Third Party & Independents Archives

Excellent argument and post, thanks David, a great read.

Posted by: gergle at July 24, 2009 12:28 PM

David:

Excellent article. I think universal health care is a noble ideal, and certainly as a country we have had the debate and should continue the debate on this issue.

One problem I see with univeral health care (I should add a solvable problem), is the idea of freedom. Stay with me a minute on this and don’t dismis this as a serious issue.

If I have prepaid for my insurance I should have the right to have the medical care I have paid for without interferance from the government. If I have paid for access, I should get access. It’s my right. And who are you, or the government to interfere with my health!!

Over time, cost in the “freedom” model will moderate or level off because I only have so much money to spend on my healthcare.

However is you give the same care to those who cannot afford coverage, and intolarable situation occurs. ie bankruptcy. If you grant anything to someone without cost and no limits waste will occur!!

So if we grant the right to all, then we take away something from those who can afford their own coverage (access), or we go down as a country.

I only see one solution that works within our history. That solution is to create a system of government run healthcare that provides basic coverage that is rationed like in systems we se around the world.

In addition we allow the current system for those who can afford it to have care on demand. To those of you out there who want one system, I would say how dare you interfere with my health needs, or the health needs of those currently able to provide for themselves. Why would you want to harm our health, or interfere with our personal care? It’s none of your business, stay out!

I think Obama has made a big error in not runnig on eliminating tax deductibility of health costs. That is an obvious compromise. You could easily say to me, ok, you can keep your coverage but we are not going to subsidize your coverage anymore with a tax deduction. Instead we are going to use those funds to provide care for the poor. You can continue to have access, but we are not subsidizing it anymore. Unfortunately Obama is boxed in on that issue.

I have sympathy to your arguement for Univeral health care. I also have sympathy for the millions of Americans who have the right to have government leave them alone. There must be a balance somewhere. We are not there yet!

Posted by: Craig Holmes at July 24, 2009 12:53 PM

gergle, thanks. Glad the time to write it was appreciated.

Posted by: David R. Remer at July 24, 2009 12:59 PM

“Profits at 10 of the country’s largest publicly traded health insurance companies rose 428 percent from 2000 to 2007, while consumers paid more, for less coverage, if they had coverage at all.”

Yep… That pretty much tells the whole story.

The only solution to the problem is to break the grip on health care held by the for-profit insurance companies, which allows them to pick and choose who they insure, for what and for how much. Here’s how:

1. Either eliminate the tax break enjoyed by companies that provide insurance to their employees or extend the same tax break to individuals who purchase insurance as well, preferably the latter.

2. Require all health insurance companies to accept all applicants regardless of “pre-existing conditions”, at the same rate as they would charge anyone else with the same demographics (age, sex and location).

That’s it. No public option, no huge, bloated federal bureaucracy except to ensure that fair premiums are charged.

Where do the plans currently being floated in the Congress talk about this sort of thing? Nowhere I’ve seen.

Unless they put something like this in the law, they are “reforming” health care the same way Bush/Cheney proposed to “reform” social security - by destroying it.

Great post, David.

Posted by: Greg House at July 24, 2009 01:01 PM

There are three major obstacles to affordable health care: Pharmaceutical companies, medical malpractice insurance rates, and personal insurance rates. While personal insurance rates are the ones that affect us first, they are the apex predator in this food chain, and in order to change the ecosystem we need to first attack the base level, the pharmaceutical companies. Before anything else, we need to eliminate kickbacks that doctors and hospitals receive from the companies for pushing their drug. we need to restrict their ability to advertise to doctors and health care institutions only. And we need to not allow them to choose their own doctors and clinical groups for studies before the drug is allowed to be put to market. This last one is the hardest but also the most necessary.

Too many times do pharmaceutical companies ghost-write their own medical studies and pay a doctor to put his name on it. Sure, in a perfect world no ethical doctor would do such a thing, but how many times is somebody gonna walk up and offer you a free 10K before you take them up on it? Also, their medical studies need better oversight. The FDA is supposed to protect the american public from dangerous medicine, so why do we let the same people who stand to profit the most from these drugs perform the studies. I’m fine with federal clinical teams of scientists and doctors who will perform the studies for drugs that need approval, on nobody’s payroll but the state’s. Too many times we let the pharmaceutical companies bring in their own scientists to test for the dangers of the drug. Experimenter bias will always be a problem, so we should try to make the method as objectional as possible.

After this, or at the same time, we need to take steps to lower the medical malpractice insurance rates for doctors. This is cited as the costliest aspect of earning an MD, which is ridiculous given that earning the MD costs as much as house! The best way to do this, and the simplest, is to cap punitive damages in medical malpractice suits at 1,000,000, on top of the medical costs and lost wages of course. Capping these lawsuits at a reasonable price (and 1,000,000 is certainly very reasonable, regardless of the offense it will change whomever’s life) will take away the biggest bargaining chip that goes in the company’s favor. The idea of $20 million lawsuits makes the incredibly high premiums and career ending raises legitimate in legal eyes, but if that lawsuit drops to $2-3 million, there is no way the current rates and the amount of the premium increase would be defensible when challenged. On top of this, costing the doctors less money to do their job would allow medical procedure costs (especially the risky ones) to drop down to almost affordable and put pressure on our third and final suspect, health insurance.

To get health insurance rates to fall, you need to take a multi-pronged approach. The aforementioned regulation of the pharmaceutical and malpractice markets would be a big step toward making it affordable. And the plans laid out by Mr. Remer are elegant and effective. The biggest problem is wading, cutting, and shoveling through the miles of corporate dollars and refuse that is congress.

Posted by: Doug at July 24, 2009 01:42 PM

Craig, your argument is that of an anarchists.

In a democratic republic such as ours, the government, as representatives of the majority of the nation’s people, confiscate at the deference of the people, taxes for many ends of benefit to the nation’s people as a whole, for things like defense, maintaining currency, and creating infrastructure which no individual state or private entity can afford or is willing to provide. This does not constitute a restriction of freedom, but, an enhancement of freedom for the collective population by providing for society’s needs, freeing the population to pursue other endeavors.

Your argument appears to be one of decrying universal health insurance as a restraint upon your freedom because tax dollars will be used to fund it. If you argument had any validity, then just one peace-nik would have the power to deny the rest of the population a national defense by objecting to the taxes required for a national defense.

That of course, is not how our nation was designed and constructed at the Constitutional level. Ours was designed to facilitate the power of the majority, with checks and balances. Not to deny the majority on the objection of a minority.

When you say: “If I have prepaid for my insurance I should have the right to have the medical care I have paid for without interferance from the government.”, something does not register as logical.

Of course, if you pay for private insurance, you have the right to the medical care that private insurer provides for your premium. Nothing about universal health insurance precludes this from being true or continuing. The government has no intention of interfering in the relationship between you and your private insurer. If you wish to pay a higher premium with less coverage or even enhanced coverage through a private insurer, your wish will not be interfered with by the government.

On the other hand, if you make the argument that: if the government provides OTHERS non-profit insurance it will have an impact on your private insurer, that much of your argument will be valid. The competition may very well have the impact of lowering your insurance premiums with a private insurer, or, causing your insurer to curtail some of its coverage even more than it now does. However, such an argument is insufficient to warrant the anarchist’s desire to prevent government and majority rule by objection.

The business decisions regarding profitability and premiums and coverage by private insurers is a matter to be taken up by the private insurer and their premium payers. It is not a matter having anything to do with government providing non-profit insurance to those who can ill afford private insurance. These are separate competitive models of insurance between separate entities and groups of insureds. And competitive models of providing goods and services is a good thing, is it not? It provides greater choice, and more choice equates with greater freedom, does it not?

So, I have to reject your argument anarchist in nature and aspiring for minority rule in a majority rule society. And I have to reject your red herring argument that universal health insurance provided by the government in any way, interferes with your option to elect a private insurer for that private insurer’s asked for premium price to support the profiteers feeding off that private insurer. The government has no intention of interfering with individuals electing such a choice.

A government universal health insurance option does not in any way prevent private citizens from insuring with a private insurer. And if the such a citizen decries the government’s non-profit option providing lower cost and expanded coverage over what private insurers offer, then that citizen and their money for private insurance will sooner be parted and in greater measure.

On the other hand, those who can afford maximal coverage offered by private insurers beyond that which the government’s universal plan offers, will remain free and unencumbered to insure through a private company at their profit insurable premium rate. Everyone wins, because everyone gets insured, and those who can afford the best will continue to pay for the best that the private sector has to offer.

Posted by: David R. Remer at July 24, 2009 01:49 PM

“After this, or at the same time, we need to take steps to lower the medical malpractice insurance rates for doctors. This is cited as the costliest aspect of earning an MD, which is ridiculous given that earning the MD costs as much as house!”

This doesn’t even make sense. A doctor doesn’t need to carry MMI to earn an MD. A lot of docs don’t even carry it after they earn their MD. I will agree that the cost of MMI is a burden to docs when they practice after earning their MD.

Here’s something I just googled that specifically says medical malpractice premiums are less than one-half a percent of total medical expenditures in this country, which is not nothing, but also probably not the first place to go looking for savings.

Having been on the plaintiff end of a malpractice claim, I can tell you that many docs and most doctors corporations will cut corners as often as possible if they think it will make them a few more bucks. One of the few things keeping them honest is the fear of a lawsuit.

Posted by: Greg House at July 24, 2009 01:58 PM

Greg, thanks. Your suggestions leave one unaddressed problem. The national bankrupting of the federal budget by the UnInsured, those who can’t afford private health insurance, and are covered by Medicare and Medicaid.

Is that 100 million Americans (by 2020) to be left without health care at all? Part of the solution has to include driving down the cost of health care delivery itself, so that our government will not go bankrupt providing the health care costs of those who cannot afford private health insurance, from the children, to the low wage employed, to the retired seniors living on low and fixed incomes. This group is growing in number in America, and our government, we the people, cannot turn our back on that demographic, and still call ourselves, humanitarian.

Any solution must address and humanely resolve this demographic. The private sector is both incapable and unwilling to even address the uninsured.

Posted by: David R. Remer at July 24, 2009 02:00 PM

Doug, good observations and analysis.

I would add paramount additional feature regarding malpractice, and that would be providing a review panel, (could be the courts or other entity), the power to bar practitioners from the medical industry, efficiently and permanently. A very large percent of the malpractice suits attend a small group of practitioners.

The ability to remove practitioners from practice, who engage in behaviors that lend themselves to malpractice, is paramount to driving down the cost of malpractice insurance.

Posted by: David R. Remer at July 24, 2009 02:05 PM

Greg,
I mean that the cost of malpractice insurance for a doctor or especially a surgeon rivals the cost of getting his medical diploma.

David,
I completely agree that an interstate disbarrment is a necessity. Too often a doctor will be thrust out of Michigan just to be practicing in Illinois a couple years later. Good call.

Posted by: Doug at July 24, 2009 02:13 PM

Greg House, total health care expenditure in 2007 was $2.4 TRILLION. One half of 1% of that is 1.2 billion dollars a year spent on medical malpractice insurance. That is not as insignificant an amount as your comment indicates. Though, as a percentage, as you indicate, there are indeed, bigger fish to fry.

Posted by: David R. Remer at July 24, 2009 02:15 PM

Good article David.

Per your comment

total health care expenditure in 2007 was $2.4 TRILLION. One half of 1% of that is 1.2 billion dollars a year spent on medical malpractice insurance.

- Aah, Trillions and billions -
Actually one half of 1% of 2.4 trillion is 12 billion dollars. And Greg House readily conceded that the amount was not insignificant. The article he linked about malpractice insurance also noted that the claims against malpractice insurance were one fifth of 1% of total expenditures, and that studies show no correlation between premium rates in states with the most restrictive tort reform laws and those with less.

In short malpractice expenses are high, but the reform needed there probably ought to target the insurers to keep them honest, not place arbitrary limits on settlements. Anecdotally one can find capriciously large settlements, but it’s empirically incorrect to suggest that those large lawsuits are a major source of our current crisis.

Posted by: Walker Willingham at July 24, 2009 03:35 PM

The medical malpractice suit cap I argue for is not the biggest part of the insurance premium crisis, but it is a part. And it also happens to be a part that we can control. While it would be nice if drug companies sold their pills dirt cheap, or companies that fabricate valves and instruments kept their prices low, or the companies that make machines like the fMRI or X-ray machines charged just a little over cost, expecting businesses to do that is just not pragmatic. We can’t eliminate the free market that let us be a leader in medical innovation for the last 50 years, and we can’t legislate a company and make it public. We could conceivably start a new, government run manufacturing program but that would be a remarkable waste of money. The parts of the process we can attack, however, are insurance and kickbacks, malpractice suits and drug studies. The only way we can alleviate the problem is by coming at it from all possible angles, and exhausting all possible routes of relief.

Posted by: Doug at July 24, 2009 04:40 PM

Walker, thank you for the decimal point correction. I thought 1.2 bil was wrong, and checked it again before entering my comment. I made the same decimal error, twice in a row. Appreciate the correction.

1/5th then would be around 2.4 billion per year. Double what I incorrectly estimated. More significant that previously discussed, and worth going after, since we must NOT ONLY halt the upward sprial of costs, but, actually force the trajectory south, and that as soon as humanly feasible, considering we begin running Medicare/Medicaid deficits in just a few years.

A billion here, a billion there, it can add up :-)
There’s only a thousand billion in a trillion after all.

Posted by: David R. Remer at July 24, 2009 05:03 PM

Doug, an alternative is to provide conditional interest free loans as start up capital for non-profit pharmaceutical innovation labs, to compete with the for profit sector. Private owned and operated, they could then offer competitive salaries to researchers, and produce pharmacological products at a lower cost to all, and repay the tax payers in a relatively short period of perhaps as little as 10 years. The American consumer and taxpayers would benefit as a result of lower pharmaceutical pricing.

Keeps government out of the manufacturing trade, while promoting long term health care cost savings to the government health care insurance programs, tax payers, and consumers.

Posted by: David R. Remer at July 24, 2009 05:12 PM

David:

Craig, your argument is that of an anarchists

Your argument is that of a communist.

In a democratic republic such as ours, the government, as representatives of the majority of the nation’s people, confiscate at the deference of the people, taxes for many ends of benefit to the nation’s people as a whole, for things like defense, maintaining currency, and creating infrastructure which no individual state or private entity can afford or is willing to provide. This does not constitute a restriction of freedom, but, an enhancement of freedom for the collective population by providing for society’s needs, freeing the population to pursue other endeavors.

From each according to his abilities, to each according to his needs.

Well maybe a socialist. Do we want to keep labeling?

Your argument appears to be one of decrying universal health insurance as a restraint upon your freedom because tax dollars will be used to fund it.

I am not arguing against universal health coverage.

What I am saying is that rationing must come or we go bankrupt with univeral health coverage. That has not been explained.

I am not arguing agaisnt rationing. I will point out however that Obama did not discus it in the campaign. Now that it must happen, there will be hell to pay when the subject comes up.

Secondly, the part of our current health care coverage that works, (ie mine), will be altered. Again, the US Senate is looking at removing my tax deduction. That would be fine with me if Obama had ran on that premise in the campaign and won. However he was clear that no one under $250,000 would see their taxes raised. I expect him to hold to that commitment.

Finally, this is falling apart. I think the best that can happen is something watered down in the fall. The reality of the budget numbers are out, and Obama is below 50% in the Rasmussen polls. He is likely to be much lower by fall. Democrats are split. It looks like it’s tumbling out of control.

Posted by: Craig Holmes at July 24, 2009 05:39 PM

Words have defined meaning, Craig, and when they don’t match the target, they are nothing more than idle banter.

Anarchism seeks independence from the affects and judgments of all others. Your argument is based on just such a premise. In a democratic republic, majority governs elections, and majority governs legislation. To argue against such majority will is anarchist.

If that was not your argument, then my response is not applicable.

I am with you on rationing. But, there never has been, and never will be, a health care insurance system in America that has not rationed health care to keep it affordable (or profitable). That is a straw man argument, to raise rationing as an issue, since we already have rationing in favor of the wealthy and against the poor, those with preconditions, and those whose illness or injury costs supersede the limits of the policy or threaten the profitability of the private insurer.

Removing your tax deduction is a trade off against competitive lowering of your private insurance premiums brought on by government sponsored universal health care insurance at a non-profit per capita rate. What you want your cake and eat it too?

The cost of not providing universal health care will be enormous. Civil unrest, failure to put this issue behind us legislatively opening the way to other high priorities to be resolved, and of course the failure to drive down the Medicare/Medicaid impact on your taxes in coming years, will far outweigh what amount you now retain in tax deduction.

Further, a very large number of businesses, especially small ones, will feel a yoke lifted off them by universal health care coverage, allowing them to become more competitive, hire more workers, generate more economic activity, and government tax revenues, and thus reduce the pressure on further tax hikes against your income going forward.

As for Obama, he has said the bill he signs will have to meet 3 criteria, provide coverage to all who want it, that it be cost neutral in the long run, and that it be portable without exclusions for preconditions. I have seen nothing come from the WH to indicate any change on that position.

The Senate version you refer to is but one of several in Congress being worked on. Political compromise to get passage is foregone conclusion. The cost of doing nothing is far more than you or I, or our children will incur as a result of political compromise provided the final product does take square aim at halting or reversing the government future costs of Medicare/Medicaid.

If it is tumbling out of control, I suggest you and I contact our representatives and tell them that is not acceptable. Failure to pass health care reform is NOT an affordable option for America. It does constitute a commitment to economic failure in less than 20 years.

Posted by: David R. Remer at July 24, 2009 06:52 PM

I think the best idea here is to treat this article like an ‘ink blot’…

To that it completely and totally misses the meaning and purpose of the constitution is mild, and turning it on its ear like this would have the founding fathers spinning in their graves.

Nevermind that the preamble to the Constituion has no bearing in law and as a preamble is not enforcible, a simple perusal of the writings of our founding fathers by anyone who can read would point out the flaws.

And anyone understanding what I mean by ‘ink blot’ will see the folly of such a discourse. If not, please go look it up.

Posted by: Rhinehold at July 24, 2009 07:29 PM

Rhinehold
I agree Remer outdid hisself on this play of words.

Posted by: KAP at July 24, 2009 08:52 PM

D.R.R.
I think you forgot one important thing in your play of words here. The beginning of the preamble says WE THE PEOPLE OF THE UNITED STATES, to me that means that a majority of THE PEOPLE must be in agreement, not just we the democrats, or we the republicans, or me the president, or me some judge. Yes we all should be able to recieve affordable health care but not just the republican way or democrat way or independents way, but by the PEOPLES WAY.

Posted by: KAP at July 24, 2009 11:07 PM

Rhinehold would disgard the preamble as inconvenient in setting the purpose and overarching objectives of what follows in the Constitution. So be it. Anarchists and Libertarians are want to do that.

KAP, we the people have the vote to reelect or depose those in Congress who fail the majority. According to the election results going back decades and decades, the voters have the government they wish, and if this Congress moves to Universal Health Insurance, that will be the will of the people, as they elected the representatives who passed it. That is how our constitutional democratic republic has been constructed.

To argue the politicians don’t have the right to pass legislation is ludicrous on its face. Your argument is ludicrous, on its face, and on Constitutional grounds. The people elected this Congress. The people’s will was provided for in Nov. of 2008. The Congress now has the constitutional authority to legislate universal health care if they can muster the required votes. That is the people’s will also, by their assent to the Constitutional framework that provides for this.

Posted by: David R. Remer at July 25, 2009 12:01 AM

Rhinehold-
We can talk about the constitution in the abstract in terms of your theory of what’s constitutional, as you do, or we can talk about current jurisprudence, it’s practiced use.

In practice, we’ve decided that general government benefits are not in conflict with the constitutional powers of the government. You hate that with a passion. But this government is not founded on your sentiments. It’s founded on the rule of law, and the Supreme Court has not, to this date, invalidated social security, nor medicare or medicaid. By that logic, there is no reason to believe that the courts will find universal healthcare unconstitutional.

Arguments of unconstitutionality, when not backed by the decisions of the court, should only be considered valid in terms of personal opinion, not as legal restrictions that the rest of us are bound to observe.

Now, if you could go to court, with the proper standing, and bring a suit that successfully challenges these programs, then we could talk about your opinion binding the rest of us. The question is, would your case ever get that far?

Posted by: Stephen Daugherty at July 25, 2009 12:02 AM

Rhinehold would disgard the preamble as inconvenient in setting the purpose and overarching objectives of what follows in the Constitution.

Disregard? No. Use it as a basis for the constitutionality of legislation? Absolutely not.

Of coure, David would like to disregard the entire constitution, the amendments, the federalist papers, the anti-federalist papers, the writings of James Madison, Thomas Jefferson, Benjamin Franklin, John Adams, etc…

Statists and Liberals are want to do that.

(oh, and is the new word of the week Anarchist? Anyone who disagrees with majority rule democracy and would rather adhere to the tennets of the constitution is now suddely an anarchist?)

Posted by: rhinehold at July 25, 2009 12:24 AM

Rhinehold,

So the compromises made for slavery still hold true to you? Huh? The same argument you just made could well apply to these.

Your constant throwback to the 1700’s as the basis for rejection of the Legislature acting for the general welfare as unconstitutional has become a joke, but one I find unfunny.

I recall watching an author on C-Span discuss the fondness for conservatives calling ideas they don’t like judicial activism, and the equally “activist” ideas they like strict constructionism, making both terms completely pejorative.

Posted by: gergle at July 25, 2009 05:54 AM

So the compromises made for slavery still hold true to you? Huh? The same argument you just made could well apply to these.

What a completely idiotic statement. Can you point to me where I said we should not include amendments to the constitution, gergle? Anywhere to back up your incitful charge? Not only was it specifically made unconstitutional after the Civil War, the 9th and 10th amendment outlawed it as well.

In fact, I charged David for ignoring the amendments, not call for them to be ignored myself.

And that is also the point I am trying to make to the rational thinkers. When the constitution was first written, a federal income tax was unconstitutional. An amendment needed to be passed to give the federal government that power. When the federal government wanted to outlaw the sale of alcohol, an amendment needed to be passed.

If you want to give the federal government the power to require people to purchase insurance on themselves, pass an amendment to the constitution. It would make the action constitutional. If you want the federal government to have the power to force people to become doctors, nurses, etc (which will need to be required once you make it law that everyone must be covered) then you’ll need a constitutional amendment.

The constitution is a document detailing the limits of the federal government, specifically spelling out what it can do only. You can see this for yourself if you want to read the words of James Madison, Thomas Jefferson, John Adams, etc. The notion that the federal government can do whatever it wants requires the supporter of those actions to completely ignore the 9th and 10th amendments, which is what Judge Bork was talking about with his ‘ink blot’ theory.

Congratulations for being on the same side as Judge Bork.

As for what you find a joke, I find it unfunny that people on one hand want to demand constitutional protections and then throw the document out on the other, based on politics. Bush used the same arguments that you are when he (imo) unconstitutionally wiretapped Americans. But, using your rational and the arguments of Stephen as well, Bush did nothing unconstitutional because no court has found it so.

How does it feel to be in the same camp as Bush and Bork? Feel funny?

Posted by: Rhinehold at July 25, 2009 11:22 AM

D.R.R.
I vote for someone one time if he or she screws up next time no. To many people in this country keep pulling the party lever at election time, not being concerned if the people they are voting for are doing the right thing, I’ve seen it in every election that I have been able to vote in and that has been quite a few. I even see it here on watchblog.

Posted by: KAP at July 25, 2009 11:29 AM

We might consider practicing fair trade instead of free trade. In this supposedly globalized economy why not permit the citizenry to purchase drugs from foreign entities? Why not allow foreign insurance firms and/or medical consortiums compete for healthcare business in the US? That’s at 20-25% whack at the cost.
That’s part of the Republic Sentry Agenda. The real crux of the matter is that there can be no real reform on this or any other issue until we achieve reform of government. Gotta take the money influence out of politics before anything useful can be achieved. How utterly ridiculous to expect a healthcare program for the ‘people’ with the millions being thrown at those who have a vote in the outcome and whose lifestyle and career hangs in the balance.

Otherwise, we have the Corpocracy we deserve.

Posted by: Roy Ellis at July 25, 2009 12:21 PM

“Your suggestions leave one unaddressed problem. The national bankrupting of the federal budget by the UnInsured, those who can’t afford private health insurance, and are covered by Medicare and Medicaid.”

Not at all. Actually, the major cause of the national bankrupting would in fact be addressed by my suggestions, though certainly not immediately or directly.

Consider that although Medicare and Medicaid (and even all that “free” care given to totally uninsured patients which is currently written off) are priced at the current, inflated prices that are required in order to permit the for-profit insurers their exorbitant profits. Also, most medical care is in some way or another influenced by profitable agreements between providers on the one hand and the for-profit insurers on the other.

Once it becomes a requirement for all insurers to accept all applicants at a fixed premium per given demographic (age, sex, location), two things are going to happen.

1. The providers will have to drop their prices on all services, especially those which do not improve health, because the insurers will no longer be able to afford to pay for their insured to receive the services.

2. The resulting deflation will permit medicare and medicaid to balance their budgets. There may need to be some additional tax revenue added to these programs, but for the most part they will become solvent at current levels.

It’s not magic, it’s just a market-driven way of forcing the insurers and providers to get out of the profit-making business and back into the health care providing business.

Ultimately, the result would be something more like the current financial planning/brokerage business in that a much wider range of insurance types and coverages would be available.

A vanilla plan might work for most, but others who want to pay less could opt for higher deductibles, lower limits and more exemptions.

The current structure of health insurance by for-profit providers who are allowed to pick and choose who they cover, what they cover and is tantamount to a trust. They do nothing to enable delivery of health care, only try to prevent health care from being delivered.

Posted by: Greg House at July 25, 2009 02:27 PM

Rhinehold,

Guess I must have struck a nerve. I see it’s pick and choose nite at the Constitution.

So police, firemen and ambulance service is not allowed in your version of the Constitution? If you can allow one you can allow the other. It is you who are making completely stupid arguments here. David made those succinct and cogent arguments. Of course, to you, that is “activism”

Stop blaming me for your continued use of Libertarian fanaticism that has made a joke of the idea of “activism”.

Frankly, someone so in love with 1700’s should really live with that kind of medicine. Had any leechings lately?

What is stupid is mindless attachment to something which was intended as a framework, not a perpetual era frozen in time.

The federal government is not a body that wants. The people CAN do whatever they want, including abolish the Constitution. A Natural right isn’t given by the Constitution. What the Constitution does is lay a framework with which to work within and is mindful of the idea of the will of the people and limiting power.

Becoming so entranced by one’s own diatribe that one fails to see an obvious will of the people, reminds me of Jefferson’s statements during the Whiskey Rebellion. He was aghast at the stupidity of the politicians in Philadelphia being so out of touch with their electorate. I think Jefferson would be aghast at your arguments, frankly.

Posted by: gergle at July 25, 2009 03:28 PM

Rhinehold,

I want to say I do respect your obvious intelligence. The above is simply a response to your post, made in haste. I know I at times aggravate you, though I don’t really mean to. I do want muster good debate with you, however. You intrigue me.

In more moderate tones, I mean what I say. I think you destroy great arguments you’ve made, at times, through overly rigid, and arcane interpretations of the Constitution, that I strongly disagree with.

Posted by: gergle at July 25, 2009 03:51 PM

gergle, that’s the thing about ideologues: fact, reality, and logic have no place in their ideology. Thus fanaticism and extremism are born in the rigid and inflexible minds of those who seize upon a pet want and throw temper tantrums a whole life long because those wants can never be satisfied. But, it does give such folks a sense of purpose and justification for throwing such illogical and irrational tantrums.

There is no finer example than the terrorists in the Middle East. They have their pet want, to have influence in their world, and they will kill anyone who tries to oppose their influence. It is mindless, irrational, and illogical, as it turns the whole world against them. But, it gives their otherwise insignificant lives a sense of purpose, and it is in the nature of human beings to find a sense of purpose in their lives, even if that purpose is entirely wasted and wasteful of their own life and the lives of others. Such is the nature of cognitive dissonance, that it can rationalize anything, no matter how absurd, or out of touch with reality or doomed its outcome.
It still permits the individual the satisfying sense of martyrdom in their own minds, and thus, for them, is worth pursuing even if it kills them.

Insanity, Einstein said, is doing the same things over and over, expecting a different result. Longing for a past that never was, and was never intended to be, is just such an exercise in futility, which then engenders deluded martyrdom, giving rise to a sense of purpose where none really exists.

Reminds me of term limits folks who reject the concept of voting out incumbents as a means to their end. When in reality, it is blatantly obvious that the incumbents are the mountain in the way of term limits. Their’s is an exercise in futility, rejecting the very means to their own end, all resulting from an irrational seizing upon a pet want which is wholly sufficient for them to justify their sacrifice to their futile cause.

Fortunately, most term limits folks are rational and quite sane, and readily see the wisdom of hitching their term limits cause to the vote out incumbents strategy in order to reach their potentially realistic objective. And most Americans reject the notion of undoing 200 years of history and political evolution to return to an ideas which some founders had but which never made it in writing into our Constitution. These folks reject what IS written in the Constitution, the preamble for example, for their version of what some founders wished had been written in, but, for which there was nor would be a consensus.

Posted by: David R. Remer at July 25, 2009 04:00 PM

Brilliant, you have put the Health Care debate into its proper context.

Keep fighting the good fight,
Randy

Posted by: Randy at July 26, 2009 08:22 PM

“A government universal health insurance option does not in any way prevent private citizens from insuring with a private insurer”

Private citizens money will be confiscated by govt in order to pay for this universal health insurance BS, that is money the private citizens no longer have to use as they wish, such as purchasing insurance from a private insurer.

Socialist health care, insurance or whatever the latest term being used is, does not in any way promote freedom and to suggest that it does is “illogical.”

Posted by: kctim at July 26, 2009 09:50 PM

kctim,

Well, since you are not an island unto yourself, you have to pay for several things that promotes the general welfare. You are quite free to hire your own fire department and police force. You simply have the earn the money to do it. Isn’t that what free enterprise is all about? Why the whining?

That the majority of Americans find it completley illogical to pay more for healthcare than anywhere in the world yet still find 50,000,000 without access to reasonable healthcare. There will still be freedom of choice, just not the freedom for you ride free at the rest of society’s cost. The Universal healthcare being discussed does not eliminate private plans, it simply fills in the current gaps that you are paying in county taxes for the indigent emergency care that substitutes as a logical healthcare plan.

Posted by: gergle at July 26, 2009 10:35 PM

David: well argued. An interesting and relevant perspective. I am stunned only to find that excuses continue to be offered, rather than solutions. This issue seriously has me considering a stint in the third party column, since my own party seems so intent to take the healthcare industry’s dirty money to block Obama’s plans.

Posted by: Jon Rice at July 26, 2009 10:43 PM

David:

Being for universal health care in principal is different than supporting what is going on now.

I understand that all Americans should receive some form of basic coverage. Where I differ with many is over the need of access, and of course rationing.

I agree that all commodities are rationed by the market. When you add the language of a right, that necessarily implies rationing or we go broke. Pike any commodity and give it to the masses as a “Right” and bingo, we over consume as it is our right.

So we have to decide what level of care is our “right”. Or what level of care and American is “entitled to.”

The problem comes when we then deny access to the few who want the market or their ability to pay to determine the “Rationing” rather than government. If we go to one extreme and go to a universal system we then take way the right of those with cash in hand to have the freedom to negotiate with their doctors/insurance companies for their own level of service.

I am wondering where the balance is.

Also, I think Obama has boxed himself in to a corner on this issue with the no taxes for all those under $250k pledge. For instance what would be logical to me would be to remove the tax deduction from those who have plans that allow the market forces to limit coverage, and use those funds to help pay the costs for the uninsured. The CBO has said this is only one of two ways they know of the really bend the curve.

The problem is Obama’s integrity. He risks being a one termer if he brakes his own “read my lips” pledge.

I still believe we need to look at ways to cut the costs. I think taxing sugar pop is interesting. If one looks at cigarette use and how taxation over time has reduced smoking, and later lung cancer, I am wondering if the same process would lower diabetes over time and thus lower medical costs. These taxes could produce a double effect.

Obama’s rhetoric has really ran into a wall on this one. His numbers are tanking as the cost of his proposals are becoming known. If this info were known in the campaign I doubt he would be president. We might have Hillary!!

Posted by: Craig Holmes at July 26, 2009 10:58 PM

kctim, the current cost of providing health care for the uninsured at E.R.’s is being born by you and all others paying for health care. As conservatives are fond of pointing out, the costs born by private concerns, whether they be taxes or costs for the uninsured and non-payers, is passed on to every other paying customer receiving health care, while the deliverer retains their profits. So you are paying for it, anyway.

And with up to 33% inefficiency and waste in the private insurance - health care delivery system, it is costing you a lot in premiums, or if you are self-insuring, will cost you enormously when you need to access health care facilities.

But, you admit that for you this is an ideological debate, and we know there is no changing an ideologues mind, since ideology, not facts, reality, logic or pragmatism, maintains their perspective.

The fact remains, universal health insurance (UHI) has the potential of reducing costs for everyone. Currently, young, uninsured wage earners do not pay into the system at all that provides health care to the uninsured. Under UHI
everyone pays into the system, thus reducing the cost per capita for everyone. Other measures are also being promoted within the UHI proposal to drive down the per procedure costs, and then there is the elimination of profits from the UHI, further reducing the cost per person covered.

The glaring reality is that the current system is broken, fails to cover 50 million, covers the rest at an inflationary rate which is unsustainable, and which threatens to bankrupt the nation in less than 20 years.

To oppose reforms which attempt to address these realities, is illogical. The Republican ideas center around keeping the current broken system in place with all its maladies, adding only a bit of window dressing which, do not address the main issue, how to provide everyone quality health care when they need it and keep the nation from going bankrupt.

Posted by: David R. Remer at July 27, 2009 11:32 AM

Craig, Obama’s numbers have dropped to around 49 to 50% as a result of his translating ideals into nuts and bolts policies, which would have happened to ANY president who attempted to address in concrete terms the realities he inherited on Jan. 20.

This is the nature of American politics. Everyone wants the ideal of universal health care coverage at no cost. The minute ANY President puts forth universal health care with a cost (called reality), a percentage of the population’s support will fall away.

What Obama needs to be concerned about is whether or not his policy implementations actually work, or not. If they do, such as the economy rebounding, then his poll numbers will rebound as well amongst independent voters. If his policy implementations fail to show improvement, then, his numbers will not rebound by 2012. That simple arithmetic has always been fundamentally the same regardless of who is president or when.

No president beginning with near 3/4 approval rating at the start of their term, has ever held onto those ratings as they tackled the real issues of their day. But, history demonstrates, it is not the poll numbers after 7 months of a presidency that determine the president’s reelection chances 4 years later. Not by a long shot. Your comment appears to be jumping conclusions by about 3.5 years.

Posted by: David R. Remer at July 27, 2009 11:40 AM

Craig asked, where is the level of balance?

The answer is, that will come after UHI is implemented. If you argue the Obama administration and the Congress are going to abandon actuarial data, I would have to argue that is wrong.

And for one simple reason. The Congress and Obama have acknowledged the unsustainability of our national debt and deficit additions, and have made ‘bending the debt trajectory’ away from its upward trend currently, back South again. The only way they will be able to accomplish that feat is through actuarial rationing or capping of the coverage which is extended under the UHI plan, to a level which permits bending that debt curve downward.

But, first things, first. UHI has to pass. Then come the actuarials with annual or bi-annual adjustments, as warranted, by the required expense caps to bend that debt trajectory. Of course there are other mechanisms that will also play a part in bending that debt trajectory South, like tax and revenue adjustments, some of which are already on the table, and long term sustainable economic stability which is being sought by reforms in the checks and balances and oversight of the securities and exchange markets as well as consumer debt markets like mortgage lending.

If they are successful in cutting the bust cycles in half, i.e. occurring half as often as in the past, that results in trillions being saved each decade in government spending. It’s not getting much media coverage, because of its highly technical and number oriented basis, but, such market reforms and checks and balances are easily passing the Congressional committees and are likely to find easy passage in both Houses, and signed by the President.

This is the kind of holistic approach that prompted me to vote for Obama, and against my incumbents in Congress. I still hope such an holistic approach to flattening and even reversing our national debt trajectory will pay dividends throughout my daughter’s life in America over the next 70 to 90 years.

Americans aren’t very math saavy, so these kinds of reforms are actually achievable without much backlash from the ideological opponents. Their follower’s eyes glass over when they try to explain the complex numbers to their followings. Hence, no public opposition to speak of on attempts to reduce the number of bubble bust cycles which have been historically averaging between one and two per decade.

But, I will be the first to admit, that we are by no means out of the woods on that one. Much rests on our ability as a nation to ride the economic stimulus to a sustainable economic activity level while diminishing the potential consequences of hyperinflation at the same time. That is a bridge that has yet to be crossed. Bernanke says we can potentially cross that bridge safely. I would like very much for him to prove that to be true. But, I will remain both hopeful and skeptical until we are safely on the other side of that bridge.

Posted by: David R. Remer at July 27, 2009 12:01 PM

Randy, thanks for your words of encouragement.

Greg House, you said your answer solves the Medicaid/Medicare debt problem of the uninsured. Sorry, but, what you proposed does not even come close to addressing that issue.

Your solution was:

1. Either eliminate the tax break enjoyed by companies that provide insurance to their employees or extend the same tax break to individuals who purchase insurance as well, preferably the latter.

The amount you are talking about here in tax breaks to the companies doesn’t even begin to address the Medicare/Medicaid deficit issue. And extending the same tax breaks to individuals would dramatically reduce government revenues, and thereby increase the deficit effect of Medicare and Medicaid.

2. Require all health insurance companies to accept all applicants regardless of “pre-existing conditions”, at the same rate as they would charge anyone else with the same demographics (age, sex and location).

This other part of your solution is so full of lethal dead falls. First, it would bankrupt many health insurance companies, because in fact, what you proposing is a cap on income while dramatically raising private health insurer costs. That is a prescription for bankruptcy and shareholders taking their investments elsewhere where returns would be better assured. Which leaves the government picking up the health insurance coverage anyway, if a domino bankruptcy effect is to be avoided in the private insurer industry.

Posted by: David R. Remer at July 27, 2009 12:14 PM

Being a Utah health insurance underwriter for www.BenefitsManager.net and www.DentalInsuranceUtah.net I have the opportunity to consult within many state insurance committee meetings. Some interesting changes took place in Utah with the passage of House Bill 188 that other states should pay attention to and perhaps the federal legislation. The bill created a state insurance pool requiring private health insurance carriers to come together and underwrite risk. Through governmental guidelines (which I have traditionally opposed in the past) they created a arena of underwriting rules that essentially guarantees the participating insurance carriers a ?no loss? or ?no gain? over each other. What this essentially means is that they pool the underwriting medical risk and spread it evenly among each carrier. All the sudden, we see guaranteed issued policies. We see rates drop by as much as 13% In Utah, our average monthly family rate is $867 for a $500 deductible plan. Some of the family rates within the ?Utah Insurance Exchange Portal? are approaching $700.00 now. To see more of HB 188 and see how Utah wrangled change without increasing taxes or rationing go to: http://www.prweb.com/releases/utah_health_insurance/health_care_reform/prweb2614544.htm
The private insurance sector can be corralled into cooperation where they can meet their goals. You have to understand that health insurance carriers are only looking for a 4-5% administration fee. That is it and they are more efficient as compared to a governmental portal that will cost more money. Take a look at Utah folks!

Posted by: Mike at July 27, 2009 12:20 PM

I believe we will get a healthcare bill passed by the end of the year. The Corpocracy is desperate to lock the illegal population in, prevent them from bailing for their home countries during this recession. I think the bill will pass but will only offer minor changes in actual healthcare.
Personally, I would like to see some anti-trust actions to bust up the big meds, big pharmas, etc and get some competition back in the system. And, let’s not be half pregnant with this free trade thing. Citizens should be allowed to purchase drugs from overseas as well as health insurance from foreign companies that want to compete in the US market.

Otherwise, we have the Corpocracy we deserve!

Posted by: Roy Ellis at July 27, 2009 12:28 PM

Mike,

I have several concerns with the Utah House Bill proposal #188.

First, the insurance companies will go along with almost anything to avoid a non-profit competitor which is what a government sponsored insurance plan would be. The reason should be obvious; for profit concerns would have to compete with the lower cost option of a non-profit offered competitor.

Second, as has always been the case, the private sector is always willing to compromise where their public relations are on the line, knowing full well, their lobbying efforts in the future will be able to largely, or completely, roll back the compromises or concessions they make today, in the future. That is one of the reasons private concerns spend so very much on lobbying efforts.

Third, your link to the article, does not spell out what caps on coverage, what limits on total claims, or what exemptions from coverage are contained withing the HR 188 proposal. And there is nothing to indicate that growing these caps, limits, and exemptions will not be forthcoming if the bill were to become law. And unless there are provisions to prevent same from occurring, then there is absolutely no gain to the public sector to be received in the long run, by the HR 188 proposal.

Posted by: David R. Remer at July 27, 2009 02:19 PM

Roy Ellis, I will go you one better. Pharmaceutical companies should NOT be allowed to charge foreign customers less than they charge American customers. One cost for all, would level the playing field and eliminate the need for American patients to seek medications from outside our borders.

Posted by: David R. Remer at July 27, 2009 02:21 PM

Rhinehold, the preamble sets out the ideals. The reason should be clear. Precisely because law can never achieve the ideal in implementation for all the people, all of the time. Any law, regardless of how laudable, will infringe on some in a society’s, perceived rights to be free of that same law.

The objectives of the Constitution are not intrinsically stated, which is why the Preamble is an integral part of Constitution, and the Supreme Courts have from the beginning taken the Preamble to be considered in the objectives of the Constitution. When the Constitution was ratified, so was the Preamble. Failure to comprehend this evidenced fact, leads to the indefensible claims your comments proffer.

Posted by: David R. Remer at July 27, 2009 02:32 PM

Gergle,

Sorry I haven’t been able to respond, life has a tendancy to get in the way at times…

I appreciate that you modified the tone a little bit so let me try to take this tact.

I don’t see it being ‘rigidly ideologue’ to be concerned about individual rights as guarenteed by the constitution. I think you feel the same way when it is in regards to violations you see taking place as well. For example, Bush’s violations of the constitution are things you rail about, right? Do you give an inch when others say that the constitution couldn’t have forseen what is going on now and we should just look the other way on his violations? I sure don’t think we should. In that respect, I am just trying to defend it against other approaches as well, even ones that you think we should ignore.

However, unlike David’s assertion that my views are ‘terrorist’ like, which he will now say he didn’t suggest (while saying we should read into what the Bush administration said to convince us that 9/11 was committed by Iraq), it isn’t true at all.

I have no problem, as I said, in modifying the constitution to give the legislature the power to do what it thinks it should be able to do. I only want us to do it the appropriately legal way, through amendments. For example, when the constitution was written, there was no income tax allowed. In order to have one a constitutional amendment was passed. The government didn’t just ‘ignored’ that they didn’t have that power, they went through the appropriate steps to do so.

The constitution is not a document detailing the rights we have. It is a document detailing the limits that the federal government has. This was supposed to be obvious, but to make sure that it wasn’t overlooked someday in the future, the 9th and 10th amendments were passed. This is all detailed if you want to read James Madison’s writings when he introduced the amendments so that it could be ratified.

So, if it is not specifically allowed for in the constitution, it is not allowed. In order to allow it, we would need a constitution.

If we DON’T do this, if we just ignore this fact, then when someone else does something we don’t approve of (like wiretapping citizens) they can use the SAME EXCUSE. We have to be viligant of our rights because we never, EVER, get them back once taken away. What rights have we gotten back since January 2009? Bush violated our rights, but so far the Obama administration has not returned any of them to us, he is defending those being taken still…

But let me get into your suggestion that because we have a fire department and police department, we can have universal healthcare. First, I don’t have a fire department where I live. So let’s not make assumptions. But more importantly, these are provided at the local, county or state level. Because this is where it should be managed. There is no ‘federal fire department’ the last time I checked…

But, some people have attached special meaning to the ‘general welfare’ clause in the constitution. Now, reading it this way completely invalidates the constitution from being a limit on what the federal (not state or local) government can do. And it was warned against by those who put the document together:

“We must confine ourselves to the powers described in the Constitution, and the moment we pass it, we take an arbitrary stride towards a despotic Government.” — James Jackson

“If Congress can do whatever in their discretion can be done by money, and will promote the General Welfare, the Government is no longer a limited one, possessing enumerated powers, but an indefinite one….”
— James Madison

Our tenet ever was … that Congress had not unlimited powers to provide for the general welfare, but were restrained to those specifically enumerated; and that, as it was never meant that they should provide for that welfare but by the exercise of the enumerated powers, so it could not have been meant they should raise money for purposes which the enumeration did not place under their action. - Thomas Jefferson

“I can find no warrant for such an appropriation in the Constitution, and I do not believe that the power and duty of the General Government ought to be extended to the relief of individual suffering which is in no manner properly related to the public service or benefit.”
— President Grover Cleveland vetoing a bill for charity relief

“I cannot find any authority in the Constitution for public charity. [To approve the measure] would be contrary to the letter and spirit of the Constitution and subversive to the whole theory upon which the Union of these States is founded.”
— President Franklin Pierce’s 1854 veto of a measure to help the mentally ill

James Madison, the Father of the Constitution, elaborated upon this limitation in a letter to James Robertson:
With respect to the two words “general welfare,” I have always regarded them as qualified by the detail of powers connected with them. To take them in a literal and unlimited sense would be a metamorphosis of the Constitution into a character which there is a host of proofs was not contemplated by its creators. If the words obtained so readily a place in the “Articles of Confederation,” and received so little notice in their admission into the present Constitution, and retained for so long a time a silent place in both, the fairest explanation is, that the words, in the alternative of meaning nothing or meaning everything, had the former meaning taken for granted.

In 1794, when Congress appropriated $15,000 for relief of French refugees who fled from insurrection in San Domingo to Baltimore and Philadelphia, James Madison stood on the floor of the House to object saying, “I cannot undertake to lay my finger on that article of the Constitution which granted a right to Congress of expending, on objects of benevolence, the money of their constituents.”
— James Madison

“Congress has not unlimited powers to provide for the general welfare, but only those specifically enumerated.”
—Thomas Jefferson

“There are more instances of the abridgment of the freedom of the people by gradual and silent encroachments of those in power than by violent and sudden usurpations.”
— James Madison

“the true theory of our Constitution is surely the wisest and best … (for) when all government … shall be drawn to Washington as the centre of all power, it will render powerless the checks provided of one government on another, and will become as … oppressive as the government from which we separated.”
—Thomas Jefferson

“The powers delegated by the proposed Constitution to the federal government are few and defined. Those which are to remain in the State governments are numerous and indefinite.”
— James Madison

“I consider the foundation of the Constitution as laid on this ground that ‘all powers not delegated to the United States, by the Constitution, nor prohibited by it to the states, are reserved to the states or to the people.’ To take a single step beyond the boundaries thus specially drawn around the powers of Congress, is to take possession of a boundless field of power not longer susceptible of any definition.”
— Thomas Jefferson

“A wise and frugal government … shall restrain men from injuring one another, shall leave them otherwise free to regulate their own pursuits of industry and improvement, and shall not take from the mouth of labor the bread it has earned. This is the sum of good government.”
— Thomas Jefferson

“If Congress can do whatever in their discretion can be done by money, and will promote the general welfare, the government is no longer a limited one possessing enumerated powers, but an indefinite one subject to particular exceptions.” James Madison

“The majority, oppressing an individual, is guilty of a crime, abuses its strength, and by acting on the law of the strongest breaks up the foundations of society.”
— Thomas Jefferson

Now, you say that these men were ‘stodgy 1700 guys’ (even though most of these quotes are taken from the 1800s)… What is it about what they say that is wrong? Debate the concept, don’t just dismiss it out of hand because you think that the country will devolve into chaos if we listen to them…

These people put this country together, put the constitution together, put in ways for us to amend the constitution without nullifying its very meaning AND gave us ways to dissolve the government completely. Why, then, do we do the exact things that they warned us against? Political expediency?

We are americans, we can accomplish anything we put a mind to, let’s put our mind to identifying and solving issues that come into our view AND protect individual liberty at the same time! We can do that. We just aren’t trying.

So yes, I, with no power at all, am screaming at the void to try and get us to be better than ourselves, better than we attempt to be, and do better for our children by not burdening them with a police state or despotic wasteland that is a definate possibility if we bankrupt our nation, turn the citizenry into subjects and kill off for good the very purpose of the experiment that several people risked their lives a couple of hundred years ago.

I saw we honor and respect them, not just with lip service but by trying to continue the experiment they created, not pretend, as David wants to do, that they meant something the exact opposite as they did because he wants to see the government controlling the lives of every citizen in the US (except him).

Take a good look at the healthcare plan as it is introduced. Read through the 1100+ pages with a critical eye and tell me if some of the things put in there are constitutional.

Like:

Pg 22 of the HC Bill MANDATES the Govt will audit books of ALL EMPLOYERS that self insure

Pg 30 Sec 123 of HC bill - THERE WILL BE A GOVT COMMITTEE that decides what treatments/benes you get

Pg 29 lines 4-16 in the HC bill - YOUR HEALTHCARE IS RATIONED!!!

Pg 42 of HC Bill - The Health Choices Commissioner will choose your HC Benefits 4 you. You have no choice!

PG 50 Section 152 in HC bill - HC will be provided to ALL non US citizens, illegal or otherwise

Pg 58HC Bill - Govt will have real-time access to individuals finances & a National ID Healthcard will be issued!

Pg 59 HC Bill lines 21-24 Govt will have direct access to your banks accts for elect. funds transfer

PG 65 Sec 164 is a payoff subsidized plan for retirees and their families in Unions & community orgs.

Pg 72 Lines 8-14 Govt is creating an HC Exchange to bring private HC plans under Govt control.

PG 84 Sec 203 HC bill - Govt mandates ALL benefit packages 4 private HC plans in the Exchange

PG 85 Line 7 HC Bill - Specs for of Benefit Levels for Plans = The Govt will ration your Healthcare!

PG 91 Lines 4-7 HC Bill - Govt mandates linguistic appropriate services.

Pg 95 HC Bill Lines 8-18 The Govt will use groups (ACORN & Americorps?) to sign up indiv. for Govt HC plan

PG 85 Line 7 HC Bill - Specs of Ben Levels for Plans. #AARP members - U Health care WILL be rationed

PG 102 Lines 12-18 HC Bill - Medicaid Eligible Individuals will be automatically enrolled in Medicaid. No choice

pg 124 lines 24-25 HC No company can sue GOVT on price fixing. No “judicial review” against Govt Monopoly

pg 127 Lines 1-16 HC Bill - Doctors/ #AMA - The Govt will tell YOU what you can make.

Pg 145 Line 15-17 An Employer MUST auto enroll employees into pub opt plan. NO CHOICE

Pg 126 Lines 22-25 Employers MUST pay for HC for part time employees AND their families. (there goes many part time jobs)

Pg 149 Lines 16-24 ANY Employer with payroll 400k & above who does not provide public option pays 8% tax on all payroll So, if an employer decides to privide better healthcare for their employees, they have to pay an 8% tax! Example of why the joke of a ‘choice’ between the private and public option is just that…

pg 150 Lines 9-13 Biz with payroll btw 251k & 400k who doesnt provide public option pays 2-6% tax on all payroll

Pg 167 Lines 18-23 ANY individual who doesnt have acceptable HC accrdng 2 Govt will be taxed 2.5% of income So much for Obama’s assertion that there will be no mandated health insurance? Lock ‘em up if they don’t have healthcare, put ‘em in with the drug dealers…

Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay)

Pg 195 HC Bill -officers & employees of HC Admin (GOVT) will have access 2 ALL Americans finan/pers recs This bears repeating… THE GOVERNMENT WILL HAVE REAL TIME ACCESS TO YOUR FINANCIAL RECORDS.

PG 203 Line 14-15 HC - “The tax imposed under this section shall not be treated as tax” Yes, it says that Bring out the Ministry of Truth…

Pg 239 Line 14-24 HC Bill Govt will reduce physician services for Medicaid. Seniors, low income, poor affected

Pg 241 Line 6-8 HC Bill - Doctors, doesnt matter what specialty you have, you’ll all be paid the same

PG 253 Line 10-18 Govt sets value of Dr’s time, prof judg, etc. Literally value of humans.

PG 265 Sec 1131Govt mandates & controls productivity for private HC industries

PG 268 Sec 1141 Fed Govt regulates rental & purchase of power driven wheelchairs

PG 272 SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS - Cancer patients - welcome to rationing!

Page 280 Sec 1151 The Govt will penalize hospitals for what Govt deems preventable readmissions. Heh, once you check in, you aren’t leaving…

Pg 298 Lines 9-11 Drs, treat a patient during initial admiss that results in a readmiss-Govt will penalize you.

Pg 317 L 13-20 OMG!! PROHIBITION on ownership/investment. Govt tells Drs. what/how much they can own.

Pg 317-318 lines 21-25,1-3 PROHIBITION on expansion- Govt is mandating hospitals cannot expand

pg 321 2-13 Hospitals have oppt to apply for exception BUT community input required.

Pg335 L 16-25 Pg 336-339 - Govt mandates establishment of outcome based measures. HC the way they want. Rationing

Pg 341 Lines 3-9 Govt has authority to disqualify Medicare Adv Plans, HMOs, etc. Forcing people into Govt plan

Pg 354 Sec 1177 - Govt will RESTRICT enrollment of Special needs ppl! Err, I thought this was healthcare for all?

Pg 379 Sec 1191 Govt creates more bureaucracy - Telehealth Advisory Cmtte. Can you say HC by phone? This is already going on in England, people are being diagnosed with Swine Flu ‘over the phone’.

PG 425 Lines 4-12 Govt mandates Advance Care Planning Consult. Think Senior Citizens end of life

Pg 425 Lines 17-19 Govt will instruct & consult regarding living wills, durable powers of atty. Mandatory! Understand, the FEDERAL GOVERNMENT will now have power of attorney over your living will!

PG 425 Lines 22-25, 426 Lines 1-3 Govt provides apprvd list of end of life resources, guiding you in death

PG 427 Lines 15-24 Govt mandates program for orders for end of life. The Govt has a say in how your life ends

Pg 429 Lines 1-9 An “adv. care planning consult” will be used frequently as patients health deteriorates

PG 429 Lines 10-12 “adv. care consultation” may incl an ORDER for end of life plans. AN ORDER from GOVERNMENT

Pg 429 Lines 13-25 - The govt will specify which Doctors can write an end of life order.

PG 430 Lines 11-15 The Govt will decide what level of treatment you will have at end of life

PG 489 Sec 1308 The Govt will cover Marriage & Family therapy. Which means they will insert Govt into your marriage

Pg 494-498 Govt will cover Mental Health Svcs including defining, creating, rationing those svcs

This just a review of the first 500 pages so far, people are still diving into the thing… I am still checking them out myself but don’t tell me that this isn’t far reaching and not infringing at all on someone’s individual liberties…

The problem arises when you accept the notion that someone else is required, by law, to provide someone else with something. This means that you no longer have a choice of your own body, your own life, your own property, if you provide that service. And if there are not enough people to provide that service, what is the government to do? We have never mandated that before in this country, except the draft, and I am 100% opposed to that as well.

We have never, until recently and only in two states, required anyone to purchase insurance on themselves in any way.

So, can you provide to me anywhere that gives the federal government the power to do any of these things? To for someone to provide a service to another person? To say when they will die? To say when they can and can’t have medical care once they are ‘of age’?

Oh, and don’t look for the interstate commerce clause to help out here, health insurance companies are, by law, not allowed to offer their services across state lines…

I am not trying at all to be ‘rigid’ here, I welcome working within the bounds of the constitution to achieve the things we need and want to achieve. But if we don’t, if we just go around it for any ‘good’ reason, then we invalidate it completely. And I fear we have already done that….

Posted by: rhinehold at July 27, 2009 09:50 PM

gergle
You do realize that people are free to choose which fire and police to pay by choosing where to live, right? You do realize that people are free to choose to live where they do not need to pay for those things also, right?
So unless you are saying that you should be able to dictate where another person lives, as you are doing with their healthcare, you are comparing apples to oranges.

And whining? Um, ok. But tell me, which bothers people more, those who whine to be left alone or those who whine for more more more of what others have?

The majority of Americans are satisfied with their current healthcare insurance plans. The majority of Americans “say” it is terrible that 40 million are uninsured, but yet they are not willing to pay more than a few bucks more per month for socialist healthcare.
Truth be told, the majority of Americans want lower premiums, but not to the point where govt is running things.

“There will still be freedom of choice, just not the freedom for you ride free at the rest of society’s cost.”

So me taking personal responsibility and providing for myself so as not to be a burden on govt, is actually me getting a free ride? No wonder the leftists want govt to take care of everything for them and give them everything at the expense of others, they have no clue as to what freedom is or they are just afraid of it.

The socialist healthcare being discussed takes more money out of private citizens budget. And if they are like me, they are on a tight budget and will not be able to afford to pay for what makes you feel good and what insurance I think is best for myself and my family. The hell with what is best for my family or for my beliefs, I either work to pay for what you believe in or I go to prison.

“it simply fills in the current gaps that you are paying in county taxes for the indigent emergency care that substitutes as a logical healthcare plan”

Are you really so naive that you believe govt will actually give us our money back IF they start saving money? Sorry, but there is no chance in hell of that happening. If anything, this joke of a plan will create more govt dependent sheeple and the need for more money to support it will only grow.

Posted by: kctim at July 27, 2009 09:52 PM

When the Constitution was ratified, so was the Preamble. Failure to comprehend this evidenced fact, leads to the indefensible claims your comments proffer.

An entirely ridiculous sentiment, especially when it goes against the stated and written down words of the people who WROTE the constitution.

You want it to say what you want, not what it does. Which is what you are attempting to do with this article. And it is that very thing that the writers of the constitution and those they debated with on it warned us about…

Posted by: rhinehold at July 27, 2009 09:52 PM

David
It has nothing to do with being ideological and everything to do with doing what is right. Doing what is right is where people differ. Some, such as myself, believe protecting our rights and freedoms is what is right, while others believe rights and freedoms are nothing but obstacles which must be bypassed in order to fit their personal agenda and make themselves feel good. Some of us believe in the American reality based solely on the fact that this country was founded on the principles of individual rights and freedoms, while others believe their reality and happiness is based on what govt does for them or gives them.

“The fact remains, universal health insurance (UHI) has the potential of reducing costs for everyone.”

Even if I believed govt would actually pass it on to the people, this comment means nothing. Why? Because you are talking about money while I am talking about our rights and freedoms. What good is saving a few bucks if what you give up is priceless?

“The glaring reality is that the current system is broken, fails to cover 50 million, covers the rest at an inflationary rate which is unsustainable, and which threatens to bankrupt the nation in less than 20 years.”

The glaring reality is that the current system for the uninsured is a govt system. Govt policy forced “all are covered” onto the healthcare field and prices rose to accomodate that govt policy. It also promoted the idea that people no longer needed to pay for their own healthcare so they could spend their money on frills.

“To oppose reforms which attempt to address these realities, is illogical.”

I do NOT oppose healthcare reform, I just am not going to give up the rights and freedoms of myself and others to do so.

“The Republican ideas center around keeping the current broken system in place with all its maladies, adding only a bit of window dressing which, do not address the main issue, how to provide everyone quality health care when they need it and keep the nation from going bankrupt”

And the liberal ideas all center around govt doing it all for everybody.
Newsflash lefties, govt is not supposed to provide healthcare and the majority of Americans do not want govt doing so, especially if govt must steal more in order to do so.

Do the leftists want to keep the nation from going bankrupt? Then quit demanding it do more.

Posted by: kctim at July 27, 2009 10:26 PM

Rhinehold,

Thanks for the thoughtful response. I am not that familiar with Madison’s positions, but I am fairly familiar with Jefferson. I will read more on Madison, in part, due to your response.

Jefferson, like most intelligent people and most of our founding fathers is an exercise in conflicting ideas. He purchased the Louisiana Territory without consulting with Congress, far exceeding his presidential powers. Fortunately for him, and us, Congress went along.

How do you explain this? Jefferson, the president, sought to increase the power of the office, often conflicting with his “ideals”

I don’t think there needs to be a Constitutional admendment to justify healthcare. The commerce clause comes to mind as precedent, if nothing else. I realize that has become a catch-all clause. I think it is erroneous to classify dealing with an obvious crisis like healthcare as “anything”.

We have a rogue industry that is clearly a threat to modern America. It needs to be dealt with. We are out of step with modern democracies and indstrial nations.

I think Bush was a lousy president who set about perverting and destroying government, through clever PR( although sometimes not), and poor decisions. I rarely accuse him of violating the Constitution. Lying? Sure. I think his entire political career was a lie, having watched him go from daddy’s subsidized oil exec to magic millionaire with the Rangers, to lying Governor, to liar in chief. He was a fop for special interest groups in Texas and nationwide. Was some of that criminal? Perhaps. Will it ever be prosecuted? Doubtful.

I don’t get excited about spying on US citizens. I think every president has done that in the name of national security. It is persecution of US citizens using that technique that bothers me. It is turning the justice department into a prosecution arm against political foes that bothers me.

I am less a Constitutional expert than you clearly are, but rather look at things from a common sense perspective. I think that healthcare reform is a no-brainer. The particulars of the bill does have problems, but I also realize it is a step, not an end.

The modern presidency is more powerful than Jefferson’s. Modern government is larger and more “communist’ than the frontier US. I don’t find this particularly controversial.

While Obama does present a danger to obligating taxpayers to financial disaster, Bush and Clinton,(and others ignoring fiscal issues) led us down this road a good distance. Obama does seem to be aware of the dangers. To date, I’m giving him the benefit of the doubt. I find the idea that healthcare reform is unconstitutional not particularly persuasive to the electorate. I find it disconnected from the average man. That was what Jefferson complained about in the Whiskey rebellion.

Posted by: gergle at July 28, 2009 07:01 AM

Rhinehold,

In looking at your response again, I find your quotes referring to oppression. I think it is hard to argue that America has become the oppressor of it’s own citizens. Certainly, we are nothing like the era of Colonial England.

While one may argue we are the modern oppressor of other nations, we are still the beacon of liberty within America.

This is a large conflict I have with your position.

Posted by: gergle at July 28, 2009 07:18 AM

kctim said: “Some of us believe in the American reality based solely on the fact that this country was founded on the principles of individual rights and freedoms, while others believe their reality and happiness is based on what govt does for them or gives them.”

That view, in my opinion, is a simple black and white caricature of an enormously complex gradation of grays. To be at either end of the spectrum as you paint it, is ideological. The reality lies in the grays in the middle and with the majority of voters in a democratically elected and represented society. Government exists to serve the people, and the majority of the people are the best guide in most circumstances as to how that government is to serve, and the definer of the nation’s needs.

Health care is a universal need amongst the American people. To pay so much in taxes and live without health care, or with the threat of having to live without access to it except as a life saving measure which may come too late, is a conflict of interests which the majority of Americans want addressed by the only entity capable of addressing it for all the people, the federal government.

One’s rights are not deprived when one pays for something and receives that something in return. How one values what one receives is variable. You can argue that having the option of universal health care insurance, should you ever lose your private carrier and are unable to find another to insure you, is of little value. But, that option still has value for the nation and society as a whole, and thus your rights are no more deprived than that of a peace-nik who rejects the idea of a military consuming their tax dollars.

The power to exact such taxes was Constitutionally established and upheld myriad times by a large number of number of cases before the appellate and supreme courts. Which means quite literally, that one’s Constitutional rights are NOT deprived by the government spending your tax dollars on policies and programs which serve the public interest whether or not, you consider yourself amongst that supporting public.

I am with you on the erosion of our Individual rights in the Bill of Rights, like a right to a speedy trial, or due process prior to the government’s taking of private property in search and seizure cases. These abridgments are potentially dangerous to our individual rights. That is why the ACLU exists and many support it.

But, the argument that one’s rights are abridged by the government seeking to serve the public interest on health care, just does not make Constitutional legal sense. If it did, the peace-nik would have the power to eliminate the nation’s military defense on grounds their tax dollars spent on such defense is an abridgment of their individual rights. There simply is no Constitutional standing for such an argument.

The integrity of the nation and its general welfare, regardless of how one feels about the issue, was established as an objective Constitutionally defensible over individual rights, by the Civil War. Secession was not permitted despite entire populations of states of individual’s protesting and fighting against that underlying assumption about the relationship between government and the individual. No individual’s preferences are permitted to undermine the government’s intact relationship with the public at large. It is a fact of history and precedent many times upheld by the courts.

And I understand what a scary prospect that is. That a government should have such carte blanche power over any individual. But, as long as the nation remains democratically elected and represented, and the public at large assents to such power and authority, that will be the way of it. America remains an intact nation, and has prospered unprecedentedly under such arrangement, and it can be safely argued that the general welfare of the nation’s people and progeny have been well served despite the incidents of grave infringement upon the Bill of Rights and individual liberty from time to time.

I wish I could think of a more perfect way, but, as yet, I have not come to it.

Posted by: David R. Remer at July 28, 2009 11:32 AM

But, the argument that one’s rights are abridged by the government seeking to serve the public interest on health care, just does not make Constitutional legal sense. If it did, the peace-nik would have the power to eliminate the nation’s military defense on grounds their tax dollars spent on such defense is an abridgment of their individual rights. There simply is no Constitutional standing for such an argument.

A pretty bad example, considering the power to reaise an army and navy are spelled out specifically in the constitution. The power to regulate healthcare is not.

To raise and support armies, but no appropriation of money to that use shall be for a longer term than two years;

To provide and maintain a navy;

If you want the congress to have the power to run healthcare then we should be putting an amendment together to give them that power.

If they don’t need that power specifically spelled out, why was the creation of an army and navy spelled out as well? Surely if that power is built in there would be no need for it to be spcifically enumerated, right?

Or do you still ignore the constitution when it suits your needs and call upon its protections when you feel personally wronged? That is the hallmark of living in the grays, the doubling over onesself into hypocrisy…

Posted by: rhinehold at July 28, 2009 12:00 PM

David:

The problem I see, and why I see Obama droping in the polls is the enourmous disconnect between what was said during the campaign and the reality of the proposals. Promising benefits without cost or sacrifice and then delivering cost and sacrifice are pretty big swings. Had he given it to us straight, I doubt he would be president Obama right now.

I think the drop in the polls is predictable because of a bait and switch.

I like the CBO because it looks like there is one group in Washington DC who is sober. It is nice to get numbers one can believe. You seem willing to just “trust” Obama and the democrats on cost containment. I do not. Now way do we just “pass this thing” and then hope for the best. It needs to be front end loaded with the sacrifices understood now on how to balance things out.

Obama’s goal of not making the deficit worse is not really good enough either. Great so we are goign bankrupt at the same pace. I don’t feel comforted.

So far for all the work Dems have done they haven’t even begun to change the fiscal picture of our country. Hopefully, democrats will get as sober as the CBO. I think they will when they come home for recess and hear from voters.

Posted by: Craig Holmes at July 28, 2009 06:36 PM

Craig said: “Promising benefits without cost or sacrifice and then delivering cost and sacrifice are pretty big swings.”

Bullcrap. Give me a link to an Obama campaign promise to provide any benefits free to anyone?

Otherwise, your assertion does not jive with my recollections nor with reality. If Obama had, for example, promised free health care for all, he would have been laughed off the campaign trail by me and 100 million other Americans.

Posted by: David R. Remer at July 28, 2009 08:40 PM

Craig, you like the CBO report because it suits your sophistry.

The CBO has a window of estimation no further than 10 years. Some of the reforms being proposed would take 10 years to implement throughout the health care system, like the IT portion. But, CBO can’t and won’t score those cost reductions because of the limitations of estimating general economic conditions like government revenues and expenses out that far.

No one in the know, however, can argue with the empirical data of the VA, which has had this IT patient tracking system and coordinated data sharing care amongst specialists a patient may visit, which allows the VA to be the MOST cost effective health system in America, bar none. It beats Medicare and the private sector in efficiency, and quality of care. And another fact, VA cost per patients have been dropping while the entire rest of the industry’s costs have been rising.

Medicare costs have not been rising as fast as the private sector. These facts, documented and researched in books and medical journal annals clearly indicate a non-profit government run health insurance system has a better record of controlling costs and providing better quality care to patients than the private sector.

Your comments remind me of the letter Obama got from a woman who said she don’t want no government insurance or government health care, and that Obama had better not touch her Medicare.

Do the research. The scare tactics and lies being funded and disseminated by the private health insurers and their lackeys is not something that speaks well of those who give them currency.

Kinda like the 7 Republicans in the House who appealed to the Obama is not a citizen conspiracy mob, with legislation to appeal to them, who when given a vote on whether Obama was a legal citizen, all voted YES! What people say in political realms, and what they say on the record, is often two different things.

The facts, are there. They are worth researching and validating, and the lies and distortions are worth dispelling if America is to provide an intelligent fact based health care system reform. And America is going to get health care reform. 72% of Americans want a public health insurance option, and about half of Republicans, according to polls, do as well. Health care reform is going to happen. Let’s all do our best to insure that it is based on facts, and not the private health care CEO’s and major shareholder’s marketing and advertising lackeys opening the floodgates of misinformation and outright lies.

Posted by: David R. Remer at July 28, 2009 08:54 PM

David:

Just to show you some evidence of a tax that I support here is an article about a soda tax.

http://www.cbsnews.com/blogs/2009/07/27/politics/politicalhotsheet/entry5192172.shtml

This tax makes sense to me because it lowers medical costs and raises revenue at the same time.

As for those who say it hurts the poor, if that is the concern make it revenue neutral by increasing tax credits for the poor. It seems so constructive to be able to help both sides of the ledger at the same time.

I would offer cigarette taxes of an example of success in this regard as well.

Posted by: Craig Holmes at July 28, 2009 10:05 PM

Craig, If you tax my Cola…I’ll see you in hell:)

Posted by: gergle at July 28, 2009 11:08 PM

Craig, targeting specific consumers of some products for taxation and not others, is a practice our government has engaged in for quite some time. Excise taxes being the best known, does not simplify the tax code, it makes it ever more complicated.

Surely, we can find simpler, more readily understandable ways of taxing in this country than the mountain high tax code which we keep adding pages to.

To tax income and then tax consumption is not an act most Americans would agree with. If consumers are to be placated, the government would be better off targeting producers for tax increases based on the social or environmental costs associated with their products. Consumers will end up paying the tax, but, the rationale would rest easier on consumers than that of targeting consumers directly.

This was a dumb move by Democrats, in my opinion. Very dumb. In politics, perception is reality. And going after the poor and middle class with a consumption tax is not going promote the perception Democrats will want hanging around their neck.

Posted by: David R. Remer at July 29, 2009 09:31 AM

David:

Are you in favor of removing taxes from cigarettes?

Posted by: Craig Holmes at July 29, 2009 10:45 AM

David:

I agree with you in general terms, but I’m not a fundamentalist like you are on the issue. Targeted taxes on certain products pay two dividends, as they make us healthier, and privide income. Just as tobacco causes lung cancer so increases in sugar pop consumption increases diabetes. I think the same methods can be used as with tobacco to help make American’s healthier.

Please don’t misunderstand. I am not saying this is the only solution. However it is a fact that this solution helps “bend the curve” of which most of the current legislation does not!!

From a conservative point of view, I was just reading a report from the CBO that says that much of our health care does not improve our health. So we subsidize and pay for health care that does what? If the care does not improve health what does it actually do?

I would be interested in looking at data where the US Government only paid for, or allowed tax deductions on health care that actually improves our health.

I am not yet convinced we have a money problem. At least not yet. It seems likely that we have an expectations problem.

Posted by: Craig Holmes at July 29, 2009 11:20 AM

David
“Government exists to serve the people, and the majority of the people are the best guide in most circumstances as to how that government is to serve, and the definer of the nation’s needs”

That is basically direct democracy in action and we were not founded to be one. We are a Constitutional Republic that has a Constitution which places limits on our govt. to protect our individual rights and freedoms and to prevent the majority from trampling the minority when deciding how govt is going to serve and how govt should address the nations needs.

The founders limited the reach of govt because they knew that individuals would use it to infringe on the rights and freedoms of other individuals. They made it difficult for the majority to take away those rights and freedoms in order to protect the minority.
Believe it or not, but if the leftists did it right and passed an admendment to take away rights, I would accept it as how our system works.

“thus your rights are no more deprived than that of a peace-nik who rejects the idea of a military consuming their tax dollars”

Rhinehold already provided the answer to this nonsensical statement.

“I am with you on the erosion of our Individual rights in the Bill of Rights”

No, I don’t believe that to be true. I actually believe ALL, not just the ones I agree with, of our rights should be protected, defended and respected.

I do understand where you are coming from David and I acknowledge that we as a country have almost completely morphed into the type of nothing special democracy leftists want us to be, but that does not mean I have to agree with such unconstitutional change.

Posted by: kctim at July 29, 2009 02:18 PM

kctim said: “That is basically direct democracy in action and we were not founded to be one.”

Right, we were not founded as a direct democracy, but as a Constitutional democratic republic, which provided the apparatus to alter and modify the Constitution as the nation grew and changed. We are now a representative democracy with a Constitutional basis. We can no more turn back the hands of time on the Constitution than we can on medical care advances or mass media.

The jurists, the Congress, the Presidents, and the American people assented to universal suffrage, and public election of the President and the Senate by Constitutional means. Hence, we have Constitutionally become a more direct democracy oriented society.

Wanting to go back in time a couple hundred years is illogical, and impossible. But, you are still free in this country to pursue futile political objectives like a return to the original Constitution, BUT, only by current Constitutional means. Good luck.

Posted by: David R. Remer at July 29, 2009 02:26 PM

Craig said: “Just as tobacco causes lung cancer so increases in sugar pop consumption increases diabetes.”

I smoked cigarettes and a pipe for 40 years. I don’t have cancer. Am I entitled to a rebate on the taxes I paid in. I am after all, not a contributor to the actuarial charts of smokers and incidence of Cancer. My Grandmother smoked for almost 70 years and never got Cancer. Is it just to have taxed her on cigarettes for a cost she never posed to society? What’s next, for you Craig, Government sponsored day care and education centers for children of parents who are too dumb or uneducated to raise responsible citizens?

You are coming across as a nanny state proponent, here, arguing the government should be shaping public behavior and psychology through taxes. To discriminate amongst groups in the public for taxation purposes is one of those great ideas that can quickly slide into tyranny. Our founding fathers were well acquainted with that principle.

To tax income is less than ideal. To tax discreet groups of the public based on their lifestyle choices which are entirely legal, is tyranny, no matter how you cut it, if you are in the group being discriminated against for taxing purposes justified by the intent to alter legal choice.

Posted by: David R. Remer at July 29, 2009 02:37 PM

Craig, no, I am opposed to all so called “sin” taxes. If the government doesn’t like a behavior, they are obligated to outlaw it. But, to punish behavior which is legal, is tyrannical and Big Brother in every Orwellian sense.

Posted by: David R. Remer at July 29, 2009 02:39 PM

kctim, and if the government is not to serve the people and their welfare, then whose? The people are the nation, otherwise the U.S. is just a piece of real estate to be bought and sold to the highest bidder. That surely wasn’t the intention of the founding fathers and their colonialist citizens.

Posted by: David R. Remer at July 29, 2009 02:50 PM

David:

I smoked cigarettes and a pipe for 40 years. I don’t have cancer. Am I entitled to a rebate on the taxes I paid in.

No, just a user fee. You are simply increasing the risk to the rest of the community by a lifestyle choice, and asking nonsmokers to subsidize your health care’s expected cost.

By your plan those with healthy lifestyles subsidize those making poor health choices. Somehow that is a more just society?

Posted by: Craig Holmes at July 29, 2009 04:44 PM

David:

We are way way past what you are concerned about. We have been doing social engineering for decades or we would not have much of the age wave issue today. We subsidize people leaving the labor force since the 1930’s. (actually before that).

Right now we subsidize, (read encourage), top end health care plans.

Big brother has been around for our entire lives. As Obama said, it seems strange that people don’t want the government messing with their medicare.

Posted by: Craig Holmes at July 29, 2009 05:30 PM

kctim, and if the government is not to serve the people and their welfare, then whose?

It is to protect the citizens from outside forces and regulate interactions between individuals.

I don’t see anything in the constitution or declaration of independance calling for serving every whim of the electorate…

In fact, I see a lot detailing that the federal government (we are not talking local or state here) has hard limits that it must work within. That would be a cruel thing to do to a government who is supposed to ‘serve the whims of the electorate’.

And I think I have already posted quotes from many of our ‘founding fathers and former presidents’ that show what I am talking about, I guess I could post them again…

Posted by: Rhinehold at July 29, 2009 06:03 PM

Craig said: “No, just a user fee. You are simply increasing the risk to the rest of the community by a lifestyle choice, and asking nonsmokers to subsidize your health care’s expected cost.”

Bullcrap. I haven’t cost the public a dime in my private life. I have paid all my taxes all my life. I am a net contributor, not a drain, at all. By your logic, we should double premiums on all African Americans and American Indians due to their genetic predispositions to genetic diseases like diabetes.

Or, everyone with a sporty car should pay much higher premiums since sporty car owners cause significantly more accidents. Let’s have a ‘user fee’ tax, to use your words, on skydivers, bungie jumpers, runaways, all young people whose lifestyle choices as a group constitute much higher risks for uninsured injuries and disease than any other age group except the very aged. Then we can add more to jaywalkers, unescorted women on our streets, etc. etc. Hey, before you know it, we can tax our nation into the poor house even faster than we already are but, make the next year’s election revenues look fantastick on the books as revenue streams till the public drops dead.

As for social engineering, I already said it has been going on for decades. Try telling me something I haven’t already written here. We used to have slaver too, doesn’t mean we should continue the practice, now, does it?

Posted by: David R. Remer at July 29, 2009 07:35 PM

Rhinehold, you apparently don’t see other things that are in the Constitution, because you left out regulating between the States. A major function.

Then there the amendments since the founding. Or, are you suggesting that amendments should be disregarded? If so, understanding of the Constitution is entirely absent. Or, is it that you wish to pick and choose which Amendments you wish to deem Constitutional and which ones are not? For, that would be that anarchist streak peeking up again.

Posted by: David R. Remer at July 29, 2009 07:37 PM

Rhinehold, you apparently don’t see other things that are in the Constitution, because you left out regulating between the States. A major function

Yup, major function, not something I ‘don’t see’, just didn’t mention in the comment talking about individuals.

Then there the amendments since the founding. Or, are you suggesting that amendments should be disregarded?

Err, no the amendments are part of the constitution. As I have stated many times previously to you and in these comments.

But I suspect you knew that…

Posted by: Rhinehold at July 29, 2009 08:28 PM

David
“which provided the apparatus to alter and modify the Constitution as the nation grew and changed.”

Then shouldn’t we at least honor the founders and the Constitution by altering and modifying it the correct way? Instead of twisting it to fit an agenda, why not pass an amendment or two which promotes socialism?
We both know the answer to that one, don’t we.

I am glad to see that you acknowledge our sad transformation into just another regular direct democracy.

“Wanting to go back in time a couple hundred years is illogical, and impossible.”

Yes, in todays US, the idea of individual rights and freedoms is now looked upon as being illogical. It is a very sad state and in a dependent country such as we are now, it is damn near impossible for people to see how rights and freedoms trump anything the govt will “give” you for “nothing.”

“But, you are still free in this country to pursue futile political objectives like a return to the original Constitution, BUT, only by current Constitutional means. Good luck.”

Current Constitutional means? Great way to say it, David. Very true indeed.

Look, I don’t hold any false hopes that we are going to return to being the United States. We threw it away a long time ago and are now on the final few steps of transforming into what our founders fought against.
I’m not fighting for a return to being the US, I’m just fighting for the chance to live out the last few years of my life in a country that at least kind of resembles what made this country the greatest one on Earth.

Posted by: kctim at July 30, 2009 09:25 AM

David:

Or, everyone with a sporty car should pay much higher premiums since sporty car owners cause significantly more accidents. Let’s have a ‘user fee’ tax, to use your words, on skydivers, bungie jumpers, runaways, all young people whose lifestyle choices as a group constitute much higher risks for uninsured injuries and disease than any other age group except the very aged. Then we can add more to jaywalkers, unescorted women on our streets, etc. etc. Hey, before you know it, we can tax our nation into the poor house even faster than we already are but, make the next year’s election revenues look fantastick on the books as revenue streams till the public drops dead.

They do pay higher premiums. By your standards all life insurance should be the same as should car insurance!!!

Auto and Life insurance is all based on lifestyle adn risk. Actually, so is health insurance which is why small companies pay higher premiums.

Your plan is to have those who avoid risk pay for those whe embelish risk. That creates a moral hasard.

Moral hazard is the prospect that a party insulated from risk may behave differently from the way it would behave if it were fully exposed to the risk

When you subsidize risk as you are proposing, you in essense enable people to take greater risk than they would have. When people pay for the risk they are taking via higher premiums (as in the cases you suggested) it keeps them from taking on extra risk.

Your idea encourages health risk taking because it subsidizes risk.

Posted by: Craig Holmes at July 30, 2009 11:22 AM

David:

http://blogs.wsj.com/economics/2009/07/27/does-health-insurance-make-you-fat/

Here is another link on the moral hazard thing.
Basically, by giving insurance of any kind to a person, it creates a moral hazard whereby the person receiving the insurance will increase the risk of their behavior.

In other word if the rich pay for health insurance for the poor, the poor might not become healthier. Research in insurance suggests that they might increase risky behavior knowing that the free insurance is there to back them up.

On the other hand, when there is a cost to the risk (as in smoking) rates go down. Smoking is a fantastic example because taxes went up, smoking rates went down, so did the cost of treating lung cancer to the tax payer.

So basically if we give health care to the poor, human nature and insurance industry stats, show that risky behavior will increase thus driving up costs.

However history also shows that if risky behavior is taxed it will reduce and save money for taxpayers at large.

Posted by: Craig Holmes at July 30, 2009 11:56 AM

Craig said: “Basically, by giving insurance of any kind to a person, it creates a moral hazard whereby the person receiving the insurance will increase the risk of their behavior.”

Yes, I wrote an article on the psychology of this phenomena years ago here at WB. However, the insurance moral hazard is not the only factor influencing health maintenance and risk aversion behavior, pain, and fear of pain, injury, or illness are empirically proven to be far more powerful motivators to preserve health, than the moral hazard of insurance is to increase risk.

Then, addiction is an even more powerful motivator than pain, fear of pain, and fear of injury or illness. Addiction, physical and psychological, to sugar, fats, alcohol, “feel good” drugs, etc. Even addiction to fear, (theme park roller coasters) is prevalent in modern societies. However, on the scale of motivators regarding health condition, the moral hazard influence ranks pretty low as a deciding influence on health maintenance behavior.

Having or not having insurance has little effect on young people who experience a natural affinity for the perception of indestructability, unless they have been tramatized in their youth. And thank goodness, eh? Or, we would not have an all volunteer military today.

Posted by: David R. Remer at July 30, 2009 12:09 PM

kctim said: “Then shouldn’t we at least honor the founders and the Constitution by altering and modifying it the correct way?”

Who is to say we haven’t, except that minority that is on the other side of the majority? On any given issue, policy, law, or amendment, there will be those opposed and those in favor. For a nation to grow and adapt to its history and future, it must make decisions in these areas, and in our nation, we try to follow the model of the majority vote, subject to the veto of the president and the tests of the Supreme Court.

That too was part of the original design, and with some modifications, some better than others, it remains the model today. There are only two failings of our current system that I believe need to be changed to improve our nation’s future. First, is for voters to hold their OWN congress person’s responsible for negative governmental results. And the second is to expand the number of political parties, forcing a true consensus decision making process in Congress instead of the false dichotomy presented by the duopoly party both buckling to lobbyist and campaign donor pressures and insuring their two party musical chair arrangement for power sharing all the while ignoring the nation’s future and the people’s interests in deference to promoting their own (re)election two, four, or six years hence.

Reversing long term strategy for our future every 8 to 16 years, is the path to future self-destruction. And that is precisely what we have with the two party system. 3 or 4 parties represented in the Congress would permit minority parties to maintain the high ground on securing our nation’s future and prevent long term strategy and policy reversals every few terms based on who has the majority in Congress.

Which is why I vote Green, Independent, and Libertarian party candidates every opportunity I get.

Posted by: David R. Remer at July 30, 2009 12:22 PM

Rhinehold, then you agree the 16th Amendment was Constitutionally created? And carries with it the full force of law that say the 1st Amendment carries?

And do you agree that the 12th and 17th Amendments are constitutionally defensible, promoting more direct democracy, and less representative government?

Posted by: David R. Remer at July 30, 2009 12:27 PM

David:

I think it works a bit like taxes. We all know the far right is wrong about tax cuts. If they were right, and cutting taxes increases revenue then we should cut the tax rate to zero right away and pay off the national debt.

Conversely, tax increases slow the economy so if we raise taxes we don’t get all that we think we will as a slower economy takes away part of the gains.

With health insurance I can imagine that spending money, does not directly improve health as much as we may think, because added health insurance allows people to be less reponsible for their own health. (moral hazard).

Just as in tax theory there must be a optimal number (I think it’s near 18.5% of gdp), Where we have a growing economy and raise enough revenue to have a country worth living in, with health insurance there must be an optimal amount of help where we are there for our citizens but not enabling bad behavior.

Posted by: Craig Holmes at July 30, 2009 02:06 PM

David:

Well if you are that against social engineering, then we can also solve the problem of finding money to pay for univeral health care by stoping social engineering in some other ways.

I know you and I have debated this in the past. We can stop social enginering early retirement. We can end subsidizing healthy people leaving work early.

There are multiple ways to have basic universal health care without raising taxes or costs to the federal treasury. It’s a matter of finding the right amount of money for the nation to spend, and then setting priorities. It’s also a matter of adjusting the nations expectations to new economic realities.

Posted by: Craig Holmes at July 30, 2009 03:41 PM

Craig, Couldn’t agree more.

Though, I am not opposed to social engineering. Education is a prevalent form of social engineering I absolutely support. But, it is largely non-discriminatory today. I oppose discriminatory social engineering in general.

One of the encouraging aspects of Obama’s UHI public option is that 2/3 of the costs are funded by cuts and efficiencies to be gained in spending in other areas of the health care and government obligations. That is taking the right tact, if it becomes a reality.

Posted by: David R. Remer at July 30, 2009 03:57 PM

In general, Craig, you are dead on regarding the effects of taxes.

Raising them can slow the economy a little or a lot, depending on the breadth of the population targeted for the increases. And empirical data demonstrates, that except in very rare circumstances over short periods, tax cuts do not pay for themselves in increased revenues.

Taxation rests upon the heart of the fundamental economic equation: infinite wants and desires amidst finite resources. I agree with you entirely on prioritizing spending so that we, and the generations following, can continue to afford to support the wealthiest middle class of any nation on earth. Health care however, is not one of the demands of the American people that can be turned away. To deprive the people of health care or insure their bankruptcy in exchange for it, while the top 5% of the population control nearly half or more of the nation’s wealth, is a reality of modern times that will not reconcile, politically. This is what conservatives fail to grasp in their reach for returning to 1776 ways of doing things. This isn’t 1776, and never will be again.

Posted by: David R. Remer at July 30, 2009 04:13 PM

David:

If we simply drew a line in the sand and said healthcare spending is going to stop here as a percentage of GDP it would be a very interesting excersize.

I believe we could have universal coverage and keep government spending in line with current spending. It is all what we expect from our government.

Medical expenses from the public till should go to our most vulnerable. By the way, many retirees are not in this category. Our wealthiest americans are generally in the elderly category. But we subsidize their medical coverage.

Posted by: Craig Holmes at July 30, 2009 05:32 PM

Why I dom’t oppose a government option, I wonder what the Blue Dog Democrats and Republicans would do if a Health Insurance Company would offer a Basic Plan for a Penny Profit.

For why most Americans could live with having the ability of seeing the doctor once a year for a check up and maybe a couple of times for minor problems or consulting. Other than injuries what else do Americans expect from basic coverage?

Because why I know that some folks must see the doctor once a month for everything from a runny nose to a pain. In my opinion that type of insurance coverage could be better dealt with by secondary insurance especially if Universal Health Care (All Americans having affordable insurance for normal and unexpected medical expenses) is to promote a healthy lifestyle and not serve the people who think that everything makes them sick (sorry, can’t figue out how to spell “hypercondreact”).

Posted by: Henry Schlatman at July 31, 2009 07:43 AM

Craig said: “Our wealthiest americans are generally in the elderly category. But we subsidize their medical coverage.”

They paid for the coverage through their Medicare/Medicaid taxes, Craig. If your comment is alluding to means testing benefits, I tend to agree. But, the subsidizing of elderly health care is a product of the demographic bulge. In the past, the program paid for itself.

Capping health care costs as a percent of GDP is a futile discussion, IMO. Politically, it would never happen, and is too arbitrary a rationale. Controlling costs has to be rationally applied in a way that makes fiscal responsibility sense, as well as sense to the majority of Americans asked to fund the system. No easy feat but, it can, and I think probably will, be accomplished.

Failure to do so, bankrupts the nation or incites civil unrest in the future. Precisely the pickle the Chinese government faces with its population going forward, but, not on health care; instead, with jobs and living accommodations. Same defensive need and responsibility for government to wrestle with, however.

Posted by: David R. Remer at July 31, 2009 11:17 AM

Wow, it’s unjust how much money you appear to have wasted on an American education to come up with this drivel. You either don’t know your history or have only been taught to twist quotes without their context. Let’s take a closer, and more sane, look at your ideological argument.

#1 To form a more perfect union refers to the Articles of Confederation that were in place before the drafting of the Constitution, and were shown to be imperfect - almost costing us the Revolutionary War due to the inability to execute the decisions of the congress

#2 You mistake fairness for justice. There is a reason we have a Judicial Branch and not a fairness committee. They are to ensure that laws are applied justly and that rights are upheld equally.

#3 You appear to have mistakenly read “provide for the general welfare” instead of promote

#4 You take quite a leap thinking we will fall into civil unrest without universal health care. In fact, it can be argued just as hypothetically that we will meet the same end with universal health care further bankrupting our treasury. You must read further on, to the actual powers granted by the Constitution, before making such outrageous claims as to what our Federal government can do based on just the preamble.

The Constitution set up a limited, yet strong and enforceable, central government. It’s powers are severely restricted to only those items enumerated in the Constitution. The mere presence of a Bill of Rights was debated at its authoring because it was thought to be clear that no power was given to either the Federal or State government that was not directly stated in the Constitution - so that nothing had to be directly excluded. We, the People, are responsible for the management of our person and estate. Government must be made happy to not waste the labor of its People under the guise of providing for them. The Constitution ensures merely the pursuit of happiness - we must each catch up with it ourselves.

Posted by: Matt Pileggi at October 18, 2009 09:13 PM

Matt, can’t put together a coherent argument, eh? That would explain the insult prefacing your comment. Your comments will not remain welcome here with such critiques of the characteristics of the messenger instead of their message.

That said, your arguments are in tatters. Promote the general welfare was one of the good parts of the articles of confederation carried over to the preamble of the Constitution. Your allusion to promoting the general welfare as being part of what made the Articles of Confederation troublesome, lacks any evidenciary base whatsoever.

No, I don’t mistake fairness for justice. Your reply simply fails to recognize that they can be synonymous under certain conditions and in reality are often used interchangeably as if they were synonyms where warranted and the circumstance fits. Your comment that Judiciary has no role in preserving fairness, negates the entire colonialist revolution against the unfair tyranny of King George, and that the Constitution proscribes a government with checks and balances to insure against such Unfair tyrannical tactics as mandatory boarding of troops and detention without due process or confiscation of property without due process and representation. All these are fairness doctrines inherent in the Constitution which the Judiciary is obliged to support, defend, and uphold. So, your comment is patently wrong. The Judiciary is very much involved in insuring fairness doctrines established in the Constitution which includes the Bill of Rights.

No, didn’t mistake provide for promote. The Preamble clearly uses the word promote. But, here again, your comment fails to comprehend the overlapping nature of the English vocabulary, in search pedantic differences to use as critique. I correctly quoted the preamble and your mind reading skills as to how I interpret the word promote are about as keen as the rest of your commentary. To promote: (Merriam Webster) “to contribute to the growth or prosperity of” among other definitions. Dictionaries are wonderful tools, you might want to consider consulting one before crafting such bereft comments.

You said: “You take quite a leap thinking we will fall into civil unrest without universal health care. “

Finally, we can agree on something. I crafted an argument in support of such a possible and potential future outcome. It is reasonable, but, not proven nor guaranteed as in fated to be so. The future hinges upon myriad variables and therefore renders prognostication on a finite variable set, always less than 100% assured.

Still, an entire mathematical science is built around reasonable predictions based on correlations of finite variable sets, and our entire global economy and political decisions and daily personal decisions rest on such probability and statistical sampling. So, while prognostication has its limitations, life continues to function on constant incorporation into all human activity.

Matt wrote: “The Constitution set up a limited, yet strong and enforceable, central government.”

Yes, a couple centuries ago for an agrarian based economy with a population less than most our largest cities. A host of amendments, a plethora of judicial interpretations, and volumes of social, economic, political, demographic, and international history have taken place since then and along with changing times came a changing Constitution as provided for in the original constitution. It is a living document for a progressive society. Sorry, if those terms offend your sedentary proclivities toward turning back the hands of time, but, hey, at least you don’t have to worry about polio, smallpox, the British reinvading, or pot holes breaking your horses leg or destroying your carriage’s wheel rim, all thanks to that living Constitution which could accommodate such future growth and change.

Toodles…

Posted by: David R. Remer at October 20, 2009 05:45 PM