Again, another letter to my senator, reproduced here for my readers (what few there are):
Senator Bennet,
When this nation was founded, it was founded on the principles of local government first, federal government last. You have highlighted the advances Colorado has made in health care in your recent newsletter. That is exactly the place where we should address health care issues, here at the local and state levels.
It is your duty as Senator to ensure that Colorado remains a strong state that is not tied down by Federal constraints. Please do not sign on to socialized, or even quasi socialized measures that pump money to a federal bureaucracy only to come back to Colorado after large percentage is siphoned off. Please do not vote for measures that kill choice and freedom.
The solution to healthcare costs is to take insurance back to what it is supposed to be: insurance against disaster. Normal people should rarely use insurance. If you are using it often without any dire circumstances, it isn't insurance! It's a cost sharing system that ensures that people are disconnected from true market costs. This always encourages them to use more healthcare then is necessary. This causes costs to rise. It also forces a bureaucracy on doctors that costs more.
The solution is to make all healthcare expenditures tax deductible, wean employers from having to provide it, and letting insurance be portable.
These measures will solve the crisis without further eroding the freedom of the state of Colorado and it's citizens who would otherwise be governed by federal mandates.
Nathan
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But thing is, nobody is proposing socialist health care in the United States. Socialist health care is where the government employs the doctors and owns the hospitals and directly provides medical services. The experience of Louisiana (which until recently operated its own state-run hospital system) is that socialist health care is much less expensive than private health care, but that experience also included extremely crowded hospitals and long waits for non-critical surgeries. (If, on the other hand, you had a critical surgery such as to repair a heart blockage that would kill you if not immediately fixed, you got it immediately).
So anyhow, socialist health care is much more efficient and cost-effective than private health care, but the disadvantages -- it is *extremely* inconvenient -- mean that nobody in America proposes it. Even Louisiana has largely abandoned socialist health care in the aftermath of Hurricane Katrina,which destroyed most of the system in the southern part of the state. What some people *ARE* proposing is that government take over the job of collecting the money for health care and redistributing it to health care providers. Government is *very* efficient at taking money out of your pocket, unlike private industry -- 40% to 50% of private individual health insurance payments goes to pay for collection and disbursment costs (it costs a *TON* of money to send out bills every month and process the payments from individuals), whereas less than 2% of Medicare collections go collecting and disbursing the money, the rest actually makes it to doctors and hospitals, because Medicare can piggy-back on the payroll tax system and thus take advantage of economies of scale that Blue Cross will never have.
In short, Medicare for All puts health insurance companies out of business and returns health care decisions to a doctor and his patient, instead of some unelected beancounter in Tennessee or Mumbai who gets paid bonuses for depriving you of health care. Having my health care in the hands of someone who gets paid a bonus to deprive me of care, who in many cases is in some 3rd world country call center and has no formal medical training at all, scares me a whole lot more than having my health care in the hands of a bureaucrat somewhere, even if it were true.
But thing is, it isn't true. My grandmother received Medicare and Medicaid. There was not ONE SINGLE TIME that a government bureaucrat interfered with her health care. Not ONE time. Period. It is a LIE that Medicare For All puts a bureaucrat in charge of your health care. It just isn't true, and the people spreading that lie should be ashamed of themselves -- they should have at least talked to Granny before spewing that sort of nonsense, if they cared in the very least about truth.
- Badtux the Health Care Penguin
I use the term "socialist" as short hand for any program that centralizes the control of a large part of the economy into the hands government bureaucrats.
Regardless of what you call it, it's wrong. First, let me set aside a moment whether or not it is more efficient or whether it provides better universal care. You should be against it because the means do not justify the ends. Just as we don't countenance brutal torture as a means to get intelligence, we shouldn't trash the the notion of federalism that created our great country in order to meet someone's notion of better health care.
The wisdom enshrined in the constitution and in the debates that created it is that people are governed best when they are governed locally first, and federally last. The move to centrally control healthcare is a move toward further eroding the power of local and state governments. Just look at the size of GDP spent on healthcare and the already huge size of the federal government. I already find it very disconcerting that people care more about the election of the president than they do about at state representative or a city council person. The national election becomes a winner-takes-all sweepstakes. This is TOTALLY contrary to the principles that founded this country. If there is decreased efficiency in letting people pay for their own healthcare, then you should consider this part of the cost of freedom. Your comment that the government is very efficient at taking our money proves my point that the federal bureaucracy is too powerful. It's power needs to be checked.
Before I get into the second part of my argument, I need to remind you that our currently broken system ISN'T a free market system. U.S. healthcare is already socialized and that is why it is broken. See this article: Socialized Medicine is Already Here. It is government mandates and controls that have lead to our ballooning costs. You talked about about how 40% of insurance payments go to cover bureaucracy instead of healthcare. This proves my point.
You think that somehow you can gets costs down by only addressing the bureaucracy of payment collection. And you seem to think that the anecdote of your grandmother proves that Medicare will still cover all the important stuff without rationing. But again you prove my point, the cost of Medicare greatly outpaced all the projections. (It began as one of those innocent little programs and is now 455 billion and rising) So medicare is another proof that when you give out a resource that your not directly paying for, the cost of the resource either goes up or you have to ration it. So far, Grandma has been happy because we've been going into debt to shoulder the higher costs. This is not sustainable, and you should know that. Obamacare, to be sustainable must ration. And any kind of rationing cannot possibly be done in a way that meets everyone's values and priorities. Some people will want to put more effort into living longer. Some will want to live it up and pay the price in lower life expectancy. Under socialized medicine, bureaucrats determine how you should live (no fatty foods for you buddy!) I think people should make their own decisions about how to live and they should pay the consequences. We can have government run healthcare for the indigent and it would be rationed. But that should be the exception to the rule that most people control their own healthcare with no government intrusion.
That is my freedom argument. Now my economic argument, that I think you missed, is this: I agree with you, let's get insurers out of the picture! When I bought my house, I used a real estate agent and a lender, not an insurer. When I bought my car, I went to a dealer, not an insurer. When I see the doctor I should pay him, not an insurer! Insurers are for events that you don't think will happen! U.S. healthcare is a system where we go through our employer's insurer to buy medicine. We shouldn't be doing that. The first step to fix this is to make healthcare tax deductible whether or not your employer administers it. (Right now, you have to go through your employer to get the tax deduction!) The problem is right under our noses and the solution is so so simple. I'd rather get paid 20% more a year from my employer than have him pay for my health insurance. I could go on the open market for portable insurance. If I don't get that insurance, I get rationed indigent coverage. There is more to my story, but I'll stop there.
First of all, we're talking about health care funding, not health care provision.
Your argument against socializing health care funding could be used against socializing highway funding, socializing funding for the police, socializing funding for the fire department, etc. By your argument, the California Highway Patrol and FBI are immoral, because a necessary societal function like law enforcement should be provided at the local level by people individually purchasing law enforcement services from their local Law Inc. provider.
The fact of the matter though is that when there is a society-wide expense, it is a quite viable and valid thing for We The People, via our government that we vote for and elect, to state "We're going to pay for this service collectively rather than try to piece-meal it." Thus we pay taxes to collectively hire police officers, rather than pay our local Law Inc. rent-a-cop provider for law enforcement services. And so on and so forth. We do this because experience has shown it gets better results and is more efficient, not because it's imposed upon us by some foreign conspiracy called "The Government". We live in a democracy, not a tyrannical dictatorship. We vote for the folks who enact this stuff, we don't have them imposed on us at gunpoint by a foreign power.
As for your appeal to morality, any time ideology leads to tens of thousands of dead bodies that ideology loses any appeal to morality. Sorry. I've known people who died because they were "uninsurable" under the current health care system, including one poor lady who was reduced to begging for insulin at the doorsteps of charities (she had been diabetic since childhood) and eventually died of kidney failure because of her inability to purchase insulin on a reasonable scale (ironically, before she got too sick to work she worked as a health care aide in a nursing home). Your answer to that problem apparently is that she should be proud to die for your ideology, that dying for your ideology is the "moral" thing to do. That is a morally bankrupt position and I don't know how you can make it with a straight face.
Finally, regarding state vs. local vs. federal provision of health care funding: We've done this experiment. Before there was any state or federal funding for health care, there was county hospitals funded at the county level. These were collapsing under the weight of caring for the indigent elderly in the late 1960's, when Medicare was passed, and many elderly had no access to county hospitals at all because their county was too small to fund one. So local provision of health care funding failed. When LBJ's Great Society programs passed in the late 1960's, Medicare was explicitly set up as a federally-administered program while Medicaid was explicitly set up as a state-administered program in order to test whether state or federal provision of medical services would be most efficient and result in the best outcomes. The results, by far, suggest that Medicare is the model that provides for best satisfaction on the part of those who qualify as well as being the solution with the lowest per-patient expenditures on administration. Medicare simply works better than Medicaid.
Finally, regarding the cost of Medicare "skyrocketing", most of that could be dealt with if the Bush Administration hadn't been so intent on guaranteeing drug makers' profits. The prescription drug benefit accounts for virtually all of the Medicare fund's current account deficit and that deficit mostly goes away if Medicare is allowed to negotiate drug prices like Canada's Medicare providers. If drugs were provided at Canada prices, the deficit goes away. Note that this would *not* kill drug research, because less than 10% of the cost of drugs goes to research, indeed for most drugs the research was done with federal funds at universities and the drug company is only involved in commercializing the drug, not in developing it.
So anyhow, over 55% of Americans support Medicare For All even AFTER they're told it would require a 5% hike in their Medicare payroll tax. Why do opponents of Medicare For All hate democracy? :).
- Badtux the Health Care Penguin
I like that you want to help people and that you want to reduce pain and suffering. I just wish you could see the unintended consequences. There is always a downside to everything. I want to ensure freedom isn't a casualty. And ironically, I think freedom based solutions do better in the long run. My proposals, I'm convinced will bring more healthcare to more people (in accordance to their priorities and values) than will Obamacare.
Nobody doubts that a powerful government can get a lot of things done. But the temptation to abuse that power never goes away. That is why the founders implemented a system of checks and balances. "We the People" are exactly one of the forces that need to be checked. The founding fathers were especially worried about the mob rule that comes with democracy. "Democracy" was a bad word. I would urge you to read Federalist #10 .
"We the people" are largely ignorant and easily sold on liberal policies that erode freedom. "We the people" are turning over our rights to a federal entity that is thousands of miles away when we could be keeping the power closer to home where "We the people" have a greater say. The constitution specifically limited the power of the federal government and left to the states all un-enumerated rights.
A word on morality. I am chiefly concerned about morality. Morality means that you do that which is inconvenient for a greater good. The greater good is something that people disagree on. For me it means a delicate balance between freedom, protection of the innocent, helping the needy, and having a longview of what is good for the continuance of society. I must take into account sustainability, the influence on the unborn, the need for people to learn responsibility, etc. You're morality seems to be entirely focused only elimination of suffering. In my morality, that is but a part of it. Suffering is an ennobling experience. It is one of the biggest instigators of self improvement. Yes, I want to reduce suffering, but I see suffering as just one piece of the puzzle. Death, too, is an important part of life.
Let's examine the morality of centralized medicine that creates a disconnect between health care users and payers. Obamacare makes each human being a liability of the state instead of an asset. Liabilities need to be controlled and reduced. We know President Obama advocates abortion. We know that Nancy Pelosi recently advocated saving the government money through contraception policy. You and I might cringe about the thousands who suffer from health maladies. But do you not have any tears for the unborn? Or for the value of life freely lived? Let me paint a picture for you. Let's say Joe Shmoe lives a life of poor choices that lead to 1 million dollars in operations to keep him alive at age 50. He didn't save a dime. Your morality says we need to pay for it or we're immoral. One million dollars is the average earnings of one human being during his or her entire working life. One million equals the labor of one man-life. You think that one man-life should be automatically awarded to anyone who needs it? That man-life could have been spent doing charity, raising upright children, inventing new technologies. You coerced the expenditure of a man-life. Now if a man-life is freely offered (such as in pro-bono work, or in charitable donations, etc.) that is one thing, but you would mandate it. That is immoral. Repeat the above reasoning, but with Joe being 80, or 90 years old? At some point, I bet even BadTux will admit that the man-life was better spent on something else. And isn't it immoral that you or I would be making that call?
Anyway, I could go on and on about morality, but I'd really need to take it to a religious level. Simply measuring morality by the number of lives that you save doesn't cut it with me.
I know that you an conjure up cases where coerced man-lives are spent every day for the betterment of mankind. But such things should be the exception and not the rule.
You're comments about the FBI and the highway patrol seem to support my view. The FBI has to be federal since it concerns crimes that cross state borders. The Highway Patrol is a state organization that covers state highways. It seems to me that these prove my point that government should always be done at the most local level that makes sense.
The medicare/medicaid example does show that economies of scale can help when you federalize administration. I too disagreed with Bush's drug expansion.
Under socialized medicine, bureaucrats determine how you should live (no fatty foods for you buddy!)nope. not in any other modern industrialized nation. of course, with you around to worry about my morals, i suppose that could become a problem.
You talked about about how 40% of insurance payments go to cover bureaucracy instead of healthcare. This proves my point.no it doesn't. you don't know a whole lot about how businesses operate in the real world, do you?
There is always a downside to everything.yep, including the freedom to die if you don't have enough money to pay a cadre of bloodsucking leeches. a bit of a downer, that.
I want to ensure freedom isn't a casualty.life, liberty, and the pursuit of happiness... now where have i heard that before? freedom is kinda difficult if you're dead, as is the pursuit of happiness.
I am chiefly concerned about morality. Morality means that you do that which is inconvenient for a greater good. the only inconvenience you'll get with medicare for all is paying a few more tax $$. you would be free to refuse the govt-financed care that would then be available to you, but making that care available to the population at large would be a much greater good than having, as badtux says, dead bodies in the streets. nasty source of germs, those dead bodies, and they really stink up the place. not much help for your property values either.
Suffering is an ennobling experience. It is one of the biggest instigators of self improvement. works that way for some. others, not so much.
Death, too, is an important part of life.well, it's an inescapable part of life, at least.
The medicare/medicaid example does show that economies of scale can help when you federalize administration.bingo.
Hmm, I must admit I am somewhat flabberghasted by the attitudes shown in this kind of discussion.
Why? Because, very strangely, for every other developed country there is only a discussion, how to balance private and public health care efforts, but the consensus stands, that a underlying public health service is beneficial. To the state, to the individual, society and the economy, too.
What also amazes me is that there does not seem to be any sort of granularity in that discussion.
Look at the word alone, "socialized health care". I mean, come on. There is no element of socialism in a Public Health Service, but lots of the concept of the inalienable dignity of man.
But don´t let´s bother you lot with foreign examples.
Simply consider the status quo. The amount of people uninsured or insufficently insured. All the people that will come off health care once they are out of a job. The losses through that to the workforce and its productivity and finally, to the American economy. The huge liability this all presents to your contry.
Reason enough, methinks, to forego the usual party rhetoric and do something that will help your country in the long run.
Oh dear, I said the "r" word ;)
Dickiputz,
I'm not against good health services. We've been talking about means, not ends. I think it takes the opposite of the 'r' word, unreason to believe that there is only one way to provide good health services (the single payer system).
I have studied the health systems of other countries. I find find parts of them worthy of emulation, and other parts I find incompatible with American ideals. I think the French system creates a host of unintended consequences that will be unsustainable in the end.
I also want to take issue with the notion that we should do what is best for the "state". What the heck is best for the state? What are the State's goals? In America, the goals have been to achieve a balance between anarchy and tyranny such as to maximize freedom. It has also been the goal to maximize the power of the individual 50 states. So if you want to help out the American state, you'll toss Obamacare into the dustbin post haste.
If the "state" want to be eco-friendly, then it needs to encourage birth control and perhaps abortion. It also needs to clamp down on freedom to reduce energy use. If the "state" wants to cause trouble with other states, it can encourage high birthrates and export excess population around the world. It it can put those people in the military. So, you see, it bothered me a little when you lumped the needs of the state or even the economy in the same position as the needs of the individual.
dude, it's only money.
you don't need a lot of it to live well, or even to maximize your liberty. you will, however, need lots of it to live should you be so unlucky as to get cancer, or have a heart attack, or any of a host of other things.
that takes care of the catastrophic conditions, what about minor medical issues? we need doctors, we need hospitals, if we get hit with another flu pandemic, or a big terrorist attack, or a major natural disaster, we're going to need all those doctors and hospitals and you can't produce those overnight. better to keep them all in business treating the sniffles so they'll be available for bigger stuff. a taxpayer-funded, federally administered program pays a reasonable fee for all these services, and on time, allowing all these providers to stay in business. it's in your best interest to keep a lot of them around and functioning.
your having to pay a few more dollars in taxes is a tiny impingement on your liberty compared to what all the other options can do to you.
Nathan said:
DickiputzI say.
I also want to take issue with the notion that we should do what is best for the "state". Did you just say you would not accept acting in the common good as a viable motivation?
Oh dear.
Dickiputz,
Why are you insinuating that I'm against the "common good"? I have taken the civility pledge, (I'd encourage everyone to do so
www.civilityproject.org) so I ask for graciousness and respect. Making offhand remarks that impute dishonorable objectives on my part is uncivil.
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