So, this one is for commenter Ed Darrell who seems to have appeared out of nowhere, fully formed, and armed to the teeth with smarts and all kinds of intellectual ammo to smash the wingnuts into oblivion, even the super-keen smart ones. In the comments to my last post, he came swooping in with all kinds of info and expressed an interest in reading the entirety of the exchange with the guy on Facebook. So, I am hereby obliging.
BTW, Ed, I note from you profile page that you live in Dallas. I grew up in the Dallas area and the particular wingnut in question is a high-powered corporate attorney who I went to high-school with and who still lives in Dallas. So, Ed, you can imagine the particular brand of insular corporatized arrogance that represents.
And while we're at it, Ed, who are you and where did you come from? Please feel free to comment all you like. And that goes for the rest of you, as well.
For all you other Blog-O-Maniacs, unless you are interested in a long, tedious and blood-pressure averse blog post, what follows is a tough and not terribly rewarding slog. I only edited the names out to protect the not-so-innocent and the order of a few specific posts for clarity. No words have been added or subtracted.
Enjoy?
BTW, Ed, I note from you profile page that you live in Dallas. I grew up in the Dallas area and the particular wingnut in question is a high-powered corporate attorney who I went to high-school with and who still lives in Dallas. So, Ed, you can imagine the particular brand of insular corporatized arrogance that represents.
And while we're at it, Ed, who are you and where did you come from? Please feel free to comment all you like. And that goes for the rest of you, as well.
For all you other Blog-O-Maniacs, unless you are interested in a long, tedious and blood-pressure averse blog post, what follows is a tough and not terribly rewarding slog. I only edited the names out to protect the not-so-innocent and the order of a few specific posts for clarity. No words have been added or subtracted.
Enjoy?
You posted a link to a news story
June 26 at 9:20am.Armadillo Joe would like to point out that if you think actual elected members of Congress will be the ones working on making this country's new health care policy, you haven't been paying attention.
NPR: Turning The Camera Around: Health Care Stakeholders
Source: www.npr.orgWhen 22 senators started working over the first health-care reform bill on June 17, the news cameras were pointed at them -- except for NPR's photographer, who turned his lens on the lobbyists. Whatever bill emerges from Congress will affect one-sixth of the economy, and stakeholders have mobilized ...read more…
CommentsLawyer friend #1 at 9:42am June 26
Ok, not all lobbyists are bad. Lots of healthcare company lobbyists, but also JDRF and American Heart Association and so on.
Armadillo Joe at 10:22am June 26
yes, that's true. Advocacy for a position is a necessary part of the American system of representative government.
And further, I'm sure even the biggest villains in that room also still love their spouses and children. The problem isn't with any one individual lobbyist's personal morality or professional ethics. The problem is the system itself, wherein the money to buy the access to affect policy is made by engaging in the very practices the policy-makers should be seeking to end.
Put less abstractly, the health-care industry is bloated and ineffective and a great many people make their personal fortunes in the ensuing chaos, which makes them the moral equivalent of war-profiteers. Those profits are then spent in defense of furtherance of the very system in need of reform.
Which is why we never get health-care reform.
Lawyer friend #1 at 10:36am June 26
Ok, so who has a better system?
Armadillo Joe at 11:14am June 26
um, every single industrialized country on earth
Lawyer friend #1 at 11:21am June 26
I've been in the UK medical system. I sat for hours only to determine that the person had no idea how to take care of diabetes. And in France, they decided it was too expensive to take an xray. So, I walked around with a broken foot for months.
Armadillo Joe’s lawyer-friend #1’s husband at at 11:32am June 26
"Every industrialized country on earth"? What are you talking aboot? Take off to Canada, eh!
Armadillo Joe at 11:46am June 26
two anecdotes don't add up to data. we have the only system on earth that doesn't guarantee everyone a baseline level of care.
However closely your particular experience in France and the UK may track with the hysterical right-wing cartooning of "socialized medicine" when compared to the gold-plated, expertly-tailored, employer-based insurance plan you enjoy here, for the 1/3 of our population with no recourse but the emergency room, they too will sit for hours for treatment but then will have no hope of ever paying the bill. When I was in Paris, I waited fifteen minutes for an English-speaking doctor and then presented a doctor's script to the pharmacy and no one ever asked for one red cent from me. Compare that to the fact that I am still getting a bill for $8.72 for a doctor's visit from three years ago because somebody typed in my social security number wrong, and I am covered by three different and very good health insurance policies.
Lawyer friend #1 at 11:54am June 26
I still wouldn't say it is a better system. I don't want mediocre service for all. Our service isn't the best, but I definitely don't want what they have in europe.
Random Friend of Armadillo Joe #1 at 12:03pm June 26
Well stated, Armadillo Joe. It seems to me we have a market economy which is fundamentally a Game About a Market, an Advocacy system that is a Game About Representation, and a Healthcare system that is a Game about a Business about Medicine -- and we are no longer able to ante up...
Armadillo Joe at 12:04pm June 26
but then, what do you want for a health-care system? How is that everyone's health-care system else is wrong and ours is somehow right?
It is generous to call what we have here in this country right now a "system" at all. It doesn't just need fixing. It needs to be rebuilt from the ground up because it is an abomination that kills people from neglect and ruins them financially by using their personal fear of sickness and death to extort money for treatment and holds their love of their family members hostage for the same reasons.
Any solution that doesn't cover everyone and make something as basic to human dignity as health will be a disgraceful failure.
and just to be clear, just because we should have a comprehensive system does not mean that people who do have gold-plated, expertly-tailored, employer-based insurance plans can't keep them.
It's like social security. Everyone pays in, everyone gets to use it, but having it doesn't mean you can't have your own private retirement plan.
I just can't understand the hysteria about having a nationalized system outside of the dishonest rhetoric from advocates for the ugly, deeply unfair status quo.
Lawyer friend #1 at 12:53pm June 26
I didn't say everyone else was wrong nor did I say ours was right. But I think they are both flaws.
While I agree that any solution that doesn't respect human dignity is a failure, I also STRONGLY believe that any system that fails to provide GOOD health care not just basic care is also a failure.
Social security is a great example. It stinks. It costs everyone a ton of money provides for really no one and doesn't actually solve anything. This is my current fear of people suggesting that any "industrialized country on earth" plan is better than ours. THEY AREN'T.
People from all over the world come to our country for expert care. Trust me, I have ENORMOUS experience with insurance and doctors. There are flaws with the way people are covered, for what, and how doctors are paid. But our flaws don't automatically create better systems everywhere else.
I wasn't creating hysteria. I was simply saying this is very complicated because in the wake of nationalizing something you lose a lot of the quality care we have. Obama's plan isn't nationalization and fortunately isn't copying other countries. He has a LOT of nooks and crannies to think about and the various other viewpoints only prove to make him analyze his own position better.
I'll take the lobbyists and even the radical crazy right wingers versus a system that simply moves to copy anything else that is out there
Armadillo Joe at 2:02pm June 26
I could not disagree more vehemently. my core argument is that money needs to be removed from the health-care system, because by commoditizing everything in life, we've put the health of our citizenry at the mercy of cure-all free-market fairy dust, which never seems to work as advertised. Say what you will about rationing under nationalized systems, we have rationing now based on income level. Who gets to live is based on who can pay and 32.7% of all Americans can't anymore.
I agree, sure, everyone should get GOOD health-care, but how about any health-care at all? Same goes for Social Security. You say it stinks, but that plus Medicare keep our poorest and most helpless elderly off the streets. We could do much better. We should have a comprehensive system of care for the aged in our country instead of the haphazard, piecemeal warehouses we dump them into now, but at least we're doing 100% more of something, of anything at all than we are on health care for the rest of the population.
You assert that "our flaws don't automatically create better systems everywhere else" but I still haven't heard anyone offer a substantive reason why our private health care system is better than any nationalized system. All I ever hear are vague anecdotes about lines and rationing and the people who offer them are almost always well-to-do people covered by robust private insurance for which they can afford the high premiums or they are politicians who have full subsidized coverage for life for just having held office. In other words, our unfair system is working for them.
I assert that any national system that protects all its citizens from preventable death and financial ruin is objectively better than a system that doesn't. No one can plausibly argue that the American system does anything but hold its citizens hostage to the fear of illness and death and, in so doing, extorts money from them. People are getting rich by so doing. That is immoral.
You can keep your lobbyists -- soulless merchants in the temple as far as I'm concerned. the radical crazy right wingers you propose to ally with over a just and moral system of care are themselves compromised by their affiliation with the current system of extortion. They want to defend a sickeningly unjust status quo because they make money off it.
Anything short of comprehensive nationalized health care amounts to the same "booga-booga-booga scary socialized medicine booga-booga-booga" argument we've been hearing since FDR tried to institute the NHI in the 1930's.
Lawyer friend #1 at 2:17pm June 26
I'm stunned by your inability to even see the other side. To say that I ally with right wingers is crazy and you know it. I simply stated that the only way to achieve the best system is to have everyone participate, everyone state their issues, and to truly listen to them. You write off any legitimate arguments because you can't get past people's concerns of socialized medicine.
One of the reasons we do have such wonderful medicine, like the Mayo clinic for example, is the competition. You can't have and you won't have people be doctors or at least not the best people if you aren't rewarding them. Look at the way people shy from the OB practice or the general practician due to lack of benefit.
Did you watch the town hall? One student indicated she was graduating medical school with over $300K in loans. Do you honestly believe she would continue in our country if you remove the money from the situation.
Obama isn't and shouldn't be proposing nationalization which is the right's issue and what you seem to be consumed by. His plan is like Massachusett's and focuses on requiring companies to provide insurance and offering a government subsidized insurance option. I can get behind that.
I have to get a few things done before B gets home, but never fear, I will email you directly a few items.
Corporate lawyer/former high-school debater at 2:49pm June 26
you say: "my core argument is that money needs to be removed from the health-care system". That can't be right.
What exactly do you mean? That we should stop paying nurses, doctors, and pharmaceutical companies? That they should provide their services for free? How exactly would that work? Do you do your job for free? Even under a nationalized system, you still need money to pay for the health care.
You compare health care lobbyists to war profiteers. Does that apply to doctors, nurses, etc., too? They charge money for the service of providing health care, so they profit from the misery of others. Is your idea to stop paying doctors and train everyone to provide first aid, and then we operate on a buddy system?
Even in a nationalized system, there must be money. Health care providers must be paid to provide services to people who need health care. And if the goovernment is the one paying the money then you INCREASE the importance of lobbyists.
Armadillo Joe, you say: "just because we should have a comprehensive system does not mean that people who do have gold-plated, expertly-tailored, employer-based insurance plans can't keep them."
To be clear, the people you're talking about with gold-plated health insurance include many union members, who have LOBBIED to get their plans excluded from any taxes on those employer-funded health plans you (and Mr. Obama) say we'll all be able to keep.
So which system are you in favor of: one where everyone is guaranteed some baseline of services, and must pay for anything they need beyond that baseline, or one where everyone is guaranteed anything they need, and they don't need to pay anything?
Armadillo Joe at 3:01pm June 26
I don't necessarily see my devaluation of the arguments opposing nationalized health care as an inability to see the other side. I just don't give much credit to an argument from anyone who is currently getting rich off the system -- for their motivations are transparent -- and all other people advocating for the status quo seem to do so either from ignorance or character flaw. I think the current system is immoral -- on par with slavery in the 19th century, frankly -- and anyone who seeks to defend things as they are cannot do so with both a clear conscience and full knowledge.
I don't want to do violence to your position. I want to characterize it as fairly as I can so that I can refute it on its own merits, so if I implied that you were allied with right wingers it was only because you wrote:
"I'll take the lobbyists and even the radical crazy right wingers versus a system that simply moves to copy anything else that is out there"
But likewise, I think characterizing my position as action for the sake of action or to be like Europe is also unfair. The Europeans have an objectively, measurably superior system to the one we have, no matter what kind of negative but nevertheless anecdotal experiences you may have had there or may be having now with the expensive, employer-subsidized care you enjoy today. I am not saying that Americans can't still have private insurance. Go ahead, keep it, but we have to say as a country that having a solid baseline of health-care below which we WILL NOT allow our citizens to fall is a MORAL issue, period.
Which is why I can't give credence to the argument from incentive. Competition? In basic health-care? As I have said again and again, health-care is a MORAL issue. It is not something that should be commoditized, made subject to the magic sparkle fairy dust of the free-market which is neither free nor much of a market.
If people want to have their own private insurance pay for Viagra or plastic surgery, fine, but to say that the naked competition we suffer here, to call our system "wonderful" is to focus solely on the high-end and very expensive medicine offered in places like Dallas and New York and Los Angeles where people with money can not only buy the care they NEED, but also the care they WANT (i.e., cosmetic surgery), which ignores the vast bulk of Americans who have no care at all.
The student you referred to, BTW, with $300K in loans raises some questions for me. First, the amount of her debt is an indictment of our system of higher education in this country, not a self-supporting argument to continuing the status quo. Second, what kind of medicine did she study? In what possible way would a nationalized system fail to allow her to practice the well-paying, high-end medicine which could help her pay back those loans? Third, the fields you cite as low-paying (Ob-Gyn, GP, etc...) would continue draw some people and perhaps even more in a subsidized system because of a certain amount of guaranteed income from people who truly NEED the care and because some people choose to do medicine for more than merely economic reasons. Teaching pays shit, but people still do it because some careers are a calling....
....And, finally, isn't this whole argument rather circular? Medicine is expensive because school for medicine is expensive so only expensive medicine should be practiced so that the expensive medical schooling can be afforded by the people who choose to do it. Circular.
It's very simple. We have a system that only works for some people. That system can stay in place for those people because they can afford it and the much-ballyhooed system of incentives can continue and people will continue to get rich. For the rest of us, some other option besides illness and death versus financial ruin must exist. Installing one does not mean outlawing the other.
Corporate lawyer/former high-school debater at 3:04pm June 26
To follow up on my last question:
The second removes money from the decision-making (which you advocate), which removes any incentive to control costs. We'll just need to spend enough to make sure there are enough health care providers to cover everybody's every need. What do you quit spending on to ensure that result? Or are you okay with financial ruin, as long as it comes from extraordinary taxes instead of extraordinary insurance costs?
The first means that poorer people still get less care than richer people, which you think is unfair. So I think you have to actually favor a law that forbids people from spending their own money on health care beyond the government-provided baseline. Otherwise you're punishing the poor.
I guess that means you hate the current proposals, too, because they don't go far enough.
Lawyer friend #1 at 3:07pm June 26
You arguments remain good theoritically, I still hold that they don't add up in reality. I'm still searching stats on the UK, but while you may see my anecdote as singular, the reason anecdotes exist is to personalize the statistics.
Public school is another moral issue. One where I stand that every person deserves a good and decent education in this world. Unfortunately, the reality of public school will never meet those lofty goals. Systems aren't always better simply because the government sits in the corporation's shoes.
Armadillo Joe at 3:10pm June 26
As for removing money from the system, you are correct that I need to be clearer. I'm not advocating for some hippie-dippie pie-in-the-sky "everyone should volunteer for the love of it" system. Nobody is arguing for such a thing. Doctor's should be paid, well paid, frankly, as well as nurses and orderlies and ambulance drivers. What would be clearer would be to say that the profit-motive should be removed from basic health-care.
When I compare them to war-profiteers, what I mean is this:
* Ron Williams - Aetna - Total Compensation: $24,300,112.
* H. Edward Hanway - CIGNA - Total Compensation: $12,236,740.
* Angela Braly - WellPoint - Total Compensation: $9,844,212.
* Dale Wolf - Coventry Health Care - Total Compensation: $9,047,469.
* Michael Neidorff - Centene - Total Compensation: $8,774,483.
* James Carlson - AMERIGROUP - Total Compensation: $5,292,546.
* Michael McCallister - Humana - Total Compensation: $4,764,309.
…as for the system I advocate, I liken it to social security or public schools or higher education. Everyone pays in through taxes and can participate if they want to, if not, they are still free to choose a private option. Having state-funded universities hasn't made Harvard, Yale or Stanford any less the envy of the world. Why would such a thing happen to health care?
so, yes, I think a certain level of baseline care should be free. Radical or extraordinary procedures would be the responsibility of the individual, which could be covered by private insurance. As to where the line is, I don't know. But unless and until we have at least basic health care for all, that line is theoretical.
BTW, I am one of those with a gold-plated union plan. Two, as a matter-of-fact, from two different unions.
Lawyer friend #1 at 3:18pm June 26
So is your issue insurance or high paid CEOs? That is a bigger and different issue entirely.
We need people to be rewarded. Not just doctors, but companies. We need them to see a new drug or a new medical device as a way to receive a reward. I guarantee the quality of my insulin pump would be much less if the goal wasn't to have a better, more chosen insulin pump than the next company. The two continuous glucose monitors truly stink, but they are both racing to have new and more useful features than the other. Solely on the purpose of making more money.
If you remove the financial incentives for these discoveries, you would still have a few scientists who continue for the good of mankind, but no where near the current innovation.
Armadillo Joe at 3:22pm June 26
as to your follow-up question, no one is advocating comprehensive cradle-to-grave coverage for any malady which should arrive for anyone.
However, the marginal cost for a basic check-up for someone making $7/hr at Wal-Mart is extremely high whereas the same for the CEO of Bank America is negligable for infinitely better care. A public system of FINANCE (not actual care -- doctor's bills for anyone in the system would be paid by the gov't, the doctors would not become government employees) would be subsidized by progressive taxation of health-care benefits.
But please don't mischaracterize my argument by saying that I think rich people should be legally limited in the care they can receive so as to not punish the poor. I am arguing for nothing of the kind and it does simplistic violence to the position I advocate. It amounts to "socialized medicine" scare-mongering and insidious class war.
Lawyer friend #1 at 3:30pm June 26
For the record, progressive taxation of my health care benefits would honestly be ridiculously hard on us.
And in the midst of discussing this, I forgot to take my insulin with lunch. So, I'm out of here for a while to focus on work and that. Ciao, guys!
Armadillo Joe at 3:33pm June 26
Why do keep trying to make my argument about eliminating incentives? Having a nationalized system of health care would not mean that competition for a bigger and better insulin pump would vanish.
Let me be clear, the financial incentive is still there to do all the R&D necessary,
I'm not talking about instituting a Soviet-style medical care system where everyone has to go to one doctor. That would be stupid.
When you have a system based SOLELY on financial incentives, then you wind up with a system where financial incentives are in place to DENY care at critical moments when the oh-so-precious free market can't move fast enough to fill the gap. As long as the insurance company has the financial incentives to MAKE MONEY (for the CEOs, for the share-holders) it will collect premiums and then do whatever necessary to not have to pay out. That amounts to fraud.
I know, I know, you could shop around the free-market for another policy or sue for damages, but if you're diagnosed with cancer you need care right now, not after years of litigation.
Corporate lawyer/former high-school debater at 4:47pm June 26
Armadilo Joe, you say: "As for the system I advocate, I liken it to social security or public schools or higher education."
1. Social Security is not a great model. Social Security benefits are based on earnings averaged over most of a worker's lifetime. So they depend on a person actually working and earning the benefits. Not to mention the unfunded liabilities and impending insolvency - that's an argument against public funding.
2. Public schools are an interesting model. Would you require patients to go to their assigned health care providers, or allow them to choose to go wherever they want? Would you pay doctors as richly as you pay teachers?
3. Higher education isn't free. If you're saying you want public hospitals competing against private hospitals, ala UT and Harvard, you already have that. There's no problem with the gov't setting up competitive health care services, as long as they aren't promising free services to everyone.
I just don't understand where you draw the line between good financial incentives and bad ones. You want to keep the benefit of profit motives when you're talking about R&D, but you don't want to keep them when it comes to selling treatment. How do you reconcile that? You can't motivate health care providers with profit incentives to get them to do good work, then remove those profit incentives because you think they result in denial of care.
Your argument is that it is immoral for some people to receive less medical care because they have less money. That's not mischaracterizing your point. You're the one who keeps talking about how it is unfair and immoral that some people have "gold-plated" insurance, while others don't.
You don't know where the line is, so you characterize it as hypothetical. But it's not hypothetical when it comes to making decisions about what will be paid for and what won't be paid for. Today the gov't pays (through Medicaid) for people below the poverty line to receive certain care. It doesn't pay for other people (who make too much to qualify for Medicaid, but not enough to choose to pay for health insurance) to receive the exact same care. You think that's immoral, right?
You think the gov't should pay for everyone to receive that basic Medicaid care, even if they could afford to pay for it (Ron Williams can attend public school just like anybody else).
Armadillo Joe at 5:00pm June 26
OK, I was afraid of this when I listed social security, schools and college. I meant all three merely as analogies to the whole notion of parallel public/private infrastructures in the context of not understanding why so many people find such a thing utterly unimaginable. It's not like we don't have similar systems already in place in other sectors of our economy.
I am leaving for work now and must suspend further responses for a few hours, but I want to come back to this.
I will answer all three numbered points you put forth above and your question about differentiating good and bad incentives.
In the meantime, could you propose an alternative? Do you think the current system works? If so, what are your standards? If not, if you agree we have a broken health-care system, what would fix it? And what would a fully functioning system look like?
and yes, I stand by my assertion that it is a moral issue.
See you in about two hours.
Corporate lawyer/former high-school debater at 5:51pm June 26
I'm not exactly sure what specific proposal you support, so I'm assuming you're in favor of one of the plans that came out of the finance and health committees.
Some alternatives:
Wyden-Bennett. State-based purchasing pools w/ required enrollment and eliminate employer-based coverage over time; CBO rates as budget neutral in 2014. You like: 99% coverage; I like: budget neutral. I don't like the required purchase of coverage (some young, healthy people would rather spend their money on other things than insurance), but I live with car insurance requirements.
See http://www.nytimes.com/2009/06/23/opinion/23brooks.html?_r=2 and http://www.cbpp.org/cms/?fa=view&id=674.
Paul Ryan. Variations on eliminating employer-based tax credit, giving individuals refundable tax credit to purchase insurance, allowing purchase across state lines. You like: everyone can get the credit; I like: people choose.
See http://www.house.gov/ryan/issuepapers/healthcareissuepaper.html
My main problem with passing health care legislation RIGHT NOW is that (a) Mr. Obama and Congress are trying to change the operation of 1/6th of our national economy with minimal debate, and (b) they have set it up so that they don't need to entertain debate by use of reconciliation budget process. That's inconsistent with Mr. Obama's promises of bipartisanship, and not good governance.
I'll agree with you that our health care system should be improved. I will not agree that it is immoral, or that the current plans out of the Congressional committees must be passed.
We should change the employer tax credit for health care - it is not a good way to encourage people to have health insurance. But we should give people choices and encourage competition between providers. We should not expand Medicaid and Medicare to cover more people. Those government-provided systems are laden with fraud and do not serve the interests of their "customers" - even Mr. Obama acknowledges that.
Armadillo Joe, you say:
"A public system of FINANCE would be subsidized by progressive taxation of health-care benefits."
And then:
"But please don't mischaracterize my argument by saying that I think rich people should be legally limited in the care they can receive so as to not punish the poor."
(1) There's not enough money in progressive taxation of health-care benefits to pay for a system of public finance for health care. You'll need to come up with a better way to pay for it.
(2) Saying that rich people should be progressively taxed for care they recieve IS PRECISELY saying that they should be legally limited in the care they can receive. Taxing the hell out of something is legally limiting access to it. See, e.g., the arguments some folks are making for increased taxes on cigarettes and sodas.
(3) When gov't denies care to a poor person who can't afford it if gov't doesn't pay, then you're still in your moral problem. It's pacemakers for elderly, not just Viagra.
Armadillo Joe at 8:51pm June 26
I'm at work and composing answers between cues, so this will be slow going. Thanks for bearing with me. I'm also going to address your posts in reverse order.
In absolutely no way whatsoever does a progressive taxation mean that rich people can't buy the coverage they want. You haven't told me, other than concocting some paranoid fever-dream about government passing laws forbidding advanced medical care for wealthy people, how any of what I'm advocating does anything of the sort -- progressive taxation or nationalized care or what have you.
1. I never claimed a progressive taxation of health-care benefits would cover all the costs of a universal system, but it would certainly help. That's why I used the word "subsidize." The rest of the money could easily be found in cutting much of the bureaucratic fat out of the system. 31 cents of every health-care dollar are spent on administrative costs, so you can't plausibly claim that a bill submitted and paid is more expensive than the game of administrative round-robin-meets-cat-and-mouse we all know and love in getting bills paid now. (31% number from this link -- http://www.factcheck.org/kerry_paperwork_ad_accurate.html)
2. Yes I said progressive taxation -- anathema to you flat-taxers I know, but progressive taxation works -- and I never said anything about taxing the hell out of anything. You cite taxes on sodas and cigarettes, I cite luxury and gas-guzzler taxes on cars. Either way, it is the government using taxation to discourage behaviors with high socio-economic costs and completely within the purview of governmental action. Such taxation manifestly doesn't out-law anything. If you can pay, you can still do it -- despite $10+ per pack of cigarette, I still see lots of smokers here in NYC -- but our government of the people will at least have some financial resources to recoup the costs of repair for damage done by the aforementioned behavior with high socio-economic cost.
With regards to health care, such a tax will help defray the costs of providing universal care by requiring those who choose to "buy up" to help those who have no other option. The behavior with high socio-economic cost in this instance is the sociopathic disdain for the well-being of fellow citizens, which results in a bunch of sick people bogging down the existing system to the point of failure, like we have now.
3. You try to push me into a conundrum with some sophistry about the gov't sometimes not paying under my proposed system and hence my moral problem remaining. You didn't really connect the dots, but whatever. Right now, we have a system wherein people die or go broke trying not to die. The cost of preventing the overwhelming majority of the population from going broke or dying while trying is relatively small compared to the larger social instability of not doing so, to say nothing of the moral question I've hinted at before. Re-phrased, the moral question really boils down to "are we going to be the kind of country that lets her citizens die because they don't have enough money for basic health care?"
Talk about the costs of extraordinary measures for poor people as a scare tactic or a way of denying the moral component of this debate all you want, but this question really is about the fundamental reasons we organize ourselves into countries and form societies in the first place. I fear this is the lasting imprint of the post-Reagan "I got mine" ethos on our national soul -- we are no longer fellow citizens but opposing forces in a Darwinian game of zero-sum resource consumption, complete with winners and losers with illness & death as the price for losing.
... OK, that's it for that post. More to come ...
Armadillo Joe at 10:24pm June 26
Response to post from 6:00pm June 26
When it comes to passing health care, why not right now? America has been trying to change health care in this country since 1912. For a century we've been trying to reform health-care and while the rest of the industrialized world found a way, mostly before WW2, we're still slogging away with no comprehensive system. This fight has been ongoing, from Teddy Roosevelt's Bull Moose Party calling for health care reform in 1912 to FDR failing to pass NHI in the 30's to Truman running on a platform of nationalized health-care in 1948 through the modest success of the Medicare/Medicaid battles in the 60's to Ted Kennedy's heroic but doomed efforts in the 70's and the star-crossed Clinton initiative 15 years ago. We've been fighting this battle for almost 100 years and, except for the legacy-producing aire that passed Medicare and Medicaid in the wake of the blood-sacrifice of JFK's assassination, we never get the health-care reform the country needs.
You wrote: "trying to change the operation of 1/6th of our national economy with minimal debate" to which I respond -- yes, because it IS NOT ABOUT THE ECONOMY, although for the record I could make it about the economy & the increasing socio-economic cost of a huge percentage of sick and dying amid our nation's workforce -- it is about us as a nation, who we are and if we're the kind of people who let other people die because they can't pay. The debate has been raging for 100 years and the rest of the world has settled on some variation of a basic system that works, except for us. This will be hard to hear, but we will eventually adopt nationalized health-care in some form or we will gradually cease to be a first-world nation with a first-world economy. Some parts of this country are already worse off than many third- and fourth- world cesspools (South Texas, the Mississippi Delta) and we can either find the national will to fix these problems or they will consume our whole economy.
But your point ignores the larger issue that the thing Obama and Congress are fixing is 1/6th of the economy precisely because it is broken. In 1981, health-care consumed 10% of our GNP. That timeline is at this link -
http://www.google.com/search?q=health+care+percentage+of+economy+history&hl=en&client=safari&rls=en-us&tbs=tl:1&tbo=1&ei=gHNFStTiO8Kktwe1-qC9Bg&sa=X&oi=timeline_result&ct=title&resnum=11
How much longer do we let this problem fester and where is the threshold where it becomes a significant enough percentage to begin addressing? 20%? 25%? 50%?
And, please, don't whine about the Democrats using the budget reconciliation process. The GOP, since they first retook Congress in the early 1990's, has used it to pass legislation with much smaller margins of victory than the current Democratic Congress and none with such a large mandate for a president in the same party, to say nothing of both at the same time (http://www.speaker.gov/blog/?p=1743):
• 2005 - Legislation That Reduced Spending on Medicaid and Raised Premiums on Upper-Income MedicareBeneficiaries
• 2003 - President Bush’s 2003 TaxCuts
• 2001 - President Bush’s Signature $1.35 Trillion TaxCut
• 2000 - $292 Billion “Marriage Penalty” Tax Cut(VETOED)
• 1997 - Balanced BudgetAct
• 1996 - Legislation to Enact WelfareReform
• 1995 - “Contract With America”Agenda
If you click the above link, you'll also see some lovely quotes from Republicans who had no issue whatsoever with the budget reconciliation process being used for their agenda, despite narrower margins for their party even at the height of their power.
What you wrote about President Obama's promises of bi-partisnaship rings laughably hollow when considered against the backdrop of a GOP caucus who spent eight years calling anyone to the left of Attila the Hun an America-hating terrorist-lover. Remember the "nuclear option"? Bi-partisanship assume a certain good-faith effort by the other side to reach common ground. Where is the middle ground to form bipartisan consensus when one side's coalition is so broad as to subsume the much-coveted middle and the other is angrily throwing spitballs and endlessly voting a reflexive "no" to everything? In the Senate, one of the three remaining moderates in the GOP became a Democrat, so where are the moderates to make bi-partisan policy?
Republicans only care about bipartisanship when they're not in power. And besides, this is the result of elections. The Democratic caucus controls 59 seats in the Senate, soon to be 60, but those 60 seats represent a far larger portion of the general population than just 60% because so many come from large states. In other words, the GOP Senate caucus is even less reflective of the popular will than their 40% of the available seats.
You agree with me that our health-care system can be improved, but not that it is immoral. OK. I can accept that because though I have advocated here and elsewhere that this is a moral issue, I don't expect everyone to agree with me at first. Or ever, in some cases. That's why I'm out here trying to get all sides of the issue, hoping to change some minds along the way about the importance of this issue. That is the whole point of the ongoing debate.
I think it is a moral issue because we let people die and we condemn them to economic ruin when we have the means to prevent it, when some people make obscene profits from what amounts to extortion and fraud because people are afraid of illness and death. It is an ugly way to organize a society and unfit for the civilized world. You say we should give people choices and I say that the much-ballyhooed "public option" is precisely that. We've given the fairy dust of the free-market several decades to work some kind of magic and it hasn't happened yet, to which millions of uninsured can attest, so those least able to afford decent care have some option besides a last-ditch emergency room visit.
And for the record, I disagree with your characterization of Medicare and Medicaid being government-run systems laden with fraud and their users being "customers". They are "citizens" in need of care, which I contend we as a society are obliged to provide. Does Medicare and Medicaid have a documented higher percentage of fraud than private insurance? If so, cite sources. If not, then what substantive difference does it make to the issue at hand?
That's all I got for now. I will have further responses to your earlier posts tomorrow, but I am at the end of the night.
... more to come ...
Corporate lawyer/former high-school debater at 12:34am June 27
I'm still not sure what policy you actually support, so please start there. One of the bills currently in Conress, or something else?
A few potshots, to avoid proliferation of comments:
31% on paperwork: your own source shoots down that number; assuming it's true, in what conceivable way is public financing of health care necessary (or even likely) to reduce paperwork?
"such a tax will help defray the costs of providing universal care by requiring those who choose to "buy up" to help those who have no other option. The behavior with high socio-economic cost in this instance is the sociopathic disdain for the well-being of fellow citizens" - Huh? How is my buying up of extra health care evidence of sociopathic disdain for the well-being of fellow citizens? Your flashy adverbs are clouding your thinking.
The U.S. spends more than $2 Trillion on health care annually. At least 3 percent of that spending — or $68 Billion — is lost to fraud each year. (National Health Care Anti-Fraud Association, 2008)
Medicare and Medicaid spending is $800 Billion per year. MSNBC reports that law enforcement officials estimate that each year $60 Billion is stolen from Medicare. (http://bit.ly/XgdhH). That is $60B of a total $68B. Yes, 88% of all health care fraud.
I'm no math expert, but that's a 7.5% fraud rate for Medicare, a 3% fraud rate for total health care spend, which means a 0.7% fraud rate for the $1.2T+ of non M/M health care spend.
These are all just estimates, but the order of magnitude on the numbers is large enough that you can't seriously dispute that there is far more M/M fraud than overall health care spending fraud. Obama knows that, hence his new crackdown: http://bit.ly/lWyet (Miami Herald).
Oh, and the fraud rates make a lot of difference. If you support a government-payer solution then you get a lot more wasted money than you do with a private-payer solution.
I'm not disagreeing with the need to solve the problem of people who want health insurance but can't afford it. I'm disagreeing with what I think you are advocating as a solution (government financed health insurance for everybody). You're arguing against a straw man by insisting that it's immoral to do nothing.
And if you want to get fired up about people who die preventable deaths, I assume you are a passionate proponent of DDT, which could contribute to saving nearly a MILLION lives per year. By your analysis, that's a moral issue, too - letting people die when we have an easy way to save them. There are a lot of other great things that could be done with $1.6T over the next 10 years.
Armadillo Joe at 10:54am June 27
A quick response for scooting off to work-
the 31% number should have gone to this link -
http://content.nejm.org/cgi/content/short/349/8/768
That's what I get for writing really fast, wrong copy and paste.
And as for reducing paperwork, ever had to dispute an emergency room bill? If not, trust me, by scaling up my few experiences from a few years ago as an uninsured emergency room visitor across the millions of fellow uninsured, a simple doctor's check-up instead would have been much cheaper on a national scale. No sources yet - in a hurry, but I will get back to this.
Flashy adverbs, eh? OK, how about this - people with means who have the financial ability to assist their fellow citizens in acquiring decent health care (but don't) engage in an anti-social behavior which the gov't (of all the people, not just the rich ones) has the duty to discourage (via taxes) because of the high cost to everyone of millions of uninsured people, sick and dying.
One more thing - regarding my point about anti-social behavior - before you say something about charity or whatnot, I advocate for a tax to make that system work because it simplifies the whole process of getting health-care for the poor financed and keeping it stable, because relying on the largesse of the wealthy to maintain a system of charity is inefficient and undependable.
For proof, look to the social milieu of Victorian London - we have the word "Dickensian" for a reason.
It is a function of one's duty as a citizen to contribute to the general welfare and every other industrialized country on earth has determined that basic health care is part of that equation.
I support single-payer
Back in a few hours
Armadillo Joe at 4:18pm June 27
OK, back at it now.
Thank you for the fraud numbers on M/M. I had not seen those and I grant that they are a matter of concern, but then fraud is always a risk no matter the source of financing - private, public or some manner of hybrid. You cite the better fraud numbers for private insurance -- which I acknowledge -- as though they are their own self-evident proof of the superiority or your position. I say they are not. I don't really see how the fraud numbers in-and-of themselves themselves constitute an argument against universal health-care. If we have fraud, so what? Investigate it and punish it where necessary.
Furthermore, you continue to insist that this is ALL AND ONLY about money, money, money -- which I contend is still very, very wrong on multiple counts -- and you have not offered a single counterpoint that wasn't an argument from a financial, fiduciary or economic perspective.
If you want to make it about money, though, then OK, let's make it about money for just a little bit longer. I will say that your fraud numbers pale in comparison to these numbers (from this link:
http://www.nchc.org/facts/coverage.shtml) - you can check the link for the numbered footnotes.
• The United States spends nearly $100 billion per year to provide uninsured residents with health services, often for preventable diseases or diseases that physicians could treat more efficiently with earlier diagnosis.14
• Hospitals provide about $34 billion worth of uncompensated care a year.14
• Another $37 billion is paid by private and public payers for health services for the uninsured and $26 billion is paid out-of-pocket by those who lack coverage.14
• The uninsured are 30 to 50 percent more likely to be hospitalized for an avoidable condition, with the average cost of an avoidable hospital stayed estimated to be about $3,300.14
• The increasing reliance of the uninsured on the emergency department has serious economic implications, since the cost of treating patients is higher in the emergency department than in other outpatient clinics and medical practices.11
• A study found that 29 percent of people who had health insurance were “underinsured” with coverage so meager they often postponed medical care because of costs.15 Nearly 50 percent overall, and 43 percent of people with health coverage, said they were “somewhat” to “completely” unprepared to cope with a costly medical emergency over the coming year.15
We're already spending way too much money on health-care in this country (note the numbers I cited above about the growth of the health-care sector from 10% to 16% over the last 25 years). When I advocate for universal health care, I know that nothing is cost-free -- that's not what I mean when I say money should be removed from the equation, I'm referring to the depredations of a for-profit health-care system -- I instead contend that the much-vaunted free market hasn't delivered the efficiencies its advocates have been promising us for decades, that for-profit health-care is a self-defeating contradiction and that the federal government is only organization large and powerful enough to bring this whole mess under control and thus prevent the current financial and bureaucratic chaos from swamping our whole economy, with ruined fortunes for some and illness & death for a great many others.
I'm heartened that you agree with me that we have a problem to solve, but once again you propose the same gussied-up retread of a solution that has failed us again and again: free-markets and competition. We've tried it your way. We've been trying it your way for close on 100 years now and all it ever brought us is a mess we try mightily to clean up once a generation or so. It isn't like we don't have other models for how to structure a working universal health-care system. Other countries have ironed out the problems with the various approaches over the decades, so we should just pick one and get this stupid thing fixed. I vote for the French model and Business Week agrees: http://www.businessweek.com/magazine/content/07_28/b4042070.htm
Although the Conservative Party of Britain think theirs is pretty keen, too: http://yglesias.thinkprogress.org/archives/2009/06/conservatives-for-socialized-medicine.php
And, with the above, I'm kinda done with engaging you on the money side of this issue. If you want to keep throwing money-based arguments out there, its your prerogative but each time you do it, you reinforce my contention that this is a profoundly moral issue and the opposition are a bunch of amoral, parsimonious bean-counters who care more about protecting a status quo that works for them than recognizing the existence of a social compact which would require them to contribute to the general welfare. This is about how our values as a nation are reflected in our public policy. If money were the only issue that ever mattered, we'd still have a slave-based labor force in the south and children working 90-hour weeks in factories in the north. Sometimes issues are about more than money and when they are, we find a way to pay for what is important to us.
But before you come back at me with more sophistry about DDT or the economically disadvantaged "choosing" not to buy health coverage or what have you -- in an attempt to change the subject by force-feeding some ridiculous or distasteful false dilemma on me by skewing my positions into your own straw-man argument -- I would like you tell me precisely why you don't think this is a moral issue when millions of Americans live in fear of illness and death and economic ruin amid the general prosperity. Enough with the ad absurdum arguments. I ask you to explain why you don't think the language of morality applies on this issue.
For your side, it always and only seems to be about the money and, it seems to me, the mysterious fairy dust of free-market forces are the only mechanisms for delivery of goods and services available to policy-makers. If that is true everywhere and all the time throughout history, then why bother having a government at all?
For my side, it is about social responsibility and, as I see it, the government is the embodiment of that shared commitment to the general welfare. It is the most efficient and equitable organ for the application of our shared values. In the end, if one side contends that they don't share those values, that we can't even agree that the state of our health care system is a moral problem, then merely agreeing to disagree and moving on maintains the grossly unfair status quo. In the last 150 years, we've moved forward on slavery, suffrage, labor rights and civil rights and at every junction we did so with a wealthy opposition that cried to the heavens about the end of the world. Each time civilization survived and people continued to be rich. On this issue, too -- as it always has -- history will move forward without your consent.
Corporate lawyer/former high-school debater at 3:32pm June 29
When you were talking about the economics, you dropped the inflammatory rhetoric and the ad homs. When you got back to the moral arguments, you started shouting and accusing again. Why is that?
Whether the US government should adopt a single-payer system for health care is not a moral issue, it is a public policy issue. It's an economic question: how much should the gov't tax people, and how much should it pay for their health care?
If you have a single-payer system, then the government will still have to make decisions about what to pay for and how to apportion the money it spends on health care. People who can't afford to pay for additional coverage still suffer and die in systems with government as a single-payer. You seem to imagine that if the gov't is paying, then everyone will get all of the care that they need, but when pushed on that you say you don't imagine everyone will get cradle-to-grave care for everything that affects them. You can't have it both ways.
The unavoidable fact is that resources are scarce, which means decisions must be made about how to apportion them. I get that you want to have the government raise taxes (or borrow money today, then raise taxes on future generations) and use more money on paying for health care. That's fine. I disagree with you that this is the best public policy, or that it will even have the great results you imagine.
The point about DDT is simply this: I think it is bad public policy to ban DDT when it could be used to effectively eliminate malaria-carrying mosquitos and thereby save hundreds of thousands of lives annually. You disagree with me. I don't think that this disagreement makes you an amoral, parsimonious tree-hugger.
The language of morality shouldn't apply because it obscures and inflames the debate. It should be possible to disagree about how governments should spend and regulate without attacking the character of those who disagree.
Random Friend of Armadillo Joe #2 at at 2:21am June 30
Armadillo Joe, et al., I come to this conversation late. I must express my outrage at the idea of state run health care. Clearly, healthy competition and not smash and grab price gouging what we experience.
As a wealthy American on tour in 2001 I was forced to use the socialist health care system in the backwater town of Toronto, Canada. You can imagine my horror as I was seen by a doctor in 15 minutes for my elective procedure. Also, the care was top notch and there was no bill--despite the fact that I wasn't Canadian. Fie!
What bothers me most is that no one will stop these reprehensible elderly folk, representatives and senators from using a SOCIALIST system of health care. Clearly, these last decades with medicare have been a sham. How are we, as a country, to meddle in foreign affairs if we are not able to use social security to fund private armies?
Listen, if we embrace socialist policies, the next step is trading openly with "communist" dictatorships.
Armadillo Joe at 4:33pm July 1
Shouting? Ad hominem? Please. This is a spirited exchange of ideas. If I was shouting - I'D BE USING ALL CAPS.
That said, however, please refrain from trying to bait me by disingenuously including a flashpoint like DDT, because we both know that a debate over its use has raged across the political spectrum for decades. Inserting a reference to it is not value-neutral, it is a red-herring that deliberately chums the water.
Also please, stop attaching claims I've never made to my viewpoint via hedging phrases like "you seem to imagine..." then attacking that characterization instead of the specific claim I advance: the definition of a straw man argument. As much as you may wish that I had claimed everyone would get ALL the care they EVER need in life from cradle-to-grave if only the stoopit gov't would just pay for it, because that would be easier for you to rebut, I never did. I'm not a hippie-dippie moonbat imagining a world with no possessions, pining away for a money-free utopia.
Yes, people suffer and die and single-payer will not end that. I'm not trying to have anything both ways. I never claimed that universal coverage was a panacea but a government safety-net can moderate that suffering for the purpose of social stability and distribute the burden of the costs to promote the general welfare. And furthermore, I ask you, how is government bureaucrat making decisions about apportionment any different or worse than the current collusion of income-based rationing with insurance company bureaucrats operating under a steep financial disincentive to provide effective care? Any amount of nationalized health-care -- however mediocre for those who need to use it -- is still 100% better than no care at all and has proven elsewhere in the world to be better than the uneven, unfair, inefficient, often dangerous and grossly expensive system we enjoy now.
France spends half of what we do per capita on health-care and they not only get universal coverage for that money, but also cheaper drugs, lower infant mortality rates and greater life-expectancy. Those who want more coverage (and can pay for it) do so and almost everyone in France so chooses, which has resulted in a robust and very profitable private health-care sector parallel to and largely integrated with the public one. However, those who can't pay anything at all at least have a third option besides death or economic ruin when faced with mounting medical bills. The social instability engendered should that kind of human suffering metastasize should be easy to imagine.
And, finally, you dismiss the use of moral language as obscuring and inflammatory, but I posit that as long as the debate remains a dry, measured exchange of policy prescriptions -- as though we're debating a change in library hours at a town council meeting rather than mitigating preventable suffering -- we ignore to our peril the deeper structural inequities in American life as embodied in our broken health-care system. Moral language clarifies the stakes, whereas your framing of the issues -- trying to make it about nothing more than policy and economics -- obscures the deepening supremacy of this issue in so many American lives.
Policy and economics are but tools, means to an end. Morality is the impetus.
Thus, what you perceive as impugning the character of the opposition is in fact a reaction to complacency -- whether from apathy or smugness or fear or parsimony -- in the face of overwhelming evidence for action.
