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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?


To: gg cox who wrote (17523)5/2/2010 12:59:15 PM
From: Lane31 Recommendation  Respond to of 42652
 
We choose to balance what we can afford for the entire citizenry, not a selected elite.

I keep saying that Canada chose queues and you keep acknowledging that you chose queues yet you frame it as a challenge to me. I don't understand that. We're agreeing. That shouldn't trigger an objection, I wouldn't think.

Compare health care percentage GDP Canada and other single payer systems to US

That was never in dispute. I have never seen anyone argue that US health care costs are lower. What's your point?

Well, golley gee...sneering??

You seem to be looking down on the former US approach. Have I mistaken that?

No I haven't missed the subtleties

Good. Then we're agreed on yet another point, that most poor Americans have gotten necessary health care, but some have had to endure a certain amount of waiting and other inconveniences for it. Sort of like the waiting and inconveniences in Canada, except that waiting and inconvenience is universal in Canada, unlike here.

You imply that you understand that you could mitigate your waiting and inconveniences if you chose to spent the money for added capacity. We have just passed a law to mitigate our waiting and inconveniences by passing universal coverage, which will make our costs exceed yours by even more. It remains to be seen how that affects capacity and whether we will have traded off the waiting in crowded waiting rooms for some people with universal waiting in queues, like you.

It seems to me that your total inconveniences are greater than ours have been but yours occur for everyone whereas ours were not evenly distributed. It seems to me that you find that a sneer-worthy condition. I don't think that one can objectively come to that conclusion. To come to that conclusion you have to find some righteousness or nobility in suffering more so that the suffering is evenly distributed. It's a quasi-religious thing. I can understand that, but I can't find it objective or useful.

you know, the ones you referred to with cheese and sushi comments.

It seems we now have two posters who don't like examples and analogies...




To: gg cox who wrote (17523)5/2/2010 2:55:31 PM
From: Brumar89  Respond to of 42652
 
We choose to balance what we can afford for the entire citizenry, not a selected elite.

So you can't afford really first class care so you don't get it unless you leave the country.



To: gg cox who wrote (17523)5/3/2010 10:15:09 AM
From: Lane31 Recommendation  Respond to of 42652
 
I continue to be interested in your attitude about universal car and queuing. I'm having a tough time getting my head around it. I just came upon this piece and was wondering if you might address your attitude in the contest of these principles. Which one underlies your thinking?

Four Principles of Human Action
Arnold Kling

I stretched to make them fit into a framework of A, B, C, and D. Think of this post as a follow-up to both the government menace post and the Ropke post.

A stands for Altruism.

B stands for Business.

C stands for Command and Control

D stands for Deity and Disgust

Think of these as principles that people use to rationally justify (or rationalize) their conduct. Principles differ from motives, in that motives, such as status-seeking, can be unconscious. Some more remarks follow.

A given action or closely-related set of actions may be based on more than one principle. I could give a talk because I am paid (the business principle), because I want to share what I know (the altruism principle), because I expect others to listen and obey (the command and control principle), or because I think I am spreading the gospel and battling evil (the deity and disgust principle).

Altruism is doing things with the intention of benefiting others, at some cost to ourselves. Ayn Rand is one of the few thinkers that comes to mind who actually opposes the altruism principle. I feel more positively about altruism, but I would say to beware of the tendency of some people to glorify altruism in order to manipulate others into being altruistic.

Not every action undertaken on the basis of the altruism principle is a success. Following the principle of altruism works well for families and other small groups. As we get farther away from people, our ability to actually benefit others through altruistic action tends to decline quite a bit.

The business principle is doing something with the intention of mutual benefit. I would claim that, over the course of history, most of the improvement in the quality of life has come from people operating according to the business principle. I would also claim that most transactions undertaken according to the business principle do in fact serve to benefit both parties. However, this is certainly not true all the time. Everyone feels ripped off every now and then, but that is not the typical outcome.

In the market, one side can try to take advantage of the other. Depending on the norms for the particular situation, this may even be expected (think of negotiating to buy a car or a house). There are market mechanisms that help to limit one-sided exploitation. Competition is one mechanism. Reputation is another. Neither works perfectly. When flaws emerge, some people believe that government regulation is necessary and sufficient to correct the problem. I tend to be more skeptical, but I do not deny that ripoffs exist, nor do I oppose regulation if indeed it does correct the problem.

When it comes to government action to curb exploitation, I would prefer a more common-law approach to a strict rule-based approach. If Goldman Sachs outwits a professional money manager, then good for them. If they rip off an ordinary civilian with a below-average IQ, then not so good for them. If someone makes a profit from following the industry's usual and customary practices, then that should be presumed ok. If they do something that catches the other party totally off guard, then that presumption goes away.

The command and control principle is that some people should command and others ought to obey. The principle sees some people as strong and superior, while other people are weak and inferior. Within a firm, we accept that principle to some extent, but it is not so difficult to leave one firm and choose a different way to earn a livelihood. As citizens we accept that principle with respect to government. It is much more difficult to exercise "exit" as a citizen. Also, whenever the exit option is weak, the "voice" option tends to be pretty ineffective as well.

From a libertarian point of view, government commands too much and we accept too many of its commands. I believe that our rulers and some of their intellectual allies have much more confidence in the morality and practical effectiveness of command and control than is truly justified.

The deity or disgust principle represents our moral sense. Often, it is our conscience telling us to curb our appetites. It used to be that many people took their deity and disgust principles from organized religion. Today, we take them from secular religions. (Another issue, which Daniel Klein raises in something he sent me, is the extent to which some in the academy play the role of clerics within our secular religions. That is an idea to chew on, perhaps in another post.)

People have often wanted to combine C and D--that is, to have their religious principles enforced by government. When organized religion held sway, government was supposed to make and enforce laws against sexual conduct that people considered disgusting. Today, the behavior that people find disgusting is more likely to be eating high-calorie foods or using carbon-based fuels. Some people also are disgusted by inequalities of wealth.

I think that some combination of C and D has produced many of the dramatically evil episodes of history. Religious wars have been brutal. The religion of Communism has been extremely brutal,

The old idea of the Divine Right of Kings was a way to combine C and D. Today, that has been replaced by the Divine Right of Electoral Victory. This doctrine is that once elected, leaders can do whatever they please, and we must obey. The way I see it, our rulers get away with combining C and D. I view those who appeal to the Divine Right of Electoral Victory as offering support for the too-powerful against the nearly-powerless.

I also object when people treat government redistribution as altruism. When you contribute to charity, that is altruism. When leaders take your money to give to what they claim is a good cause, that is not altruism. That is command and control, perhaps buttressed by a D-type justification.

When President Obama claims to have the authority of "us," he is claiming a D justification for his command and control. The Divine Right of Electoral Victory is so firmly ensonced in people's minds that to challenge his claim is considered shocking. What is the alternative? Anarchy? Dictatorship?

The alternative is a set of norms that places limits on the actions of the rulers. Instead of a religion that honors command and control, I prefer a religion that reviles it. Citizens need as much power as they can possibly obtain to check the command and control of their rulers. The last thing that citizens need is more excuses for their rulers to exercise command and control.



To: gg cox who wrote (17523)8/9/2010 3:05:28 PM
From: Peter Dierks  Respond to of 42652
 
Richard Foster for President
Medicare's chief actuary vs. President Obama on the ObamaCare facts.
AUGUST 8, 2010.

There probably isn't a worse job in Washington than Medicare trustee, unpaid Capitol Hill interns included. Every year the trustees issue the gravest warnings about entitlement spending and at best prompt a moment of brow-furrowing before the political class returns to its default state of indifference.

This year's report, issued last week, has more than the usual political meaning because Democrats are hailing it as validation of their claims that ObamaCare will save taxpayers money. The trustee report shows "how the Affordable Care Act is helping to reduce costs and make Medicare stronger," the White House said in a statement.

One problem: That spin ignores the extraordinary companion analysis by chief Medicare actuary Richard Foster that repudiates this conclusion and is the most damning fiscal indictment to date of the Affordable Care Act.

The trustees do estimate the Medicare hospital trust fund will run out of money in 2029, some 12 years later than they estimated last year. (Keep in mind that the trust fund is a meaningless accounting artifact because Medicare was long ago financed in part by general tax revenues.) It's also true that, thanks to ObamaCare's changes under current budget rules, Medicare's unfunded 75-year liability has fallen to about $30.8 trillion from nearly $37 trillion in the previous audit.

Even in Washington, $6.2 trillion is real money. Yet this is a strange excuse for celebration. Democrats wrung about a half-trillion dollars from Medicare over the next decade, but then they turned around and plowed these "savings" into their new middle-class health-care entitlement. It's akin to paying off one credit card with another—while still being deeply in hock on the first.

But then comes the report's final appendix, where Mr. Foster disowns the previous 280-odd pages. Mr. Foster has been Medicare's chief actuary for 15 years, and as such he is required to evaluate the law as written. But as he notes in his appendix, the law as written bears little if any relation to the real world—and thus, he says, the trustee estimates "do not represent a reasonable expectation for actual program operations in either the short range . . . or the long range." In an unprecedented move, he directs readers to a separate "alternative scenario" that his office drew up using more realistic assumptions.

Mr. Foster shows that the Medicare "cuts" that Democrats wrote into ObamaCare exist only on paper and were written so they could pretend to reduce the deficit and perform the miracles the trustees dutifully outlined. With the exception of cuts in Medicare Advantage, those reductions will never happen in practice.

One of the fictions Mr. Foster highlights is the 30% cut in physician payments over the next three years that Democrats have already promised to disallow. Republicans would do the same, we hasten to add.

Another chunk of ObamaCare "savings" are due to cranking down Medicare's price controls for hospitals and other providers that Mr. Foster says are also "extremely unlikely to occur." In the absence of "substantial and transformational changes in health-care practices"—in other words, a productivity revolution in medicine that has never happened—costs will simply rise for private patients, or hospitals will refuse to treat seniors insured by Medicare. Congress will never allow that to happen either.

In other words, under ObamaCare the "cost curve" will not be bent as the White House has advertised.

Under his more plausible outlook, Mr. Foster notes that Medicare's share of the economy will rise 60% between now and 2040, while under the trustees report that Democrats are crowing about it would "only" rise by 35%. Didn't President Obama tell us that health-care reform is entitlement reform?

Politicians have deliberately written the ObamaCare rules, as they have for all entitlements, so the real costs are disguised and hard for taxpayers to figure out. During the ObamaCare debate, Mr. Foster was honest enough from his Medicare perch to expose the plan's true costs, and his new Medicare demarche continues this public service. He ought to receive the Presidential Medal of Freedom, or at least some media attention. But in Barack Obama's Washington, his honesty will be rewarded with obscurity.

online.wsj.com