009 11:03:43 PM

I am starting to actively oppose Obama's health care reform but for different reasons than others. What I am deeply disturbed by is the mandatory coverage requirement. I find this to be unprecidented for two reasons. One without government option it would be a legal requirement to purchase a service from a private company. That goes beyond facsim in that even under facists all the businesses may be party owned but citizens are not required to buy under penalty of fines or imprisonment. The 2nd issue is even if a government option is available, this would essentially be a tax for being alive. Some equate it to car insurance, that is wrong. It is not legal requirement to own a car. In Obama's plan the only way not to be subject to this "tax" would be to commit suicide.

 

 


Your reason is not that different. They want power. That power will be at least in part that derived from controlling the wealth involved. Your ontological tax is an example of controlling wealth.
Controlling wealth derived from taxing people is controlling that part of their working lives devoted to earning the wealth that goes for that taxation.
 
Controlling people's working lives is slavery. It is a slavery of lesser degree than that of chattel slavery but it is slavery in kind nevertheless.
 
When the government runs healthcare, it owns the people.
 
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sentinel28a       9/20/2009 7:48:55 PM

"I am just advocating that there should be a safety net to catch those who for one reason or another don't have health insurance, to prevent them from dying unnecessarily."

 

Well sir...arguing that the government should prevent unnecessary death is crazy...Why not pass a law making unnecessary death illegal?


 

arguing that the government should prevent unnecessary death could be  for nefarious reasons, why on earth would you start with the unnecessary deaths caused by lack of insurance when many times that die with insurance?



I am reminded of that old "Kentucky Fried Movie" skit...
 
"Despite years and millions of dollars worth of research, dying is still the leading cause of death in America."
 
 
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Aussiegunneragain    Xylene   9/21/2009 7:01:13 AM

I am starting to actively oppose Obama's health care reform but for different reasons than others. What I am deeply disturbed by is the mandatory coverage requirement. I find this to be unprecidented for two reasons. One without government option it would be a legal requirement to purchase a service from a private company. That goes beyond facsim in that even under facists all the businesses may be party owned but citizens are not required to buy under penalty of fines or imprisonment. The 2nd issue is even if a government option is available, this would essentially be a tax for being alive. Some equate it to car insurance, that is wrong. It is not legal requirement to own a car. In Obama's plan the only way not to be subject to this "tax" would be to commit suicide.  



I remind you that payment for emergency medical care is already socialised in your country. If you turn up to a hospital with a condition requiring emergency care it is illegal for that hospital to turn you away without care, irrespective of your insurance status or your bank balance. If you cannot pay and are not covered by a government program then the hospital wears the cost which is then distributed to all its other patients. Mandatory health insurance and/or a government run option is just a  more efficient and humane way of dealing with an existing social contract which is implicitly accepted in the United States.
 
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Hugo    AG   9/21/2009 7:07:47 AM
 

Our local libertarian party draws its influences both classical liberal scholars like Adam Smith and Austrian School economists like Hayak. Both schools of thought advocate less government, the Austrian school was just 150 years more up to date, so I don't think that you can really make that much of a distinction between a libertarian and a classical liberal upon that basis. In any case Australia and many other countries including the US have seen considerable economic liberalisation since the early 1980's, hence my comment. Of course it hasn't gone "all the way" and gotten rid of government completely as many liberatarians might like, but there has been an undeniable influence of free market ideologies.

 

 

We simply have a disagreement here though that may be because my original use of the term classical liberal was incorrect. However if one wishes to consider liberal in the libertarian sense the politics of parties such as the Liberal Party in Australia or the Republican party in the United States then one has to also answer the question as to why those parties' politics is so fundamentally at odds with libertarian principle. The freer trade of modern "liberal" parties (only in the sense that the trade policies are freer than those of their political opponents) is not free trade.  Socialist Yugoslavia was not libertarian (or liberal in the libertarian sense) because it was more liberal than the Soviet Union.

 

As I have previously outlined, ensuring that people have access to primary healthcare doesn't necessarily mean that the service has to be provided or funded by the government. It might just mean that having a private insurance policy that incorporates primary care to a certain value is made compulsory, with the type of care that this includes being agreed between the individual and insurance company. 

 

 

Compulsory insurance is a dangerous concept. Many persons, given the option, make the rational choice of not paying for insurance but opting instead to pay for healthcare when it is necessary. Many of those not insured in the United States simply choose not to be insured. The role of government, in my view, ought not to be one of compulsion. What is to be the consequence of not buying compulsory health insurance - government appropriation of income or a prison sentence?

 

 

However, I still contend that people won't donate as much of their time and money volentarily as they provide through taxation. That is fine with other social services but I am not prepared to take the risk that bases aren't covered because of inadequate donations with something as important as healthcare. Basically I'm prepared to accept some loss of liberty and some inefficiency to ensure

that it is provided.

 

Actually though it is not merely that you are willing to forgo some loss of liberty of your own (of which I have no problem), but also you are willing to forgo the liberty of someone else. You argue this to be valid on account of the importance of healthcare. But then what type of healthcare should be compulsory? Will the government make the choice of whether conventional, homeopathy, acupuncture, naturopathy, Chinese medicine or a combination is to be compulsory? 

 

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Aussiegunneragain    PM   9/21/2009 7:09:38 AM

Well sir...arguing that the government should prevent unnecessary death is crazy...Why not pass a law making unnecessary death illegal?


There are lots of laws like that, road rules spring to mind. Would you be advocating getting rid of those and unnecessarily increasing the risk to your own and your loved ones lives? Think about it and get back to me, I suspect it might give you cause to be a little bit less glib.
 
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Aussiegunneragain    Xylene   9/21/2009 9:53:59 AM




I am starting to actively oppose Obama's health care reform but for different reasons than others. What I am deeply disturbed by is the mandatory coverage requirement. I find this to be unprecidented for two reasons. One without government option it would be a legal requirement to purchase a service from a private company. That goes beyond facsim in that even under facists all the businesses may be party owned but citizens are not required to buy under penalty of fines or imprisonment. The 2nd issue is even if a government option is available, this would essentially be a tax for being alive. Some equate it to car insurance, that is wrong. It is not legal requirement to own a car. In Obama's plan the only way not to be subject to this "tax" would be to commit suicide.  





I remind you that payment for emergency medical care is already socialised in your country. If you turn up to a hospital with a condition requiring emergency care it is illegal for that hospital to turn you away without care, irrespective of your insurance status or your bank balance. If you cannot pay and are not covered by a government program then the hospital wears the cost which is then distributed to all its other patients. Mandatory health insurance and/or a government run option is just a  more efficient and humane way of dealing with an existing social contract which is implicitly accepted in the United States.

I was just thinking about this and realised that the example of the compulsory treatment laws for US hospitals probably isn't even the biggest example of existing socialisation in the US healthcare sector. That honour would probably fall to the tax exemptions that employers get for providing health insurance to their workers, a law which has its origin around the time of World War 2. If you accept the premise that some taxes are needed for needs such as defence, law and order and some types of infrastructure (as even Adam Smith did) then it follows that the loss of revenue that comes from tax exemption given to one group (like the employees of firms with a health plan) has to be made up with extra revenue collected from everybody, including those who don't benefit from an employer subsidised health plan. If that isn't socialisation of healthcare costs I don't know what is. Even McCain's plan of shifting the tax exemption to individuals would have constituted socialisation, as everybody including the self-insured and those who couldn't have afforded insurance irrespective of the tax break would have had to have paid for it.
 
So basically what I am saying is don't fool yourselves. As predominantly employed middle-class individuals you have your snouts in the trough of socialised healthcare right now and somebody else is being compelled to pay for you to do so through the taxation system. If you don't want to level the playing field entirely and get rid of all government subsidisation of healthcare, then I suggest to you that it is only fair that everybody should benefit as you are.
 
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Aussiegunneragain    Hugo   9/21/2009 11:06:19 AM

We simply have a disagreement here though that may be because my original use of the term classical liberal was incorrect. However if one wishes to consider liberal in the libertarian sense the politics of parties such as the Liberal Party in Australia or the Republican party in the United States then one has to also answer the question as to why those parties' politics is so fundamentally at odds with libertarian principle. The freer trade of modern "liberal" parties (only in the sense that the trade policies are freer than those of their political opponents) is not free trade.  Socialist Yugoslavia was not libertarian (or liberal in the libertarian sense) because it was more liberal than the Soviet Union.

The reality is that the Republican's and the Liberal Party of Australia exemplify libertarian theories because they are just that, theories. They provide useful insights into directions that societies might like to take and they have done so in many instances over the last two hundred years. However, they ignore basic realities about our nature as social animals and therefore haven't, can't and won't predominate. 

Compulsory insurance is a dangerous concept. Many persons, given the option, make the rational choice of not paying for insurance but opting instead to pay for healthcare when it is necessary. Many of those not insured in the United States simply choose not to be insured. The role of government, in my view, ought not to be one of compulsion. What is to be the consequence of not buying compulsory health insurance - government appropriation of income or a prison sentence?
 
The reality is that most people couldn't afford the pay the cost of a major healthcare event out of their own pocket nowdays, so you can't really consider them not buying insurance to be a rational choice. It really is just gambling and you might argue that that is their right, but while they would still expect to be treated if they were uninsured when it happenned then I argue that in fact they have an obligation to be insured. I do however think there should be exemptions for people who earn over a certain income level or have enough assets for self insurance to be a credible option. 

Actually though it is not merely that you are willing to forgo some loss of liberty of your own (of which I have no problem), but also you are willing to forgo the liberty of someone else. You argue this to be valid on account of the importance of healthcare. But then what type of healthcare should be compulsory? Will the government make the choice of whether conventional, homeopathy, acupuncture, naturopathy, Chinese medicine or a combination is to be compulsory? 

Yup, I am arguing that elected governments have the right to make decisions that involve a loss of liberty for everybody in order to achieve a greater social good. Those sorts of decisions are in fact why governments exist and if people don't like that then it that is basically tough. However, I lean towards keeping this intrusion to an absolute minimum and therefore my answer to your second question is that there should be the maximum flexibility for people to choose what type of care they are insured for within the bounds of being insured to an adequate value.

 Yet is nourishment not equally important as health? Does that not mean that there is a valid argument for the government provision of food to those who cannot afford it? What about the correct types of food and who will make that decision? Will the government also determine which type of food is valid and in which proportions?  Who is going to provide the food and will they also be compelled to do so at a compelling price? How much liberty to sacrifice for how much food?

That argument has been made many times here and it is still as lame as ever. People in modern countries like Australia and the US are generally not having trouble affording food ... even those on low incomes prioritise it because hunger is an immediate reminder to go to the shop and buy their roceries. It is far easier to put aside paying for health insurance until it is too late, at which time most people can't afford the consequences. They really are entirely different examples.

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Nanheyangrouchuan       9/21/2009 4:22:53 PM

Have you ever been routinely denied service by your insurance provider, Nan?  It's never happened to me, and I've had three of them, including Blue Cross.  The only time I've been rejected was when my policy didn't cover a certain procedure, or if I hadn't met my deductible--in other words, things I already knew about because I actually read the contract.  Yeah, it sucks that if I have to get a root canal, it's all coming out of my pocket--but since I'm not paying the extra $15 a month for dental, I kind of have to expect that.
 

Instead, you want to put our health care in charge of government bureaucrats who are not doctors, have no idea what certain procedures are, and have already proven they're not competent to run it--i.e. the VA, the IHS, and Medicare.

 

Sane people call that policy "stupidity."  Some people call it "socialism."  Some people even refer to it as "communism," which as I recall, Nan, you're none too fond of.

 



Actually, I have. For an alleged "pre-existing condition" that was diagnosed after HIPAA went into effect and in writing, bans denying coverage for pre-existing conditions.  I found other ways to take care of that issue without lawyers and a long court fight.  Thankfully I was never in real danger because of the problem. 
 

And you at first say "never" than go on to mention denial for procedures not in your contract.  Sounds like a car warranty where everything is covered except the parts that routinely wear down.
 

And the people who make the decisions are not doctors and nurses.  Medical people are only hired to act as advisors.  People with healthcare management, accounting degrees or MBAs have  the final say.  Many make more than primary care physicians not including their bonuses (and what do they get bonuses for?).
 

Sounds like Technocracy or possibly a warped version of Theocracy to me.
 
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sentinel28a       9/21/2009 6:26:16 PM
You know what, Nan? I agree with you. 
 
Which is why I think doctors and nurses should be the ones in charge of health care and not the bureaucrats.  Yet if government health care is passed, who do you think is going to be running it?  It won't be Ph.Ds, but the very Accounting majors that you so rightly fear.
 
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