And Again

“assuming McArdle is right about the r&d shortfall, I would prescribe: r&d. ” We have pretty much a single-payer system for the military. That system may have killed a lot of things, but innovation and r&d are not among them.

A lot of writing that in essence is simply the “not my money school of thought”, it is always easier to moralise when spending other peoples money. Especially easy when moralising from Ivory towers that are funded with tax payers money.

Let us take your last paragraph, and assume it is YOU that is morally obliged. YOU are morally obliged to give me free lessons because I do not have the money, YOU have the moral duty. If the response is “well it is not the same as healthcare”, I say why not ? surely people have the right to free education, so I demand that YOU give me that free tutoring. I emphasize the YOU, because if a certain moralising viewpoint is not adhered to by YOU then do not expect others to. So please let us meet up I want YOU to give me those free lessons please.

“I know this goes against the principles of liberal pluralism, but sometimes arguments are more intelligible once you realize that they are motivated by opportunism, malice, dogmatism, and narcissism.’

Call me a liberal pluralist, but I think this is unfair. Strike the word “malice”.

Seriously. Look at David Brooks, for another example. I never have the impression of malice coming from him. Opportunistic and narcissistic and dogmatic in an understated way, but there’s no malice there. He wants everyone in the Beltway to like each other.

I agree with nearly every word of this post, but would substitute “ever” for the final appearance of “now”.

In terms of rationing, we Canadians really look at this argument from a completely different perspective than those in the US.

From my limited reading the argument over there seems to be all about coverage. Who is going to be extended (public insurance) coverage and how will that affect private insurers and the costs of health care.

I think for us here it is all about rationing. Realizing there are finite resources, and deciding who is going to get them: the most in need (i.e the sickest) or the most able to pay (i.e. the richest).

Why should we be scared of the r-word? If we called it like it is it would be easier to frame the problem in terms of ethics and society’s well-being, which should be the topics under discussion.

But again, I am from a different world on a lot of issues, living only a few degrees north.

n the health case, there is no obvious reason why the government couldn’t fund r&d if private funding should fail.

Government already funds r&d; a discussion of weeks on McArdle’s blog. She initially said, “No” (exact quote) when I said it; evolved to, ‘yes, government funds early r&d, but doesn’t bring drugs to market.” And even there; I would question the validity of the statement. Much of the early research is funded by National Institute of Health (NIH); comparative clinical trails are funded by NIH. And on the other end of the process, safety is evaluated by FDA. Government investments straddles both ends of the r&d process.

The other faulty argument she makes in saying innovation would be stalled with healthcare reform comes in the form of saying r&d and innovation don’t happen in countries with nationalized systems. We have a global market, but a lopsided reimbursement system; products developed in other countries are often brought to market in the US first because we’re willing to overpay compared to other nations.

Anyone who really believes reform will strangle innovation ought to pay more attention to our education system, the real feeder for new, improved, and innovative. Funding for research at universities, teaching hospitals, and non-profit groups has a long, well-proven track record, not only for innovation, but for weeding out dangerous or ineffective treatments. And it’s investment that feeds for-profit industries, particularly pharma; a form of social welfare libertarians/conservatives fail to recognize in their zeal to prove government is always the problem.

I think of Brooks and McMegan as Republican niche operatives whose job is to slice off a tiny percentage of the potential Democratic vote by making plausible, clever, less-batshit-crazy, non-Michelle-Bachman arguments that might convince a few comfortable professionals and hip libertarian units that it’s OK to move into the R. camp. Neither one of them has to convince more than 1% of their audience. Division of labor.

Also. I have never seen so much time and energy spent trying to convince someone that they are using a word in two different and incompatible ways, sometimes one way, sometimes another way.

Dear. Moloch. In. Heaven. Above. If. That. Is. Indeed. Where. Moloch. Lives. c/o. Megan. McArdle. Ambiguity. In. What. You. Mean. By. A. Word. Ought. Not. Be. This. Effing. Hard. To. Resolve. Love. Salient.

she has a philosophical abhorrence of certain things

Such as coherent thought.

It is very evident to me that McArdle is on the other side of the divide between those who have become resigned to their own mortality, and those who have not. (She had a very revealing post a couple of weeks ago in which she admitted that thinking about making a living will upset her so badly she had to go lie down for a while, or words to that effect.)

I think her constantly-repeated argument about the importance of medical innovation amounts to a version of Pascal’s Wager: Whether she would admit it or not, she thinks there is a real possibility that the pharmaceutical industry, as presently constituted, will come up with an immortality drug in time for her to benefit from it, and reducing the industry’s profit margins will lessen or destroy that prospect. In comparison, nothing else matters at all.

“Rationing” is a proxy for managed care

The actual basis behind the exaggerated and mislabeled fears of reform leading to government “rationing”, is the fact that proposals for reform tend to call for the government payer (the public option, or single payer) to manage the care it pays for in order to reduce costs. Obama, specifically, seems to think that this is a key feature of reform, in that this management of care by the public option payer is seen as the means of making the public option cheaper, and thereby forcing the private insurers to practice the same management of care to drive down their costs, so that their premiums can be competitive with the public option’s.

Yes, it is misleading at best for opponents of reform to throw out the accusation of “rationing” as a reason to be against reform, when what they are actually referring to is the same managed care that the industry practices under the status quo. But this way of formulating the matter sheds light on the why the opponents of reform prefer to call it “rationing” rather than managed care. The industry already does managed care, and its demand management feature is wildly unpopular, especially with its victims, beneficiaries so uncooperative as to generate claims. So industry defenders want to tar the reform proposal with the same brush, by pointing out that the public option will also practice managed care, but they can’t be open about it, because they don’t want to remind people that the status quo already involves the industry practicing managed care. So their faxed talking points have to call it “rationing”.

Dishonest or not, they do have a point about the government practicing managed care, attempting to manage medical care top-down in order to reduce costs. While I think that having a government entity doing the managing for the public good is not as bad as having it done by the industry for profit, I think that the fundamental problem is letting any payer manage medical care. The payer’s role should be just that, to pay for any medical care that the patient requests that is also dictated by the standard of care, a standard of care that should not be defined by the payer.

Leaving the patient in control, letting the patient do all the managing that is allowed to control medical care, will not bankrupt the payer. Medical interventions, mostly, have a high monetary cost only insofar as they carry a high human cost. A bone marrow transplant is in itself so horrendous that no patient will ever want one except the very few with some even more horrendous condition that will benefit from a bone marrow transplant. Patients will manage their care so as to minimize the human costs, and in so doing, will minimize the monetary costs from the bottom up.

We need a single payer in order to kill off the industry that now controls the providers, but we have to structure the way it pays so that this single payer doesn’t simply replace the industry in its control of the providers. The simplest way to do this would be to let the patients control a sizable “continuity bonus” that they can confer or withhold from primary care providers by staying with, or deserting, such providers. Primary care will start working for patients, and the rest of the providers will start working for primary care.

Megan “Freudian Projection” McArdle: “So I’m not sure that this conversation is likely to be productive, since at least one side of it has decided to substitute sarcasm for engagement. “

Megan “Freudian Projection” McArdle: “So I’m not sure that this conversation is likely to be productive, since at least one side of it has decided to substitute sarcasm for engagement. ”

She’s using sarcasm to mean “allocate inherently scarce humor.”

Megan “Freudian Projection” McArdle: “So I’m not sure that this conversation is likely to be productive, since at least one side of it has decided to substitute sarcasm for engagement. ”

She’s using sarcasm to mean “allocate inherently scarce humor.”

And engagement to mean “allocate inherently scarce patience.”

I WILL get the joke right this time. Sheesh.

Megan “Freudian Projection” McArdle: “So I’m not sure that this conversation is likely to be productive, since at least one side of it has decided to substitute sarcasm for engagement.”

She’s using sarcasm to mean “allocate inherently scarce humor.”

And engagement to mean “allocate inherently scarce patience for my bullshit.”

To add to Uncle Kvetch at #24, it really can’t be stressed too often that if you are a conservative, in the broad sense of being someone who is more-or-less happy with the status quo, it is really not necessary most of the time to argue, to advocate for anything, to express any clear opinions, observations or sentiments, or even to think. All you really have to do is piss on anybody who tries to do any of these of these things. The most efficient way for conservative intellectuals to advance their goals in a great many situations is simply to aim make meaingful discussion impossible. And judging by the general level of the current US health care ‘debate’ they have once again been extraordinarily successful.

Also.

For each of these free things, I can easily use your moral arguments to justify them, with your arguments one can never draw the line, one can keep on adding something and claim it as a fundamental human need.

OK. So, what do you see as a fundamental human need? Let me rephrase that question. In your opinion, what is a human being entitled to, by sole virtue of being a fellow human being, regardless of what they do or say?

Salient
The right to be protected from violence from others, the right to private property, the right to free speech, a government defined on its limits not on the free goodies it gives out, a defense force to guard against foreign aggression, the rights of the smallest minority that is possible – the individual.

There I have listed mine, you dare to list yours ?

Albert Jensen at 28: ‘For each of these free things, I can easily use your moral arguments to justify them, with your arguments one can never draw the line, one can keep on adding something and claim it as a fundamental human need.’

There are plenty of arguments distinguishing needs from mere desires, and there’s a large literature on human rights and what they do and don’t cover. John H, so far as I can see, thinks that some things – e.g. basic health care – are human rights, which create communal (not necessarily individual) duties, and that some other things – e.g. elective plastic surgery – aren’t (sorry if I’m misrepresenting you, JH). This isn’t an unusual or undefended position.

So, I don’t see any reason to think that one can ‘keep on adding’ indefinitely. Why do you think so?

(Idle background thought: as it happens, JH already is giving you free education, by writing these posts; but that’s probably supererogatory not obligatory.)

Sam C
One can keep on adding indefinitely, because that is exactly is what is happening ! Those free things I mentioned, care to debunk any of them as not being a fundamental human right ? I can easily find some number that states that because of lack of soap, x number of people are dying, therefore it is the “collective duty” to supply this soap. So please tell me which of those I mentioned do not count as the fundamental need, I will quickly use your arguments to show that they are !

There I have listed mine, you dare to list yours ?

Eh, you must not know me very well. That’s okay. I’ve done this before on this site, but sure, here we go.

A human being is entitled to a life that is free of suffering induced by material deprivation.

That requires a couple definitions. In particular, “deprivation” is defined time-dependently as that which mean-averages as positive over the human population of binary answers to, “True or false. If X did not exist and was therefore unavailable to you, you would inevitably suffer as a result.” (Roughly, if more than half the human population answers yes for some well-defined material good or well-defined category of material goods X, then lack of that X is defined to be material deprivation; we can assume honesty in the answers because we’re assuming rationality, etc, etc.)

From this, approximately what I mean by “suffering” should be obvious.

What I’m discovering is, this is both a very weak condition (because it doesn’t take into account rights to non-material things like education) and a very strong condition (because not much value is assigned to the “right” of owning lots of wealth). So don’t hold me to it for the rest of my life. But for now, there you go.

I can easily find some number that states that because of lack of soap, x number of people are dying

Really? Please, do so.

Yes they have the right to be fed, next stupid question please.

No, not next stupid question. To answer the question, you have to explain how by your list of rights alone, we can see a human baby has the right to be fed. A logical-deduction argument, please. Otherwise, you forgot to list an important right!

next stupid question please

Here it is then: So an infant has a right to be kept alive by being fed, but an adult does not have a right to be kept alive by having her infected appendix removed. Wherein lies the difference?

The material deprivation can imply basically anything, including my free soap argument … do we need material deprivation committees that decide on it ?

cf.

The right to personal property can imply basically anything, including the right to keep slaves, prisoners, .. Do we need rights committees that decide on it?

(Hint: yes, we do. We call it ‘the legal system’.)

John Holbo
You clearly do not think to highly of humans, if you think they need to be told by philosophers that they have to feed their baby ??? To stay on topic, does the surgeon have the moral duty to offer free care to your mother, it is a very simple question ?

If you want to know where the most babies have been starved in the real world, I suggest you look at those countries that were attempting the “common good” idea.

(I note that roac has offered you a very nice example of just such an addition.)

Albert Jensen: ‘It is very easy to distinguish, you have no right for me to pay for someone elses health costs.’

That’s not a way to distinguish, that’s just a reassertion of the very distinction I’m asking about. What is the principle on which you make this and other, similar distinctions? Because if you don’t have one, you’re just dogmatically committed to your particular favoured list of rights, and your argument against John Holbo’s different list fails.

Slavery implies violent force, it violates all libertarian principles

Using violent force to defend one’s property violates all libertarian principles?

Excuse me, delete the ‘someone’ in the first sentence.

Sam C
The difference is 1 )physical force unto me versus 2) me paying for someone to go to the doctor . Me not paying for some else to do go to the doctor is not me forcefully violating him in any way, if you cannot see the difference between the two, then I cannot help you.

You are no less dogmatic in demanding free health care, except you claim it as being undogmatic of course, unless you want to openly declare in front of everyone that perhaps you are not for free health care.

Engels, libertarians have a highly technical definition of “violent force,” as you will no doubt learn shortly.

By way of full disclosure, I was once a libertarian myself, though I didn’t know the name for it. I was converted to libertarianism by a science fiction story — I don’t remember the title, but Eric Frank Russell was the name of the author. Nor do I remember how old I was — say about 13 — nor how long elapsed between the time when I said to myself “This explains everything!” and the time when I said “Oh, wait, no it doesn’t” — say about 48 hours.

Fortunately I kept the whole episode to myself from that day to this. But I find it useful to keep in mind.

Albert, I haven’t demanded anything about health care, and I’m not going to. I’m a philosopher interested in human rights, and you’ve made some claims about such rights which I think are problematic.

You have at least now offered some kind of grounding principle for your list of real human rights: they’re all rights not to be subject to ‘physical force’. OK, that’s a familiar position. The equally familiar problem with it is: there are all sorts of things people can do, or fail to do, to one another, which are as bad as exerting physical force. People can die just as painfully from lack of oral rehydration salts as from gunshot wounds. So what’s so special about physical force?

So what’s so special about physical force?

Libertarians will never be numerous enough to raise an army.

roac
There body is sovereign, to violate it for the “collective good” is violent force. Is that too technical for you ? The altruists and the “moral guides” of society their definitions are will take pages of heavy impenetrable philosophical jargon, to basically mask “the sacrifice on the individual for the good of the whole”. The same ilk that in the 1930’s “saw the future and it works” are basically here moralising from their ivory towers. The only solace is that all these ivory towers are crashing down, I will never hire an American student again, they have been tarred with too much of this “common good” brush, many Indians and Chinese are thankfully not afflicated with the Soviet style thinking anymore.

Bunbury
Many sub saharan countries have deaths due to lack of basic hygiene, a fact that if you had the most rudimentary understanding of the death rates of the pre hygiene world should know, you had better start sending those billions soaps.

Most Americans I know are hard-shelled Marxists. It’s True!

You can tell when they wear their iPods just so.

Albert, just out of interest what do you hire all these international students for anyway?

@Albert Jensen

That “aging demographic”

Well, in the US, we already have the aging demographic on a public option/single payer, Medicare. Sure, the Medicare-aged present a cost problem if they are a growing demographic compared to the demographics still working, who therefore have to be relied on to do most of the paying. But the public has already eaten that potential problem, we’ve already socialized that risk so that those Heroes of Libertarianism in the health insurance industry can ply their trade on the lower risk younger population, unencumbered with the responsibility of caring for the elderly.

What’s under discussion now is not how we pay for the care of the elderly in the US. That’s a cash loser, so no one wants to take it from the government. We’re trying to sort out who controls the health care contributions from the positive-cash-flow demographic, the young. Based on prior experience, the smart money says that we will find a way to continue, and even enhance, socialization of the risks and privatization of the profits.

Oh, fuck. A sincere libertarian. Less fun than even McMegan.

Libertarians are worse than Hitler. I declare this thread closed.

It just shows that George W. Bush had one distinct capability: to make doctrinaire libertarians look less insufferably tedious than they really are.

I have a great idea. If I could form a company to market my product, I think I’ll make a lot, even after paying off any venture capitalists. But I am having difficulty finding one to lend me money. I don’t have a problem with the interest rate, but they want collateral.

I’ve found one venture capitalist, though, with whom I can come to a mutual agreement. He’ll lend me capital if I agree to be his slave-for-life after a designated date if I haven’t paid him back by then.

Why does the supposed “libertarian” on this thread want to use force provided by the state to prohibit capitalist relations between mutually consenting adults?

I think for us here it is all about rationing. Realizing there are finite resources, and deciding who is going to get them: the most in need (i.e the sickest) or the most able to pay (i.e. the richest).

Why should we be scared of the r-word? If we called it like it is it would be easier to frame the problem in terms of ethics and society’s well-being, which should be the topics under discussion.

Because it isn’t rationing. To compare to food for example: in WWII (and for years after) Britain had rationing of many types of food – black market aside, if you didn’t have a ration book with a spare slot available you couldn’t get any more of that type of food.

In the US currently you have food stamps, so that in general a minimum level of nutrition should be guaranteed no matter how poor you are. I don’t think any reasonable person is going to argue that food in the US is currently rationed.

There are no mainstream proposals for US healthcare I have heard about that would go any further than the food stamps example, and most aren’t even in that ballpark even. While you can make arguments that the Canadian system is essentially rationed (with travelling to the US for private healthcare being the equivalent to the food black market), it seems unlikely anyone (with political power) is going to suggest the Canadian model or anything remotely like it in the US at this time.

He’ll lend me capital if I agree to be his slave-for-life after a designated date if I haven’t paid him back by then..

Change “be his slave for life” to “donate my heart for transplantation into his ailing relative,” and you get a 16th-century example of flagrant State interference with the sacred right of contract — The Merchant of Venice.

If you eliminate the distraction created by the anti-Semitism, the play would be an excellent litmus test to separate the true libertarians (the ones rooting for Shylock) from the wishy-washy ones.

McArdle’s argument is confused long several angles! For another: she quotes Hayek on the functions of the price mechanism, not realizing that his argument applies to supply and demand over an ENTIRE system, and does not invalidate the making of one portion of it into some other sort of rationing mechanism. So even with a totally nationalized healthcare system, outside of it the private suppliers of goods to it would still exist, and be innovating according to its demand.

Indeed there would be MORE demand, because more people would be in the system.

Of course in the U.S. reform debate, a national healthcare system is not on the table: merely a public insurance choice for consumers in the market. Here, her argument appears to jump to the position that this would crowd-out, and put an end to, private insurance. But by the Congressional bills being offered it would not, and she offers no theoretical or empirical argument that it would.

This makes it difficult to accept her implication that one’s own philosophical opinion on a policy issue should make reference to particulars. In fact, she appears to be making the general “slippery slope to communism” argument again, vacillating as usual between the liberty and efficiency aspects of that old chestnut. Unfortunately for her, The Road to Serfdom never came true in a democracy, and by the way, Hayek was in favor of national health insurance.

In a single payer system you can purchase additional health care but to some degree you are very much stuck within the system provided by the govt. You really are stuck living in the house they provide. Repurchasing such an expensive item is effectively impossible.

So given that the NHS is a single payer system, you are saying that BUPA, Aviva, Standard Life, etc. don’t exist? Seeing as their coverage must be so expensive no one would consider buying it?

Given that. I am not sure why it isn’t permissible to say but a single payer system will/might result in X and so lets not support this proposal. The slope might not be that slippery. But hey lets at least talk about it.

Well, given that my government isn’t proposing a single payer plan, and given that whatever reforms (if any) that are passed are going to seriously change my relationship with healthcare, I’d really rather spend my time talking about what’s actually on the table. It really does seem that reform opponents want to focus on single payer because they feel that it’s a debate that’s easier for them to win.

“Right, she doesnt want poor people to die, but apperently her level of indifference is high enough to let them die if it would cost a penny to save them.”

This seems a common misreading of her post, which is mysterious since she explictly says:

“If it were up to me, I’d combine a broad income subsidy like the EITC with some sort of reinsurance pool for high-risk patients, then I’d probably force everyone to buy some sort of catastrophic medical coverage on the grounds that otherwise, people with adequate income but few assets will be too tempted to freeload off the generosity of the public. “

The right to be protected from violence from others

Some nerve. Why should I pay for your protection from violence? If you need protection, hire your own bodyguards, mister.

The doctors get paid, because people are forcefully(yes they have to) taxed to pay that free health care.

I have never experienced being forced to pay taxes, for any meaningful sense of the word ‘forced’. I freely give my consent to being taxed. The fact that, if I were to withhold consent, my compliance might ultimately be coerced by MEN WITH GUNS means very little to me; apart from anything else, any regime which was so illegitimate that I would want to withhold my taxes would probably have MEN WITH GUNS coercing the citizenry in any number of ways. And this last-instance possibility of coercion certainly doesn’t suggest that my situation actually is one of coercion (“objective” coercion, perhaps). Do Libertarians have a theory of false consciousness to deal with people like me?

“Maybe that is great since it is a swell house and more people would have housing but lots of people would be stuck.”

And under the current system, those people are also stuck–they are stuck *without* access to adequate healthcare.

Though I suspect Albert Jensen will not trouble to read it, let me recommend Allan Gibbard’s “Natural Property Rights” to anyone interested in libertarian principles, property rights, social welfare, etc. Therein Gibbard argues that the hard libertarian position that nobody can be deprived of a property right without their consent in fact fails to justify unencumbered property rights—so that even hard libertariansim plausibly supports a fairly robust social welfare system.

I just checked this out, and from the looks of it what Gibbard calls “hard libertarianism” is not a view that any libertarians actually hold. He seems to assume without argument that the world is somehow jointly owned by everyone, whereas libertarians usually believe (quite reasonably, I think) that this is not necessarily so, and that the default status of the world is unowned. So if he is trying to derive the legitimacy of the welfare state from principles that actual libertarians would accept, he fails because we do not accept the principle he mentions, and if he thinks that the principle he mentions is superior to the alternative that libertarians actually hold, he owes us an argument (which is lacking in the paper) to this effect.

(A single payer system is not currently even being considered by the government – at least in the US. So what it will and won’t lead to is irrelevant.)

Isn’t the problem that a Public Option is still on the table, and that means that because the government is so much better at providing healthcare than private corporations (one side arguing the issue would never admit it of course, but the evidence around the rest of the world makes it fairly clear this is the case), that amounts to something that will approach a single payer system in the long run anyway, as the superior government system will marginalise private health care to those for whom price/cost effectiveness is an irrelevant consideration.

Stuart,

Is Medicaid superior to private insurance?

Someguy,

I’ll say this – Coburn’s plan is an improvement over the status quo. A national exchange goes a long way towards solving the problem of affordability. Pooling, properly regulated, is a great idea. I’d rather see risk-adjustment overseen by a government agency that is responsive to voters, but that cuz I’m a liberal. A tax credit is a by and large fine way to subsidize costs. I’ve got no problem with throwing in tort reform to keep doctors happy. All in all it’s workable, but I don’t think it provides quite the same level of good outcomes as the Democratic plans on the table. From what I understand this does not differ too significantly from Democratic plans that do not contain the public option, but maybe you can enlighten me on that score.

The fundamental factual premise of McArdle’s argument is false.

http://www.prospect.org/csnc/blogs/tapped_archive?month=09&year=2009&base_name=the_atlantics_mcardle_problem

She ridicules Holbo for not dealing with the world as it is, and then she constructs her entire argument around the world in her own head.

It’s not worth arguing with her. It’s not just that she argues in bad faith. It’s that she doesn’t understand what a good faith argument looks like.

In the US currently you have food stamps, so that in general a minimum level of nutrition should be guaranteed no matter how poor you are. I don’t think any reasonable person is going to argue that food in the US is currently rationed.

Oh yeah? Good luck taking $50,000,000 out of a bank and spending it all on Goldenberg’s Peanut Chews, even at market rates. Some people will be unable to get what they want.

Why did she say “80-90%”? Her point would have been more convincing if it was 100%. See, this is why Republicans never win arguments, they’re too timid.

On the libertarian principle that the fruits of coercion and theft are tainted, there’s basically no clearly legitimate private property anywhere in the world. In the US, for instance, we did in fact have Woodrow Wilson, state governments dominated by the KKK, internment and theft of the interned people’s goods in both world wars, sundown towns, restrictive covenants imposed in law, and a whole lot more. It is certainly possible for someone to do the research and establish that their real estate and the things on it do not depend on ever having displaced someone coercively or fraudulently, but it’s hard to do, and in practice it’s much more common to assert “my stuff” than show it.

(Libertarian philosophical discussion of the fruits of theft and force don’t get into statutes of limitation, and I remember David Friedman being equivocal about whether he thought they were actually a good idea for acts that would count as violations of rights libertarians recognize. But I’m not trying to be sophistic about this and definitely not insisting that statutes of limitation are anti-libertarian or anything. I note it as a point of vaguery, at most.)

How many libertarians can show, rather than simply assert, that no significant part of what they are pleased to call “mine” depends on the violent and/or fraudulent taking of others’ labor and goods?

Without a eugenic trim and a subsequent maintenance program of population stabilization, our health care is good enough, technically, to keep lots and lots of us going, at resource consumption levels that are already past terminal.
Most of the anti-reform side on this issue really want a eugenic program, to take control of that runaway train.
Most of them are fine with lots of people dying as long as it happens outside their clads and affinity groups. But overt championing of that direction is socially prohibited, and has dangerous public consequences in reaction. So it gets masked as harsh but necessary policy and ethical toughness. And regrettable loss at the lower edge.
It isn’t.
It’s a softly held, invisibly present desire for a eugenic solution to the nightmare chaos of modern civilization’s mindless consumption of everything.
And it’s creepy and evil.

Also, thank you to Sam C: I am currently in the “trying to read enough fundamental philosophy of ethics to ensure the basic idea is not absurdly incompatible with reasonable systems” phase of self-development, and will take a look at Wiggins’ book.

You have to be personally interviewed by a heavily overworked case-worker who in worst-case scenarios can’t see you for weeks if not months, etc. There are emergency provisions for emergency situations, allegedly, but even if you technically ought to qualify the burden of proof is on you and is quite stringent. Additionally, you’re required to take basically any job offered at any legal wage, which apparently means minimum wage for work that everyone else is getting paid $8 or more to do.

yeah, but at least there’s no rationing. If the government bought everyone an ice-cream (and thus created a distribution of ice-creams different from what the free market outcome would be), then it would be rationing ice creams.

Would it be more palatable if she expressed ( in not so many words) that her general opposition to national health care (but not all alternatives to the status quo) was a clinical observation, made in a professional capacity, that the probability of increased ‘bad’ outcomes was notable enough to disseminate among your audience an imperfect exposition of your analysis? Some of the comments here seem to be imputing a Glenn Beckian disjunction between rational thought and flights of ideological fancy in McArdle’s mind but, for such long-tail problems, neither party will realize the gains/losses from a potential change for quite a few years. Longitudinal studies (some running right now) will be crucial in assessing whether or not people experience the better health outcomes that all politicians/pundits/bloggers promise. Causation cannot be determined until the data is gathered.

Btw, ever heard of non assitance of a person in danger?

Ah wait, right you have a legal obligation to help people…. )-:. Damn socialist countries.

someguy, you said:
In a single payer system you can purchase additional health care but to some degree you are very much stuck within the system provided by the govt. You really are stuck living in the house they provide. Repurchasing such an expensive item is effectively impossible.

Umm, right now I’m stuck living in the health-care house my employer provides. It’s not a terribly good health care plan — it does not cover any preventative care or maintenance/follow-up care, and the coinsurance for even non-catastrophic care is prohibitively expensive — but I don’t have much of a choice. I am very much stuck within the system provided by my employer.

I’d much rather extend Medicare for all, but really, “stuck within the system provided by the government” is moderately better than “stuck within the system provided by my employer” …if only because the government has greater power to negotiate a good deal.

The government cannot conduct health reaseach, of course, such as this report, which will probably save a lot of you guys from your melanomas in 10-15 years

http://www.rdmag.com/Life-Sciences-Study-reveals-genetic-culprit-in-deadly-skin-cancer/

I haven’t read the thread (sorry). I’m sure it has been pointed out several times up thread that the US federal government already spends a huge amount of money on medical R&D via the National Institutes of Health (about 85% of the money goes to investigator initiated peer reviewed grants). I believe this is a similar quantity to total R&D spending by US based pharmaceutical companies.

Also I wonder if McArdle is aware that PhrMa (the big pharmaceutical company trade association) is running advertisements in support of health care reform. Odd if it would be so horrible for them.

It’s the lack of innovation that scares me, imagine the sorry state of aeronautics if the government squeezed out the private militias? While the invisible hand may have identified polio as market, without the kind of cost-plus contracts only a government can provide, innovation would have stopped at outsourcing the manufacture of braces & iron lungs. Without medicare, it would be all viagra, allergies and restless leg syndrome. Instead of smart prosthetic limbs we’d be seeing all-terrain rascals.

(accidentally posted in old thread)

I missed out on part of the previous thread on this, but hopefully the participants are still around,

Dan,

Yes, some Libertarians do attack limited liability ( although the Russell Long article you linked to just had a footnote stating LL was controversial among Libertarians, and then stipulating it as legitimate. It mostly is arguing that government is intrinsically responsible for the existence of big business, a completely different argument). They do not, however, from what I have seen, follow through with the consequences of that position. Limited liability is why the corporation exists. Without it, there is no corporation as we know it. There is no stock market. No ability to raise huge quantities of anonymous capital well beyond what a small group of owners could manage on their own. Vastly reduced liquidity. In short, no modern Capitalism. Without this huge mobilization of capital and the research and technology, as well as economies of scale, that can come from it (especially if you exclude the government from mobilizing capital or doing research as Libertarians are wont), most of the benefits of modern Capitalism would not be possible.

Yet Libertarians claim the successes of actually existing Capitalism as successes of their philosophy. Calls for cuts in regulation or taxes imposed on corporations seem never to mention that the corporation should be abolished. The limited liability position seems dragged out only to explain what Libertarians would advocate in place of regulation in cases where regulation seems necessary – in the wake of Exxon Valdez, or the recent financial debacle. But at no other time do Libertarians seem to suggest that Exxon and Citigroup have no right to exist; instead their interests seem to loom rather large as aspects of “liberty”.

Many of us on the Left accept limited liability for its practical advantages, but recognize that corporations, being not fully responsible entities (liability is just a legally-enforceable form of responsibility) are not entitled to full rights either. Therefore, we are untroubled by restrictions on corporations that are not legitimate to impose on individuals. Others reject limited liability, while embracing the logical consequences: opposition to the corporation as such, which is manifest in opposition to public recognition of the legitimacy of “corporate interests”. Both of these are more consistent than the Libertarian position.

Ugh. It’s especially galling that healthcare discussions get plunged into the moderation pit because ‘spec!@list’ in its proper form contains ‘c!alis’.

Isn’t this enough on McArdle or whatever she’s called? I mean: you’re preaching to the choir (it appears that even David has given up his mock-defense), repeating yourselves and there’s very good stuff on the rest of this site.

I know it’s a very therapeutical thing to do but as long as you do it McArdle will respond, this is getting her the attention she desires & makes her a little bit of a martyr for the cause (& even the libertarians like their martyrs, I guess).

Or, well, carry on!

Incidentally, is there an academically respectable version of the Libertarian “taxation = coercion (in the last instance) by MEN WITH GUNS” argument? Ted’s version of it seemed silly, but it had the look of an nth-generation photocopy of a stronger argument. Who’s the Libertarian Rawls?

Phil: Probably Jan Narveson.

GSK: UK
AstraZeneca: UK/Sweden
Sanofi-Aventis: France
Roche: Switzerland
More medium-sized pharma firms than I care to list: Germany

It doesn’t seem to be happening in practice, does it? But then, the ‘totherside’s position is roughly “it works in practice, but does it work in theory?”

Phil,

Nozick is probably the man you are looking for, but this paper by Ed Feser (and I’d just like to point out that no, I do not endorse everything he says) is IMHO a pretty good reconstruction and development of the argument: http://www.independent.org/pdf/tir/tir_05_2_feser.pdf

Dan S. – sure, there are such intuitions. But, even assuming that intuitions are authoritative: (1) actually-existing morality is a lot more complex than that, and it importantly also includes a capacity for empathy which can be cultivated (gestures in the direction of the great naturalistic moral philosophers – Smith, Hume, Mill – on whose shoulders Hauser is standing). (2) Intuitions against direct, personal, etc. physical action don’t apparently apply to tax demands. And (3) Albert Jensen wasn’t claming just that physical force is bad, he was claiming that it’s the only bad thing, and therefore that it’s completely impermissible to ‘force’ him (through taxation) to save someone else from a painful death, even if the cost is no more than getting his shoes dirty. This view strikes me as… implausible (or perhaps I mean ‘vile’). What I was trying to do was show AJ that the good reasons for resisting violence are also good reasons for resisting disease.

Salient,

Why not give people a choice? The govt can sell SCHIP or Medicare or whatever coverage they like at the cost person of the program. We can provide whatever redistribution is needed in the form of vouchers or tax xredits or debit cards or whatever. The same rules would apply to public and private. Wouldn’t that be the best way?

Why wasn’t say SCHIP set up that way?

Have you considered the possibility of switching employeers? I think most folks would find that a bit easier than say switching nationalities.

Who said I wanted to switch nationalities? That makes no sense. Are you saying that by advocating for a public health care option, I am becoming un-American? It’s a strange comment.

Why not give people a choice?

Because healthy people tend not to “choose” insurance until after they get sick. Basically, people want health care as a right, not health insurance vs. catastrophe. If we really insist on this stupid insurance-based system for paying for health care, then we probably have to write some correspondingly stupid rules that require people to sign up before they fall ill. Frankly, I’d rather just have health care coverage for all — Medicare for all.

Also, what choice? Health care is not the kind of thing one chooses. One should never have to choose between treating a gall bladder infection and treating these weird sores appearing on one’s forearm, or even have to choose between buying a semester’s textbooks and having one’s impacted wisdom teeth removed. One might reasonably have to choose between buying an LCD TV and buying materials to build a deck out behind the house.

And as an aside, the idea that one can “choose one’s doctor” or “choose one’s hospital” is utterly alien to me. I’ve never had a “choice” in my life for which doctor to see, any more than my students really had much “choice” in me as an instructor (what are they going to do, delay their own graduation until I teach something else? Some choice.)

Doctors of a given specialty, like most service providers, are basically fungible, in that they are all nearly equally capable of providing the same thing, and are all trying to provide the same thing: treatment. I’ve never known anyone who got to meet with a committee of doctors as if on interview, and “choose” their favorite to serve them. I’ve never even known anyone who actually goes through the list of treatment providers the company hands you and googles each doctor’s name to see which one is “best” — seriously, does nobody else run into the situation where every doctor on the list can’t see patients until April 2011, so you pick the one doctor who can see you this year? Really?

Of course, I’ve never understood the idea of having a “primary care physician” either — I suspect that most folks my age don’t comprehend this quickly-becoming-antiquated idea, by the way. You make an appointment to go to the clinic, whoever is on duty will be your physician that day. They check your charts, ask what’s up. I gather that some folks used to just go in to their primary care doctor twice a year, just because?

Personally, I find the idea that we should hold as our highest priority “choice” in health care to be appalling:

Choice, sense 1. You choose to get, or not get, care. (Those without enough money are forced to choose no.)
Choice, sense 2. You choose who provides care to you. (This inevitably comes at the expense of lots of people not getting any care at all.)

Both bother me. Of course, if we could accomplish choice sense 2 without the expense of preventing people from getting any non-emergency health care at all, I’d be happiest with that. But full access to the public good of health care comes first.

Also.

Why wasn’t say SCHIP set up that way?

Because kids usually don’t have jobs.

I hope that question was sarcastic. The idea that kids should have to pay for their health care is just unbelievable. (And of course, kids can’t be held responsible for what their parents do or don’t do, so you can’t just say the parents pay for it — the whole point of SCHIP was to provide health care to kids whose parents cannot afford it.)

Also, for the record, my sister (who lost her job and has been struggling to find similarly-paying employment) is “on” SCHIP (for her daughter / my niece) and so defending the appropriateness of the program is quite personal for me. It’s basically the only reason my niece has a decent, low-pain, happyish life at age 5.

So please, no callousness about how my sister should have foreseen she would be laid off years later and should have aborted my niece, or should have never started a family with her husband without such foresight, or whatever. (Yes, I get such comments all the time, as does she. Please don’t add to them.)

Salient,

You said,

“Umm, right now I’m stuck living in the health-care house my employer provides. It’s not a terribly good health care plan—it does not cover any preventative care or maintenance/follow-up care, and the coinsurance for even non-catastrophic care is prohibitively expensive—but I don’t have much of a choice. I am very much stuck within the system provided by my employer.”

Why not switch jobs? You really aren’t that stuck you can switch jobs.

But with a national health care system the only way to switch health care plans is to switch nationalities.

“Because healthy people tend not to “choose” insurance until after they get sick. Basically, people want health care as a right, not health insurance vs. catastrophe. If we really insist on this stupid insurance-based system for paying for health care, then we probably have to write some correspondingly stupid rules that require people to sign up before they fall ill. Frankly, I’d rather just have health care coverage for all—Medicare for all.”

“Choice, sense 1. You choose to get, or not get, care. (Those without enough money are forced to choose no.)
Choice, sense 2. You choose who provides care to you. (This inevitably comes at the expense of lots of people not getting any care at all.)

Both bother me. Of course, if we could accomplish choice sense 2 without the expense of preventing people from getting any non-emergency health care at all, I’d be happiest with that. But full access to the public good of health care comes first.”

Surely vouchers can fix both problems and people can still choose. Folks are unlikely to throw a 5K voucher in the garbage.

the idea that one can “choose one’s doctor” or “choose one’s hospital” is utterly alien to me

Amen to that. They’ve been trying to push this bright shiny idea over here for about the last decade, and it doesn’t make any more sense now than it did to begin with. (“Do you want the good doctor or the lousy one?” isn’t a choice. “Do you want to be treated now by a lousy doctor or in three months by a good one?” is a choice, but not one people should have to make – let alone one that should be designed into a system.)

Albert Jensen seems to have left the building, but at the risk of calling him back:

His (main) problem is that — mercifully — he misunderstands how any doctor would act in a situation where he or she was capable of providing help to someone who needed it. If someone walks into an emergency room with an appendix about to burst, that appendix is going to be taken out, whether Albert Jensen likes it or not. If the patient can’t pay, the appendix is still coming out. At that point, somebody is paying for it. I’m not stupid enough to claim any special knowledge about an incredibly complicated issue, but this is the crux of the health-care debate as far as I can see, on the practical rather than philosophical level: Given that emergencies are going to require our resources anyway, and that more neglect leads to more emergencies, what’s the most affordable and efficient way around the problem?

Salient,

“Hmm. Ok, so the idea is, provide vouchers and debit cards to the kids so they can go buy health care. Single-payer sounds simpler and easier to manage. A public option sounds simpler and easier to manage.”

A voucher program does not need to be complicated. Social Security is a pretty efficient program. A check in the mail. A voucher program could work the same way. A voucher in the mail.

Who gives a shit about “building a customer market this exchange that”? All very minor. Until universal coverage achieved, the jargon buzzword bingo is a distraction. That’s why it exists.

I see we have one of the Voucher People here…

I’ve never known anyone who got to meet with a committee of doctors as if on interview, and “choose” their favorite to serve them.

I think you miss the subtext here: “choosing a doctor” actually means “choosing the kind of patients you want to share a waiting room with” and “choosing a hospital” means “choosing the kind of people you want in the rooms on either side”.

The tacit segregation of healthcare in the US really needs to be seen to be believed.

Why not switch jobs? You really aren’t that stuck you can switch jobs.

Right, you can always change jobs. And your new job may or may not offer a better health plan. And if it turns out that it doesn’t–well, change jobs again. It’s not like there’s a shortage of jobs out there.

Right, you can always change jobs. And your new job may or may not offer a better health plan. And if it turns out that it doesn’t—well, change jobs again. It’s not like there’s a shortage of jobs out there.

And since one health care company provides the same services to all employers in this state, changing jobs literally would leave me with the same plan. I mean, if we informally consider State of residence to be one’s nationality, I literally do have to change “nationality” and move to a different state where there is some actual availability of alternatives.

You have claimed that she is indifferent to the poor though. “Philosophically, there just isn’t a case to be made against reform unless it’s this simple one: if you don’t have any money, you shouldn’t be entitled to any medicine. McArdle is very indignant when people accuse her of indifference to the fate of the poor, but – honestly – if it isn’t that, then it’s nothing. At the philosophical level.” This is an insulting statement, and it’s wrong, in ways that should be obvious to you. You should not be surprised that she was upset by it. You have misidentified the conclusion, that an entitlement to medicine is wrong, with an argument, and then proceeded to claim that non-argument is the only one that can be made. Hell, rich people aren’t entitled to medicine either, but they have greater ability to pay, so you aren’t even stating the conclusion in any sort of accurate sense.

It is possible, even likely, for someone to care about the fates of poor people, but to nonetheless be philosophically opposed to entitlement programs in general, or to some particular type of program, or to specific programs. Enslaving doctors for example (over the top to illustrate the point) would be an unethical solution. Going more general, many utilitarian libertarians think most entitlements are counter productive in the long term. Nothing about that line of thought indicates indifference.

dsquared,

Yea if you enough extra money lying around that you can afford to buy 2 health care plans for everyone in your family.

Salient,

“And since one health care company provides the same services to all employers in this state, changing jobs literally would leave me with the same plan. I mean, if we informally consider State of residence to be one’s nationality, I literally do have to change “nationality” and move to a different state where there is some actual availability of alternatives.”

You have only one health insurance provider and every business uses that one provider in your state and that they only provide one insurance option?

I find that very hard to believe. What state do you live in?

Also, again just to be clear, I want tax dollars to provide adequate health care for everyone. We are just talking about the best way of providing that care.

If any health care system is to work in terms of care delivery and containment of costs, and I would argue that so far no system has done this, the individual must be responsible for the maintenence of their own health. This means following the simple rules of a healthy diet, exercise, and stopping smoking, as well as being prepared to use the simple home remedies that are effective for minor problems.

Also, NO GOING OUTSIDE.

Salient,

Regulations and competition seems to work pretty well for the auto insurance market.

Sam C. – oh, I agree. I was just a) wandering off topic b) assuming everyone would somehow know I see as that as a flaw/incompleteness in our (possible) moral intuitions & c) figuring that any engagement with Jensen was pointless and that this was much shinier/interesting.

scarn,

“Ceri B.,

If what you think is true you should have no objection to vouchers. Any govt plan will on it’s own out perform the priovate plans and we will be left with just the govt plan.”

you = If what Ceri B thinks is true.

I don’t think that at all. I don’t think a govt plan is even needed. I don’t think a govt plan could compete. But I am more than happy to give it try depending on how it is implemented. I am sure hard core public choice folks are sadly shaking their heads at my stupidity but I don’t mind all that much.

someguy, if by “you = If what Ceri B thinks is true.” you mean I should also have no objection to vouchers, well, I really don’t have any strong objection to vouchers. I think I misread your earlier comment to Ceri B to read that any public plan would outperform all other private plans on the market, something which I think is unlikely.

Ceri B. ,

Sorry about your health.

On para 2 –

I think if we hand people a voucher they can pretty much handle it on their own. Especially since there would be some kind of regulatory body. We could default to a plan or set of plans. IE I get a voucher in the mail. I throw it out. The default is I am enrolled in the govt plan. Any difference can come out of my taxes.

On para 3 –

You have it completely backwards. Look at education. Dear heavens a few tiny programs hand out a voucher that is 60% of the public voucher[implied]. Private school enrolle parents are happier, you get at least the same educational results, it costs 60% less, and the competition might improve public school performance. The public sector fights tooth and claw to take that away from the few low income families that qualify.

You really have very little to worry about look at Medicare or SS.

I find that very hard to believe. What state do you live in?

It’s an exaggeration to say that one insurer has the entire state in its, though living in one of the ten states where BCBS has over 70% of the market (and its nearest competitor making up most of the rest) probably makes it feel that way.

But “oh, just switch jobs!” is no more than an exhortation to dine on brioche in best Megan Antoinette fashion.

We’ll get to the shortages in a minute. But first, assuming McArdle is right about the r&d shortfall, I would prescribe: r&d. The government should fund it (if, ex hypothesi, no private party will).

Granted, academia is better at putting information into the public domain ( a public good. ) But outside of that it seems that this scenario you propose involves (assuming an R&D shortfall occurrs) removing an effective method for bringing drugs to market and replacing it with a likely more costly one. There’s a reason medical treatment rates are so much better in the US than in Europe. In other words, we’d be taking something out of the hands of private developers only to bring it back at, likely greater, public expense. That sounds like failure.

zic – And on the other end of the process, safety is evaluated by FDA. Government investments straddles both ends of the r&d process.

Granted, the NIH is one of the best run government agencies and has done some good work.
But the FDA is more of a barrier than a helpful party. Kindof like how you and the police officer
cooperate at driving; You drive, and he gives you speeding tickets if you go too fast. He’s certainly not
helping you plan your route or paying for gas.

Anyone who really believes reform will strangle innovation ought to pay more attention to our education system, the real feeder for new, improved, and innovative

You’ve just recapitulated what Megan said, then asserted she’s denying it. Her argument was; academia helps develop new targets, but
private enterprise plays a big role in bringing drugs to market. Which dovetails with her point that without market reimbursement, you’ll have less drugs brought to market.

Salient –“I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.”—from the Hippocratic Oath

There’s nothing in that quote that supports your point. If you can give some citation of some ancient text describing how the Hippocratic oath, specifically, compelled a physician to give treatment I’ll reconsider my belief that you’ve invented this obligation out of whole cloth.

medical treatment rates are . . . much better in the US than in Europe

What does this mean, and where is the evidence for it?

Salient -“I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.”—from the Hippocratic Oath

There’s nothing in that quote that supports your point.

Umm. They used different words for “provide medical care to” than you or I would, of course. I know that “apply dietic measures” is not, like, common parlance, but neither is it completely incomprehensible as translating to “provide medical care to” (the “diet” they’re talking about includes medicines intended to treat illness).

Unless you think they were preoccupied with weight loss plans in the 18th century?

If it helps, an alternate translation is: I will prescribe regimens for the good of my patients according to my ability and my judgment.

A modern version, which is also pretty clear, is here.

If soc*alism gives you and erection lasting more than four hours, see your physician.

(You wish! Never happens. But dream on.)

Dead thread, but I’ve never seen why all the cost of innovation (granting McMegan all her fake facts) should be dumped on American citizens while the citizens of other more democratic countries get cheaper drugs.

I also don’t think that American citizens should be the mule of globalization or cannon fodder for the new world order either. Let the rest of the world pull their share of the load.

It’s sort of odd to see McMegan pushing that kind of Peter-Singer-ish internationalist consequentialist altruism, which goes entirely against various of the dimestore principles that she wants us to believe that she holds dear.

Nick S,

Good link. I am pretty sure market concentration doesn’t = no competition but good link. Has some persuasive power. Thanks.

Anyway, exchanges and/or allowing individuals and companies to purchase insurance across state lines very directly addresses such situations.

Even accepting this or that market failure doesn’t mean the solution = nationalization = best.

Is anybody still out there? I’m going back to dsquared’s nugget in #132 (an actual fact that got lost and strayed into the dorm) that Glaxo doesn’t actually find the USA more profitable than its other (evil socialist) markets.

Hypotheses:
1. Evil healthcare socialism reduces distribution costs. Nah, these are chickenfeed.
2. USA has very high regulatory and admin costs. Nah, ditto.
3. EHCS constraints marketing expenditure for all participants. What’s the point of flying the board of the Rochdale Primary Health Care Trust to Cancun? They aren’t allowed to take such perks, and take their pharmaceutical decisions from NICE. To the extent that drug marketing is a zero-sum arms race, all the corporations benefit if it’s forcibly cut back. Bribing NICE would be cost-effective but it’s horribly risky : high risk of failure, discovery and even jail.
Any 4?

Yea if you enough extra money lying around that you can afford to buy 2 health care plans for everyone in your family.

It costs less to both get private health care and pay your taxes in Britain, than it costs to get only private health care in America.

‘You mean like life insurance?’

Life insurance has benefits that are defined at the time of purchase, not left ultimately to the discretion of someone on a profit-oriented bonus scheme in 40 years time. So it’s more like buying a TV than it is buying health insurance.

If life insurance worked comparably to health insurance, it would be defined as ‘we’ll give your children and loved ones sufficient money to complete their education and overcome any difficulties they may suffer in consequence of you not being there for them’. Where each word in the above has a footnote referring to a boilerplate definition that amounts to ‘we’ll decide what this word means when you are dead’.

Does anyone think that would work out?

I suspect the countries where private health insurance does work, it is not so much because of the detail of the law, but mainly because they are not as ideologically capitalist as the USA, don’t have profit sharing schemes and stock options, do have unions and employment law. So the profit motive isn’t enough to induce managers to improve the company bottom line by denying care.

Most of the rest of the world simply has no idea why you are getting your knickers in a knot over public health care. Works alright here in Australia, a mix of public and private. Could be better, but such is life. The rich still get better health care than the poor, which won’t satisfy the ideological purists on either side but nothing ever will.

This Obama as Hitler and Death Panel stuff is seriously freaky – entertaining to be sure, compelling and fascinating that what would be the fringes of debate here is so central in your country. Good luck and take it easy.

exchanges and/or allowing individuals and companies to purchase insurance across state lines very directly addresses such situations.

Unless one or two states become the regulatory equivalent of South Dakota w/r/t credit cards. Which happens quite a lot in the US. And is BCBS of State X really going to “compete” with BCBS of State Y?

> Doctors of a given specialty, like most service providers, are basically
> fungible, in that they are all nearly equally capable of providing the
> same thing, and are all trying to provide the same thing: treatment.
> […]
>Of course, I’ve never understood the idea of having a “primary care
> physician” either—I suspect that most folks my age don’t comprehend
> this quickly-becoming-antiquated idea, by the way. You make an
> appointment to go to the clinic, whoever is on duty will be your
> physician that day. They check your charts, ask what’s up. I gather
> that some folks used to just go in to their primary care doctor
> twice a year, just because?

Um, if you are younger than 30 (35 if you are lucky) in the US or Western Europe, the odds are very good that you will experience no serious medical problem, and thus any walk-in doctor can give you equivalent care for the occasional strep throat. Once you pass 30-35-40 and serious things start to go wrong (and you start to get symptoms of things which could be serious even though they often turn out not to be), then it helps quite a bit to have a doctor who you see regularly and who is familiar with your chart and treatments (because she wrote and ordered them, respectively). Although I am good with masses of technical detail myself I was surprised at how much my adult medicine primary care doctor was able to remember from visit to vist and how positively it affected my care.

Cranky

Then he got sick of dealing with insurance companies and managing a small business, and went back to academic research…

Jonathan, going from $96bn to $167bn in 12 years is a 4.72% annual growth rate. By comparison, Canada’s GDP grew 5.44% ($837bn to $1580bn, IMF, April 2008) over the same period. So you’re saying that medicare spending in 2008 takes up a smaller portion of GDP than it did in 1996. Sounds like a good thing to me.

@228: Generally speaking, the stronger and nastier a political system, the more it actually imposes on people’s live and forces them to do what it wants, the more vehement it’s defenders get. It’s basic Stockholm syndrome: you don’t want to be small and weak, so just adopt the perspective of those who are screwing you, and then the more powerful they are, the better you feel.

Take an international incident where, say, some plane maybe crossed a border but noone really has solid information on what happened. It is a law of internet politics that the number of posts strongly backing the position of either side will be, adjusting for demographics, proportional to the amount the political system of that country was reducing life expectancy in comparison with its international peers.

You can see examples across the net from Russia to Iran: look at the thread on this site last years war in Georgia. If North Koreans were allowed onto the internet, every forum would be full of praise for the Dear Leader and denunciations of those attempting to undermine his rule.

Thing is, Americans, when compared to pretty much any other first world countries, have much less personal freedom, are much more bullied and intimidated and threatened by larger powers.

Consequently, there is much more visible, stronger and emotional support for the american political system.