by hilzoy
Here's an
exchange from ABC News' special on Obama's health care proposal:
"Q: If your wife or your daughter became seriously ill, and things were not going well, and the plan physicians told you they were doing everything that could be done, and you sought out opinions from some medical leaders in major centers and they said there's another option you should pursue, but it was not covered in the plan, would you potentially sacrifice the health of your family for the greater good of insuring millions or would you do everything you possibly could as a father and husband to get the best health care and outcome for your family?
OBAMA (after talking about his grandmother): I think families all across America are going through decisions like that all the time, and you're absolutely right that if it's my family member, my wife, if it's my children, if it's my grandmother, I always want them to get the very best care.
Ed Morrissey
calls this Obama's Michael Dukakis moment", and writes:
"Oopsie! So ObamaCare for thee, but not for me? Hope and change, baby! (…)
If ObamaCare isn't good enough for Sasha, Malia, or Michelle, then it's not good enough for America. Instead of fighting that impulse, Obama should be working to boost the private sector to encourage more care providers, less red tape and expense, and better care for everyone."
It's worth taking this apart a bit. It is true now, and would be true under any remotely plausible insurance scheme, that sometimes insurers will not pay for treatments, on the grounds that they are too experimental and unproven, or that they just plain don't work. That is true under our current system, and it would remain true under Obama's plan.
It is also true, both under our present system and under Obama's proposal (and, for that matter, any other proposal out there) that people who want medical care that is not covered by insurance can get it, so long as they are willing to pay for it themselves (or find someone else to pay for it.) Thus, if Bill Gates wants to try some very expensive unproven treatment, he can. If I wanted that same treatment under the same conditions, I would not be able to have it.
If this counts as "ObamaCare for Bill Gates but not for me", then it exists now, and will continue to exist under Obama's plan, and any other plan under even remotely serious consideration. Curiously, we have the same system for all sorts of things. Cars, for instance: much as I love my Prius, I would really, really love to have a vintage Jag. Unfortunately, I can't afford one. I imagine that Barack Obama can. Oh no: he's a hypocrite again: it's ObamaCar for him but not for the rest of us, who can't afford vintage Jags! I could go on — ObamaFood, ObamaLivingRoomSets, and so forth, but you get the point.
The main difference between ObamaMicrowaves and ObamaCare is that the government does not so much as try to ensure that everyone will have a toaster oven. So Obama and I get what the government provides in the way of toaster ovens, namely nothing, and then we have the option to buy more. This is what we call "the market", and it means that some people end up better off, toaster-oven-wise, than others.
With health care, by contrast, we guarantee that certain kinds of people — the elderly, children, veterans, federal workers, etc. — will get health insurance, which in turn provides them with health care — at least, it's
supposed to. As I said above, it will not pay for experimental treatments, or treatments that don't work. Nonetheless, unlike toaster ovens, the government provides some people with a decent level of health care; as with toaster ovens, they are free to get more.
Obama's health care plan would extend insurance to more people; ideally, to everyone. The point is to put a floor under everyone — and a decent one. It's also to give them more choices about the health insurance they or their employers purchase. The point was never to put a ceiling on how much people can spend, or to make absolutely sure that Bill Gates has no advantage over anyone else, as far as health care is concerned.
Nothing — nothing – about this idea is in any way inconsistent with the idea that someone who can pay for health care that his or her insurance company declines to cover should be able to do so. The alternative would be to forbid people to get any care that is not covered by their insurance. Again, that is something that no one has seriously proposed. Surely Ed Morrissey isn't faulting Obama for not proposing to forbid people from buying health care on his own — is he?
Meh. Who cares? Obama’s plan is designed to fail. Let the right-wingers attack it, and Obama for proposing it, and instead people who care about everyone having access to health care in the US should be openly proposing either single-payer or a national health service. You know: something that will actually work to improve health care, instead of a bashed-up way of keeping health insurance companies in business.
“”This is not a trick. This is not single-payer. That’s not what anyone is talking about — mostly because the president feels strongly, as I do, that dismantling private health coverage for the 180 million Americans that have it, discouraging more employers from coming into the marketplace, is really a bad direction to go.” – Kathleen Sibellius
So in fact, Obama (according to Sibellius) – seems to agree with Ed Morrisey: allow everyone in the US the same choices and the same level of health care as in the UK, and that would be a bad thing. Can’t allow people to have a basic level of health care plus their own choice of top-up, because you’ve got to protect the private health insurance industry!
I hadn’t read that interview with Sibellius until this morning: goodness, why even bother defending Obama’s health care plan, if you want people to have access to health care?
Well, there are actually some people that do propose that people should be banned from certain medical procedures under certain circumstances, even if they could pay for it.
No, I am not talking about abortion but e.g. hip replacements for people that are ‘too old’. Some of those are extremists that follow the ‘useless eaters’ or the ‘if any would not work, neither should he eat.’ ideology, others limit that view to limited resources areas (e.g. organ transplants).
But to my knowledge neither group plays a major part in the current discussion.
Medicaid saved my life this week.
I’ve been putting off seeing a doctor about some persistent problems for several years, in large measure for lack of money. But last week my new counselor (also covered by Medicaid) pointed me at doctors they work with who take Medicaid, and this week I had my checkup. It turns out I have hypertension so high that the doctor said he was genuinely surprised I hadn’t already had a stroke or heart attack, and put me on emergency dosage of medication for that and gave me special instructions for how to handle cardiac trouble in case it happens before he can get test results back and set up time with a vascular consultant.
He thinks that if I’d put it off very much longer, I really couldn’t have escaped a fatal episode.
I have Medicaid because of systemic illness. But you know, I don’t deserve it any more than a lot of my fellow citizens who happen to be healthy, or at least not so sick, and simply not able to afford what good health care costs in America if you can keep it once serious problems develop. There are, I’m sure, people very much like me dying of this kind of crap because unlike me, they either weren’t eligible for the coverage or nobody helped them find out that they were.
If this were a just country, people wouldn’t have to put off going to the doctor out of fears like mine. It’s immoral, as well as ultimately inefficient and socially corrosive.
“Obama should be working to boost the private sector to encourage more care providers, less red tape and expense, and better care for everyone.”
I think it’s worth pointing out that this is something that you hear a lot, but never with any substance to it, just a vague government-is-the-problem ideology backing it up.
What an incredibly long post avoiding the point, we should spend our time and the opportunity to revamp healthcare solving the problem that rich people can get better care, rather than assume all systems will have that inequity and institutionalize it in a single payer government system. Any “cheaper” government system by default quickly becomes the only system for most people, again except those pesky rich people, so, to be clear, Obama wants to cut the cost of healthcare by providing limited care for all through a government controlled single payer system and NOT solve the real problem.
Thats what he said, in many beautifully articulated words on his best stage, not me. Someone just translated it from Obama to understandable.
Well, we all know where Jes stands on this. Nothing less than and precisely what the Brits must accept. But we have millions of Americans (many, if not most, of whom support the idea of health care for everyone) who prefer many, if not all, aspects of our current approach over anything that would remotely resemble Britain’s approach. And it’s not as if we don’t have a clue regarding the corruption and other unsavory behaviors displayed by our elected officials and corporate health insurance executives.
Those Americans would rather see a serious effort to fix some of the obvious defects in our existing approach and separately take action, through government programs where necessary, to insure coverage for those who somehow don’t get needed coverage through market mechanisms. I think there are few thinking and feeling people who like conditions where others cannot get necessary health care.
As one who favors Federalists concepts in our governing approach, I think I see some similarities in this issue. Just as I believe a better result on political issues becomes possible when everything is not decided in Washington, I think many different solutions can emerge in health care insurance under the right conditions. Just one example that I have not heard discussed very seriously by elected officials would be to change the tax benefit for premiums from businesses to individuals. This would changed the relationship between the insured and the insurer in a direction more favorable to the insured. It would lend a more lifelong focus rather than just for the term of one’s employment with a particular organization. Individuals could change their coverage to another company which largely does not happen now. The tax system could also be used to provide a more broadly based benefit across all taxpayers and perhaps even to the point of helping induce those now without coverage to get it. Health insurance savings accounts are another component. Regulations that do not allow conditions where individuals can be denied coverage by all sources could be put in place. There are a number of other reasonable things that we can do, among them methods that could influence how we build and sustain our cadre of medical professionals.
If we just throw in the towel and go whole hog for the government solution, it basically says to me that we have given up on our ability to influence what we want these elected officials to do.
I do have to add in response to a few comments here that the UK system does directly control access to treatment based on a cost/benefit system. Old people may not get a transplant if it doesn’t statistically add enough years to their life, no hip transplant if the individual good doesn’t outweigh the public cost, etc. They have a government board that sets those standards and reviews cases where the value of treatment is in question.
In Canada, where healthcare is expensive enough by virtue of incredibly high taxes, the impact of the same high cost of care is translated into long wait times for care as the system gets overburdened and under funded. The same is true in the UK. Neither has solved the problem, only changed the symptom.
“The point is to put a floor under everyone — and a decent one.”
Precisely. Thank you.
I do have to add in response to a few comments here that the UK system does directly control access to treatment based on a cost/benefit system
Every country in the world rations health care. In the US, we do it based on personal wealth and complete randomness. In the UK, they do it by having statisticians try to think rigorously. Can you explain why the UK system is worse?
the impact of the same high cost of care is translated into long wait times for care as the system gets overburdened and under funded.
Canadians have chosen a system that covers everybody in Canada and is a lot cheaper than ours at the expense of long wait times for some elective procedures. If Canadians wanted to spend an extra $4,000 per person per year, they could dramatically reduce wait times while still paying less than we do. I don’t think they want to do that and to be honest, I wouldn’t want to do that if I were them either. I’d much rather have an extra $4,000 and have to wait for elective procedures once or twice in a lifetime.
Russell,
I agree, but the floor under everyone can be attained without making everyone subject to a government run system. And even though the language includes denial that’s where we are headed, most of us have enough specific experience to know that’s where we will wind up if we open the door.
For those of us lucky enough to have insurance, what Charles Gibson is talking about already exists. You get the care that your insurance agrees to give you, not what the doctors want to give you. If you are rich enough, you go outside the insurance company.
My son lives in Canada and has experienced the two health systems first hand — he vastly prefers the Canadian system. Of course, that may have had something to do with his parents getting notification from our insurance that our premiums were going up $200 A MONTH effective July. (Neither of us has any health issues.)
Screw Charlie Gibson. Let’s cut his salary down to $60,000 a year, still vastly over what most Americans make, and let him buy his own health insurance. Then let him get back to us.
the impact of the same high cost of care is translated into long wait times for care
in my experience (in the US), wait times to see a specialist for a non-emergency matter is measured in months. not days, not weeks, months. allergists, dermatologists, endodontists – months.
also, Canadians live longer than Americans.
Great stats :), “wait a few times in a lifetime for elective procedures” well I waited 8 weeks, in the hospital, for an “elective” CTScan to determine I needed a stent to prevent another heart attack, if I had left the hospital the wait time for that scan would have been 4-6 months.
Please don’t waste my time with wait times for a dermatologist….
The UK system is not the same as insurance driven limits, they just say no to available care based on age and overall health and it’s fairly draconian.
And in the end there is a floor in the US, emergency care is available to all, lets just raise the floor a little and then solve the problem with a system that those other countries can emulate.
Canadians may live longer than Americans, but how much of that difference can be attributed to the difference in health care available to the residents of the respective countries.
In the US, for example, there is a significant gap in life expectancy between blacks and whites. Some of this gap undoubtedly derives from health care differences just based on economics of demographics, but several other components affecting life span averages come from environmental, behavioral, genetic and possibly other reasons as well. These factors may or may not be present in the Canadian population to similar degrees. I don’t know. So a simple comparison of the bottom line may not be enough.
Marty: Old people may not get a transplant if it doesn’t statistically add enough years to their life, no hip transplant if the individual good doesn’t outweigh the public cost, etc.
Marty is either ignorant or being deliberately misleading.
There are always more people in need of organ transplants than there are people recently dead in such a way that, if they/their family consent, their organs can be used for transplant. This is unlikely ever to change.
To be placed on a waiting list to receive an organ, you must both be in mortal need of the transplant, and you must be otherwise healthy enough to justify your receiving the transplant
– that is, the NHS will not give you an organ transplant if the drugs you will have to take for the rest of your life are likely to kill you.
How possible recipients are decided on when an organ – to put it passively – becomes available, is based on a complex weighting of factors, including the recipient’s smoking and drinking habits, their age, how badly they need it – and of course, how close a match they are to the donor.
It’s not a perfect system. I don’t doubt sometimes it goes wrong. But the intent of it is that donor organs go to the possible recipients who are most likely to live longest as a result of receiving them – and tries not to waste a donor organ on someone who is likely to die as a result of receiving it.
The hip replacement claim is just a lie: hip replacement is always a last resort, but it’s never off the table if it is needed as the last resort.
The UK system is not the same as insurance driven limits, they just say no to available care based on age and overall health and it’s fairly draconian.
Marty, in which NHS Trust hospital – and when – were you waiting for 8 weeks to get an CTscan?
I agree, but the floor under everyone can be attained without making everyone subject to a government run system.
This is a non-argument, that seems entirely dependent on the phrase “subject to.” First, why is it worse to be “subject to” a government run system than a private run system? As hilzoy points out, most of us have very little practical choice about our health insurance coverage under the presence system, the rich accepted. That would also be the case under whatever system emerges from Congress. And, no, a guaranteed public option would not necessarily put private insurers out of business (case in point: Germany), unless one of the explicit goals of the reform is to outlaw private insurance, and for better or for worse nobody in DC is interested in doing this. Finally, the choice most Americans are most interested in maintaining/creating involves care not insurance. Many of the arguments against health insurance reform involve a huge shell game in which opponents invoke “choice.” But there’s no evidence that most (or even any) Americans will have less choice among insurance plans. And even if they did, less choice among insurance plans has nothing whatsoever to do with less choice among doctors or procedures, which is what most Americans actually care about.
GOB: Some of this gap undoubtedly derives from health care differences just based on economics of demographics, but several other components affecting life span averages come from environmental, behavioral, genetic and possibly other reasons as well.
Huh? So, how is that an argument against trying to level out health care availability for all? True, being poor / being rich would still be a factor, so black people would on average tend to live less long than white people, but there would be less of a gap…
To be placed on a waiting list to receive an organ, you must both be in mortal need of the transplant, and you must be otherwise healthy enough to justify your receiving the transplant
This sounds like exactly the same system we have in the US. In the US, you may not get a transplant that you need if the committee decides that you’re too old or too unlikely to survive. It has nothing to do with money or insurance per se. It has everything to do with the fact that organs are scarce and that the medical community rations them.
And in the end there is a floor in the US, emergency care is available to all, lets just raise the floor a little and then solve the problem with a system that those other countries can emulate.
Yes, the emergency care system forms a kind of floor in our system.
But it’s a floor with almost nothing going for it. It’s incredibly inefficient, both in terms of costs and in terms out individual outcomes. It also has pretty major public health externalities. It’s incredibly inequitable. It imposes huge delays in treatment (funny how delays are a big issue when discussing any other system, but not this one). It is not a system in need of minor repair, but rather in need of being scrapped.
Can any defenders of the status quo make a case for the preferability of the emergency care floor that does not boil down to a theological belief that government is always bad?
It has nothing to do with money or insurance per se. It has everything to do with the fact that organs are scarce and that the medical community rations them.
Generally true but money does help.
Take a look at the Steve Jobs case; it’s pretty certain his money gamed the system somewhat.
Once again, I must point out that nobody is talking about a government run system of healthcare.
Secondly, the whole purpose of thsi debate is have a system where everybody has access to basic healthcare at a reasonAble cost. Consider that word basic and think of the ramnifications of everybody receiving basic health care as a given.
Think in terms of larger medical problems and more costly treatment being avoided due to that.
Also consider that the UK has one of the least effective plans in Europe, thanks to Thatcher, and is still probably better than ours.
And consider that insurance companies in Europe and Canada are doing quite well covering things the government plan doesn’t cover.
Consider the fact that insurance companies are doing quite well in this country offering coverage to seniors to pick up what Medicare doesn’t cover.
Certainly, if the present approach of most private insurance coverage provided by employers (where the contactual terms are between the employer and the insurance provider) were replaced by an approach that allowed the employee to receive in direct compensation the business expense paid for insurance as an employee benefit, and the tax benefit currently enjoyed by the business went directly to the employee instead, then the insurance providers would be dealing with and competing for the business of individuals who could spend a lot more effort evaluating what coverage they could get for their money. I believe this would introduce greater choice for the individual.
Of course, the individual would actually have to expend some energy and effort to try to make a good choice and this might just be too much to expect when they can just let somebody else decide for them. Market-based approaches do not favor the lazy.
One more point. By having greater choices among insurance providers who are competing for the individual’s business, the individual should be more likely to be able to increase his/her choices of practitioners, procedures, and medicines, as well.
I don’t see any reason at all to believe that we can cover all Americans unless the government does it. Fundamentally, I’m not interested in insurance, but in access to care. This week, what mattered to me is that I could see good professionals and get the medication they prescribed, without an out-of-pocket cost. People are suffering and dying for the lack of such care, and they shouldn’t have to. The hell with competition, I want access. I’ll be glad to talk about competition on luxuries the very moment I know that no fellow American is going without the opportunity to get help with their health needs….and that’s what private insurance will never, ever deliver.
at enormous cost to society and the taxpayers, not to mention the cost of misusing and overloading a system that’s meant for emergencies, nor that of not providing any preventative (cheap!) care to any of the people forced to rely on this “floor”.
no. let’s build a better floor higher up and save money on the deal while getting more people better healthcare in the bargain. we know this can be done, because numerous other countries do it, and their systems work just fine. why would the USA have to suck so much harder than they?
John Miller: Once again, I must point out that nobody is talking about a government run system of healthcare.
I am. If you mean “nobody in power” well, no, more’s the pity.
GOB: then the insurance providers would be dealing with and competing for the business of individuals who could spend a lot more effort evaluating what coverage they could get for their money. I believe this would introduce greater choice for the individual.
Yes, because people need to be able to make the “choice” of how much health care they’re going to need over the rest of their life.
One more point. By having greater choices among insurance providers who are competing for the individual’s business, the individual should be more likely to be able to increase his/her choices of practitioners, procedures, and medicines, as well.
Whee! Now Americans can decide if they want lung surgery or a hip replacement – absolutely free choice!
Honestly, GOB, do you have any idea how silly this sounds? I had a friend who came down with a virus that destroyed his heart muscle such that he needed a heart transplant, just over 13 years ago. If you had asked him when he was 25 what “choice” he wanted to make about what kind of health care he wanted to receive over his lifetime, he would likely never have thought to list all the health care he did in fact need – because you don’t. He always had the choice of refusing the heart transplant: but his “choice” of where to go was zero – he was operated on in the only heart transplant unit in Scotland, by the best-qualified transplant surgeon available. Why substitute “choice” for quality?
The government doesn’t provide anything. It takes from some and gives to others. It is only a conduit. The ones it takes from are the providers.
In the US, for example, there is a significant gap in life expectancy between blacks and whites.
Cuba’s population is roughly 11% black (compared to our 13%), and they have a higher life expectancy than we do, too.
Puerto Rico also beats us, with 18% black/mulatto. PR also has a strange hybrid public/provate health insurance system.
to me, that suggests that the white/black life expectancy gap is not genetic. which means it’s a failure of our health care system.
An example of how the US health care system frustrates patient choice:
One more point. By having greater choices among insurance providers who are competing for the individual’s business, the individual should be more likely to be able to increase his/her choices of practitioners, procedures, and medicines, as well.
This would only be true if the individual was young, healthy and with no pre-existing conditions. If you don’t fit each of those criteria, then you will end up paying much more because no insurer would want you as a client. Through your employer, the costs are spread out so that the infirmed/older individual doesn’t get singled out and dinged with extremely high premiums (the employer can negotiate a bulk rate that is attractive to the insurer). The point of government provided insurance is to spread those costs out over an even larger group. That’s also the problem with state by state approaches: bigger risk pools are better. At least if the goal is to see all Americans provided the dignity of health care.
cleek
“to me, that suggests that the white/black life expectancy gap is not genetic. which means it’s a failure of our health care system.”
It is a complex world. There could be other factors you haven’t controlled for.
jesurgislac,
I apologize, in advance of the answer,for my lack of precision in the original comment.
I was told it would be eight weeks and they couldn’t release me from the hospital (as that would take me off of the critical priority list), the timing of actually getting the stent was even less clear. The gentleman in the ward with me had been waiting for five weeks already for his scan (I believe his echo had been done) and had his office set up in the room so he could work each day, so I knew he would go before me. So I checked myself out over doctors orders (a three day discussion), went home to the US and in 4 weeks (none in the hospital) I had a stent.
I would prefer not to reference an individual hospital as it is not really the point of this discussion, and I did receive exemplary critical care and am alive today I’m quite sure because of that.
If I had a dime for every time Ed Morrissey declared that Obama had a “Dukakis moment,” I could afford a vintage Jaguar.
So I checked myself out over doctors orders (a three day discussion), went home to the US and in 4 weeks (none in the hospital) I had a stent.
You didn’t answer; when did this happen?
Also, Marty, I take it since you speak so highly of Emergency Room care, that when you went home to the US, you went home to no health insurance – you simply showed up in the ER of your local hospital 4 weeks after you got back and were promptly provided with a stent?
Or what?
“The hip replacement claim is just a lie: hip replacement is always a last resort, but it’s never off the table if it is needed as the last resort”
I suppose one can say it is available as a last resort, but it is the standard protocol for some people and a last resort for others with identical diagnosis. A slippery slope that in the UK has slid on more than once.
Calling something a Lie is a bad accusation, I am occasionally imprecise and very rarely misinformed. But I don’t lie.
Marty: I suppose one can say it is available as a last resort, but it is the standard protocol for some people and a last resort for others with identical diagnosis.
You really have no idea what you’re talking about, do you? Age is a factor in recommending a hip replacement; the younger and more active a person is, the less likely a surgeon is to recommend this operation, because the more likely it is that the artificial joint will wear out and have to be replaced again – and a hip replacement is major surgery.
Individual diagnostic assessments will differ between NHS Trusts, probably between individual consultants, and always depending on the patient’s individual needs.
Calling something a Lie is a bad accusation, I am occasionally imprecise and very rarely misinformed. But I don’t lie.
Fine: I accept that your blethering about transplants and hip replacements in the UK is due to your arrogance in thinking you can give others the benefit of your ignorance, rather than actual malicious misinformation.
So, when did you go back to the US, that time you just walked into the ER to ask for your stent – no waiting around required?
“You didn’t answer; when did this happen?
Also, Marty, I take it since you speak so highly of Emergency Room care, that when you went home to the US, you went home to no health insurance – you simply showed up in the ER of your local hospital 4 weeks after you got back and were promptly provided with a stent?
Or what?”
Hmmmm, not sure what the point is here, 4 years ago, no I had insurance, that they gladly billed in Canada as well as the US. I went to a cardiologist recommended by my primary care physician, they scheduled and echocardiogram and CTScna of my heart over a three week period and then scheduled the angio for the next week. All on an outpatient basis except for the last night I stayed in the hospital because the angio was done very late in the day.
But, again, I’m not sure the details here are more revealing to support or debate my position that we can do better, even Canada believes it can do better. Health care is not even a level playing field there as Alberta and Ontario have very different delivery networks.
My question is always, why are we copying someone else who isn’t in some ways better, when theeir are good things about what we have.
I’ve said this a couple of times before, and it’s a little off topic here, but:
I don’t buy that the problem with US health care stem from health insurers operating under the profit motive; non-profit health care providers (e.g. blue cross) frequently behave in very similar fashion, and other nations with UHC have providers that can operate for profit (e.g Netherlands).
That said, I also think (as I’ve said before) that HC hyperinflation stems from the private sector, and that von is wrong about his high spending in the public sector point.[from a thread with von commenting]
Jes
Am I correct that you live in the UK? If so, why do you have such an interest in the US health care system?
“It takes from some and gives to others.”
Let me introduce you to the concept of “spreading risk”.
“to me, that suggests that the white/black life expectancy gap is not genetic.”
Amazing that this even needs pointing out, isn’t it?
Hmmmm, not sure what the point is here,
You asserted that “And in the end there is a floor in the US, emergency care is available to all” – so I take it that you went home to the US and walked into the nearest emergency room to get care?
I went to a cardiologist recommended by my primary care physician, they scheduled and echocardiogram and CTScna of my heart over a three week period and then scheduled the angio for the next week.
Your “primary care physician” being the doctor from the nearest ER? That’s the standard of care you are recommending as superior to the UK system, remember?
My question is always, why are we copying someone else who isn’t in some ways better, when theeir are good things about what we have.
If you think there are “good things” about getting health care by just showing up at an emergency room, how often – besides this time when you needed a stent – have you done that?
I just used to have a “Sucks to be you” attitude to the US health care system – aside from the frightening terrorist/political campaign against reproductive health care, as any feminist would care about that.
Then a few years ago, a friend I’d never met got cancer. She was involved with another friend, who lived in the UK: they were in the middle of a complex set of decisions about which of them moved where: she was unhappier at her job, he had a more portable set of skills.
But as soon as she developed cancer, all those options got shut down – she had to stick with the job she had because without that job, she didn’t have health care: this wasn’t the kind of cancer you can afford to take chances with.
To cut a long story short: she died, dave. Maybe she would have died no matter what. But she died without her chosen partner, in a place she wouldn’t have chosen to die in, after sticking with a job she was unhappy with that kept her far from where she wanted to be, because of the sucky US health care system that gave her no goddamned choice at all. And I never did get to meet her face-to-face, which I still regret.
But that did kind of awake me to US friends who make very careful and worried comments online about how they can’t really afford a checkup, but there’s this rather worrying lump…
I suspect that my friends average out at a lot poorer than your friends, d’d’d’dave – rich people, and you’ve claimed to be very rich, tend not to make or keep friends a lot poorer than they are.
But whatever. I have friends who have health problems and money problems you clearly never have had. And they don’t go on about how much they love having choice and quality health care in the US: they worry – and they’re right to – about how to balance not having enough money with wanting to stay alive.
Oh, I do have one friend who is very affirmative about the choice and quality of health care available to her family in the US. I think it’s no coincidence at all that she’s also the wealthiest friend I have, with old money on both sides of her family.
I love her dearly and I’m glad her (relation) got the health care he needed to survive – but she’s the only close friend I have in the US where cost was not, ever, going to be a factor in how much health care her (relation) could have.
Who said that in the US we get our primary care in the emergency room?
I recognize that if one does not explain each reference in detail at this site, there will likely be an effort to put a negative twist on the point. My reference to genetics as a possible factor in the black/white longevity gap was meant to take into account that ethnic groups who are minorities in the US sometimes have higher incidences of medical conditions for which R & D expenditures for pharmaceutical, medical devices, and treatment regimes are less than for medical conditions that are more common across the general population. This has an effect that in some way could be attributed to a country’s health care system, but would not necessarily be negative as to the US system since many medical advances are developed here that would not be available to other countries if they weren’t. If this is not statistically significant, I can accept that.
“I agree, but the floor under everyone can be attained without making everyone subject to a government run system.”
I have no problem with that. I have absolutely no investment in health insurance being provided either by the private sector, the public sector, or both.
Whatever gets the job done.
And, in fact, we currently have a model where both are available. The public offering is just not available to everyone.
The only problem I see with your point of view here is that, in fact, the private offerings currently available DO NOT make a reasonable floor available to everyone, and show no inclination to do so.
It might be helpful for employers to simply pay employees the money they currently pay for health insurance on their behalf, and then give the tax writeoff to the employees.
That doesn’t help all of the people who work for themselves, or who work for folks who don’t currently offer health insurance, or who don’t work at all.
What about them?
The history of public intervention into private industry and commerce in this country is, to an incredibly consistent degree, one of government response to enormous if not catastrophic failure in the private sector.
It’s extremely rare, so much so that it’s hard for me to think of examples, for government to simply decide to take on responsibilities that are effectively being borne by the private sector.
The reason we’re even having this conversation is because the private sector *is not getting it done*.
If you have a magic wand to wave and change that, great. Have at it. If not, then our choices are getting it done through a public effort, or not getting it done.
I vote for getting it done through a public effort.
Wow. Jes gets more worked up, in my view, than almost anyone else here, and it’s not even from first hand experience as a victim of our heartless system.
GOB: The US places almost no emphasis on preventive care. As a result, many of the uninsured or underinsured use the ER as their primary care. Of course, this is far more expensive and, often, situations have deteriorated so what was once a minor condition becomes more serious.
By having greater choices among insurance providers who are competing for the individual’s business, the individual should be more likely to be able to increase his/her choices of practitioners, procedures, and medicines, as well.
No. All insurance is based on the ability to spread risk. A greater number of insurers would shrink the capability to spread risk.
Currently, the healthcare insurance industry is run by about 6-7 companies. However, these companies may own hundreds of subsidiaries. The reason for this is to maximize profit (or shareholder profit). In this case, the market solution has caused insurers to very, very well while the consumer is jobbed.
The government doesn’t provide anything. It takes from some and gives to others.
Accepting this moronic assertion for the sake of argument, isn’t this exactly what private insurers do, except their goal is to skim profits rather than improve access to health care?
The government doesn’t provide anything. It takes from some and gives to others. It is only a conduit. The ones it takes from are the providers.
That’s right. They should go Galt to get away from those parasites in government.
Please?
Good Ole Boy: Jes gets more worked up, in my view, than almost anyone else here, and it’s not even from first hand experience as a victim of our heartless system.
Yeah. The friend who died of cancer – she didn’t get particularly worked up about the situation, at least not to me. I suspect she couldn’t afford to – why get emotionally energised about something you can’t change when you’ve got strictly limited time and energy?
But d’d’d’dave asked why I cared about your sucky health care system when it didn’t affect me directly, and the short, very short answer is … friendship and death.
However. It’s Friday. It’s nearly 5pm where I am. I do believe I will go mellow out with a glass of wine and a sandwich, and I wish you all welll for the weekend.
Well, Russell, I think it would help all those who work for themselves and those who work for employers who don’t provide medical benefits precisely because the insurance business environment will have changed to one where the dealings are between the individual being insured and the insurer. The need for COBRA would go away and workers would have greater employment mobility since their coverage would no longer be tied to their employer. Attention potentially could shift toward greater emphasis on preventive care since the insured/insurer relationship would endure longer than just the employee/employer relationship.
This subject area is very complex and we are only touching a few aspects in this thread. I just don’t like the idea of giving up when we haven’t made any real efforts to change and improve the approach we have been living with. The employer provided medical benefit took off over half a century ago and has only been tweaked since. And almost no progress in individual medical insurance has occurred. So, to me, reform means to try a fix on known problems in the current approach, not to throw everything out and opt for something completely foreign to our experience.
And the closest thing we have that we could call on as experience with state control of medical care is Medicare. Many of us think Medicare operates in strange and costly ways and the future is dim.
Jes,
Actually, my closest and longest kept friends are almost all schoolteachers. Well, the males are mostly school teachers and the females are nurses.
Inner circle
A: secondary school administrator/former teacher
B: secondary school administrator/former teacher
Z: secondary school teacher
B2: nurse
J: Speech therapist
Next circle
S: Can’t seem to keep any job for long. Seriously.
C: nurse
M: nurse
D: secondary school administrator
B3: Banker
B4: Industrial magnate
A2: architect
J: engineer
C2: Office manager
B5: Project manager/real estate
K: Project manager/real estate
B4 Is very wealthy, having started with nothing.
B3, J, and B5 are probably in the top 5% income-wise
S: is poor.
Everyone else is probably around median income.
“But we have millions of Americans (many, if not most, of whom support the idea of health care for everyone) who prefer many, if not all, aspects of our current approach over anything that would remotely resemble Britain’s approach.”
Cite, please? Actual polls:
Full poll. Now, where’s your cite to actual facts about what “millions of Americans” think?
Wow. Jes gets more worked up, in my view, than almost anyone else here, and it’s not even from first hand experience as a victim of our heartless system.
Losing a friend to cancer is not “first hand experience?” Since when?
Of course, the individual would actually have to expend some energy and effort to try to make a good choice and this might just be too much to expect when they can just let somebody else decide for them. Market-based approaches do not favor the lazy.
So it’s only out of laziness that people wouldn’t be able to make good choices about health insurance, aye? Or is it laziness that makes people say such things? This whole notion of people individually bargaining with many competing insurance companies is completely unrealistic and goofy. If you want a system that’s even worse than the empoyment-based system we have now, you’ve found it.
I don’t pretend that government health insurance will be perfect or that all of the problems with our health-care system are even due to the way in which we’re insured, but it’s pretty clear that we need a public option, probably among other things. And it’s even more clear that the last thing we need (other than the sun exploding or something like that) is individuals trying to work this out on their own.
…not to throw everything out and opt for something completely foreign to our experience.
What does this even mean?
Oh I get it, you want to argue about the floor and whther I needed it blah blah,
“And in the end there is a floor in the US, emergency care is available to all”
Quite off the point, someone said there wasn’t one, I pointed out there was. I have family and friends who have useed, family it has not served well, it is certainly not a great floor, just an established one. I believe the relevant part of the statement you didn’t quote was that we should raise the floor.
Enough for this, I have multiple experiences some good and bad in different places, when it works here it is the best health care in the world, I don’t want to give that up to fix the rest. I want both.
Jes takes exception to Sebelius’s statement :
dismantling private health coverage for the 180 million Americans that have it, discouraging more employers from coming into the marketplace, is really a bad direction to go.
Jes, I read this as a statement of political reality rather than as an expression of the desired or best outcome, and as probably correct: it’s a political calculation that an insufficient fraction of US voters who currently have health insurance are willing to support single-payer, and that this eliminates single-payer one of the achievable outcomes at this time.
And I read this as an indictment of the damage that thirty years of Republican political rhetoric have done to the moral fabric of this country — that those of us who have much are too fearful of losing what we have to be willing to risk a change that will help those who have not. Our sense of national community, of the common good, has been replaced by a fearful, selfish clinging to personal advantage, with the zero-sum conviction that “if others gain, I must necessarily somehow lose”.
“Am I correct that you live in the UK? If so, why do you have such an interest in the US health care system?”
“Wow. Jes gets more worked up, in my view, than almost anyone else here, and it’s not even from first hand experience as a victim of our heartless system.”
When substance isn’t available, use ad hominem.
Gary, I know the comment is yours if it starts with ‘Cite, please’. I’ll just use your cites, thank you.
Seriously, if you believe that we cannot achieve substantial improvements in quality, access, and costs of health care in the US by making major (not minor) reforms in our private sector based system, some of which have been discussed in this thread and some that have not been brought up here, then just stay on that position.
I believe we should try the reforms before giving into the state solution.
To be fair, Mr. Farber, support for adding the US government as a player in the health insurance market could be plausibly construed as favoring aspects of our current approach, especially as opposed to support for an NHS. Remember, it’s “Medicare for all,” not “VA for all.”
I know, I know, I’m trying too hard to justify an argument by someone who asserts:
which adds to the reams of evidence of an almost total lack of understanding about health care issues.
GOB, I don’t know that having a public option and improving the private sector-based system are mutually exclusive. There are (at least) two things at work that have to be considered: insurance and health care-delivery systems. The private side that needs to be worked on in any case is the delivery system. So far, I haven’t seen any major proposals under serious consideration for government delivery, just insurance. And even on the insurance side, it think even single-payer for basic coverage can coexist with private insurance for other-than-basic coverage.
“I believe we should try the reforms before giving into the state solution.”
The thing is, this kind of assumes that there is something inherently wrong with public involvement as part of the solution.
In this context, I don’t see that there is.
“Gary, I know the comment is yours if it starts with ‘Cite, please’. I’ll just use your cites, thank you.”
Have you considered the possibility that a methodology of believing without checking facts, let alone instead first checking facts, and then deciding what it makes sense to believe, isn’t a methodolgy to go through life with if you want to actually understand reality?
Belief unconnected to facts is what we call “fantasy.” Or, perhaps, “wishful thinking.” It seems to be the basis of your general approach to politics. You might want to reconsider the usefulness of it.
GOB, it’s not that we disbelieve improvements are possible. It’s that we disbelieve they will happen, for practical reasons: they would require insurance companies to settle for less wealth and privilege than they have now, and they always fight to the best of their ability against any such change, even slight ones. Their comments on recission illustrate the point.
It’s in light of this half-century-long history that we say, “Since even minor changes would require as much political and social effort as a complete overhaul, let’s do it right rather than settling for patches. Use political capital wisely.”
An effective counter-argument would have to show insurers acting constructively to broaden rather than restrict coverage, to simplify administration, to provide greater openness about their decision-making, and to do all these things without the threat of imminent litigation and legislation. It’s not the possibilities in the system we’re concerned with but the possibilities of actually existing entities and the people within them who make decisions.
As it is, you’re in exactly the position of communist apologists telling us that just because Stalin and Tito and Mao and all the rest have been awful people is no reason to give up yet on the dictatorship of the proletariat.
GOB: I’m all for reforms and improvements, but thus far you haven’t offered any. The one change you posited was doing away with employer based coverage and replacing it with each individual for his/herself.
But I raised a counterargument that you completely ignored. One that gets at the fundamental weakness of your proposition. I’ll repeat, again, why individualizing health insurance acquisition will be problematic:
This would only be true if the individual was young, healthy and with no pre-existing conditions. If you don’t fit each of those criteria, then you will end up paying much more because no insurer would want you as a client. Through your employer, the costs are spread out so that the infirmed/older individual doesn’t get singled out and dinged with extremely high premiums (the employer can negotiate a bulk rate that is attractive to the insurer). The point of government provided insurance is to spread those costs out over an even larger group. That’s also the problem with state by state approaches: bigger risk pools are better. At least if the goal is to see all Americans provided the dignity of health care.
“Market-based approaches do not favor the lazy.”
It’s not that insurance companies fail the people; it’s that people fail the insurance companies.
Straighten the great revolutionary unity of the insurance companies!
I’ll try to get some more understanding of health care issues. Regarding the ‘public option’ that some opponents have criticized variously as the first step on the slippery slope to the UK model, as an unfair competitor to the private entities, and as a competitor that is also the referee, I’ve heard its defenders saying not true to these criticisms, that government rule-making or regulation would be completely separated from the ‘public option’ entity, that the government would not represent an unlimited source of funding for the ‘public option’, that this option is not a strategy to eliminate private sector insurers, and Barack Obama himself has said that we will not be forced to change our insurance coverage and our choice of caregivers if the ‘public option’ is in place.
The question this leads me to ask is, what is the essential difference between ‘public option’ and a not-for-profit entity similarly capitalized and chartered?
I have yet to see a practical reform to the current market based, private insurance system offered.
Having individuals do their own bargaining is a non-starter. The whole issue of cost of insurance is based upon size of the pool. An individual is a very small pool, thus increasing risk to the insurer, thus increasing cost.
Plus, for all those people who believ in state’s rights, remember most of the laws surrounding health insurance are developed at the state level. There are only a few based upon Federal law.
Increasing coverage (and the only practical way of doing that is through a public option) so that most people have access is the best way to reduce overall cost.
In fact, the more people who have coverage, the lower private insurance costs will be as providers will be able to charge less (speaking of hospitals and hospital based doctors) as they do not have to cover as much “free” care.
With a single payor, mandatory coverage, of course, overall costs for employers and individuals would drop significantly as workers’ comp insurance costs would be drastically reduced, as would automobile insurance, and a whole lot of other things people tend not to think about.
The question this leads me to ask is, what is the essential difference between ‘public option’ and a not-for-profit entity similarly capitalized and chartered?
GOB, are you suggesting a private entity that would behave the same as the proposed public entity, but that wouldn’t be, strictly speaking, part of the government? If so, why? I’d ask the same question to you – what’s the difference?
Shorter GOB:
Surely individual persons will be able to secure a better deal from insurers than a corporation!
To echo Eric’s and part of John Miller’s comment, the single-payer, universal-coverage system is ideal in terms of the risk pool. It’s the ultimate insurance scheme. With individuals going out for their own insurance, you get pools of young, healthy people paying very little for insurance, and you get old, sick people paying lots. The individual scheme begins to approach not having insurance at all and simply paying for your health care out of pocket. It defies the whole point of insurance. Under single-payer, universal-coverage, yes, young health people will put more into the system than they will take out. But old, sick people will take out more than they put in. Maybe this sounds unfair. But young, healthy people, as a group, get to be old, sick people, as a group. It all comes out in the wash over the course of one’s lifetime. And if you spend your life putting into the system without taking much out of it, you can consider yourself lucky for being so damned healthy (or unlucky for being hit by a bus something, at which point it won’t much matter). Insurance is about security, not about absolute equality or fairness. (Not that anyone is making that argument, but it seems to underly people’s thinking at times, as though having a neighbor down the street with the same homeowners’ insurance company as you should make you envious if his house burns down, since he gets to take advantage of the insurance and you don’t.)
All you really needed to write is “Ed Morrisey is an idiot.”
No additional explanation is needed.
Gary
I fail to see how my question to Jes is ad hominem.
dietalics.
I used to harbor secret elation when a neighbor’s house burned to the ground, under the religious heading of “There but for the grace of God go I”, figuring God’s grace was a rationed commodity (oddly shunted my way, but why lookagifthorse without insurance in the mouth) and if everyone wants the same amount of grace as I possess, they can damn well pay for it out of their own pockets.
It says so in the Constitution.
Then, I found out they weren’t paying the full cost of the damage to their property because they were in the same insurance pool (starts with “p”, rhymes with socialism, I’d say we’ve got trouble) as I am.
You can imagine how my feeling of grace-tinged superiority turned to one of anger, envy, and regret as I came to understand that I was paying for my neighbor’s misfortune and yet my house had not burned down and I certainly wasn’t getting an insurance settlement.
I later learned that the same neighbor’s post-fetal little daughter had a tumor the size of a cantalope removed from her brainstem at no cost despite her previous short life of shiftless recreation in the front-yard of the aforementioned burned-out shell of a house.
This again, despite the fact that I pay my insurance premiums every month and haven’t benefited one bit (not so much as a suspected melanoma).
I did receive a barium enema once but I complained all the way through it that I was sure that part of that procedure was subsidized somehow, somewhere along the way.
That enema didn’t sit well with me.
My ideological underpinnings had been corrupted. I have a pristine colon but I don’t feel that I deserve it, the state somehow finding its way up there.
The worst part of it is that had to remove my head from my on to allow this subsidized test.
“… remove my head from my colon to allow this…”
GoodOleBoy, this is why sensible people favor universal coverage: so that there aren’t points to be scored in cutting people off. The pressure should be to demonstrate that people are getting the help they need and that the program is well administered with that as its goal, and that doesn’t happen in the private market.
The history of 1994-2009 is instructive in this regard. That’s fifteen years. Three full presidential terms, and parts of two more. Clinton’s effort at health care gave warning to the insurance industry that there was substantial public interest in such a thing, and took a very extensive, very dishonest campaign to defeat. In the intervening years, the rising costs and declining reliability of care have been ongoing topics of interest, with polling showing growing public support for public guarantees of coverage. Obama came into power in part on a promise of attending to that desire.
And what do the insurance companies do, fifteen years after their warning? They testify with pride about recission.
You and other advocates of continuing to trust them really need to show us why. In particular, why should we trust them more than, oh, Taiwan’s successful step into universal coverage in the 1990s, with its improved outcomes and reduced cost. Show us any point where what we’ve done compares favorably to that, or any other public plan. Give us reason to believe that the insurers will ever do anything but minimize their outlays at every step, honestly and dishonestly, legally and illegally, while maximizing profits likewise. What have insurers done to warrant this amazing confidence you have in them? What policies show their commitment to public health?
“I fail to see how my question to Jes is ad hominem.”
You didn’t address any substance of what she said; you simply questioned why she should be interested, because of her location. Your point wasn’t about substance, it was about her.
That at 2:09 PM is not me!
What a low business, trolling as someone else. And what a low comment the troll GOB made. I don’t want to break posting rules, but the term for that is, first-part ‘rat’ and second part – well you know….(check with Dick Nixon if you aren’t sure).
And yes, I *am* conjuring a reason to resurrect Nixon’s moldering political body and drag it around a little. Nixon is the gift that keeps on giving; his political legacy is enormous.
I am feeling very left out. That ubiquitous troll has yet to use my name. You can tell who the troll thinks are the more cogent voices.
‘GOB, are you suggesting a private entity that would behave the same as the proposed public entity, but that wouldn’t be, strictly speaking, part of the government? If so, why? I’d ask the same question to you – what’s the difference?’
Don’t we already have not-for-profit health insurance cooperatives around the country? Many complaints in this thread relate to the perceived greed associated with private sector profit motive. I really am in question mode here because I have no knowledge regarding the pros and cons of these cooperatives. But it seems as if you would get something resembling the ‘public option’ once you figured out a regulatory approach to insure coverage regardless of pre-existing conditions and not allowing removal because of deteriorating health. What does the ‘public option’ offer that a regulated not-for-profit does not?
The 2:28 and 2:34 pm posts were mine, sent by me.
I admit to conflating myself and someone else’s colon for, well, for amusement.
I think we should all fess up and emulate the health insurance industry executives who proudly recited their policies before Congress of paying bonuses to lower level employees for denying coverage to lymphoma sufferers.
Under future Republican administrations, after Obama successfully institutes universal coverage, government will not do that sort of thing.
Government employees will be expected to deny services to lymphoma patients even without the benefit of bonus incentives.
Now that the financial industry executives, health insurance industry executives, and our elected representatives have been completely discredited, if we can figure out what to do with the lawyers, we should be able to commence our recovery.
Just a query: Where were these “single payer or nothing” folks when Dennis Kucinich was scrambling for even the minimum of funding and press attention?
d’d’d’dave:
A: secondary school administrator/former teacher (public service plan)
B: secondary school administrator/former teacher (public service plan)
Z: secondary school teacher (public service/union plan)
B2: nurse (health care plan)
J: Speech therapist (health care plan)
Next circle
S: Can’t seem to keep any job for long. Seriously. (no plan, apparently)
C: nurse (health care plan)
M: nurse (health care plan)
D: secondary school administrator (public service plan)
B3: Banker (wealthy)
B4: Industrial magnate (wealthy)
A2: architect (private or employer plan)
J: engineer (wealthy)
C2: Office manager (private or employer plan)
B5: Project manager/real estate (wealthy)
K: Project manager/real estate (private or employer plan)
B4 Is very wealthy, having started with nothing.
B3, J, and B5 are probably in the top 5% income-wise
S: is poor.
Everyone else is probably around median income.”
So, from my experience (and I do not know if it it exact), I have added where your friends get their health coverage, and I would say that they all get above average access to health care. Nurses and other health care practitioners usually get good insurance through their employers, and (where my wife works) the practice/hospital waives any out of pocket costs, including deductibles, if you get treated at their facility. School administrators often get public plans, which tend to cover better (or had better with the property taxes continually rising), and only 3 of your group has employer or personal plans, plus the one with no apparent plan.
Your circle is better covered than average.
In mine, only one could be considered wealthy/good employer based, about half have employee plans, one is VA, the rest are private coverage with high ($5000) deductibles and/or public and/or none. And I’m a top quintile type of income distribution.
Sometimes what you see is what you think everyone else has; and I often see that they don’t have it. And don’t get me started on transitioning between employer based plans. Coverage to COBRA to coverage is a nightmare depending on when the bills are sent.
John Thullen’s 2:28 comment is a masterpiece. But damn him for fumbling the punchline and having to correct it at 2:29. If it’s technologically possible, I implore the editors to incorporate the correction into the original comment so that when future Google searches for “insurance pool and socialism” turn it up, Thullen’s gem will be displayed in its full brilliance.
One point even John overlooks is that a fraction of his insurance premium (his contribution to the pot called “health care spending”) pays the residuals of the actors in all those boner pill commercials. Whether that makes John feel better or worse, I can’t say.
–TP
“Don’t we already have not-for-profit health insurance cooperatives around the country?”
Yes, those do exist. I’m aware of some related to religious denominations, I’m sure there are others.
“What does the ‘public option’ offer that a regulated not-for-profit does not?”
Universal availability.
Hilzoy:
Why use Bill Gates as a hypothetical example when we have Steve Jobs as a living, breathing, actual example? If he didn’t have the means to “relocate” to Tennessee, where the transplant waiting list was the shortest, he’d be without a liver right now. It’s a perfect example of the “yes to me, no to thee” phenomenon you’re talking about, even if it’s not a “highly experimental” treatment.
Group Health Cooperative in Washington is one of the non-profit wholistic systems that is apparently being used as an example of how health care can be changed using non-profits(according to our Governor, anyway). I had surgery there once, and while it reminded me of jiffy lube in the OR, I received good care and easy access to specialists.
Group Health
What does the ‘public option’ offer that a regulated not-for-profit does not?
GOB – I couldn’t really say, but why is that so important? If you’re looking for something that does what the government would do, but that isn’t government, I’d ask why. I don’t see how this highly regulated non-profit wouldn’t be subject to as much potential political influence as a government entity. It just seems like you think the government doing anything that could otherwise be done by the private sector is to be avoided. Period. Just because governement is bad, even if it’s doing the same thing. What am I missing? Where’s the beef?
tgirsch
How much does it cost to catch a flight to Tennessee? $200 dollars? It’s one of the lowest cost of living states. How can you seriously say it is not possible for most americans to relocate there?
fraud guy
“Your circle is better covered than average.”
I don’t quibble with this. However, for the record, the teachers/school administrators are not in the public system and therefore don’t get the gold plated benefits that most public employees get.
How much does it cost to catch a flight to Tennessee? $200 dollars? It’s one of the lowest cost of living states. How can you seriously say it is not possible for most americans to relocate there?
Wow, either you’re missing something very basic and obvious and simple, or I am. How rich do you have to be to move to a new state without a new job lined up, especially with mushrooming medical bills? Do you honestly believe the plane ticket is the only problem, or are you just trolling?
You know, I wasn’t as, you say, “stupid” enough to support Kucinich, esp. since I consider myself a moderate.
But all this handwringing over our limited health care reform options begs the question of what exactly self-ID’d “progressives” were prioritizing during the election and why they think single=payer should be on the table at all since the one guy who supported it was given the rhetorical shaft.
— Paula 2
because most americans need jobs to pay their way, and those aren’t just handed out on landing at any tennessee airport.
nor can most americans pack their homes and belongings into a carry-on bag to go along on that $200 flight ticket. moving costs real money.
John Thullen, 2:28
If you go back and look at my various healthcare related comments you’ll find that I said I am not opposed to a government plan or pooled risk in principle. What I am opposed to is plans where a particular set of coverages is priced to different persons based on income rather than an identical premium amount being charged to each person.
IMHO a government plan is more likely to conflate the tax subsidy aspect of a program with the actual cost savings of a program, so that one cannot determine what is the true price of the thing. The government will sell it to the population as ‘i”m saving you money’. Some will hear it as ‘the government is efficient and has pushed down overall costs’ when in fact, they have lowered the costs to most people by subsidies rather than actual cost reductions.
Gary 2:42
“You didn’t address any substance of what she said; you simply questioned why she should be interested, because of her location. Your point wasn’t about substance, it was about her.”
That is just not true. There has been a running give and take on healthcare across many threads for many days. In those various places I have addressed Jes and others on substance.
Are you saying I have to wait for an ‘open question’ thread before I ask her a question? That would be a silly requirement.
2:58 was not me.
Hairshirt
“If you’re looking for something that does what the government would do, but that isn’t government, I’d ask why.”
See my comment at 4:55p for my view on why.
I begrudge no man his boner, and if he requires a little subsidized stimulation, who am I to stand tall and erect obstacles in his way. In the affairs of men, it often arises that suspicion, at the very least, is aroused by those among us who would make it hard to fulfill our manly destinies. Let no man falter or grow limp in the face of criticism from those who believe only some, those who are more priviliged than others, should be able to take fortune in their two bare hands and penetrate the mysteries of life’s pleasures.
As an aside, I’ve often wonder about the auditions and rehearsals for those commercials.
It would be funny if Harry and Louise, of Clinton healhcare plan fame, were hired to do a Viagra commercial. At the crucial moment, as they disappear into the boudoir smiling fondly, the overvoice could point out that the pills are not covered by Medicare. The lady would suddenly reappear and be shown looking grimly into an open refrigerator for the last of the ice cream, while the man of the house, in his bathrobe, walked the dog.
“Do you honestly believe the plane ticket is the only problem, or are you just trolling?”
I honestly believe that if your life depended on it you would do it. Lack of a job in Tennessee is not a barrier. Ever heard of welfare? What you’re really saying is that it would be inconvenient for you to move to Tennessee. You’re smearing Steve Jobs and the system because it was more convenient for him to go to Tennessee than for you to do it. Not because it is impossible for you. In my opinion, it is more inconvenient to die than relocate and live on welfare. And at what point does an inconvenience become a need and a right?
Nomen Nescio
“because most americans need jobs to pay their way, and those aren’t just handed out on landing at any tennessee airport nor can most americans pack their homes and belongings into a carry-on bag to go along on that $200 flight ticket. moving costs real money.
When I graduated college I had no job, few possessions and very little money. I moved 750 miles and arrived in a place where I had no home and no job. Now, you’re talking about being in a circumstance where you’ll probably die unless you move and you’re saying you won’t do it because it’s too hard to move your possessions.
?
d’d’d’ddave:
I may have started my 2:28 comment with something you wrote in mind, but the riff always gets the better of me.
Perhaps I erected a straw man (and let no straw man be denied his straw erection), but I think even straw men should be covered under a universal, gold-plated, single-payer (something along the lines of the federal employees healthcare plan which, of course, permits access to private, but subsidized, healthcare providers) arrangement.
Including straw men and women would make the insurance pool even larger.
On the other hand, the scarecrow and his inner straw, like Steve Jobs, got his brain transplant because he had the means and the connections to get to the Emerald City at the right time.
Have a good weekend.
Wait a second.
“Ever heard of welfare?”
I’m happy for Steven Jobs, but he would not have gone to Tennessee while on welfare with its onerous (I’m assuming) welfare-to-work requirements.
Plus, if was on welfare, he would have all of those out-of-wedlock kids to account for.
Maybe he would drag his diseased body around for job interviews, trying to explain to the employers that he might need tomorrow off for the emergency liver transplant, and, by the way, tell me about the company health insurance plan.
to living under a bridge, no. to getting urgent and serious healthcare, it most certainly is.
if you’re fresh out of college with no possessions and no obligations, moving across country to start up a brand spankin’ new life is no problem. if you have a life-threatening health problem and a family to worry about, not to mention worrying about how to keep the medical insurance that’s your only realistic way of treating that health problem, then the situation is no longer comparable, and you’d have to be mind-numbingly ignorant and naive to think it was.
“Lack of a job in Tennessee is not a barrier. Ever heard of welfare?”
I don’t know if you’re the troll or not, but either way, in point of fact almost no state offers any form of “welfare” to single males above the age of 18 and below the age of 65, unless they’re disabled.
After ddddave’s dragging out of all the friends he has in this world out to defend his views on healthcare (“Why don’t you move to Tennessee? Here’s a 20 for the planefare”), perhaps he will give us detailed medical records of all his friends, made up on the spot. Or maybe his version of the Sally Field’s Academy Award Speech. Unfortunately, the guy we would like would be the troll impersonating you.
I think something I wrote got caught in the filter, so just in case:
I’ve deleted four comments, which were written by one IP address under four names belonging to other commenters. One was purportedly by GoodOleBoy, the one he said wasn’t his. The other three were two comments (purportedly by d’d’d’ and Paula) denying that a comment (a real one) was by that person, and one was from JonnyButter saying: yeah, the troll hasn’t used my name either.
I will keep looking around to see whether the troll has used other IP addresses besides this one. Because, of course, I have nothing better to do.
Ack: in ” and one was from JonnyButter”, above, please insert the word “purportedly”. If it had been from JonnyButter, I would not have deleted it.
If it had been from JonnyButter, I would not have deleted it.
I appreciate that!
What possible fun is there in masquerade-trolling? Talk about ‘having nothing better to do’!
Regarding Group Health. it should be noted that they have varying plans that provide different levels of coverage. My wife and I have had the coverage through her employer for 30 years and are basically happy with it, but it should be noted that we have had one of the better plans. We have a friend, who is working at a barely above minimum wage job, with reduced hours, and this year a further reduced Group Health plan, which doesn’t cover the lab tests. Guess who is not getting and can’t afford a routine physical. So yeah she may have insurance, but it definitely stops short of being meaningful health care. It may provide catastrophic insurance, but even there the co-pays will essentially bankrupt our friend should she survive her treatments. Insurance != health care.
Posted by: John Thullen | June 26, 2009 at 05:21 PM
Lord have mercy, I havne’t laughed this hard in few days.
When I graduated college I had no job, few possessions and very little money. I moved 750 miles and arrived in a place where I had no home and no job.
Did you have a support system behind you? Some family you could call in case things got really hairy, or there was a dire emergency? Friends who might help you out?
Do you have any idea whatsoever — and not “I read it in a book” or “I own a trailer park,” but actual on the ground experience — what it’s like to be desperately poor? You might find this illuminating, although I doubt it. Just remember, no choice is too difficult, no option too problematic, for someone who never actually has to face it.
what exactly self-ID’d “progressives” were prioritizing during the election
Defeating the Republican candidate was _my_ first priority.
I don’t claim certain knowledge that, had Kucinich been the nominee, he would have lost in the general election due to lack of general popularity, but I strongly suspect as much.
Articulating and advocating superior policy positions is not very important in American Presidential elections.
I find the discussion about Jobs kind of interesting, because as I understand it, he didn’t move to Tennessee. The list in Tennessee was shorter than the list in the Bay Area, so he went where the list was shorter. And from what I understand, he got on the approved list there in part because he could show that he could get to Tennessee within 6-8 hours of getting notice of the available liver. And he was able to do that because he’s the CEO of Apple and he could afford a private jet to get him there.
If I needed a liver transplant, I would have to settle for the list where I live (no matter how long it is), because I don’t have the resources to get myself to Tennessee within six hours, without any advance notice.
This is how privilege games the system.
it’s “gaming the system” in the sense that Jobs’ wealth bought him a much shorter wait for a liver in Tennessee than he could have had in California.
but on the other hand, he also shortened the waiting list in California by one name. to some degree or other, his privilege worked to equalize the organ donation wait times between those two states ever so slightly.
which is not to say that what he did was unquestionably or inarguably right, merely that i think the bioethics involved are not that clear-cut. there are arguments on both ends of it.
if he’d bought himself an earlier spot on the same one waiting list he was already on, that would have been (IMO) a much more clearly wrong act, one i could much more easily argue as being an abuse of privilege. but he didn’t do that. he bought himself a place on a different, shorter, list entirely. so long as his place on it was not bumped up because he’s rich, above what a less wealthy native Tennesseean would have received, it’s not so obvious to me that he did entirely wrong.
he also shortened the waiting list in California by one name. to some degree or other, his privilege worked to equalize the organ donation wait times between those two states ever so slightly.
But by the same token he lengthened the list in TN. He got as liver that someone behind him would have gotten instead.
Of course, the irrationality here is that the TN wait is shorter than the CA wait. What’s that all about?
I’m not inclined to criticize Jobs. I would have done the same.
That’s all about the remnant of state sovereignty left to the great state of Tennessee. It wouldn’t be gaming the system unless Tennessee somehow made such a judgement. And the waiting time is different between two states, how would that be irrational?
What’s irrational is that we are just one big collective and we need to just get in one long line for whatever.
With health care, by contrast, we guarantee that certain kinds of people — the elderly, children, veterans, federal workers, etc. — will get health insurance, which in turn provides them with health care — at least, it’s supposed to. As I said above, it will not pay for experimental treatments, or treatments that don’t work.
The VA and lots of other government provided insurances also don’t pay for some expensive treatments that do work, or for medications that work.
My husband uses the VA for his asthma, aggravated by a collapsed lung while in the service, so his asthma is considered service connected. One of the medications that works wonders for his asthma, the VA will not prescribe because it is too costly.
My daughter has a friend on healthy kids who has an injured knee for almost a year now, but healthy kids will not pay for an MRI, because they won’t pay for it. At some point they may, but given my husband’s experience with the military (which refused to do an MRI of his knee when he injured it and only did it 5 years later to learn that he did indeed have a tear which now can’t be fixed, because the scar tissue is so bad it needs a knee replacement).
MRI’s are costly, but they aren’t expiramental and they aren’t ineffective.
Many programs for medical insurance the government pays for already says “no” to some treatments that are effective but opt out because of the cost.
So please don’t make the argument that a person getting their medical care through the VA, healthy kids, military etc have access to all viable treatments, because they don’t.
What’s irrational is that we are just one big collective and we need to just get in one long line for whatever.
So can someone pinpoint the date for me that conservatives stopped believing in shared values and all of us being in this together?
Of tangential interest: A recent post by Mark Kleiman on the incentives for organ donation.
Please tell me dave’s 5:41 was the troll.
“What’s irrational is that we are just one big collective and we need to just get in one long line for whatever.”
What we’re talking about are livers available for transplant.
If you’re rich, apparently you go to the head of the line.
It ain’t irrational, it just sucks.
Actually, his 5:46, too.
“So can someone pinpoint the date for me that conservatives stopped believing in shared values and all of us being in this together?”
I’m not aware that “all of us being in this together” has ever been an article of American conservative faith. Unless you construe “all of us” fairly narrowly.
If I’m wrong about that, let me know, because I’d actually like to *be* wrong about that.
That’s all about the remnant of state sovereignty left to the great state of Tennessee.
Ah yes. As a former Tennessean I too long for the days when the state was strong and independent – defended its borders, made its own laws, signed its own treaties, etc. – before unwisely agreeing to be absorbed into the Federal government. When was that exactly?
Not only that, try cutting in line for bullets at the local gunshop in Memphis, or into the communion queue at any old local church on any old Sunday morning.
At Graceland, Randian chaos reigns as conservatives jostle each other willy-nilly for a glimpse of the King’s stuff. Lines aren’t permitted, don’t you know, Davy, Davy Crockett.
This is why conservatives rarely volunteer for the American military. Too many straight lines, which oddly enough they are trying to get to the back of (like the preposition in that sentence).
On the other hand, have you ever seen a Marine unit converge on the mess hall? Dress right dress, my arse.
If you want to see a conservative paradise of queue-forming, visit the teller windows at any bank on a busy day in the Philippines, or spend a couple of hours trying to board a bus in Manila.
It’s a delicate dance of social interaction. No lines form, just a mass of men, women, and children, gently jostling (casting smiles to left and right) for position, as if in a human funnel.
One wants to go all arch-conservative and start barking like a Nazi (get over it, a John Cleese Nazi) for order, above all, and begin stringing velvet rope like a crazed movie usher.
As a personal admission, were I standing in line for a liver in Nashville, I’d carry a calf’s liver with me, and at some strategic point, I would toss it across the room near the queue for Viagra dispensing, and watch the assorted conservatives scurry away as I sidled up to the liver-transplant window, smiling wanly.
I’m not aware that “all of us being in this together” has ever been an article of American conservative faith. Unless you construe “all of us” fairly narrowly.
Yeah, the party with Jesus has always had a problem with the teachings of…well, Jesus.
Ack: Should be party “of” Jesus.
Damned hangover. Did I really have to do a beer an inning at the Yanks/Mets game last night? Apparently, “yes” is the correct answer.
Did I really have to do a beer an inning at the Yanks/Mets game last night?
The way CC was pitching you had to down them pretty quickly, didn’t you? Maybe the Mets’ fielding balanced it out.
3 errors in one inning! Poor Mets fans.
“So can someone pinpoint the date for me that conservatives stopped believing in shared values and all of us being in this together?”
I’m in this for you because I give heavily to charity, pay a disproportionately high amount and rate of taxes, and produce durable goods (houses) that people will have and enjoy long after i’m gone. When I’m gone I will pay an estate tax that gives a significant part of everything I have to the govt.
Explain to me how you are in this for me.
-Sponsored a family of immigrants from egypt. check
-Pay college tuition for an immigrant from Ethiopia. check
-Bought boat for some islands in Micronesia who had no way to get to medical care on main islands. check
-Ride bike to work. check.
– Countless other things, many of which I’ve mentioned before to derision and charges that I lie.
You? What are you doing?
Oh right, you VOTED for the govt to help people. So you did something, right?
Progressive my [bleep]. [bleep], selfish, heartless bastards, that’s what you guys are. Don’t do [bleep] yourselves – just advocate for govt to do something with other people’s money. [bleep] hypocrite bastards asking what Jesus would do. Jesus did things himself! He didn’t [bleep] lobby for the Romans to do things!
Yes. Yes. I know. I violated the posting rules.
I’ll go back and bleep out the expletives.
Clearly, dave is aware of every charitable act that I and every other commenter has done.
For the record, dave, I am one of the lucky few (and I do mean lucky) that would be subject to Obama’s tax increases due to the salary I earn. Doesn’t bother me, because we are all in this together. Nor does it stop me from giving loads to various charitable causes.
So [bleep][bleep] yourself.
Eric
You are free to make donations to the government all you want. Why do you insist that others do it?
I’m talking here about new additional programs above what is already in place. You are lucky enough – so do it. Why do you insist on selecting causes for the rest of us to ‘contribute’ to?
[bleep} {bleep] right back.
I’m talking here about new additional programs above what is already in place. You are lucky enough – so do it. Why do you insist on selecting causes for the rest of us to ‘contribute’ to?
Is there something magical about what’s already in place that makes it the basis upon which to judge what else might be done? Reasonable people can disagree about what government should be doing, but I don’t think even you, d’d’d’dave, would argue for government nothing at all. So, once you’ve agreed that we should have a government and acknowledged that it will cost something, you’ve selected at least one cause for others to contribute to.
Do you think those arguing in favor of public health insurance are doing it because they want to stick it to someone, or what? Even if you think they’re wrong, might you at least consider the possibility that they think it would be better for the country as a whole, maybe even wealthier people, at least in the long run.
I’m in this for you because I give heavily to charity,
How does this make you in it for me? My only relationship to charity is that I give both money and volunteer time to it.
pay a disproportionately high amount and rate of taxes,
“Disproportionate?” That’s up for debate. Want to compare salaries? If, as you claim, you are subject to the estate tax, you are a millionaire at least three times over, so you in fact pay a disproportionately low amount and rate of taxes, especially compared to someone in your same financial position 50 years ago.
and produce durable goods (houses) that people will have and enjoy long after i’m gone.
I own my own home, so how does this make you in it for me?
When I’m gone I will pay an estate tax that gives a significant part of everything I have to the govt.
To be perfectly accurate, you will, in fact, not do anything at all after you are dead except be cremated or decompose. Your survivors might do something with assets you leave behind, though.
Oh right, you VOTED for the govt to help people. So you did something, right?
Are you under some kind of weird misimpression that I don’t pay federal, state and local taxes — the last of which is calculated on EARNED income, Box 1 on the W-2, not on NET income, so I pay taxes to my locality even on FICA and on money I’ve deferred to my 401k, so can in fact, be described as “disproportionately high?”
Are you under some kind of weird misimpression that I do not spend some of my free time — time I could be spend engaging in my own hobbies and interests — standing behind a counter handing out bags of food to poor people? Or helping to raise money for heart research and cancer research?
Do you really think that “I got mine, you get yours” is the best way to run a country?
I mean, this thing with charitable donations again . . . you do realize that it’s people like ME that go out there and leverage that money into actual on-the-ground help for those in need, right? Why do conservatives, who in any other case ever say “Just throwing money at a problem isn’t going to solve it?” suddenly think that pointing to the size of their charity deduction on their 1040s is inherently meaningful? A donation without the work of staff and volunteers is just a pile of money.
Also noteworthy: For all that your activities there are laudable, Micronesia, Ethiopia and Egypt are not, in fact part of the United States.
d’d’d: To echo what others have said: it would be a mistake to assume that you are the only person commenting here who has ever given money (or anything else) to charity. It would also be a mistake to assume much of anything about how much anyone else has given.
This is one of those moments when I think Christ had it right: “So when you give to the poor, do not sound a trumpet before you, as the hypocrites do in the synagogues and in the streets, so that they may be honored by men. Truly I say to you, they have their reward in full.
But when you give to the poor, do not let your left hand know what your right hand is doing, so that your giving will be in secret; and your Father who sees what is done in secret will reward you.”
– Countless other things, many of which I’ve mentioned before to derision and charges that I lie.
You also said you were going to take your rent checks and move to Singapore. This is your second handle here. Why should we believe what you say now as ddddave and not what you said as frank?
When von argued that Obama reducing the tax deduction for charitable giving was going to reduce the amount of money that you kind rich folks give to charity, you were rather quiet. How do we know that you haven’t got some angle on Homeland Security grants for the Egyptian family, or that the boat in Micronesia isn’t being deducted as operating costs for some time-share scam, or that you are biking only because your employees (or the drug dealer you’ve said you rent to, hey he’s a nice guy and he pays his rent on time) would probably key your pimped ride?
Why, given your persistent attempts to disrupt the conversation here with specious comments, should we privilege your claims as truthful? If you really think the causes you contribute to are so worthy, why don’t you explain how others can help rather than trot them out to prove that you are jes folks?
When asked why you didn’t move to some place in the rust belt where your real estate nous would bring even more benefit, you gave a whole raft of reasons why you couldn’t move, but when arguing about health insurance, you baldly state that people should just by a plane ticket to Memphis and get a spare liver. When a post about Nixon comes up, you complain about dragging Tricky Dick out of the grave, but when it comes Michael Jackson, you are willing to score points while the body is still warm. Those aren’t lies per se, but they demonstrate that you aren’t interested in actual discussion, you are more interested in trying to piss on any argument that comes from the other side.
You are what you have revealed yourself to be, why should we believe you are some image of a philanthropist that you have constructed in your head rather than what the tenore of your comments here has shown?
“…and your Father who sees what is done in secret will reward you.”
I’m extremely hesitant to mention specific people, setting aside that they might not like me to, but mostly because I know for an absolute fact I’ll forget to list far more people than I remember to include, but among those here who have substantially helped me with charity on more than one occasion, whether in cash, or extremely valuble kind, include Hilzoy, Russell, Phil, Nicholas Weininger, and many others. For the record.
“Progressive my [bleep]. [bleep], selfish, heartless bastards, that’s what you guys are. Don’t do [bleep] yourselves – just advocate for govt to do something with other people’s money”
First, you know f**k all about what anyone here does or doesn’t do by way of charitable efforts. It’s great that you are generous with your wealth. You have nothing to say about anyone else.
Got that?
Seriously, who the hell do you think you are?
The topic of the thread is whether it’s hypocritical for Obama to advocate extending health insurance to currently uninsured people through a public plan. It would presumably be hypocritical for him to so because under that public plan, folks might not have access to medical care that Obama and his family could receive by virtue of their being wealthy.
Guess what? Wealthy people can buy things that other folks can’t buy. Amazing but true.
What Obama is trying to do is to make some basic level of health insurance available to people who currently can’t get it. So they can, you know, go to the damned doctor. Instead of having to go to the freaking ER to get some help every time their kid gets the flu. Or dying from some stupid, preventable, easily treatable disease.
What is your freaking problem with that?
How are your charitable efforts in any way relevant to that discussion?
And for the record, I subscribe to Gary’s blog. I do so because I like to read it, and because I’m interested in repaying him in some small way for the very broad range of useful information he brings to this blog. It’s of value to me, and it no doubt has taken him a non-trivial amount of time and effort to do all of that homework.
If we want to traffic in Bible verses, I’ll offer this one: “The workman is worthy of his hire”.
Charity has nothing to do with it.
Nuff said about that.
Progressive my [bleep]. [bleep], selfish, heartless bastards, that’s what you guys are. Don’t do [bleep] yourselves – just advocate for govt to do something with other people’s money. [bleep] hypocrite bastards asking what Jesus would do. Jesus did things himself! He didn’t [bleep] lobby for the Romans to do things!
D’d’d’dave, you’re no Jesus…
The idea that many conservative self-identified Christians seem to have is that Jesus didn’t advocate helping the poor so that the poor should be helped: he advocated helping the poor so that wealthy Christians could earn Jesus-points. The philosophy behind this is that if poor people are helped collectively and efficiently by everyone paying taxes and the government enacting legislation and policies to bring people out of poverty, this means that wealthy Christians won’t be so inclined to give money and so won’t be able to earn their Jesus-points.
I’m familiar with the argument: d’d’d’dave’s hardly the first righteously selfish rich “Christian” to make it.
“No one can serve two masters. Either he will hate the one and love the other, or he will be devoted to the one and despise the other. You cannot serve both God and Money. Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more important than food, and the body more important than clothes?”- Matthew 6:25
“When Jesus heard this, he said to him, “You still lack one thing. Sell everything you have and give to the poor, and you will have treasure in heaven. Then come, follow me.” When he heard this, he became very sad, because he was a man of great wealth. Jesus looked at him and said, “How hard it is for the rich to enter the kingdom of God! Indeed, it is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom of God.” – Luke 18:18-25
“”Now listen, you rich people, weep and wail because of the misery that is coming upon you. Your wealth has rotted, and moths have eaten your clothes. Your gold and silver are corroded. Their corrosion will testify against you and eat your flesh like fire. You have hoarded wealth in the last days. Look! The wages you failed to pay the workmen who mowed your fields are crying out against you. The cries of the harvesters have reached the ears of the Lord Almighty. You have lived on earth in luxury and self-indulgence. You have fattened yourselves in the day of slaughter.” – James 5:1-5
“Clearly, Christian thinking on wealth and property has “evolved” over the last 1,500 years. It is rather rare, these days, to hear a Christian assert or even defend the idea that “superfluity is theft” — yet that was the consistent and universal teaching of the church during the first four centuries of Christianity. ” – Fred Clark, 2005
You are free to make donations to the government all you want. Why do you insist that others do it?
Sweetness and light, are you totally unaware of the free rider phenomenon and the collective action benefits? If not, your answer is there. If so, go acquaint yourself.
Jesus did things himself! He didn’t [bleep] lobby for the Romans to do things!
Yes, and clearly the “Party of Jesus” doesn’t lobby the government to do anything. Nothing. That is, they don’t lobby the government to do anything about poverty. Now if it’s a question of sexuality, or breaking down the separation of church and state, will that’s another story isn’t it? Then it’s not about “Jesus did for himself, and so should we!!!”
Further, we’ve already tried your method and it was a spectacular failure. There was a time in America when we relied almost entirely on the private sector’s charity to ameliorate the conditions of poverty – and it didn’t work. Big time.
Turn the clock back before FDR, and what you see is not some utopia of Americans helping other Americans through the kindness of their hearts. What you see is a lot of human suffering, a lot of poverty, a lot of older Americans spending their final days without even a shred of dignity.
Sometimes you need the government to step in and create certain solutions to market failures, and failures of inadequate charity. Not all the time, in every way, but things like health insurance, social security, unemployment insurance and basic welfare have greatly softened the hard edges of poverty in a way that 100% reliance on charity never would. In the case of health insurance, it needs to be expanded.
Further, America’s story in this regard is not unique. It is repeated the world over. Whereas your fantasy has no historical precedent.
“Sometimes you need the government to step in and create certain solutions to market failures”
I’ll amend this slightly, if I may.
Sometimes a society decides to step in and create solutions to problems. And sometimes the way a society decides to do that is through its government.
It’s not the only possible solution, but it is quite often a very good one, perhaps the best one.
Things that need to scale across a whole population, things that are not particularly economic, things that are too essential to be left to the vagaries of the market. All good candidates for providing through government.
In a lot of cases, government is the only institution everyone has in common, which makes it particularly good at addressing issues that are broadly in the public interest.
Private charity will not make basic health care available to everybody. By way of proof, I offer the fact that it does not do so now, and never has, in spite of the fact that nothing stands in the way of it doing so.
Likewise for private insurance carriers.
So either we do it, collectively, as a society, or will not happen.
lol. How nutty of you.
Many people argue that since other nations have it and are fine, that therefore we should.
Of course we forget these nations get all the innovations in medicine from America for free, so they don’t have to allow the free market to create it in their countries.
but when Nobama the shithead’s plan kicks in, innovation will drop as people seek to make money outside the medical field.
Thos AIDS and cancer vaccines aren’t coming with Nobama care, bitches.
Thos AIDS and cancer vaccines aren’t coming with Nobama care, bitches.
Because what the world needs now is another private-sector solution to erectile dysfunction!
This discussion sure took a distasteful turn during the period when I failed to check back. Lest any erroneous assumptions emerge regarding my views on universal access to health care, I want to state that I am for it. And I also think that at some level government must insure that it happens or actually take measures to provide it.
My concerns, as expressed on numerous issues at various times, are with centering our reliance on government actions when needed in Washington. Our constitutional system was established with the view that limited matters would be decided in Washington and much would remain at state and local areas. We have moved away from that concept; many would say for the better and to our benefit. Even so, one cannot necessarily conclude that we can continue to move, without limitations, in that direction without detrimental effects.
Notions of popular direct democracy at the national level have gained support over the years. Several states have turned to voter referenda in recent years for critical state issues. The results have been sometimes surprising and even paralyzing as in California. So there are two issues here. At what governing level should decisions be made and by what form of ‘democratic’ process.
I see the EU as in some ways following a model more in line with my thinking as we here in the US seem more inclined to move away from that model we once had. The Swiss model is often reference when advocates promote direct democracy but that nation is small and relatively homogeneous. The US is diverse and large, both in population and geography, and may not function well in a more directly democratic form.
Just my way of presenting my thoughts regarding how we handle issues as opposed to whether or not we agree that a particular issue like health care needs a solution.
“My concerns, as expressed on numerous issues at various times, are with centering our reliance on government actions when needed in Washington. Our constitutional system was established with the view that limited matters would be decided in Washington and much would remain at state and local areas. “
This seems like a perfectly legitimate concern to me, FWIW.
In point of fact, the feds would probably do a better job of running something like this than the state of MA would, so from a purely selfish point of view I might prefer a federal program.
But assuming a public solution is to be offered, the question of where responsibility for something like that ought to lie is a good one. IMVHO.
GOB, just a question, was the 7:30 post yours? It just seems a lot less measured than your 9:11
Both are mine. I get much more exercised at the notion of direct democracy (decisions by referenda or popular vote) at the federal level than at the state level.
” I get much more exercised at the notion of direct democracy (decisions by referenda or popular vote) at the federal level than at the state level.”
Personally I’d have to say that California’s history of making law by referenda is a pretty good case for demonstrating how well an excess of such procedures can screw up a state.
(This isn’t to state that I in any way hold a blanket position of opposing referenda. Neither, obviously, are legislatures incapable of being incompetent and screwing up a state; I’m not saying anything more than what I just said: that California has made a good example of screwing themselves up with referenda by passing a variety of contradictory mandates.)
And, for the record, I hold the incredibly anodyne position that some issues are best dealt with on a state level, and some on a federal level (and some on a muncipal/county or village level). The devil is in deciding/arguing over which is which. These tend to be things in many cases that I think reasonable people can reasonably differ over.