Editore"s Note
Tilting at Windmills

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January 16, 2007
By: Kevin Drum

TODAY'S HEALTHCARE POST....DELAYED BY ACTUAL HEALTHCARE!....Sorry for the light posting today. I was feeling a little under the weather this morning, and after after typing desultorily at a healthcare post for a while I suddenly decided to call my dentist about a tooth I've been having trouble with. To my surprise, they told me to come right over. So I did. Turns out there was nothing wrong with the tooth, but they weren't busy so they suggested I just hang around and get my regular checkup and cleaning. Since it usually takes two or three months to get an appointment with these guys, I took them up on their offer.

This was all routine work and it cost me nothing thanks to the fact that I have dental insurance. The woman sitting next to me was not so lucky. She apparently needed to get a couple of crowns, and the office administrator was pushing hard to get her to buy some fabulous Captek crowns at $1200 each. Without insurance, though, that was pretty steep. There was still some resistance even after describing the inferior qualities of the alternatives and providing dire warnings of possible future root canals, so the admin person says, maybe we can do something on the price. Maybe $750. Let me ask the office manager.

I felt like I was in a used car dealership. I half expected some closer with a bad suit and blow-dried hair to sail in and start doing a hard sell on the Capteks. But no. The administrator came back in a few minutes and said they could do it for $750. Another successful sale.

So instead of the meandering healthcare post I was working on this morning, this is today's replacement healthcare post. The earlier post was a response to Arnold Kling, who thinks the healthcare biz need less insurance and more free market capitalism in order to drive down costs and force people to buy only the care they need. I doubt it. More likely it would result in what I saw today: medical offices becoming more like Turkish bazaars (or used car dealerships), filled with distraught patients trying to decide whether they can afford a crown today or if they should wait and run the risk of needing a root canal later. No thanks.

For more cogent and comprehensive responses to Kling, check out Matthew Holt and Jonathan Cohn. They both hit most of the high points.

And my earlier post? Basically it boiled down to this: libertarians would sure be a lot more interesting if they'd deal with the real world a little more than they do. Proposing a healthcare system that increases the risk of not being able to afford the care you need has as much chance of gaining public support as a proposal to give away fleets of Cadillacs to welfare recipients, so why bother? The rest was just fluff.

Kevin Drum 3:23 PM Permalink | Trackbacks | Comments (104)

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Comments

Kling and his ilk should be exiled to a third world country with unregulated free market health care. They will feel right at home.

Posted by: gregor on January 16, 2007 at 4:00 PM | PERMALINK

Some people like "Turkish bazaars." I hear what you are saying Kevin, but what you actually witnessed this morning is the incredible mark up insurance companies pay for medical services. No used car salesman would be able to discount a car price 37.5%. Do you really believe the Dentist was losing money at %750? I doubt it.

Because they can pass costs along to their insured in the form of higher premiums (and because they set their own compensation as a percentage of claims paid), insurance companies have little incentive to really negotiate price with health care providers.

Posted by: Ron Byers on January 16, 2007 at 4:02 PM | PERMALINK

Kevin wrote: "... libertarians would sure be a lot more interesting if they'd deal with the real world a little more than they do."

The very essence of libertarianism is a refusal to deal with the real world. Libertarianism is at its heart a rejection of the complex and difficult real world in favor of a cartoon comic book fantasy world where everything and everyone behaves according to the simplistic rules of the libertarian religion.

Posted by: SecularAnimist on January 16, 2007 at 4:03 PM | PERMALINK

Kevin: Proposing a healthcare system that increases the risk of not being able to afford the care you need has as much chance of gaining public support as a proposal to give away fleets of Cadillacs to welfare recipients, so why bother?

If you do not want any public health system, make sure the one under discussion has no chance of being adopted.

Posted by: anandine on January 16, 2007 at 4:04 PM | PERMALINK

Libertarians do deal with the real world, they're just willing to accept outcomes that many of the rest of us find unacceptable in order to remain true to their principles.

It's not that hard to find a health care thread on a libertarian site where at least a few folks are happy to stipulate that:

They'd rather run the risk of dying untreated in the streets than be forced into a mandated insurance scheme.

They are perfectly comfortable with a system where the poor have less access to medical care than the middle class and the rich.

The problem isn't that they don't see reality. They just have radically different premises with which to process it.

Posted by: just sayin on January 16, 2007 at 4:06 PM | PERMALINK

I don't have the link handy, but there is a famous (in Health Service Reserach) study by RAND that demonstrated that when people choose the type of health care the should receive they make poor choices (usually skrimping on preventative care). The result is that they end up with more severe problems with higher costs than similar populations that had preventative care.

Posted by: Dan on January 16, 2007 at 4:07 PM | PERMALINK

Ron: Actually, I'm not sure about that. You might be right, but an alternative is that the insurance company has already bargained the price down, so people who are insured get the low price automatically. It's only the uninsured who run the risk of getting ripped off in the first place.

Posted by: Kevin Drum on January 16, 2007 at 4:09 PM | PERMALINK
Because they can pass costs along to their insured in the form of higher premiums (and because they set their own compensation as a percentage of claims paid), insurance companies have little incentive to really negotiate price with health care providers.

Strange, then, that every employer provided health insurance program I've ever participated in has, while I was on it, cut many providers and even whole provider networks after failing to get those providers to accept the payment schedules the insurance company demanded.

In the real world, insurance companies do, in fact, compete with each other on price for similar nominal benefits, and one of the main ways they do that is by setting the fees they will pay for specific services and not covering services by providers that refuse to accept those rates.

Posted by: cmdicely on January 16, 2007 at 4:11 PM | PERMALINK

I wouldn't be surprised if $750 is the amount that insurance companies tend to pay for the same thing.

Those who do not have insurance often get charged a lot more than those who do.

IF this is a result of that, then individual barganing would not have much impact on health care costs.

Posted by: Catch22 on January 16, 2007 at 4:12 PM | PERMALINK

Health insurance needs to be looked at beyond
mere dollars and sense (pun intended).

Life flows along very differently for those who

have decent coverage vs. the rest.

I have always groused about the meager dental insurance that I have for my sons. But it's better than nothing.

As an educator (and one who gets grief for having good health insurance paid by....taxpayers), I am grateful for my health insurance.

Yes, the system is corrupt. Yes, prevention cuts costs. But accidents happen, children are born without lung-heart connections, etc.

I see no reason why certain public employees should benefit from decent health plans while everyone else except the wealthy, get by.

The solution, and a way to dampen animosity, is to provide a base coverage for all citizens.

Think about it. We all know thw bennies of prevention, so why not treat the poor sooner, rather than later?

Posted by: Tom Nicholson on January 16, 2007 at 4:21 PM | PERMALINK

I don't have dental insurance. My dentist cuts me a slight deal by giving me the senior discount (I'm 32) which is certainly nice, but all the same, I'd rather have insurance. Unfortunately, as an individual, buying dental insurance would be prohibitively expensive.

One of the things that really annoys me about our current system is that those who don't get it through their employer have to pay more for insurance, and those without insurance have to pay more for that care. The system is maximally brutal to those in the worst circumstance.

Posted by: Royko on January 16, 2007 at 4:23 PM | PERMALINK

what you actually witnessed this morning is the incredible mark up insurance companies pay for medical services. No used car salesman would be able to discount a car price 37.5%. Do you really believe the Dentist was losing money at %750? I doubt it.

I think you've got the story backwards, Ron. Maybe Kevin can set us straight on this, but it sounded to me like $1200 was the price for people who DON'T have insurance. We don't really know what the insurance companies pay, but it's probably in the $750 range (because they would negotiate the best discount available). So what we're really seeing here is the incredible mark-down that insurance companies get for medical services.

Posted by: Oregonian on January 16, 2007 at 4:24 PM | PERMALINK

The problem Kevin as I see it is that "health insurance" is no longer insurance at all. It is viewed as a subscriber plan. This is fine if you are the one with it and can happily go to the dentist and not be charged. But this is offloading a tremendous amount of risk onto the third party - either the dentist or insurer.

Health insurance used to be "major medical," e.g. actual "insurance" against the expense risk of catastrophic illness. This risk was unevenly spread and was, I suspect, fairly simple to price across a broad group of insureds. But somewhere along the line health "insurance" became health "indemnity" or guarantee against any expense. Conservatives say this happened when Medicare came about. I don't know. But indemnity is a very different ball game. If that is what we are talking, and most Dems are, then we should use the right name. It is not insurance.

Much as I am for universal coverage, I don't see how we as a country can afford to indemnify everyone against all costs of medicine. Plus there are perverse incentive issues if we as consumers don't have to pay something. Co-pays probably resolve this better than deductibles which disincentivize preventative care.

Wish I had the answer. Nothing I see on the right or left sounds like the right combination of re-allocating the insance amounts what we are already spending in ways that provide better access.

Posted by: Martin on January 16, 2007 at 4:29 PM | PERMALINK

Yes, by all means, socialism works. It's worked so well, let's be sure to adopt it for health care.

Explain to me again why Fidel Castro isn't using Cuban doctors.

Posted by: Dan on January 16, 2007 at 4:33 PM | PERMALINK

Kevin, cmdicely, Catch22 very good point.

Posted by: Ron Byers on January 16, 2007 at 4:36 PM | PERMALINK

I have healthcare, including a prescription drug co-pay. I am blessed with reasonably good health, so last month was the first time in several years that I'd had to fill a prescription for a month's supply of a new medication (cholesterol-lowering pills).

I didn't even think about the insurance issue until they handed me the pills. "One hundred forty-eight dollars," the clerk said.

Buh. It must have shown on my face. "Oh," she said. "Do you have insurance?"

Why yes. I gave her my card.

"Five dollars," she amended.

Those who have not had to go without insurance really do not have a %@#$@%ing clue what health care is like without insurance. I just saw it from a distance, and that's more than enough for me.

I have underemployed friends. They're going to die a lot younger than I am, because when they reach their fortieth birthday and need to watch their cholesterol, they'll laugh at the idea that they should take those pills.

I don't like that. Not even a little.

Posted by: eyelessgame on January 16, 2007 at 4:38 PM | PERMALINK

And let's also point out that this was just a tooth. It wasn't her kid facing a life-threatening disease. It was a tooth.

Ugh, sickening display. Also, I'll bet her insurance company paid less than $750 for that crown. Insurance companies have a LOT more negotiating clout than individual schmucks in incredible pain.

Can we also officially give up the "moral hazard" canard--the belief that if we deny people health insurance, they'll invest in preventive care on their own? Ask any dentist--nobody flosses, whether they have insurance or not.

Posted by: anonymous on January 16, 2007 at 4:40 PM | PERMALINK

Oregonean, I think you are probably right, but how were the "normal" market rates established?

Posted by: Ron Byers on January 16, 2007 at 4:45 PM | PERMALINK

I would like to take this opportunity to complain about how much income dentists make. My previous dentist retired at forty-four and is now sailing around the world. He is a close friend of my brothers, so I am in the loop about his wealth, how big his sail boat is and where he is in his journeys (parked the boat in Ecaudor and took a train to Patagonia with stops in the Peruvian rain forest.) This dentist worked four and half days a week, which is a half day longer than most. I had the misfortune of needing to have oral surgery and the (epithet) surgeon did not work on Fridays, the best day to have oral surgery so the week-end can be used for recuperating. Anyway, I know dentistry is shitty work, but not as bad as a dishwasher or sewer man. At least it provides prestige.

I just cannot believe these guys earn so much money, especially after they attend public universities. We need to triple the amount of dentists so they can earn a more respectable median wage instead of a princely Saudi one.

Posted by: Brojo on January 16, 2007 at 4:46 PM | PERMALINK

Dan wrote: "Explain to me again why Fidel Castro isn't using Cuban doctors."

Please provide evidence for your claim that Fidel Castro "isn't using Cuban doctors".

Cuba has some of the best doctors in the world, and is also a world leader in biomedical research. US corporations have received special exemptions from the US government's embargo of Cuba to allow them to license anti-cancer drugs that were developed in Cuba.

Posted by: SecularAnimist on January 16, 2007 at 4:47 PM | PERMALINK
The problem Kevin as I see it is that "health insurance" is no longer insurance at all. It is viewed as a subscriber plan. This is fine if you are the one with it and can happily go to the dentist and not be charged. But this is offloading a tremendous amount of risk onto the third party - either the dentist or insurer.

Er, that's why insurers charge an amount which exceeds the expected costs (the "premium") for coverage: the entire point of insurance companies is to have risk offloaded onto them. (Of course, the aggregation of lots of individuals experienceing the same type of risk means that even though each individual subscriber is offloading considerable risk onto the insurance company, the insurance company experiences very little of that risk in practice; most of the risk medical insurance companies experience is the risk of their own investments.)

This is true both when the coverage is only for catastrophic expenses and when it extends to more routine care, as well (if anything, while the costs for which insurance companies are liable are greater with more routine care covered, the risk is less, not more.)

Posted by: cmdicely on January 16, 2007 at 4:48 PM | PERMALINK

SecularAnimist

There is a report that Castro's docs imported a Spanish specialist. Apparently he wasn't able to do any more for Castro than his long attending physicians.

Posted by: Ron Byers on January 16, 2007 at 4:49 PM | PERMALINK

Sure, here ya go:

Expert flown in in to see Castro:

http://www.cnn.com/2006/WORLD/americas/12/24/castro.health/index.html

Posted by: Dan on January 16, 2007 at 4:52 PM | PERMALINK

"No used car salesman would be able to discount a car price 37.5%." -- Ron Byers

You obviously don't know the used car business!

Royko gives the most itsucksinct effect of present health and dental care.

Healthcare is not and should not be a market. It isn't stimulated nor react like one. It springs from necessity and common humanity in a society that can well afford to protect its poorest and most vulnerable. Universal coverage doesn't have to mean indemnity. And there are so, so many different ways to skin this cat -- just look around the world. There's nothing wrong with co-pays at a rate people can afford, but set the level above the poor so that atleast all necessary preventive medicine is done, particulalry children.

So far, this country hasn't attempted looking for the answer, and pharmas, health insurance, HMOs and all will continue to contribute millions to try to see that it doesn't.

Posted by: notthere on January 16, 2007 at 4:57 PM | PERMALINK

Any of the 'fixes' for rising health care costs which start with the assumption that the problem is too many people are making uneccesary visits to the Dr is doomed to fail because that assumption is WRONG.

Even if healthcare was free the hassle of getting to it and the inconvenience of many of the exams and treatments will deter most people.

Put another way - if colonoscopy's were free I'm still not having another one for at least 5 years!

Posted by: Tripp on January 16, 2007 at 5:05 PM | PERMALINK

I agree with Kling's premise, just not the conclusion. He writes:

>>>Real insurance, such as fire insurance, provides protection against rare, severe risk. Real insurance is characterized by:

– low premiums
– infrequent claims
– large claims

This makes some sense to me. If I have a fire and my home burns down, the insurance company knows they are out $250,000 and they pay. If I get sick, they don't know how much it will cost. The easiest way for a health insurance company to make money is to deny claims. Why would I want such an adversarial relationship in regards to my health care? I think the answer is to take the profit motive out of it.

Also, I don't think good coverage leads to more use. I go to the doctor when my wife makes me, never of my own accord (like many other men I know).

Posted by: dave on January 16, 2007 at 5:05 PM | PERMALINK

If you have a "right" to health care, then since you can't provide it for yourself, that means someone else has the duty to provide it to you, which basically means that person is your slave.

Posted by: Dan on January 16, 2007 at 5:06 PM | PERMALINK

eyelessgame wrote: "I have underemployed friends. They're going to die a lot younger than I am, because when they reach their fortieth birthday and need to watch their cholesterol, they'll laugh at the idea that they should take those pills."

I laugh at that idea too. I laugh until I cry.

I am 53 years old. I just had a blood test in December. My doctor told me that I have the lowest cholesterol level (110) that she has ever measured in an adult. When she discussed the results of my blood test with me, she said that as soon as she looked at my lipid profile, she knew that "this is a person who doesn't eat any animal foods".

She was right. I have eaten a vegan diet for 18 years. I was a lacto-ovo vegetarian for 14 years before that.

There is abundant scientific evidence that a vegan diet -- which contains no foods of animal origin, just plant-based foods (fruits, vegetables, grains and legumes) -- is more effective at lowering cholesterol and maintaining a proper balance between LDL and HDL than any drug available.

Indeed, if a vegan diet were a "cholesterol-lowering drug" the results would be front page news and you'd be seeing commercials for it on every TV show.

I offer this as free advice to you and your "underemployed" friends, who may be interested in a low-cost (in fact, money-saving) way of maintaining healthy cholesterol levels without costly, and risky, pharmaceutical drugs.

I also offer it as an example of what's wrong with our so-called "health care" system, which is actually not a "health care" system at all, but a "medical services" system, the purpose of which is to treat disease, not to care for health.

A true health care system would begin by keeping people healthy. And a big part of keeping people healthy would be educating them about, and finding ways to encourage them to adopt, healthy diets and exercise practices.

Most of the debate about "health care" is actually a debate about who will pay, and how to pay, for medical services.

Regardless of who pays, the cost of medical services will always be unnecessarily high as long as America is burdened with deadly epidemics of completely preventable disease that arise from grossly unhealthy lifestyles, which most definitely includes the toxic meat-based diet that most Americans eat.

Posted by: SecularAnimist on January 16, 2007 at 5:07 PM | PERMALINK

A purely libertarian system would need to eliminate free emergency room care for the poor. Presumably true believers would not be troubled by the pileup of dead bodies.

Posted by: Joe Buck on January 16, 2007 at 5:07 PM | PERMALINK

Brojo: I would like to take this opportunity to complain about how much income dentists make. My previous dentist retired at forty-four and is now sailing around the world.

I remember when Dental insurance starting being a part of employee benefits around 1970 or so. Dentists' fees almost immediatelly doubled. My plan paid 50% of the dentist's fees. ZMy 50% of the new fees turned out to be about 100% of the prior full cost. I saved no money. The dentist doubled his income.

This is the kind of extra cost that gets added to the health care system when the plan covers minor, routine visits. Virtually every insurance expert recommends that people buy major medical insurance (or get it from the government or their employer) and pay for their own routine care.

Kevin's idea of paying for routine care would be a madhouse ignores the concept that insurance would cover the high cost items. People would pay for their own routine medical items, which are affordable.

P.S. If we had all the money in the world, then cost wouldn't matter. In the real world, excess medical care cost will come out of some other area, like inner city education.

Posted by: ex-liberal on January 16, 2007 at 5:08 PM | PERMALINK

Dan: Yes, by all means, socialism works. It's worked so well, let's be sure to adopt it for health care.

Hey, in healthcare it works for Japan, Australia, Germany, Canada, France, Sweden, Spain ...

Of course, as a result of the inefficiencies of "socialism" they all pay less per capita than the US (whether measured as exchange rate, PPP or %/GDP) and by most measures have better outcomes, and almost no one in those countries lacks coverage.

Damned Reds!

Posted by: alex on January 16, 2007 at 5:09 PM | PERMALINK

One more beef about dentists: selling tooth whitening. Whitening teeth is not a health benefit. When the dentist pitches a tooth whitening prescription, s/he is only doing so to increase revenues. I rather dislike that in a healthcare provider, who statistically makes ten times the income I do.

Posted by: Brojo on January 16, 2007 at 5:09 PM | PERMALINK

Free market healthcare does hold down costs. I hold myself out as an example of what you get in a free market healthcare system.

Out with the kids on the playground I decided being 43 years-old didn't mean I couldn't do some monkey bar work so I swung around like I was twenty. But my 43 year old shoulder tore on me. Got it x-rayed ($300 out of pocket) but that didn't show anything so I had the choice of just hoping it would heal on its own or getting an MRI or physical therapy. My health insurance has a $1500 deductible before it would pay any of that.

My free market decision? Forego healthcare and live with a torn shoulder. One year later it is better but most definitely still messed up. I expect some arthroscopic surgery would fix it up. However, I don't KNOW that so should I plunk a few thousand down and try to get it fixed?

That same summer I once again acted the fool and severely sprained my ankle jumping off of a rock hidden under leaves. Six months later the ankle is usable but I suspect that I completely tore one of the tendons and need it fixed. But to find out I'll need to plunk down another thousand.

The free market system saved money! Of course it did so by making someone who needs care not get care. Is that what we want? Is that the ideal?

Posted by: Curt M on January 16, 2007 at 5:12 PM | PERMALINK

Ron Byers: "There is a report that Castro's docs imported a Spanish specialist."

Dan wrote: "Sure, here ya go:"

There is nothing in the article that Dan linked to that says "Fidel Castro isn't using Cuban doctors":

Though the doctor had been briefed by the medical team that is treating Castro, he wanted to perform his own examination before deciding if another form of treatment is appropriate, the newspaper said. Garcia Sabrido is a specialist in general surgery who last month led a conference at the 9th Cuban Congress of Surgery in Havana.

So Dan is a deliberate liar, in addition to being a font of brain-dead boilerplate libertarian cliches.

Posted by: SecularAnimist on January 16, 2007 at 5:12 PM | PERMALINK

libertarians would sure be a lot more interesting if they'd deal with the real world a little more than they do.

I think that about sums up why we need not take them too terribly seriously.

Posted by: craigie on January 16, 2007 at 5:13 PM | PERMALINK

Can you say NON-Profit Health Care.The problems started when the ind. went for profit.

Posted by: Thomas3.6 1/2 on January 16, 2007 at 5:13 PM | PERMALINK

Dan wrote: "If you have a "right" to health care, then since you can't provide it for yourself, that means someone else has the duty to provide it to you, which basically means that person is your slave."

Are policemen your "slaves", Dan?

Posted by: SecularAnimist on January 16, 2007 at 5:14 PM | PERMALINK

As a "health care professional" (or HCP or hiccup) I can assure everyone here that free market principles do not work in the medical care field. More doctors, CT scanners, hospital choices--you name it, it doesn't work. More supply actually creates more demand and prices of everything you can think of associated with medical care do not go down. Competition doesn't bring them down. Increased choice doesn't bring them down. Consumer education doesn't bring them down. Only in some make-believe Adamsmithland do any of these things work.

Posted by: John on January 16, 2007 at 5:16 PM | PERMALINK

Has anybody ever published a study of how much is actually collected from the uninsured?

Posted by: Ron Byers on January 16, 2007 at 5:16 PM | PERMALINK

Conservatives see shifting risk to the individual (aka market capitalism) as the central feature of their program. Actually it is their program. They are quite aware that it will mean more inequality and more poverty but that doesn't matter. They explain it away as the natural order. With it they will achieve all their goals: the rich will maintain their wealth and an aristocratic society, but even more importantly they will create a conservative society. They have noticed that the nations with the greatest safety net are also the most liberal. Risk sharing liberalizes society which in turn places more tax burden on the rich. An insecure society is a conservative society.

In general, an element of all these (conservative policy approaches) is to create a parallel system based on more legitimate principles. In the process, you change people’s view of risk- you get people to think differently...You could just say, “Accept risk, walk it off.” But what we say is “Let’s essentially privatize the risk management for health or retirement.” You give people other vehicles to manage the risk of living too long or being sick. You wean people gradually off or social insurance risk management into private risk management without making them fearful about it. You have got to do it in steps and have some government protection, at least at the beginning


An interviewed with Stuart Butler, one of the grand architects at the Heritage Foundation.

The Great Risk Shift
Jacob Hacker


Risk sharing even contributes to views on marriage:


All this is happening in Britain. With the Nordic pattern's spread across Europe, Britain's out-of-wedlock birthrate has risen to 40 percent. Most of that increase is among cohabiting couples. Yet a significant number of out-of-wedlock births in Britain are to lone teenage mothers. This a function of Britain's class divisions. Remember that although the Scandinavian welfare state encourages family dissolution in the long term, in the short term, Scandinavian parents giving birth out of wedlock tend to stay together. But given the presence of a substantial underclass in Britain, the spread of Nordic cohabitation there has sent lone teen parenting rates way up. As Britain's rates of single parenting and family dissolution have grown, so has pressure to expand the welfare state to compensate for economic help that families can no longer provide. But of course, an expansion of the welfare state would only lock the weakening of Britain's family system into place.

If America is to avoid being forced into a similar choice, we'll have to resist the separation of marriage from parenthood. Yet even now we are being pushed in the Scandinavian direction. Stimulated by rising rates of unmarried parenthood, the influential American Law Institute (ALI) has proposed a series of legal reforms ("Principles of Family Dissolution") designed to equalize marriage and cohabitation. Adoption of the ALI principles would be a giant step toward the Scandinavian system.


The End of Marriage in Scandinavia
The "conservative case" for same-sex marriage collapses.
The Weekly Standard
Stanley Kurtz

Posted by: bellumregio on January 16, 2007 at 5:17 PM | PERMALINK

Dan: that person is your slave

SecularAnimist: Are policemen your "slaves", Dan?

Stop it, both of you! This is not the appropriate site to get kinky.

Posted by: alex on January 16, 2007 at 5:18 PM | PERMALINK

John wrote: "Only in some make-believe Adamsmithland do any of these things work."

Actually, that would be "some make-believe Aynrandland". Adam Smith did not say what most libertarians think he said.

The make-believe world of Ayn Rand's ludicrous fantasy novels is all that libertarians have to point to as an example of the triumph of their values and beliefs.

Posted by: SecularAnimist on January 16, 2007 at 5:19 PM | PERMALINK

What's particularly disheartening is that the woman in the dentist's office may very well have had "health" insturance, but not dental coverage. How odd it is that we have a health care system in which dental and vision care are considered "extras," as though the care of our teeth, gums and eyes are not part of our health and have no impact upon it.

We should really be counting as "partially insured" those with insurance, but without dental and vision care, should we not? If we were to distinguish between the uninsured, the partially insured, and the fully instured, how might that change the general perception of our health care system? If we distinguished between those who are fully insured and those who are not (because they're unisinsured or partially insured), how much easier might it be to push for universal coverage?

Posted by: MF on January 16, 2007 at 5:22 PM | PERMALINK

Interesting Kevin should mention non-emergency dental care, one area of health care that arguably could be handled without insurance.

People who are injured or ill are poorly positioned to shop around and bargain for individual procedures. The process of comparison shopping for maintenance care is likewise too time consuming (for both consumer and provider) to be worth it. But we Americans are so used to paying fixed prices for everything (except houses and cars, by far the most expensive things most of us ever buy) that the thought of bargaining with a health care provider, even over the price of a procedure we know we won't need immediately, instantly produces stress. We would rather pay more -- in one form or another -- just so we won't have to deal with it.

Maybe this is a permanent fact of our existence. It's probably also a reason why health care costs as much as it does.

Posted by: Zathras on January 16, 2007 at 5:24 PM | PERMALINK

The last thing I want is for every visit to the doctor or dentist to be like buying a used car. It's getting like that already, and I hate it.

Posted by: abe on January 16, 2007 at 5:25 PM | PERMALINK

cholesterol-lowering drug

Doctors will prescribe a costly drug with many possible side effects. They almost never advocate going on a redless meat and oatmeal diet for lowering cholesterol.

My mother recently was given an anti-cholesterol drug that made her depressed and suicidal. That was distressing to her children, especially since she has one of those extra-optimistic attitudes. She thinks her doctor is some kind of god. Thankfully he took her off the drug and decided not to prescribe the anti-depressant. I think it is a rare doctor who takes someone off of a drug.

Posted by: Brojo on January 16, 2007 at 5:26 PM | PERMALINK

SecularAnimist wrote:
I am 53 years old. I just had a blood test in December. My doctor told me that I have the lowest cholesterol level (110) that she has ever measured in an adult. When she discussed the results of my blood test with me, she said that as soon as she looked at my lipid profile, she knew that "this is a person who doesn't eat any animal foods".

Your comments about the positive results of a vegan diet sound appealing to me, as I (56 yr old male) slog through middle age with only moderate success at reducing my weight. Do you also have good blood pressure measurements that could be attributed to your diet? I know there are many vegan and vegetarian web sites, but I'm interested in any that you find especially useful, as you are a positive testimonial for the diet. Please post anything you may recommend. Thanks!!

Posted by: trbtx on January 16, 2007 at 5:28 PM | PERMALINK

Make the Healthcare Ind. NON-PROFIT.Why should rich people make money off of the sick people.God will exact revenge on these immoral people.

Posted by: Thomas3.6 1/2 on January 16, 2007 at 5:33 PM | PERMALINK

>The free market system saved money! Of course it did so by making someone who needs care not get care. Is that what we want? Is that the ideal?

You didn't get it because you would have to pay for it yourself, but you would get it if someone else paid for it? Good attitude. If you don't value your own health enough to pay for it, I certainly don't value it enough to pay for it.

Posted by: VRWC on January 16, 2007 at 5:36 PM | PERMALINK

Universal healthcare would only encourage people to smoke, over-eat, avoid exercise and neglect brushing and flossing their teeth.

Our current system rewards those who take care of themselves, and allows those who don't to experience the natural consequences.

Posted by: Al on January 16, 2007 at 5:36 PM | PERMALINK

"My previous dentist retired at forty-four and is now sailing around the world."

But in libertarian/econ-100 fantasy land the more you pay people the more they work (though this does not apply to poor people, of course)! It is quite impossible that a person would pile up so much money that they would simply stop working.

Actually two freinds of my family were in the medical profession. One an optometrist, one a physical theripist of some sort. They have both retired early. The physical therapist is now finishing up the renovations of his mansion in some farming town.

Of course some doctors work a lot. Some of them even work part time in a regular practice and volunteer elsewhere the rest of the time.

Posted by: jefff on January 16, 2007 at 5:40 PM | PERMALINK

trbtx: Google "DASH diet" for improved BP control.

Every day I try to talk people into making lifestyle improvements for their health. Eventually, you just get worn out trying to convince people to sacrifice their free time. Heck, I can't even get my spouse to exercise routinely and eat more than token amounts of green food.

HMOs are not some different form of healthcare institution. They are simply insurance schemes brought to you by the same companies that provide "fee for service" insurance. They are a method for shifting risk from the insurance companies to doctors' groups. The insurance company takes their 30% or so off the top of the premium fees, does some minor interfacing between doctors and potential patients, and contributes little else of value for their very fat fees.

Posted by: J Bean on January 16, 2007 at 5:40 PM | PERMALINK

trbtx - I've been lacto-ovo veg for 14 years, as are about half of my friends. we tend to be skinnier than the american average, although we're also younger and exercise more than average. when one friend was on a research semester, his school did a study on their students since they had a good split of lacto-ovo/vegan/meat eaters. the vegetarians and vegans absorbed a much smaller proportion of the calories they ate, but they didn't study why.

Personally, I think a lot of the benefit comes from the fact that the lifestyle (and it turns into a lifestyle for most people who stick with it) forces you to be more conscious of your eating habits and tends to reduce the amount of processed food you consume. One friend who still eats meat is losing weight by cutting out all high-fructose corn syrup.

Posted by: Hillary on January 16, 2007 at 5:48 PM | PERMALINK

...all that libertarians have to point to as an example of the triumph of their values and beliefs.

Well, they could also point to the U.S. health care "system".

Posted by: exasperanto on January 16, 2007 at 5:51 PM | PERMALINK

I've dealt with so many sleazy dentists here in LA it's sickening. Ferinstance, most offices that accept my crappy insurance refuse to do amalgam fillings. They refer to them as "mercury" fillings and I've had dentists put on a show for me and wonder out loud if they're even still legal seeing that they're so harmful and poisonous. Rather they will only do crowns and some sort of ceramic filling, and of course these cost 10 times as much as an amalgam filling.

I had a dentist tell me a filling I just had replaced a few months before was very old and needed to be replaced (with a $250 filling, of course), and the same guy told me he couldn't do any work on me until I bought a night-guard thing for grinding my teeth at night because I'd undo all his work without it. The price? $750.

I had another dentist during a cleaning take one look in my mouth and then have his assistant bring over the big book of gum disease, flipping through the pages telling me I needed $1000 worth of work or that was gonna be me (this was after about 3 checkups with the same office where they told me everything was awesome).

I'd say 80% of all the dentists I've encountered here in LA are just plain crooks. They've all lied to me, they've all tried to force uneccesary work on me, and they've all pushed the most expensive option in every case.

Posted by: The Tim on January 16, 2007 at 6:00 PM | PERMALINK

Our current system rewards those who take care of themselves, and allows those who don't to experience the natural consequences.

Actually, no, it really doesn't. It rewards those who have jobs that happen to offer health insurance as a benefit. You could be the most unhealthy slob on the planet, but if your employer offers insurance, you pay the same premiums as your healthier coworkers. Meanwhile, if you don't have a job that offers insurance, no matter how much granola you eat, you're going to be paying more to get covered.

Posted by: Royko on January 16, 2007 at 6:05 PM | PERMALINK

trbtx wrote: "I know there are many vegan and vegetarian web sites, but I'm interested in any that you find especially useful"

Here are some suggestions:

Vegan Outreach:
http://www.veganoutreach.org

Physicians Committee For Responsible Medicine:
http://www.pcrm.org

Vegan: The New Ethics of Eating, Revised Edition
by Erik Marcus

The Vegan Sourcebook
by Joanne Stepaniak

The Vegan Diet As Chronic Disease Prevention: Evidence Supporting the New Four Food Groups
by Kerrie K. Saunders

Becoming Vegan: The Complete Guide to Adopting a Healthy Plant-Based Diet
by Brenda Davis, Vesanto Melina

The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-term Health
by T. Colin Campbell

If you like to cook there are a number of vegan cookbooks, for all types of cuisine, at Amazon.com. I eat a simple diet of whole foods and don't cook much, except for steaming vegetables.

The key to losing weight and keeping it off is simply to consume less calories than you burn. While on a vegan diet I gained a lot of weight, eating frequent large Chinese carryout meals. Then I got disgusted with myself and lost 60 pounds in a year by eating a diet of mostly raw fruits and vegetables with small amounts of grains and legumes, and have kept that weight off for the last 8 years.

Suppose you determine, based on your level of physical activity (ie. how many calories you burn in a day), that in order to maintain your body weight, you need to consume the "standard" number of calories per day, which the nutrition label on any packaged food will tell you is 2000 calories per day.

If you ate nothing but butter to get your 2000 calories per day, your belly would feel empty and you would feel hungry all the time -- because 2000 calories is a very small amount of butter.

On the other hand, if you ate nothing but carrots to get your 2000 calories per day, you would feel stuffed -- in fact you couldn't stuff yourself full of enough carrots in a day to get 2000 calories. So eating only carrots, you would not even be able to consume enough calories to maintain your body weight, and you would lose weight.

Of course neither of those diets is realistic. But they illustrate the point: filling up on low-calorie, high-water-content foods -- namely, fruits and vegetables, preferably raw or very lightly steamed -- and minimizing your intake of dense, high-calorie foods, is the way to lose weight. And it is healthy in other ways too.

This advice applies even if you do eat animal products.

This is my "health care post" for the day.

Posted by: SecularAnimist on January 16, 2007 at 6:05 PM | PERMALINK

>>what you actually witnessed this morning is the incredible mark up insurance companies pay for medical services. No used car salesman would be able to discount a car price 37.5%. Do you really believe the Dentist was losing money at %750? I doubt it.

Ron, you most certainly have this backwards. My brother had the misfortune of facing cancer without insurance, and my family learned a lot from the experience. Over the span of a month, he had racked up $130,000 in bills. He didn't want to pay the full price, so he asked the hospital and the doctors to itemize the expenses. He then took those itemized expenses and gave them to his ex-wife, who worked for a health insurance company. She compared each itemized price to what her insurance company would pay for the exact same treatment. The prices were consistantly three times what the insurance company would pay. So my brother hired a lawyer and started to negotiate the prices down. He died before the negotiations ended, so my sister finalized the deal. The final cost? $45,000 to the doctors and hospitals, and $5,000 for the lawyer (he had already done the hard work). Insurance companies have a tremendous advantage by being large purchasers.

Posted by: fostert on January 16, 2007 at 6:10 PM | PERMALINK

I just posted a reply to trbtx's request for pointers to vegan info online, and received a page telling me that my comment was being held for review by the blog owner. I'm posting this comment partly to see if it happens again, and also to ask if anyone else has gotten this same message.

Posted by: SecularAnimist on January 16, 2007 at 6:11 PM | PERMALINK

fostert: Insurance companies have a tremendous advantage by being large purchasers.

We could always form a large purchasing cooperative. Perhaps we could call it something like the "government of the United States of America".

Posted by: alex on January 16, 2007 at 6:14 PM | PERMALINK

Hmm. That short comment didn't bring up the "being held for review" page, but the previous one, which was longer and contained links to a couple of websites and several books at Amazon, did. Curious.
I hope the first comment will be permitted, since it contained information that is potentially useful to trbtx.

Posted by: SecularAnimist on January 16, 2007 at 6:14 PM | PERMALINK

Hillary wrote: "I've been lacto-ovo veg for 14 years, as are about half of my friends. we tend to be skinnier than the american average, although we're also younger and exercise more than average."

The Physicians' Committee For Responsible Medicine summarizes several 2006 scientific studies "linking vegetarian diets with healthy body weight, improved heart health, increased insulin sensitivity, and other benefits."

Posted by: SecularAnimist on January 16, 2007 at 6:17 PM | PERMALINK

What goes
9 1 click
9 1 click
9 1 click ?

A libertarian with a house fire.

(Yeah. Someone was gonna post this. It might as well be me.)

Posted by: ThresherK on January 16, 2007 at 6:22 PM | PERMALINK

VRWC, the point is that only rich people get their shoulders fixed in this country. If you are not in a position to plunk down several thousand dollars our system discourages you from even getting testing done to see if a fix is even possible. A doctor isn't deciding if my shoulder would respond best to physical therapy or to surgery. Instead, unqualified me and my thin pocketbook make that decision.

Now I do value my own health. But I also value my financial position. Keep in mind that I have insurance. Someone without it wouldn't have a $1500 backstop to fall back on. It would be a rare individual who doesn't have health insurance who could afford thousands to fix a bum shoulder.

I'd prefer a system where everyone has the opportunity to get their shoulder fixed regardless of their financial status but then again maybe 43 year olds who are stupid enough to swing on monkey bars don't deserve help.

Posted by: Curt M on January 16, 2007 at 6:23 PM | PERMALINK

alex, I used to think that would be a bad idea. But now, I see no alternative.

Posted by: fostert on January 16, 2007 at 6:24 PM | PERMALINK

Some great posts and opinions here gals and guys, indeed.

I suppose because they don't have 80 story office buildings, hundreds of underwriters and are not on tv every 15 minutes, they can afford to offer a national plan for anyone who wants it including dental up to 80% off. (56% on average)

Libertarians, independents, democrats and republicans combined could never put together a plan 2 twin brothers did in 1992.

And it's not insurance as we have owned our plan since 2003 and go when ever we choose that also includes our sons with no age limits or cut-offs and includes one son eventho he has moved out.

Isn't this the way it's supposed to be?

Access without restrictions with a :shield of protection: against the high costs.

Heck if it's good enough for Bank of America, GE, AT & T, Wachovia and numerous other corporations, it must be the right direction.

For my family, I know it's good. I mean where can you find a plan anywhere that will include your parents and in-laws as well as any children of any age, at no extra cost?

You can't. The lowest insurance rate we could locate in 2003 for just dental was $92 a month, yet we pay almost half that monthly for five of us 100% Full Medical and have yet to open an HSA.

They even have their own non-profit governing body also separate from any insurance connections. It is named the Consumer Health Alliance I believe.

Give it away free, it will become abused for sure.

Put it in the politician's hands and we are all doomed.

Only in America

Steven

Posted by: Steven on January 16, 2007 at 6:34 PM | PERMALINK

What about Glenn with the free rifles & ammo?

Posted by: Hedley Lamarr on January 16, 2007 at 6:48 PM | PERMALINK

Hmm, a buyers club for medical care. Of course to really have "insurance" you'd also need a catastrophic insurance policy. I had one for a while. Being under 30 at the time it was $54 a month with a $3000 deductible. For a 50 year old it was more like $250 a month.

The buyer's club alone still leaves you on the hook for tens or hundereds of thousands of dollars if anyone gets seriously sick.

Posted by: jefff on January 16, 2007 at 6:48 PM | PERMALINK

Kevin sez:

You might be right, but an alternative is that the insurance company has already bargained the price down, so people who are insured get the low price automatically. It's only the uninsured who run the risk of getting ripped off in the first place.

I don't know. Perhaps some medicos can chime in about what is standard, but I know for a fact that some doctors do hit the insurance companies for a higher price than they do their patients who do not have insurance.

In my case I switched from gold-plated insurance to catastrophic one year ago, so I am now responsible for the full price of a simple doctor's visit, eg. The first time I went to the doctor, I was explicitly told that the price I was being charged is less than what they charge the insurance companies, so they did not want to report the amount to my insurance company (I just wanted it counted against my huge annual deductible) for fear of alerting them to that fact.

Posted by: Disputo on January 16, 2007 at 7:03 PM | PERMALINK

Consider France. Best medical care in the world, provided by the state, of course, everyone is covered, home to some of the world's oldest and healthiest people. The state pays half of what we pay in the US per person to achieve this.

People who keep insisting that nationalized health care won't work in the US or who think the free market is always the best solution are just impediments to a solution. I don't know why anyone bothers to listen to their dreary obstructionist whining.

We know that what we have been doing isn't working: Healthcare costs too much per person, excludes too many people, and makes it harder for American businesses to be competitive.

Posted by: PTate in FR on January 16, 2007 at 7:09 PM | PERMALINK

I kept comprehensive blue cross/blue shield with a $500 deductible for spouse and me, and $3000 maximum of out of pocket expenses per year. It is the best available for comprehensive care.
People who opted out of blue cross for managed care plans are horribly disappointed and regret it. Complaints abound, services denied. My hubby, a financial advisor, says if your car needed $3000 you'd pay it--how much more important is your body, you health, your life.

Posted by: consider wisely always on January 16, 2007 at 7:19 PM | PERMALINK

I also have been in the position of negotiating down the cost of medical care. I also have had discussions with doctors concerning the rate of default on the bills that they submit to the uninsured, and their willingness to reduce their fees when providing service to poorer patients. One of the reasons that Drs charge less for insured patients is that they know they'll actually be paid.

What is wrong with high-income doctors? You don't have to seek out their services unless the services are worth the price you are going to pay. It's not like taxes where you have to pay whether you use the service or not.

In Germany and Switzerland, the state-run insurance (so to speak) can be supplemented by enrollment in a private insurance company. The people who pay the premiums and enroll get enhanced care compared to the people who depend on the state. Would you object to a system like that for the U.S.?

Posted by: calibantwo on January 16, 2007 at 7:27 PM | PERMALINK

In France, Germany, Italy and Spain, do the ordinary people get the same medical care for sports-related injuries as the professional atheletes get? Anybody know?

Posted by: calibantwo on January 16, 2007 at 7:33 PM | PERMALINK

So who in the government will be in charge of deciding who gets a transplant when there are too many people applying at once and not enough doctors? Will there be a waiting list, overseen by a corrput pol who puts his friend high on the list? Of course there will.

What about when a certain amount of doctors don't go in to a certain specialty the government deems important? Will people applying to medical school be forbidden from going in to some specialties and forced to either go in to others or not go to medical school? Of course they will.

The bottom line is: health care is not a right. It's a product. Being tied to your employer is a reason it's over-priced and that's as a result of government interference, not the free market.

Your current system was brought to you because the government said salaries could only be so high. Companies then introduced health care as a way to attract employees, then the rest is history.

Leave me alone, and stay away from my doctor. Can't you fix your own life, , and stop trying to fix mine?

Posted by: Dan on January 16, 2007 at 7:46 PM | PERMALINK

Dan wrote: "The bottom line is: health care is not a right."

Nothing "is" a "right" -- unless a law is passed that makes it a right, and a government exists to enforce that law.

If a government passes a law that makes medical care a "right", then it "is" a right.

Posted by: SecularAnimist on January 16, 2007 at 8:08 PM | PERMALINK

SecularAnimist wrote: I just posted a reply to trbtx's request...

I just finished reading your suggestions - they are very useful. Thanks!

Posted by: trbtx on January 16, 2007 at 8:11 PM | PERMALINK

calibantwo --

Also in the UK companies have provided extra medical covrage as a benefit, or an individual can buy it, since the 60s.

On sport injury, back in the 70s I played rugby for a first divsion London club. It was then still an amateur sport. I was three times injured requiring specialist care. Torn deltoids, achilles, ham string. Club doctor referred you to one of the London teaching hospital sports specialist clinics. Fantastic. Full therapy and back on the field in no time. Yep. That's National Health for you.

That's kind of out of date now, though. But I do have a couple of stories in the last few years of US friends who got sick/injured in the UK and France and couldn't believe that they were charged so little and got great care.

I know how hard it was to set up for my last check-up here.

Posted by: notthere on January 16, 2007 at 8:22 PM | PERMALINK

Is a liberal a libertarian who just had coronary bypass surgery?

Or a libertarian who gets colon cancer?

Assuming said libertarian wasn't extremely wealthy; many are small business owners and aren't.

Posted by: sara on January 16, 2007 at 8:24 PM | PERMALINK

Dan --

Nothing in the US is a right except, it seems, according to some, carrying a gun.

If you haven't noticed, healthcare is already rationed here. Insurers have increasingly introduced policies that discourage people from taking proper care of themselves. We are closing on 50 million people who have none, but we all pay for the consequences both in medical costs and economic costs. People in poor health don't just go away.

There is a waiting list for kidneys, hearts, livers, which the rich find ways (sometimes) to jump.

All in all, you betray your ignorance on the economics of health care, which every other western nation has decided it's cheaper to look after the workforce.

And guess what?

It is!

Significantly.

Get your misaligned capitalist brain around that one.

Posted by: notthere on January 16, 2007 at 8:32 PM | PERMALINK

Dan: Your current system was brought to you because the government said salaries could only be so high.

Yes. Of course that ended in 1945. Don't you think that 62 years is enough time for the market to adjust?

Companies then introduced health care as a way to attract employees, then the rest is history.

Since there is no law requiring employers to provide health insurance, they obviously do so as part of the free market. Do you want gov't intervention that would prohibit that?

Posted by: alex on January 16, 2007 at 8:33 PM | PERMALINK

No, I don't want government intervention that would prohibit that. I was just saying that the pricing structure we have now in health care was created in the first place by government meddling with our freedoms in the first place.

Leave me alone. Go join a co-op and try your Utopian schemes there.

Same with the minimum wage -- it's absolutely none of your business if I want to accept $1 per hour to do a job.

Stop trying to tinker with my life and live your own.

Posted by: Dan on January 16, 2007 at 8:47 PM | PERMALINK

Same with the minimum wage -- it's absolutely none of your business if I want to accept $1 per hour to do a job.
Posted by: Dan

but it is my concern if your derelict, syphillitic ass is posing a public health risk from your high risk bisexual prostitution.

we have a vested interest as a community in ensuring minimal health for our population, which extends far beyond the rights of prepubescent, poorly informed randians.

Posted by: Nads on January 16, 2007 at 8:57 PM | PERMALINK

I was just listening to the radio...4200 janitorial workers in the twin cities are threatening to strike over health insurance issues. Half of the 4200 work full-time. 24% have personal health insurance through work. 14 have family health insurance through work. That's a total of 14 people out of 4200, not 14 percent. We need universal coverage now.

Posted by: dave on January 16, 2007 at 8:57 PM | PERMALINK

Dan: I was just saying that the pricing structure we have now in health care was created in the first place by government meddling with our freedoms in the first place.

That meddling lasted less than 4 years, and ended 62 years ago.

I dare say that that meddling - part of the Arsenal of Democracy being the greatest arms producer in the history of the world - may have served some greater purpose. Unless of course you think that Hitler or Tojo would've meddled with your freedom less than the draconian measure of introducing temporary wartime wage and price controls.

Go join a co-op and try your Utopian schemes there.

Utopian? I've heard that Australia is a nice place, but I don't know that I'd call it Utopia.

Posted by: alex on January 16, 2007 at 8:58 PM | PERMALINK

Leave me alone. Go join a co-op and try your Utopian schemes there.

How about *you* go to some place where you can realize your dystopic fantasies of a powerless central gvmt -- like, eg, Iraq -- and leave the rest of us alone?

Posted by: Disputo on January 16, 2007 at 9:23 PM | PERMALINK

Why the personal insults?

For the record, I'm not an Ayn Rand fan and I'm not a pure libertarian.

But I don't see why it's any of your business what I get paid, or why you should have a say over my health care.

The difference between America and all the countries mentioned: we were supposed to be free.

Your policy prescriptions all boil down to one thing: me paying for you to get goodies you want.

Posted by: Dan on January 16, 2007 at 9:39 PM | PERMALINK

I want more free market in healthcare... and a pony.

Posted by: Daniel on January 16, 2007 at 9:41 PM | PERMALINK

Dan: The difference between America and all the countries mentioned: we were supposed to be free.

Oh, the choices we face. Whether to be Free in America, or move to the People's Republic of Australia. Guaranteed healthcare, but you have to submit to the Kommunist Kangaroos.

Your policy prescriptions all boil down to one thing: me paying for you to get goodies you want.

Of course on the bright side, you'd save money. Personally I prefer greed to ideological blindness.

Posted by: alex on January 16, 2007 at 9:44 PM | PERMALINK

Your policy prescriptions all boil down to one thing: me paying for you to get goodies you want.

No. It's all about getting free-riding cheats to pay their fair share of public goods.

Posted by: Disputo on January 16, 2007 at 9:49 PM | PERMALINK

Dan --

If you are not a pure libertarian, then you probably understand that you or I pay taxes for a number of services you I or you may agree or diagree with, but it's arrived at through the democratic process.

I don't know how old you are, but when the idea of universal health care is brought up, people who are aginst it don't argue it out. They bring out words like socialist, communist, or not wanting to pay for other people.

Where do you lie on the curve of providing help for physically or mentally disabled members of society, whether by birth or accident?

That's why it is called a society. Hopefully not a disfunctional group of me-firsts.

Posted by: notthere on January 16, 2007 at 9:56 PM | PERMALINK

I have been in need in my life, and I went to my church or family or friends. I would never demand that people help me against their will.

I'm not a my-enemies-are-nazies type person.

But where we part ways is that I don't see a love for freedom as a quest for ideological purity. It's a basic tenet for life and what it means to be an American.

Calling "universal health care" socialism is not some crime; it's the truth. It's Orwellian to call it anything other than socialism.

Posted by: Dan on January 16, 2007 at 10:01 PM | PERMALINK

Dan: I don't see a love for freedom as a quest for ideological purity. It's a basic tenet for life and what it means to be an American.

"In this world nothing is certain but death and taxes."

-- Benjamin Franklin

The only "freedom" that you would be deprived of is the "freedom" not to pay taxes for it. My heart bleeds.

Of course Franklin believed in liberty, not anarchy. Anarchy is the one state where you don't have taxes.

Calling "universal health care" socialism is not some crime; it's the truth. It's Orwellian to call it anything other than socialism.

"Every line of serious work that I have written since 1936 has been written, directly or indirectly, against totalitarianism and for democratic socialism"

-- George Orwell, 1946

So my guess is that George wouldn't have objected to your characterization (he was also a very influential proponent of socialized medicine in Britain).

Ok, you've got a label for it. Congratulations and so what? Have you got a coherent argument, or, in the absence of one, are you just going to slap a label on it?

Posted by: alex on January 16, 2007 at 10:26 PM | PERMALINK

Juvenile libertarian fantasies aside, speaking as a healthcare professional, I'd be more than willing to reduce my salary if I could forgo the paperwork and hassle of trying to justify and wrest what meager fraction of a percentage any given insurance company is willing to pay for any given service.

Over 30% of the kids I see are UNinsured; another 40% are MediCal, and are thus already covered by a state system which has a vested interest in preventative care, vaccines, and routine checkups. Serious diagnoses can occasionally be covered by an ancillary agency, in California CCS.

This is bullshit, patchwork, flawed, full of gaps in coverage, full of paperwork, and STILL preferrable and less beauracratic than the crap I have to deal with Aetna and Blue Cross patients.

And this doesn't even cover adult medicine, which I thank god I'm nowhere near. ... ED visits for old fat guys who should have PMDs and been on 3 separate meds for 10 yrs, but for whatever reason haven't ... to blame them as irresponsible for their health because of 10 yrs of financial reality RIGHT AS they're stumbling in having a heart attack seems very ... republican.

Why not just spit on them?

Single payer isn't perfect, but a few unrealistic teenagers whose testicles have yet to descend whining about "socialism" is, I submit, a small (and cheaper) price to pay than what we are paying now.

Posted by: Nads on January 16, 2007 at 10:31 PM | PERMALINK

Every time I have to get dental work done, and face our entirely private system for that, I feel like falling on my knees and thanking Tommy Douglas for the canadian public medicare system.

Posted by: Bruce the Canuck on January 16, 2007 at 10:35 PM | PERMALINK

I'm not a my-enemies-are-nazies type person.... Calling "universal health care" socialism is not some crime; it's the truth. It's Orwellian to call it anything other than socialism.

LMAO. Right. You're not a "my-enemies-are-nazies type person"... you're just a "my-enemies-are-socialists type person".

You pretty much missed Eric Blair's entire point, didn't you?

Posted by: Disputo on January 16, 2007 at 11:14 PM | PERMALINK

One of the problems with US healthcare is that Americans no longer demand that they get their money's worth. What made the US of A great in its early years is that you were given a dollar's worth of service/product for your dollar. If you didn't get your get your money's worth, you demanded it back and the service provider/product got a bad reputation and had to work harder to change that reputation or go out of business. Most Americans do not get whatever they or their insurance company is charged in medical services. I went through a period where every doctor I saw said, "I don't know what is wrong with you" or "I can't help you." Since I was not paying them for NOT knowing what was wrong with me nor paying them for NOT helping me, I demanded my money back. I really did. I wrote the insurance people and told them to give me money back if they were not going to help me.

I did my own research, talked to a lot of people, wore myself out doing what I was paying doctors for; and, I finally found something that seemed to describe what was wrong with me. I went to my doctor gave him the research and he said, "You may be right." For that I paid a $10 copay plus what was being taken out of my paycheck biweekly. If we are to have a true free market, then medical services that are not quality should not be paid for.

Also, I hurt my right knee just about the same day as Michael Jordan when he was playing for the Washington Wizards. He had x-rays, mri's, surgery, rehabilitation, and was back on the court playing baskedball while I was still trying to get approval for an MRI. US healthcare is rationed, whether you want to admit it or not. If you have a lot of money, you get a lot of healthcare. If you have a little bit of money, you get a little bit of healtcare. If you have a medium amount of money, you get a medium amount of healthcare. If you have no money, you only get healthcare if you are dying.

Also, dental insurance is totally separate from health insurance. This is the first year, it has been offered to the Feds in any but the most minimal form. I have only had dental insurance for the past five years through my labor union. Spent two years getting my teeth fixed after a decade of no dental care except for emergencies. About the only thing I regret is allowing the removal of stainless steel crowns that had been put in by an excellent dentist when I was 18. They may not have looked great; but, every fancier, more expensive replacement has yet to last more than a year. What a ripoff! But, I guess that is one way to make money.

Posted by: Mazurka on January 16, 2007 at 11:59 PM | PERMALINK

What you just described, Kevin, was free market forces lowering the cost of health care (by about 40%!) If patients aren't going to make decisions based on cost, who will?

Posted by: Bad Shift on January 17, 2007 at 12:15 PM | PERMALINK

Kevin,

It is safe to write that you and most of your readers don't know one friggin thing about libertarians. Libertarians don't reflexively look to others or government to take care of them and their problems. What, exactly, is so unworldly about such an attitude? And even if I grant that their proposals have little chance of ever being enacted, what is wrong with standing on one's principles? However, your assertion that the proposals will make it less likely that one could afford necessary healthcare, is just that, an assertion. Libertarians make very persuasive arguments that today's byzantine mess of healthcare is the result of government interference, for which you and others prescribe even more interference, not less. Small wonder you have trouble understanding them.

Posted by: Yancey Ward on January 17, 2007 at 12:24 PM | PERMALINK

The difference between America and all the countries mentioned: America has a higher infant mortality rate. The dead babies would like to thank GE, Boeing, General Dynamics, and the Texas Republican Party for making their country a beacon of free market economics.

Posted by: Brojo on January 17, 2007 at 12:56 PM | PERMALINK

Yancey Ward wrote: It is safe to write that you and most of your readers don't know one friggin thing about libertarians.

I know several self-described "libertarians" personally. As far as I can tell, apart from their recitation of dogmatic libertarian rhetoric, the actual content of their so-called "libertarianism" consists of a monomaniacal hatred of paying taxes, and to a lesser degree, a fetishization of guns. They consistently vote for right-wing extremist Republicans and seem wholly untroubled by the Bush administration's most heinous violations of Constitutional protections of actual individual liberties or its imperialistic foreign military adventurism. They somehow believe that this administration -- the most blatantly totalitarian-leaning government that I have seen in the USA in my lifetime -- exemplifies "limited government", because it reduced taxes on the ultra-rich.

Yancey Ward: "Libertarians don't reflexively look to others or government to take care of them and their problems."

In my experience, it would be more accurate to say that libertarians are opposed to the use of government as a tool or mechanism through which we, the people, cooperate to solve the problems of our society, because libertarians equate cooperation with coercion.

Posted by: SecularAnimist on January 17, 2007 at 1:55 PM | PERMALINK

I just won't go to dentists who are trying to upsell me. If you offer pamphlets in lobby or something, I don't have a problem with it, but I won't have some one who is supposed to be primarily looking out for my health trying to make a few extra bucks on this or that unnecessary procedure. I expect my dentist to behave as ethically as my doctor. I recommend that people not let dentists know that this sort of behavior bothers them.

Posted by: Mavis Beacon on January 17, 2007 at 2:56 PM | PERMALINK

"If you destroy a free market you create a black market. If you have ten thousand regulations you destroy all respect for the law."
-Winston Churchill


Posted by: Dan on January 17, 2007 at 3:11 PM | PERMALINK

Development Emergency Medical Service in America has received the second wave, improvement of quality of service and speed of reaction WBR LeoP

Posted by: Leo on January 17, 2007 at 8:56 PM | PERMALINK

The problem with the idiotic notions of "free market" is that there is no such thing. A free market without government intervention is merely a way for the unscrupulous to fleece the ignorant and the unwary. In a modern economy the "free market" starts with government-backed money and includes a government-based tort system as well as a government regulated securities industry - all based on long-established precedents demonstrating the fundamental malice of free market based regulation. Even the dumbest of libertarians isn't likely to demand the removal of government interference in the tort system, and few are so out of touch with reality as to demand the government get out the money business.

In other words, libertarians are idiots ignoring the basic infrastructure that creates the pre-conditions for their fantasy utopia; they are air travelers condemning the science of aeronautics as a waste of effort.

Posted by: heavy on January 17, 2007 at 9:55 PM | PERMALINK




 

 

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