From a legislative perspective, it’s not over until the Presidential pen comes out at the signing ceremony.
And, yes, it is possible that Obamacare will still run into turbulence. Conservative blogs overflow with reasons why this could all fail. To review: Democrats in the Senate and the House disagree about a slew of important details from taxes to the public option; abortion is still a sticking point; and, complicating matters, Congress is unlikely to conference and vote on final legislation before February – plenty of time for plenty of problems to emerge.
But, for once, I accept the White House spin. They have the ball and it’s on the one-yard line, to paraphrase Press Secretary Robert Gibbs.
Let’s be clear: there are those in Washington who have serious reservations about the size, scope and cost of the health reforms being debated. They are called Republicans, and they are the minority in both the House and the Senate.
With today’s vote, the remaining task for the White House is relatively small: to smooth over the House-Senate policy differences and round up votes, as they have done before. The President is on his way to Hawaii; his reforms are on their way to law.
The coming political achievement is incredible. The White House gambled big – and looks likely to pass the most sweeping healthcare legislation in more than four decades. Republicans and conservatives will need to do some soul searching and attempt to answer a gut-wrenching question: how did we lose this?
But, in terms of policy, the victory is not quite so complete. For much of this year, the President spoke of health reform beginning with the 25th holder of his office. “It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way.”
In September, when addressing Congress, he added: “I am not the first President to take up this cause, but I am determined to be the last.”
Much work remains to be done. The Senate bill that passed today leaves many details to be filled in later. More importantly, the biggest task remains: how to bend the cost curve in the coming years. As I’ve noted before, if anything, Obamacare will worsen the problem of health-cost inflation, not tame it.
The President hopes to be the last President to take up this cause. Nonsense – the challenge of paying for a modern healthcare system with an aging population has not been fundamentally resolved today, nor will it be resolved with this presidency. The debate continues.
Let’s then return to Gibbs’ analogy. The ball is on the one-yard line, but it’s still the first quarter. Those of us who favor market reforms are on the defensive. But there is much football ahead to be played.
52 responses so far
1 Raider1 // Dec 24, 2009 at 10:01 am
How did we lose this?? Simple: Graft, Bribes to buy votes for those who deep down are opposed but are spineless worms not worthy of the office. And an arrogance on the part of liberals who see this not as an end, who know that once this door is open it will eventually lead to ultimate control of the entire healthcare industry by that government in which they hold power. This is not about healthcare per se. This is not even about good legislation (otherwise the shameless bribes would be unecessary — if it’s a good bill Ben Nelson, why did you require your state to be exempt from a key portion of it FOREVER??). This is about a bunch of low-life politicians, a bunch of shalllow, small, completely unimpressive men and woman who would be abject failures on the outside attempting to cement power for power’s sake. This is about getting more than 50% of the voting public hooked on big government. Once that happens, then we are done as a nation–certainly as the nation we originally set out to be.
For anyone who voted for Obama and this band of liberal thieves I thank you for the higher taxes, the poor quality care, the rationing and the unsustainable defeicts this orgy of liberalism has produced. Have you figured out how you;re going to apologize to your kids and THEIR kids for this?
Hope and Change my ass you fools. You absolute pie-in-sky fools. You got hoodwinked by a Chiago politician who probably never even balanced a checkbook and now thinks that he and his ilk should control your economy and your healthcare. But hey, he gave a nice speech right? Oh, and he’s Black. I guess that’s all you needed to pull the lever huh? I cannot wait until YOUR expenses shoot through the roof. Change you can pay for!
2 canadianmoderate // Dec 24, 2009 at 10:19 am
Raider1, I live in Canada, and we are hooked – like really hooked – on big government. But do you really believe that “This is not about healthcare per se….This is about getting more than 50% of the voting public hooked on big government”? Do you actually think that this is the real intention of the Dems?
3 Raider1 // Dec 24, 2009 at 10:26 am
Yes. This is about POWER. Absolutely it is. And this is about a bunch of self-important blow-hrads wanting to “make history”–even if it’s BAD history.
4 Raider1 // Dec 24, 2009 at 10:29 am
Canadian…How do you like your healthcare if I may ask?
5 canadianmoderate // Dec 24, 2009 at 10:32 am
I don’t know, I can’t believe it’s all about power for all the Dems. But the point you make about the wanting to make history – that seems spot on.
Do you believe Bush and friends did things just for power too?
6 teabag // Dec 24, 2009 at 10:38 am
Tom Delay anyone!!!
7 canadianmoderate // Dec 24, 2009 at 10:47 am
Oh, well it’s not without its problems. But the stuff people say about ‘waiting in lines’ mostly cannot be taken literally. We have to wait in waiting rooms, but so do Americans. The waiting we do is for elective surgery, and it’s not always a problem. Actually, the older people are, the more they’re made to wait. We do ration, but it’s nowhere near as stark and nightmarish as it’s made out to be. We tend to distribute in order of most serious to least serious conditions, and from youngest to oldest. The younger you are and the more life-threatening your condition is, the more likely you will receive care that’s essentially the same as American health care. I’ve watched both my parents get tested by specialists and into operating rooms for surgery in just a few weeks, just like Americans with a decent plan expect. But their conditions were serious – inaction would have meant death rather than just discomfort. But people do wait months for things like shoulder surgery and hip replacements, which can suck. And what really sucks is that we can’t pay for those things even if we have the money. It’s seen as cutting in line, or paying your way to the front of the line. It’s the worst part, I would say. There’s actually a bit of a buzz growing in Canada now about the unconstitutionality of not letting people buy what is obviously available – like something that could make your life better, but you’re not allowed to buy it. We’re likely going to be moving toward sort of a hybrid public-private system in the coming decade(s). It’s already starting (and working!) in Quebec, which is allowing more for-profit delivery of care.
8 canadianmoderate // Dec 24, 2009 at 10:50 am
Actually, the last time I saw bunch of people literally waiting in line for health care is watching the H1N1 vaccine fiasco in the U.S. And that was in the private sector! My point is that the private system is not immune to lines and waiting, even if it’s definitely more of an issue here in Canada.
9 WillyP // Dec 24, 2009 at 11:09 am
canadianmoderate,
if i’m not mistaken, quebec is the most highly subsidized province of canada. if it’s “working,” it may be because the rest of canada is footing the bill for quebec’s public plan. yes, there is a slowly growing private sector (so I hear), but the fact that Chaoulli had to sue the government to be able to operate on patients in a public hospital (is he supposed to build his own? do you think they’d seriously allow THAT!?) strikes me as overwhelmingly orwellian.
all i saw up there was a lot of strikes, and resulting business closures. matter of fact, walking around montreal, you see the effects of socialist policy: every other block has a large abandoned lot, right downtown! the residences, all rent controlled, do not look like they’ve been updated since the 60s or 70s. ironically, the airport is something like 30/40 miles outside of the metropolitan area, and was put there (government planning) when montreal was growing, before the FLQ terrorists and increasingly socialist policies scared off business to ontario.
it’s left to these people to do the Lord’s work
http://www.iedm.org/main/main.php
and I can thank them for educating me!
10 sinz54 // Dec 24, 2009 at 11:10 am
gratzer:
There’s a fundamental reason and an immediate reason.
Fundamental reason: The Republicans stopped caring about health care reform when the party turned to the right with Reagan. Prior to that, Nixon had a viable proposal which the Dems shot down for partisan reasons. Gerald Ford had a viable proposal which he campaigned on. But after that, the GOP decided that the status quo was good enough. After Gingrich shot down HillaryCare in 1993, the GOP took over Congress. At that point they could have passed “GingrichCare”–if Gingrich had cared enough to propose such a thing. But he didn’t. The GOP was seen as a party that had nothing to contribute on the issue that made any sense–just a party committed to defending the status quo.
Immediate reason: When the recounts ended and Franken was declared the winner over Coleman, the Dems got a 60 seat filibuster-proof majority in the Senate. Then the die was cast. The GOP no longer had the power to stop health care reform–if the Dems could cobble together a proposal that avoided defections from their side. They did, and there went the ball game.
11 WillyP // Dec 24, 2009 at 11:18 am
“canadianmoderate,
if i’m not mistaken, quebec is the most highly subsidized province of canada.”
note: this is surely done to pacify the boisterous french, who really don’t like english canadians.
12 canadianmoderate // Dec 24, 2009 at 11:19 am
Well, I can’t argue the point about Quebec being the most highly subsidized province. They tend to complain (or threaten to leave) when we challenge this, and that’s obviously unfair. All I mean when I say that it’s working is that people, if they can afford it, are able to get some of the treatments (but mostly scans) that they want. It’s not perfect, but it’s better than forcing everybody to wait when some of them could easily pay for what they need.
And yes, Montreal is one of the wackiest places I’ve ever seen in terms of abandoned buildings downtown.
13 Raider1 // Dec 24, 2009 at 11:28 am
Canadian…what I hear from you is that just as Americans are being forced (against their collective will mind you) to adopt a more Canadian like healthcare system, you all are moving more towards American free market. What does that tell you?
And I have seen people in need of him and shoulder surgery. They are in AGOY many of them (usually older) and but for fast access to procedures they would have been positively IMMOBILE.
14 canadianmoderate // Dec 24, 2009 at 11:38 am
Well, what we’re going to try to do is become more of a hybrid system. I’d say we’re copying Europe more so than America (for better or worse). It tells me not that our system is an utter failure, but that it’s got serious problems that are more likely to be solved in the private sector.
And the only thing Canadian about your new bill, should Obama sign it, is that the middle and upper classes will now be subsidizing more care for those below them on the social ladder. We don’t really have a problem with that aspect of it. It’s the waiting (for orthopedic surgery like you said) that really bothers us.
But I’m interested to know, what do you think about paying for health care for the poor with your tax dollars? There’s going to be a lot more of that in your world soon.
15 WillyP // Dec 24, 2009 at 11:46 am
I couldn’t agree more with Raider’s comment:
“This is not about healthcare per se….This is about getting more than 50% of the voting public hooked on big government”
That’s absolutely correct. And we can see a symptom of an already run experiement – Canadian”moderate” is actually a statist, and yet does not quite recognize it. There is no meaningful debate in Canada about the healthcare system. The State’s stranglehold on medical care is not up for debate – only a minor matter of degree: 99% socialized, or merely 90% socialized. This can hardly be called political debate, and it is precisely the same thing that will happen here.
Studying paradigm shifts throughout history, you will see civilizations usher in “great reforms” that eventually no one bothered to question the fundamental nature of. It is only in the wreckage of these civilizations that historians can point out that in fact, these so-called reforms were the problem. And eventually, slowly, real intentions emerge – permanent majority, expanded power, monopoly power, unobstructed economic power which functions to pay the military/fund wars. These cycles repeat themselves throughout the expanse of history.
Look at the Church in the 15th century. Would anyone have thought that the overlordish nature of the institution would slowly crumble, and the State would emerge as the new Lord? And our Federal Reserve, which has the notable accomplishment of rewriting nearly the wisdom accumulated from political economy in less than a century. Well, the Church eventually lost its political power (I say this as a Catholic, and someone who values faith and organized religion). And the Fed has painted itself into a corner, confronting the choice between out control inflation and extremely high unemployment (in the short term).
Nationalized healthcare, what seems so typical and enlightened today, will eventually follow in the path of other fossilized institutions. What should concern us is the pain and suffering we needlessly endure before its collapse.
16 canadianmoderate // Dec 24, 2009 at 12:01 pm
I’m just trying to be a realist. I doubt as if the welfare state is going anywhere in either Canada or the U.S. It’s definitely expanding down there, once Obama signs this bill into law. And if everybody does get hooked on big government, then it’s not going to go away.
Do you really think you’ll see then end of the welfare state in your lifetime? If you don’t, then all I’m saying is you should try and come up with ideas to make it better. I know you can’t square a circle, by the way, but I don’t think anybody’s about to throw away the whole system and start over, even if that were the best plan.
WillyP, what do you think of subsidizing the poor? I’m not trying to patronize you here, I sincerely want to know what you think about that issue.
17 WillyP // Dec 24, 2009 at 12:28 pm
“Do you really think you’ll see then end of the welfare state in your lifetime? If you don’t, then all I’m saying is you should try and come up with ideas to make it better. I know you can’t square a circle, by the way, but I don’t think anybody’s about to throw away the whole system and start over, even if that were the best plan.
WillyP, what do you think of subsidizing the poor? I’m not trying to patronize you here, I sincerely want to know what you think about that issue.”
Fine. How do you make it better? It’s really not brain surgery – YOU SHRINK IT WHEN POSSIBLE. You DO NOT sit around and try to come up with more precise soviet inspired technics for managing society. Alexis de Tocqueville was fairly clear on this matter – government up, private sector (i.e., society) down. And the reverse holds true, too. The reason: government does not produce anything (except force), but redistributes (and in doing so, disincentivizes).
How do I feel about subsidizing the poor? Well, I think we’re going to have to be more specific. The poor is not a homogeneous group of disenfranchised people (if only), but a melange of people under vastly different circumstances. Some are perfectly able to work. Some are able to work, but have not the skills or education. Some are able to work, but have proven themselves criminal and must start at the very bottom. Some are able, but must tend to their children (the oft-mentioned “single mothers”). Some are incapacitated, either from birth or from tragic accident. Some are drug addicts, some crazy.
I don’t have a problem keeping the truly needy alive and cared for. By all means, this should be done – preferably by charity, in the very last case by government (which, after all, tends to conscript them into a voting block and make them dependent). As for the addicts and crazies, get them off the streets first. The addicts should not be subsidized at all, but forced to endure the consequences of bad decision making. If they need some sort of publicly paid-for counseling, they should have to pay for the services once they’re employed. The crazies, well, I’m not sure. If not dangerous, they can exist in public. If they are, then they must be kept in holding cells (like mankind has done for centuries).
The problems arising from broken families must be dealt with on a case by case basis, preferably again through private charity. The real cause of broken families is out-of-wedlock births/divorces, which comes back to the liberal left’s fetish for ill-conceived individual freedom (what is better termed license). Kids need parents, and having a mother AND father is a lot more stable than just one or the other. So let’s stop the talk about the “underprivileged,” start enforcing the law in inner city ghettos, and get these populations to clean up their own acts. As we can see from the war on poverty, all statist solutions not only fail, tragically, but make things significantly worse.
Does this sound cold-hearted? Well, consider the generations that have been lost because too few have been able to step up and speak the truth. Tom Sowell is the best at this.
18 sinz54 // Dec 24, 2009 at 12:38 pm
Politico.com is now reporting that Pelosi is going to accept most of the Senate bill’s version of health care reform, rather than fight for the House version. So most of the Senate bill will end up signed into law by Obama.
How “socialistic” is the Senate bill?
Here’s what Blue Cross/Blue Shield had originally proposed for health care reform:
The Senate bill does not seem to differ all that much from these basic principles.
Blue Cross was against the public option–but the public option isn’t in the Senate bill.
19 WillyP // Dec 24, 2009 at 12:44 pm
“Government subsidies help support a personal responsibility requirement to obtain and maintain health coverage.”
ok…
1) government subsidies to private insurers (i’m sure the lefties like this, no?)
2) personal responsibility “REQUIREMENT” (how ominous! undoubtedly this pleases the free marketers. oh wait…)
I think it’s pretty clear to anyone besides a reality denier that the White House basically said to the private insurers: we’re passing this thing whether you like it or not, so you might as well support us. in return, we’ll subsidize you.
a giant political payoff scheme in the making. reminiscent of fascism, actually.
20 Kanzeon // Dec 24, 2009 at 12:49 pm
“Republicans and conservatives will need to do some soul searching and attempt to answer a gut-wrenching question: how did we lose this?”
It’s blindingly obvious.
For my entire working life, my health insurance premiums have gone up, my co-pays and deductibles have gone up, and my coverages have declined. That is the case with every person I know, and statistical studies confirm it again and again.
The health care system has been dysfunctional for forty years, and getting worse every year.
Back in the 70s, health care proposals could be characterized, maybe with some accuracy, as liberal Utopian social engineering. But those days are long gone. It is apparent to most people that the current system doesn’t work.
The Republicans could have responded to the needs of the nation to reform the health care system. It isn’t as if they completely lack ideas. For example, tort reform, while not a silver bullet, is a reasonable proposal. Shifting some costs to health savings accounts, etc., are also good ideas. The health insurance exchange is hardly a socialist plot. But they didn’t even push their bad ideas very much – usually only defensively, to try to scuttle Democratic plans.
Instead, every time the Democrats took power, they pushed for major reforms with every last bit of their political capital, and every time the Republicans took power, they did nothing (except, of course, pass a Democratic-style prescription drug benefit). Republicans continued to shriek about how reform was a communist plot. They had many chances to combine their proposals with moderate Democratic proposals, or present real plans, promoted heavily by the leadership, but they never did.
The Republicans lost all credibility on this issue. It took them decades. In contrast, Democrats worked the issue tirelessly.
It’s those old conservative values of hard work and commitment. Democrats deserve this victory. They worked for it.
21 WillyP // Dec 24, 2009 at 12:55 pm
Kanzeon, with that reasoning, perhaps the democrats “deserve” this victory. But Americans do not, and cannot afford it!
22 balconesfault // Dec 24, 2009 at 1:22 pm
Willy – reading your summation of who are “poor” in America – you seem to not acknowledge that there are a lot of people in America who are working … yet too poor to afford insurance.
We have a minimum wage which guarantees about $15K a year in salary. Someone working multiple jobs at near minimum wage can be putting just as many hours a week into working as the most dedicated Wall Street exec and be making $25K/year. Without benefits. Or pay when they get sick.
Or pay for health insurance, if they want to put a roof over their families head and keep a step ahead of the bill collector.
We’re competing in a world where we’re buying products from places that pay their workers 40 cents per hour. So “get a better paying job” just isn’t going to be a real alternative, when our trade policies have been aimed at eroding the wages of American workers for the last 40 years.
I guess they can always fall back on the healthcare policy of “don’t get sick …”
23 canadianmoderate // Dec 24, 2009 at 1:40 pm
Actually WillyP, what would you suggest people who cannot currently afford health insurance do (if it weren’t subsidized through taxes like Obamacare)?
I doubt you believe that the policy should be “don’t get sick.”
I suppose you might say that in a truly free market the prices would come down because of competition, and then everybody would be able to afford it. Is this what you have in mind?
But since the world doesn’t work like this (I doubt as if insurance companies would like as much competition as you would; they’re comfortable with their current market share), really, what should people who can’t afford it do?
24 SpartacusIsNotDead // Dec 24, 2009 at 1:40 pm
Gratzer wrote: “But, for once, I accept the White House spin. They have the ball and it’s on the one-yard line, to paraphrase Press Secretary Robert Gibbs . . . Republicans and conservatives will need to do some soul searching and attempt to answer a gut-wrenching question: how did we lose this?”
Republicans lost the HCR debate because they are totally detached from reality and because they care more about political wins/losses than about policy consequences. For months Gratzer’s been denying HCR would pass; only now does he accept its inevitable passage. Had the GOP been both connected to reality and concerned about policy, it would have acknowledged the inevitable passage and it would have tamped down all the crazy talk.
By letting the crazy talk get out of hand it became impossible for any GOPer to make any constructive contribution without angering the GOP base. Of course, a constructive contribution would have also required an intellectual honesty that would have supported the Dems’ proposed Medicare cuts and the IMAC (a.k.a. Death Panel), both of which had been previously supported by Republicans.
25 SpartacusIsNotDead // Dec 24, 2009 at 1:53 pm
Sinz wrote: “How “socialistic” is the Senate bill?”
Your post assumes that GOP/conservative opposition to the bill is based on its content and not its authorship. You’re being very generous.
26 WillyP // Dec 24, 2009 at 2:05 pm
candian/balcones:
what i’d suggest to those who are working and still cannot afford health insurance would be to get a better job. if we didn’t have a lunatic socialist in the white house who was intent on destroying the economy like fdr, this wouldn’t be so hard.
if you two were truly concerned with “the american worker,” you’d address the systemic problem of the business cycle, which is created, in part, and certainly exacerbated, by our Federal Reserve system. you’d also realize that socialist ploys always fail, and always reduce average living standards for everyone. is this what you call progressive?
minimum wage raises the incidence of unemployment, and this is true with 99.999% certainty. why? because, unmistakably some people are laid off by mandating that they deserve a higher wage. there’s more unemployment, less insured people.
young people, new to the workforce are typically those who will go without insurance. this is their choice, and if they go bankrupt, well, what can i say: tough luck. life isn’t fair sometimes, bud. in any event, if you were concerned with these people, you’d decouple the tax incentives from employers, and allow them to form a low-cost insurance pool: young people are low risk, and by averaging their risks you could likely provide adequate coverage for this cohort. once again, the reason that this does not happen is because, as sinz pointed out (in an attack on me, bizarrely) FDR’s wage controls led to insurance being provided by employers.
“I suppose you might say that in a truly free market the prices would come down because of competition, and then everybody would be able to afford it. Is this what you have in mind?…
But since the world doesn’t work like this (I doubt as if insurance companies would like as much competition as you would; they’re comfortable with their current market share), really, what should people who can’t afford it do?”
We should not design policy with the 5% exception in mind. We should design policy that addresses the VAST, VAST majority of people. If people LIKE YOU would stop acting as apologists for liberals, while claiming not to be one (what’s a moderate? can you even define this ridiculously obnoxious term? i think it means “unprincipled and confused”), perhaps we could get across true market reform – which would, in the end, amount to repealing former “reform” measures.
And that’s the world as I see it, pessimists and naysayers be damned.
Merry Christmas to all!
27 WillyP // Dec 24, 2009 at 2:06 pm
oh, right
“Is this what you have in mind?…
But since the world doesn’t work like this (I doubt as if insurance companies would like as much competition as you would; they’re comfortable with their current market share), really, what should people who can’t afford it do”
well, i’m not a corporate apologist – i’m a free market advocate. i could care less what the insurance companies think of more competition. that’s not my concern. my concern is society at large.
28 SpartacusIsNotDead // Dec 24, 2009 at 2:08 pm
Here’s a clear explanation of why the GOP lost (and will continue to lose):
http://ta-nehisicoates.theatlantic.com/archives/2009/12/the_great_jim_cornette_on_obama_and_health_care.php
29 canadianmoderate // Dec 24, 2009 at 2:42 pm
I know Willy, I know. So how should society at large all get covered, in the absence of something like Obamacare?
30 mlindroo // Dec 24, 2009 at 2:45 pm
WillyP — could you please give a few practical examples of the following:
>[...] civilizations usher in “great reforms” that eventually
> no one bothered to question the fundamental nature of.
> It is only in the wreckage of these civilizations that historians
> can point out that in fact, these so-called reforms were the problem.
>And eventually, slowly, real intentions emerge – permanent majority,
>expanded power, monopoly power, unobstructed economic power
> which functions to pay the military/fund wars. These cycles repeat
> themselves throughout the expanse of history.
You make it sound as if reforms (in the name of “progress”, I assume) cause “civilizations” to fail. Perhaps you can name some examples? You mention the Roman Catholic church as a great example of this, but I would argue that the Reformation was an inevitable result of the way (increasingly capitalistic/nationalistic!) Europe was evolving at the time. And in any case, it is hard to argue that the transfer of power away from the church was not a good thing, right? According to almost any metric Westerners are better off today than in the 15th century after all…
Maybe there are some cases that I have not thought about, but it seems to me that the most successful civilizations are the ones that constantly reinvent themselves (e.g. the Western world from the 15th century onwards) whereas the ones that don’t adapt — the Chinese empire, for example — fall from power sooner or later.
Merry Christmas to Willy and everybody else, by the way!
MARCU$
31 canadianmoderate // Dec 24, 2009 at 3:52 pm
Oops, looks like you already answered my question, no need for me to ask again. Your policy is not ‘don’t get sick’ but ‘get a job/better job.’ Meh, nothin’ new. ‘If we had x’ and ‘if we had y, then…’ But we don’t! Not here and not down there. Neither Canada nor the U.S. is about to end their central banks, and they’ll both probably end up doing more quantitative easing and the like in whenever depression fears are looming. This is the reality we live in, as I’m sure you’re well aware. But since this system isn’t going anywhere, how do we keep everybody covered in this system? I guess that’s what I’m trying to ask.
Oh, and I call myself moderate because I’m not radical, like you. I’m not looking for changes like you are. I see them as unrealistic goals anyhow. Though like I said before, I can imagine a world where there’s no fed, where I could issue my own student bonds privately to higher-risk investors (I got this idea from Sowell), and where there’s absolute free-market competition. But neither of us live in that world, as great as it might be. So how do we cover people in this world?
32 Zilu // Dec 24, 2009 at 4:28 pm
I suppose that getting a better job is one way for a particular person to get better HC. However, I’m not sure I like it. I think this is an acceptable response when we’re talking about non-moral goods. If someone wants a bigger house, they should get a better job. If you want to eat steak instead of spam, get a better job. Steaks and big houses are clearly non-moral goods. But health care does not strike me, anyway, as a non-moral good, so I don’t accept this response to the problem. Moreover, if the ideal situation is that everyone has HC, I don’t think the ideal social situation is that everyone tries to get a better job. As a society we want people sweeping streets, teaching in secondary schools, working in restaurants, etc. We want division of labor all the way up and all the way down. I have a hard time wanting people as a whole to take those jobs while at the same time acknowledging that the HC that comes with some of them will be insufficient.
33 Arch // Dec 24, 2009 at 4:42 pm
Hey, I know this is off topic, but since they never do open threads here, I just wanted to wish everyone a Merry Christmas!
34 anniemargret // Dec 24, 2009 at 4:47 pm
Zilu: I’m with you on this.
The ‘get a better job’ is arrogantly flippant given the fact that thousands of Americans are now looking for jobs, any job, anywhere, in desperation to keep their homes and families intact.
This type of response, which is typical for the comfortable Republicans, always smacks of indifference, or the “I got mine” attitude. It is similar to The ‘Rushbo’s’ comment about some Americans not being able to afford or keep their insurance- he said they could just ‘get the car repossessed.’
There but for the grace of God go I.
35 sinz54 // Dec 24, 2009 at 5:18 pm
anniemargaret:
In fact, surveys have shown that the most frequent cause of personal bankruptcies in the U.S. is out-of-pocket medical costs.
But I don’t want to attack personally those who disagree. Let’s hope that neither “WillyP” or “franco 2″ or Limbaugh is visited by three ghosts this evening.
Merry Christmas to all!
36 FosterBoondoggle // Dec 24, 2009 at 6:53 pm
WillyP: “what i’d suggest to those who are working and still cannot afford health insurance would be to get a better job. if we didn’t have a lunatic socialist in the white house who was intent on destroying the economy like fdr, this wouldn’t be so hard.”
So, until 11 months ago when Obama took office, loads of high-paying jobs were there for the asking? Are you expecting to persuade anyone with that argument, or is this pure rant?
37 balconesfault // Dec 24, 2009 at 7:20 pm
Zilu – a great way of expressing the dilemma. We aren’t going to pay certain jobs enough to to maintain healthcare. Period.
I don’t really care that a minimum wage employee can afford a car, instead of using public transportation. Or live in a single family home with a quarter acre lot, instead of an efficiency apartment. Or eats porterhouse instead of ground meat.
But healthcare access is not a luxury … it’s like a and we’re all better off if people have access to a baseline level of healthcare.
Merry Christmas, and Happy Festivus!
38 TonyS // Dec 24, 2009 at 7:30 pm
This health care debate is going to be overshadowed by the inevitable fall of this nation’s currency. Has anyone looked at the budget for this year? $3.5T. How many more years can we run up the credit card $1.8T? This house of cards that Obama and the Dem’s are furiously building will crash before the four years this health care system takes to implement. And we have not even factored in the real cost of this health care take over.
Risk takers will not venture out with new products/developments with the new taxes that are being imposed, and jobs will not materialize. The only growth in this economy is in government jobs. The private sector is on the side lines for a long time to come.
39 balconesfault // Dec 24, 2009 at 7:58 pm
How many more years can we run up the credit card $1.8T?
Hopefully, there is not a need to run up that large a debt going forward.
You should note that betweeen Feb 1 2008, and Feb 1 2009, the US debt grew by 1.42T. And right now, thanks primarily to deficits amassed while Reagan, Bush I, and Bush II were in office, we’re paying about 18 billion a month in interest payments to service our debt – so even if everything else were balanced we’d be spending about 210 billion a year in interest … you may or may not be surprised to know that this is greater than the average annual deficit run under the 8 years of the Clinton administration.
Risk takers will not venture out with new products/developments with the new taxes that are being imposed, and jobs will not materialize.
I fully expect this prediction to look as prescient in a few years as the 1993 predictions of imminent economic collapse when Clinton raised some taxes.
40 balconesfault // Dec 24, 2009 at 8:03 pm
The only growth in this economy is in government jobs. The private sector is on the side lines for a long time to come.
Are you thinking of the last 8 years, by any chance? You realize, of course, that the Bush tax cuts kicked off an era that saw the worst job growth in every sector but construction since WWII?
Construction netted an annual growth rate of 0.08%, ahead of the Ford and Bush I years which both had negative construction job growth.
By the way, if you want your head to explode, you might note that the top 3 post-war administrations for annual employment growth rate in America, in order, were:
1. LBJ 3.74%
2. Carter 3.11%
3. Clinton 2.42%
Last?
11. GW Bush 0.28%
Fail
41 WillyP // Dec 24, 2009 at 8:51 pm
actually, TonyS, I’ve repetitively brought up the problem of debt and the precarious position of the currency.
these sad excuses for wannabe statesmen ignore just about every word i say, claiming i’m out of touch. frankly, they’ll be be hoisted by their own petards in due course, but they’re far too arrogant to realize this.
42 Joe In NH // Dec 24, 2009 at 11:44 pm
The one thing I never heard any GOP health care plan really deal with is the question of coverage for those of us with pre-existing conditions. Try being in your 50’s with high blood pressure and other conditions and see what the free market has available for you.
The real problem here is that everyone talks in terms of right V privilege. I would frame the issue as public good and private good. Look at public education. The individual benefits by free education from K to 12 and subsidized college after high school but there also is a benefit to the public to have an educated citizenry. So too there is a benefit to have a healthy country.
43 sinz54 // Dec 25, 2009 at 9:33 am
Joe in NH:
Try being in your 50s with kidney failure and on dialysis, as I am–and see what the free market has available for you then. Any insurer will lose money on me, because my yearly claims are in the neighborhood of $80,000, every single year till I either get a kidney transplant or die.
McCain’s proposal, which he unveiled during his 2008 campaign, was that states should set up high-risk pools for those with pre-existing conditions. Where the states would get the money for this, and how high the premiums would have to be, McCain didn’t explain.
The National Review proposed dealing ahead of time with health conditions. Under their proposal, you would buy a policy at a very early point in your life that insured you against the chance that you would get a chronic illness later in your life. If you did pick up that illness, the policy would pay off and compensate you for your inability to get health insurance from that now pre-existing condition. This seems analogous to how many of us purchased long-term disability insurance (LTD) while we were still young and healthy.
The difference, however, is that the premiums for LTD can be reasonably low because only a small percentage of us ever end up totally disabled. But a far higher percentage of us, like you for instance, acquire these pre-existing conditions eventually. For that reason, it seems to me that the insurance policies proposed by National Review would have to have very high premiums, in order to compensate folks for the chronic illnesses they may pick up in the future. Most of us will die of some illness, except those who perish in war or as victims of crime or fatal accident.
In short, while conservatives have toyed with ways to get around the pre-existing condition problem, they don’t appear to have scored them mathematically for how much they would cost, both to individuals and to governments. At this time, they all remain just half-baked ideas.
44 sinz54 // Dec 25, 2009 at 9:43 am
WillyP:
You’re contradicting yourself.
You say you want to see more innovation and dynamism in the economy.
Yet if you want to quit your job and go into business for yourself (perhaps you have a great invention you want to sell), you’ll be deterred from doing so by the prospect of losing your group health insurance.
Even if you’re healthy, you’ll find that the premiums on individual health insurance are higher than they were on group insurance, and the tax breaks are much fewer.
And if you (or one of your dependents) already have a pre-existing condition, you may be unable to purchase individual health insurance at all.
In which case you may forget the whole thing and stay stuck in your dead-end job with your employer–just to keep that health insurance.
45 sinz54 // Dec 25, 2009 at 9:49 am
The employers who give their workers generous group health insurance tend to be large corporations. Small businesses, especially startup “garage” operations, can’t afford it.
And yet much of the innovation and dynamism in our economy comes from small businesses. (Microsoft was a tiny business once.)
Yet bright people who might otherwise want to go to work for a small business and help grow it, may be deterred by its lack of generous health insurance.
That’s the flaw in the argument put forth by “WillyP.” The tax breaks given to group health insurance are an UNFAIR advantage given to giant corporations over small business and the self-employed. We haven’t had a free market as WillyP would want. Instead, we had a distorted market in which large corporations could offer generous group health insurance in lieu of offering a well-run company. A prime example was General Motors.
46 balconesfault // Dec 25, 2009 at 11:49 am
Joe in NH: Try being in your 50’s with high blood pressure and other conditions and see what the free market has available for you.
And note that Willy’s ideal would exacerbate this problem: if you were concerned with these people, you’d decouple the tax incentives from employers, and allow them to form a low-cost insurance pool: young people are low risk, and by averaging their risks you could likely provide adequate coverage for this cohort
If you form a low-cost insurance pool for the young people who are currently included in an employers insurance plan … the cost of covering the higher risk older people doesn’t stay the same.
47 sinz54 // Dec 25, 2009 at 6:28 pm
balconesfault:
It wouldn’t matter anyway.
“If we could decouple the tax incentives from employers”??? And if pigs had wings???
Both the doctrinaire Left and the doctrinaire Right wanted to decouple the tax incentives from employers; the Left via a single-payer system, the right via a free-market system.
But every single attempt to force Americans with generous group health insurance into something else has flopped. The public revolted against HillaryCare, because those who do well under the current system don’t want to give up what they already have.
By 2008, the mainstream Dems had learned their lesson. Both Obama and Hillary went out of their way to promise those who already like their group health insurance that they could keep what they already have.
That tends to limit the scope of reform. But it makes incremental reform attainable without a voter revolt.
Anyone, Left or Right, who says “Now we start by scrapping the current group health insurance system and replacing it with….” is just blowing smoke. Never gonna happen.
48 WillyP // Dec 26, 2009 at 6:18 pm
“Yet bright people who might otherwise want to go to work for a small business and help grow it, may be deterred by its lack of generous health insurance.”
I will answer this question in detail, for I feel it is the last possible excuse for allowing so-called conservatives to encourage national healthcare. It also relates to the question of whether, and why or why not, extending public health insurance to all Americans would encourage entrepreneurship. Truth be told, I was not always zealously against nationalized healthcare. I considered it for what it was worth while in Canada, and one of the thoughts I had was that by providing a minimum level of comfort, creative brains could work out better market ideas than if they were forced (by necessity, of course) to work at low paying jobs that paid by the hour (i.e., no health insuance provided). So, while I ultimately decided against this idea, I think it is a good line of thinking. Ultimately, you must answer these questions by evaluating the alternative scenarios, and this I will attempt to do now. Imagine the following scenario.:
Scenario 1: A highly educated, intelligent young person with a mind towards starting her own business is employed at Banana Republic making $10/hr. She is paid overtime past 40 hours per week. No health insurance is provided, and she does not buy any on the open market. All told, over the course of her first year she makes $34,0000 in pretax income. She works a second job, part time as a bartender, and earns an additional $25,000. This assumes a commitment of 60 hours of work per week. She has the idea that she wants to start her own restaurant, and would like to spend 9 months creating the menu, picking out a suitable location, designing the interior, and developing a viable investment strategy. To be safe, she determines that she needs to purchase health insurance for 1 year, since she will be eating through her savings and would not have the money to pay out of pocket. She has saved enough to live off of, and currently resides with her parents. The insurance is estimated at $400/month, so $4,800/yr. To save this extra money, she needs 6 months. This is the world of the status quo.
Now the hypothetical difference(s):
STATE CARE
The question of insurance is moot. She is provided health insurance by the state. All her fellow working citizens will pay for her if she falls ill. To pay for the programs, she estimates that she pays $300/month in taxes at her current wages. When she needs care, she must go to the state, and endure long wait times. But she is young, and this does not yet taint her nationalistic feelings. The plan is a great source of national pride, and she is proud that her country provides insurance to all.
OR
FREE MARKET REFORM
She is provided with nothing from the state. If she quits, she will be uninsured and earning no money. She will have the money she has saved, and health insurance should she choose to purchase it. As a result of free market reform insurance for her cohort is only $200/month. This allows her to either work for 1/2 the period of time to provide for 1 year, or keep the additional savings. She enjoys all the advantages of a free market healthcare system, and although she realizes its perils, she recognizes that a responsible person can effectively plan for risks.
Some questions are in order:
1) In which case is she more motivated to be successful? What is the price of failure in both cases?
2) What coverage is actually cheaper for the girl when working? What is more expensive if she is not working?
3) In both cases, her success means more for society at a whole. But who pays for the price of failure in each case?
4) What is the likelihood that someone with such little work experience would be successful in business? What is the likelihood that the same person would be more successful with 5-10 years of real world work experience?
5) What happens, in both cases, if more and more people become unemployed? In which case does the price of medical care fall faster to accommodate those with less of an ability to pay? Which case had more rigid price rules, and by what mechanism are they investigated – through bureaucracy or through the interplay of market forces?
6) What system protects private property rights by allowing for lower and predictable tax rates?
7) Assuming the second case, what would be the problem with adding that all patients must be treated for life threatening illnesses/injury regardless of their ability to pay, and then letting a judge decide on said patient’s debt to society?
Sinz says, further:
“Anyone, Left or Right, who says “Now we start by scrapping the current group health insurance system and replacing it with….” is just blowing smoke. Never gonna happen.”
Oh, something will happen all right. You can be sure of that. Nature eventually has her way one way or the other, and a system that cannot adequately serve people’s needs and/or encourages national bankruptcy will have a day in the court of natural law. At least I am providing workable solutions that would endure in the long term, rather than cynically selling future prosperity for very short term gain.
49 WillyP // Dec 26, 2009 at 6:29 pm
balcones says:
“If you form a low-cost insurance pool for the young people who are currently included in an employers insurance plan … the cost of covering the higher risk older people doesn’t stay the same.”
You have this precisely, 100% backwards. Question: who is kept out of the current system more – young people or older, more established people?
Since this entire movement is about provided healthcare to people “who aren’t well established,” who is more typically considered well established – middle aged peoples or young peoples? So, the logic being: add more young people with low premiums, and diversify the risk pools. This is done already in companies depending on policies!! Conclusion: The price of insurance would FALL for the sickly, because more young people would be paying into the system. They would do this voluntarily to protect themselves in the unlikely event of catastrophe. Is this not how all insurance works? Why do we not have the same problems with the car insurance market as we do with health insurance? Do you think we should have state car insurance? Do you think we should have our car insurance policy provided by our employers?
People, for all the confusion around this debate, it’s not such a mystery.
Yet you stand here like Orval Faubus, refusing to end (what effectively amount to) employer provided insurance. Stop restricting the access to health insurance by the young earners. Stop selling your country into statist schemes. Let people be free!
50 WillyP // Dec 26, 2009 at 6:30 pm
err, let me correct something:
“Yet you stand here like Orval Faubus, refusing to end (what effectively amount to) employer provided insurance. ”
should say:
Yet you stand here like Orval Faubus, refusing to end (what effectively amount to) *subsidies to* employer provided insurance.
51 athensboy // Dec 28, 2009 at 7:10 am
As much as Limbaugh says “its the end of this nation” everyone with a brain knows the gop cries wolf on everything Obama and the Democrats do. People trust the gop even less than they trust Democrats. The gop is the party of know. Too me they are like a child that whines all the time. After a while you just tune them out. The gop had a chance to reform healthcare when they had power, they punted and instead gave tax breaks to the uber wealthy. Nothing the Democrats do would please them, they have quit trying to be part of the solution.
52 WillyP // Dec 28, 2009 at 10:02 am
mlindroo says:
“Maybe there are some cases that I have not thought about, but it seems to me that the most successful civilizations are the ones that constantly reinvent themselves (e.g. the Western world from the 15th century onwards) whereas the ones that don’t adapt — the Chinese empire, for example — fall from power sooner or later.”
If you go back to the Roman times, you’ll find that the tax system eventually led to serfdom – it tied people to the land, making sure they paid their taxes or else, so that Caesar could fund the military. Yes – it was taxes that created serfdom. Yes – it is socialism that represents the model of 100% taxation. And this, I surmise, is why Hayek titled his warning against socialist planning “The Road to Serfdom.)
What about all those Acts passed in Great Britain before the American Revolution? Take the Navigation Acts and the Molasses Act. Were these not championed as reform movements? Surely, they were popular in Britain because they safeguarded British shipping interests through a program of prohibition (of continental shipbuilding) and subsidy (through tariffs). Yet clearly the colonists were not so impressed by these reforms.
Beethoven wrote Symphony #3 with Napoleon in mind, only to later realize that the man was primarily interested in self aggrandizement through war and conquest. He was popular at the time, and the population proved itself naive trusting such a man.
Many disaffected aristocrats were openly sympathetic to socialism; indeed, even championed its cause. Marx and Engels were unquestionably “bourgeois.” J.S. Mill wrote elegantly about the promise of socialism. Good intentioned and bad, both Mill and Marx were wrong about socialism.
But we need not go back that far. Many Western intellectuals looked abroad to Fascism as a great step forward for mankind. W.E.B Dubois and H.G. Wells were both in awe of the European strongmen of the 20th century. So, as a matter of fact, was J.M. Keynes (or at least appreciated their economic system, which consisted of planning from atop).
FDR was extremely cynical in promoting his Social Security scheme. He sold it to the people as “insurance,” and to the Supreme Court as just another tax (when they challenged his claim that it was actually “insurance”). He knew it was destined for cyclical bankruptcy, that it was not a stable and self-perpetuating program. So he told that court, Look, I know as well as you do that this really isn’t insurance. But I need revenue, and this is unarguably another source of revenue. Later generations can clean up my mess. And, by the way, it gives my party a big electoral advantage!
Keynesianism represents another fork in the road for intellectuals. Eminent economists of the day, including Paul Samuelson and Lionel Robbins, came to regard government interventionism as the purpose of economic advisory (Samuelson later “wrote the book.”) They did this while bucking ~200 years of established wisdom, and never refuting arguments they previously held to be true.
So the history of mankind is not, as we’d like to believe, only upwards and onwards. Many times we turn down dark alleyways and don’t realize it until it is too late. Eugenics, remember, was once a respected “science” as well.
In the context of the current healthcare debate, the point is this: central planning does not work because it cannot work. It has failed in the past, and will fail in the future. Any so-called reform that involves centrally planning resource allocation is regressive. We’ve known this, in theory and in practice, for almost 100 years now, and yet the supposedly enlightened GOP moderates don’t quite get it. I have no patience for such ignorance, and I wish you’d all wise up… and fast.
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