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Medicare is bankrupting our country. The argument for single payer can't just be
"old folks like Medicare."

Medicare is bankrupting our country. The argument for single payer can't just be
"old folks like Medicare."

There is a difference between having the courage of one's convictions and being to dumb to come in out of the rain.

I've never been able to understand how libertarians expect to sell their snake oil.

"Abolish"? How do you abolish employer-provided health insurance without violating libertarian principles?

Bring it on, baby.

But how many patients will die and be irreparably harmed due to the long waiting lists and sharp rise in costs due to your single payer system? We shouldn't be playing politics with people's lives by running liberal social experiments on them. The American people deserve better.

"Abolish"? How do you abolish employer-provided health insurance without violating libertarian principles?

Well, there you have it. Like "strict constructionism" of the Constitution and "literalist reading" of the Bible, true libertarianism doesn't exist. They simply choose which principles and which cases of governmental intervention they find it convenient to endorse.

yes, Kevin, because American Medicare recipients endure less rationing of health care goods and services than any other large demographic group on earth. I suspect you know this, and I also suspect you know that such a regime of minimal rationing will not be scalable to the entire U.S. population.

Well, the people who oppose your preference know this as well, and they will not be shy about informing Medicare recipients that adopting what you advocate will mean more rationing for them. Given that Medicare recipients are about the most powerful electoral group in this country, and they really have been trained to think that rationing is mostly for other folks, your preferences will get nowhere, absent a successful effort to massively energize young people to vote against the gerontocracy that the U.S. political culture has become.

Lemme know when you've convinced the middle aged kids to let granny croak without spending 250,000 bucks on health care in the last six weeks of her life, or when granny says it's o.k. to wait eight months for a knee replacement.

A new study released last week revealed that Americans' health care varies dramatically from state to state. It should come as no surprise that in general Southern states ranked at the bottom in almost every category. After all, whether the issue is health, education, working conditions, or virtually any indicator of social pathology, things are worst in precisely those states that voted for George W. Bush.

For the details, see:
"Health Care the Latest Red State Failure."

I hope socialized medicine will work, but I suspect the result will be as Kling predicted. This country has the wrong spending priorities - no money for preventative care for kids, $50,000 for 3rd heart bypasses and terminal cancer medication.

I imagine Kling would merely end the tax advantaged status of employer provided health care coverage.

Yeah, that is what a gerontocracy produces, anon.

I imagine Kling would merely end the tax advantaged status of employer provided health care coverage.

Well I'm sure watching their health care costs explode would be considered an excellent outcome by most Americans. Wait, maybe not.

The Libertarian response to every argument: "That's fine in practice, but in theory it just won't work."

Drum: I'm up for that. Like Kling, I have the courage of my convictions.

Oof. The difference is that you don't live in Libertarian Utopia, where you can ignore reality, make bad arguments, and still be taken seriously.

From the Kling article Kevin linked to:

First, labor unions traditionally have pointed to employer-provided health insurance as something that they wrested from corporations on behalf of their members. Anything that disrupts the current employer-provided system takes away a source of prestige for union leaders.

Then why did the Business Roundtable, Service Employees International Union, and the AARP get together earlier this year to push for universal coverage?

Second, notwithstanding all of the talk of "crisis," many Americans are satisfied with their current health care.

Really? According to this:

Most Americans in the poll said they were satisfied with the quality of their health care, but there was widespread concern about costs. Nearly half of those with insurance said their employer had cut back on benefits or required them to pay more for their benefits in recent years. A quarter of those with insurance said someone in their household had gone without a medical test or treatment because insurance would not cover it. Six in 10 of those without insurance said someone in their household had gone without care because of the cost.

So, while people are happy with the quality of their healthcare, they are concerned about the cost of access to that quality healthcare.

Third, it will be difficult enough to find the tax revenue to provide health insurance for those who currently are not paying for it themselves. Increasing taxes to pay for health insurance for the much larger segment of the population that currently does have employer-provided benefits is a really tall order.

Yet in the same NYT article I referenced above:

The poll found Americans across party lines willing to make some sacrifice to insure that every American has access to health insurance. Sixty percent, including 62 percent of independents and 46 percent of Republicans, said they would be willing to pay more in taxes. Half said they would be willing to pay as much as $500 a year more.

And so on...

Most people with employer-provided health insurance are under the illusion that they get it "free" from their employers. If they lose their employer-provided health insurance and their taxes go up to pay for government-provided health insurance, they will view this as having to pay for something that they thought was free...

Yeeah...I have a large amount deducted from my paycheck each month and a copay to make when I visit the doctor or pharmacy. That statement is just plain dumb.

If Kling gets it this wrong in an obscure article, I can only imagine how bad his policies would make things...

Beautiful, rod.

This issue is going to require a LOT of discussion with everyone AND companies, including insurance companies.

I see no reason to dismiss ANY possibility while it's being discussed.

Every presidential candidate who has a plan must accept that their view alone is not likely to satisfy the whole of America.

This is economically huge and requires a lot of consensus making. You know, kinda like Immigration policy.

"I've never been able to understand how libertarians expect to sell their snake oil."
Posted by: majun on June 26, 2007 at 12:18 PM

Norman Mailer once noted in "The Naked and the Dead" that liberals and conservatives simply want the world to be changed to match their respective thinking patterns in order to be happy. Libertarians are no exception. They represent a tiny minority whose agendas will gain little traction. By all means, let's go to a single-payer system which will satisfy the vast majority of most people quite fine, and they can continue to complain forever and it won't bother me in the slightest.

Medicare isn't bankrupting the country, out of control medical costs that are left uncontrolled because of people letting pharmacutical companies run our medical system is what is bankrupting the country.

you don't live in Libertarian Utopia, where you can ignore reality, make bad arguments, and still be taken seriously

But Kevin routinely ignores reality and makes bad arguments. Or are you saying nobody takes him seriously?

The Libertarian response to every argument: "That's fine in practice, but in theory it just won't work."

Completely untrue, but hilarious.

Well, Col one could alternately simply extend to individuals the same tax benefits of buying their own coverage that is currently extended to employers who buy their coverage for individuals. Of course, that presents the problem of getting people coverage if they lack it now, and open enrollment is no longer available to people with pre-existing health issues. In any case, now that I've looked at it, it sounds as if Kling simply wants to go down the road of a Canadian or British system, with the view that it won't last very long.

I really don't care much about it anymore, given that the percentage of people, from any part of the political spectrum, who are willing to honestly discuss the topic, in the sense of being willing to acknowledge that trade-offs exist, and that rationing will always occur, if only in different forms, is so small as to be barely identifiable. When I talk about the topic these days, it is mostly for amusement.

Arnold Kling sounds like the name some author invented for a protagonist of a book satirizing Ayn Rand.

Speaking of courage of one's convictions, what ever happened with all the Libernuttians moving up to New Hampshire to start their Libertopia? According to their own dogma, if Libertopia is as efficient a way of arranging a society as they claim it is it should have taken off centuries ago and spread across the planet like the 1920s flu. Isn't it about time these chuckleheads put up or shut up? I'm willing to bring NH refugees to IL until the entire tragic scenario plays itself out and we once and for all can put a stake into the heart of Randianitis.

Speaking of courage of one's convictions, what ever happened with all the Libernuttians moving up to New Hampshire to start their Libertopia?

the current residents of NH aren't exactly enamored of wealthy libertarians moving to their state to strain public services all the while whining about how unfair taxes are.

Disputo, could you tell us which part of your post is irrelevant, so we can avoid commenting on it, and thus refrain from making you mad?

I really don't care much about it anymore, given that the percentage of people, from any part of the political spectrum, who are willing to honestly discuss the topic, in the sense of being willing to acknowledge that trade-offs exist, and that rationing will always occur, if only in different forms, is so small as to be barely identifiable. When I talk about the topic these days, it is mostly for amusement.

What amuses me is people who are under the impression that we don't have rationing under our current system. Why is it better when an insurance company makes you wait three months for an MRI or six months for a knee replacement?

Ever notice the drug ads that appear in many main stream magazines? Pages and pages of fine print. How much does this cost? Does anyone read it? Why are the ads there in the first place? Ever wonder how much this costs? There are many reasons why the US healthcare system is so horribly expensive.

It's obviously not, Mnemosyne, but what Kevin's post is disingenuous about, despite (I suspect) his knowing better, is that the reason Medicare is so popular with it's recipients is because they really are exposed to less rationing, even less so than is the case with retirees in the health care paradises that Kevin favors. He seems to think that the electoral implications of that reality can simply be ignored.

Disputo, could you tell us which part of your post is irrelevant, so we can avoid commenting on it, and thus refrain from making you mad?

My good man, a small lesson for you, although you show a dangerously liberal-like inability to learn from your mistakes. You lost that round, young man, and you let the screaming socialists make mincemeat of you. Continuing to pick that scab in public does neither you nor the Party any good whatsoever.

You have several other handsome options, each of which has served me well on occasion. You can change the subject to how much money you make (I hope it's more than I suspect it to be, or this one will be complete flop), accuse your detractors of drug abuse (today's "healthy mind, healthy body, aren't we holy" liberals are absurdly sensitive about this), claim that business cares require your attention and you've got to hit the road, Jack, or any combination thereof. What you do not do is keep lamely fighting a battle in which you've been soundly thrashed. If you lack the necessary dignity to protect yourself, at least consider other Republicans and show a little restraint for our sake.

Preserve you essence, Norman; distilled water and pure grain alcohol only!

"Ever notice the drug ads that appear in many main stream magazines? Pages and pages of fine print. How much does this cost? Does anyone read it? Why are the ads there in the first place? Ever wonder how much this costs? There are many reasons why the US healthcare system is so horribly expensive."
Posted by: tip of the iceberg on June 26, 2007 at 1:28 PM

Good point. I read somewhere that about 50% of the cost of new drugs is the marketing of them. If someone has a link that would be nice. Have you ever been to a doctor's appointment and have it delayed or interrupted by a drug rep? One of the biggest mistakes ever made was allowing prescription drugs to be advertised anywhere but trade publications for doctors. Drug reps turn on your doctor to far more than just coffee mugs and pens. There's something terribly wrong with wining and dining them along with package trips to Vegas in exchange for prescribing their drugs. But that's just me.

It's obviously not, Mnemosyne, but what Kevin's post is disingenuous about, despite (I suspect) his knowing better, is that the reason Medicare is so popular with it's recipients is because they really are exposed to less rationing, even less so than is the case with retirees in the health care paradises that Kevin favors.

I'm afraid I've gotta disagree with you there, Will -- have you not heard of Medicare Part D? You can argue that Medicare patients are now being faced with rationing that they haven't had much of before because they're dealing with for-profit health insurance companies just like the rest of us, but you can't argue that it doesn't exist at all.

Not to mention the rationing that was happening when Medicare patients were having to choose between medicine and getting to eat. That rationing is just as real as Grandma having to wait a few extra months for her knee replacement.

To be absolutely clear, please put "prescription medication" in place of "medicine" in my last graf there. Just saying "medicine" is a little too general for what I was trying to say.

Drug reps turn on your doctor to far more than just coffee mugs and pens. There's something terribly wrong with wining and dining them along with package trips to Vegas in exchange for prescribing their drugs.

Vegas? Vegas? More like Hawaii, St. Barts, Rio, Paris...

A friend of ours is a family physician. A few years ago when he was doing his residency at a large academic medical center (at a university and in a small city renowned, incidentally, for their progressive tudes), he complained about the practice of letting drug reps run all over the hospital interrupting patient care. He further suggested that it was highly unseemly, not to mention unethical, for physicians to accept junkets and toys from big pharma.

He was taken aside by hospital administrators and strongly encouraged to stop making waves on this topic.

Will Allen on June 26, 2007 at 1:30 PM:

He [Kevin] seems to think that the electoral implications of that reality can simply be ignored.

Well, let's see how the fear of 'healthcare rationing' matches up against the desire for affordable healthcare...Then again, reading the AARP's position on the matter is that:

Cost is at the root of this problem. Health care is expensive and getting more so every day.

I dunno, Will Allen...waiting an extra month for a hip replacement versus not being able to afford the procedure and never getting it done?

One thing that you forget about the older folks is that they understand the need for people to look out for each other. I realize that concept doesn't dovetail with the Ayn Rand nonsense that libertarians read as teenagers, but that's how it is.

"I also suspect you know that such a regime of minimal rationing will not be scalable to the entire U.S. population."

Considering that the rest of the population is considerably younger and healthier than the current Medicare recipients, I see no real problem with scaling Medicare to everyone. Care to back up this assertion?

Ever think about the administrative overhead involved in maintaining FSA and HSA programs? And in terms of FSAs, don't you think it's silly to have to *predict* how much health-related spending you'll do for you and yours in the year to come? More reasons why US healthcare is unnecessarily expensive (and complicated, and sometimes ineffective).

Mnemosyne, I never said they were exposed to zero rationing, just less than what any other sizable demographic group is exposed to, including retirees in other countries, especially once one considers expenditures in the last weeks of life. A lot of us might agree that is an unwise use of resources to spend a hundred thousand on intensive care for a ninety year old at the end of the line, but that isn't how our incumbent politicians perceive the voters, at least not the voters most likely to show up.

Drug coverage is just another area where nobody wants to honestly examine trade-offs. Kevin, in this forum, has put forth the notion that private capital is irrelevant to pharmaceutical innovation, but of course he really does lack the courage of his convictions, because if he really believed that, he would simply call for an end to all pharmaceutical patents. People opposite of Kevin pretend as if the current drug patent regime has somehow magically, at the behest of the 535 hacks elected and sent to D.C., arrived at the point where the optimal tradeoff between innovation and price competiton occurs. Like I said, nearly everybody is lying, so there isn't much point in taking the debate very seriously.

PaulB, perhaps you should look at rationing for non-poor retirees in other countries as opposed to the U.S.. If such people endure more rationing than is the case in the U.S., might it not be because in those places they to scale their single payer system to cover the entire population? Of course, as the baby boom population bulge ages here, scalability for even retirees will increasingly become a problem.

Kevin, in this forum, has put forth the notion that private capital is irrelevant to pharmaceutical innovation

Really, where? I think you are distorting his position. But then, maybe when you say no one is willing to discuss this issue honestly, you are just projecting...

but of course he really does lack the courage of his convictions, because if he really believed that, he would simply call for an end to all pharmaceutical patents.

Patents are production monopolies. They provide an incentive to produce drugs because of the opportunity for monopoly rents, whether or not they are necessary to provide research incentives (even if the initial research is done largely with public funding, if manufacturers can't exclusively license the privilege of making the drug, they'll be less likely to produce it.) This is evident from the drugs now that stop being made when patents expire.

So, not only is your characterization of Kevin's position a distortion, the position you think he ought to take if he is serious about the position you misattribute to him does not follow from that position.

You pretend that drug coverage discussion begins and ends with the patent regime, which is a bizarre limitation, and which seems to guide your other distortions on the topic.

Like I said, nearly everybody is lying

"Everybody else is doing it" is not an excuse, Will.

PaulB, perhaps you should look at rationing for non-poor retirees in other countries as opposed to the U.S.. If such people endure more rationing than is the case in the U.S., might it not be because in those places they to scale their single payer system to cover the entire population?

It might be because the US system is massively less efficient at providing service, for which there is considerable evidence. When an already established fact provides an adequate explanation for an effect, there is no reason to go looking for other explanations.

Disputo, could you tell us which part of your post is irrelevant, so we can avoid commenting on it, and thus refrain from making you mad?

I'm sorry that you fear me so much, but that is probably best in order to protect your self esteem. However, your obsession with me is far from healthy.

As to most relevant, using your metric, I'd say my metaphorical reference to the 1920s flu is most deserving of your focused attention since the flu actually happened between 1918 and 1920, and therefore it was a stretch for me to describe it as occurring in the 1920s. It's an easy way for you to win the debate. Go for it, Will! Do me proud!

I have the courage of my convictions.

I thought that you wanted funding from increased taxes on the rich, and reduced autonomy and profits in the private sector.

This is what Kevin has written here previously, quoting another author....

"But wait. If the feds negotiate prices, then prices will go down. And if prices go down, pharmaceutical companies might make less money. And if pharmaceutical companies make less money, they'll do less basic research and churn out fewer lifesaving drugs. As Jonathan Cohn says in The New Republic, this is ""a potent argument."" It's also probably wrong:"

""The most important basic medical and scientific research that leads to major medical breakthroughs usually takes place under government auspices — typically, through grants from the National Institutes of Health. In other words, taxpayers — not drug companies — are the ones financing the most important drug research today. So, even if the pharmaceutical industry did reduce its research and development investment because of declining revenues, what we'd lose probably wouldn't be the next cure for cancer — it would be the next treatment for seasonal allergies, and likely no better than the ones we have already.""

....thus clearly positing that reducing current levels of private capital devoted to drug research would be irrelevant to producing new life-saving drugs. In fact, the quoted author makes no qualification as to how far private investment could be reduced without affecting important new drugs being brought to market, so the logical conclusion to his assertion is to simply do away with patents on drugs altogether, thus allowing all drugs to be manufactured and sold like aspirin (excepting the need for a prescription) is today. The lack of a patent on aspirin, after all, doesn't inhibit it's manufacture and distribution, despite plenty of competing chemicals.

cmdicely, you last point regarding efficiency does not address why non-poor retirees in the regimes Kevin favors endure more rationing than non-poor retirees in the U.S..

Disputo, since you are given to fantasizing, for no apparent reason, about people with their pants pulled down (!), you may be well advised to avoid accusing others of being obsessed.

I think it would be helpful for everyone to remember why we have employer-based insurance. It was done during WWII because it was the most efficient way to make sure everyone was covered. Most people were working for a company or had a family member who did, and the companies were already helping the war effort via bonds, rationing schemes, etc.

Also, let's not forget that the right-wing and the health care profiteers have spent 40 or more years convincing Americans that any health care that does not pay them their cut will be bad. (The right has convinced most Americans that anything government-run must be bad.)

America has a long and distinguished record of using collective means, including especially the government, to provide needed services. Does government fire-fighting suck? Does government road-buidling suck? Does government-run universities suck? Are all the state-run lottos awful?

We can make government work, if we want it to. We could have a brilliant health-care system if we wanted. America is a pretty great country with lots of smart people of goodwill -- left and right. We could have something wonderful if we wanted. All we lack is the political will to do it.

First, we have to solve the forever-dinging cash register when you have your completely unexpected heart-attack. At some point, we all must share the risk against gigantic, unpredictable medical expenses that wipe out someone's life savings. It's called insurance. The bigger the pool, the better. Even a libertarian -- at least one who actually understands its real meaning -- should be able to embrace that, and we take care of the biggest single problem. It's major medical health insurance that's absolutely universal, absolutely portable, absolutely guaranteed, absolutely no worry about pre-existing conditions, and absolutely simple to understand for political feasibility purposes. Even if you have no other insurance, with this Federal umbrella you at least won't get completely wiped out. However high budgets and tax limitations make us raise the bar before it kicks in, it's a start, and we have to start somewhere. We can argue for the next 100 years how low we can afford to go -- how much of the deductible and co-pays we can eliminate -- and most people will keep the pressure on to push it lower and lower. When we cut back on ridiculous bleeding from unnecessary foreign entanglements and the like, it will get easier. Meanwhile, insurance companies and employers can work the space underneath the Federal umbrella if they want -- now much, much lower in cost because the completely unpredictable unlimited space doesn't have to be covered -- with current expenditures on Medicaid possibly re-directed to helping low-income people get some "underneath-the umbrella" insurance, too.

In other words, yes, it's like Medicare in theory -- which isn't really single-payer because of all the private gap and supplemental insurance plicies -- but probably with considerably higher trigger-points.

We can't do everything at once. I'd rather not see doctors pushed into being government employees myself -- and any plan that ever tries to do that won't get off the ground anyway. This is by far the biggest need. We can proceed more rationally on the other healthcare issues -- the wonky things like per cent of GDP -- once that bottomless pit of fear of losing your life savings is eliminated. Libertarians and socialists will have the opportunity of actually being civil to each other, as their theses and antitheses fine-tune the best of all possible worlds -- the private and public spheres just getting along in perfect balance.

I think it would be helpful for everyone to remember why we have employer-based insurance. It was done during WWII because it was the most efficient way to make sure everyone was covered. Most people were working for a company or had a family member who did, and the companies were already helping the war effort via bonds, rationing schemes, etc.

Actually, not really. There was a wage freeze instituted during the war, and employers started introducing health insurance as a form of alternate compensation since they couldn't offer higher wages to attract employees. Health insurance, therefore, was a disguised salary.

The most efficient way to make sure everybody was covered, then as now, would have simply been a government-supervised single-payer system.

"PaulB, perhaps you should look at rationing for non-poor retirees in other countries as opposed to the U.S."

Will, perhaps you should point me to the research that supports your assertions? Or you could just admit that you, as usual, were simply making shit up.

PaulB, if you seriously are asserting that non-poor retirees from other nations that Kevin has cited as having prefereable health care delivery services to the U.S. do not have their care care rationed more, let me know what measure you would use to prove otherwise. The last time I cited the evidence, in terms of waiting times for procedures, or intensive care services delivered in the last weeks of life, I was told that, for some reason, those facts didn't apply.

The last time I cited the evidence, in terms of waiting times for procedures, or intensive care services delivered in the last weeks of life, I was told that, for some reason, those facts didn't apply.

Maybe because you didn't provide any reason to believe that your cherry-picked list was a valid indicator of overall impact of rationing in the two systems.

"PaulB, if you seriously are asserting that non-poor retirees from other nations that Kevin has cited as having prefereable health care delivery services to the U.S. do not have their care care rationed more, let me know what measure you would use to prove otherwise."

Translation: I cannot back up my assertions, so I'll huff and puff and pound on the table and hope nobody will notice. Oh, and for the record, this was your specific assertion that I questioned, Will:

I also suspect you know that such a regime of minimal rationing will not be scalable to the entire U.S. population

"The last time I cited the evidence, in terms of waiting times for procedures, or intensive care services delivered in the last weeks of life, I was told that, for some reason, those facts didn't apply."

ROFL... More bloviating. Even for you, this was pretty lame, Will.

Oh, and Will? Your first response was pretty pathetic on substantive grounds, even ignoring the fact that you didn't bother to try to support your assertions. Of course such a system is scalable, particularly when you consider that it already covers the recipients who are far and away the most expensive to cover. And even ignoring that, your response is still, well, non-responsive, since any system can be scaled to any degree you like, so long as you have the resources to do so.

What you are really arguing is that we don't have the resources to provide national health care without some degree of rationing. But since you obviously haven't done your homework and cannot actually provide the facts and figures to support this, you have to come up with these idiotic hand-waving arguments, all the while ignoring that we already have significantly greater "rationing" today than we would under any proposal that Kevin likes.

In short, and as usual, there's nothing there.

Yeah, paulb, OECD studies amount to bloviating.

cmdicely, go blame the OECD for cherry picking; I just provided their website adress. Your reference to "overall impact" is just useless verbiage on your part. If you have something specific to assert, do so.

In any case, the only thing that matters politically is what the most electorally powerful demographic group, non-poor retirees, wants. What you believe to be the overall impact matters about as much as what you would like to have for lunch tomorrow. What the most powerful demographic group wants is nothing less than they have today, in terms of rationing, no matter what anybody has to say about overall impact.

"Yeah, paulb, OECD studies amount to bloviating."

LOL... Still waiting for any data that supports your assertions, Will. I suspect I'll be waiting a long time.

"Your reference to 'overall impact' is just useless verbiage on your part."

LOL... Oh, the irony...

"If you have something specific to assert, do so."

LOL... And yet more projection. I do so love Will. He's almost as much fun as our resident trolls.

"In any case, the only thing that matters politically is what the most electorally powerful demographic group, non-poor retirees, wants."

What they want is what they have, Will. You have provided no reason and no data why they cannot continue to have what they already have, nor have you provided any data as to why they would not be willing to accept some limitations so long as they knew that in doing so they would be extending what they have to their children and grandchildren.

In short, and as usual, you got nothing.

"What you believe to be the overall impact matters about as much as what you would like to have for lunch tomorrow."

Gee, Will, that's what we've been trying to tell you. Are you finally starting to get it?

PaulB, on your planet, do OECD studies amount to data? No, I'm not going to dig them up again, because I've done it before here, and I don't want to do it again. I really don't care all that much; nothing is going to happen, because people like you are so silly as to believe that you can convince non-poor retirees to give up something that they currently are getting other people to pay for. Sheesh, that is about as dumb it gets.

"PaulB, on your planet, do OECD studies amount to data?"

ROFL... Yes, dear, but since you haven't posted any studies that support any of your assertions, forgive me if I refuse to climb on board your bandwagon, particularly when it's clear that you have no idea what you're talking about.

"No, I'm not going to dig them up again, because I've done it before here, and I don't want to do it again."

Translation: I cannot back up my assertions, so I'll huff and puff and pound on the table and hope nobody will notice. Oh, and for the record, this was your specific assertion that I questioned, Will:

I also suspect you know that such a regime of minimal rationing will not be scalable to the entire U.S. population

Still waiting, Will.

"I really don't care all that much"

Nor do I, Will; I don't take you seriously enough to care one whit about your opinions.

"nothing is going to happen, because people like you are so silly as to believe that you can convince non-poor retirees to give up something that they currently are getting other people to pay for."

ROFLMAO... Dear heart, since nowhere on this thread, or anywhere else for that matter, have I said anything even remotely resembling this, forgive me if I take this just as seriously as I do your other assertions.

"Sheesh, that is about as dumb it gets."

Funny, I was just thinking the same thing. Pretty typical, though. Like I said, you're my favorite non-troll poster.

Of course the elderly like Medicare. They don't have to pay for it. I'd love health insurance I don't have to pay for too.

The truth is that Medicare's total unfunded obligations are approximately $47 trillion over the next 50 years. Not really as great a system as one that actually pays for itself.

re Will Allen's "non-poor retirees" - apples and oranges again. "Letting granny croak" does not equate to "waiting eight weeks for a hip replacement"!
I do hope his position isn't that there isn't "rationing" already? Care is now rationed by money/insurance rather than need. Perhaps Will Allen is simply projecting his own pschological need for immediate gratification onto all adults.
Oh, and I couldn't find any link in all his posts to any OECD site either.

"'Letting granny croak' does not equate to 'waiting eight weeks for a hip replacement!'"

Yup, not to mention that he hasn't been able to back up his assertions that granny will indeed have to "croak" and/or wait eight weeks for that replacement.

His primary point about "scalability" is pretty stupid, when you think about it. If you're already covering the 25% most expensive recipients, scaling the program to cover the 75% younger, healthier, and cheaper individuals is a piece of cake. On a per capita basis, it will cost significantly less to cover those others. So much for "scalability."

Of course, there is a response to this and an error in this argument. I wonder if Will is smart enough to figure it out?

Doug, Paul, tell me how much money you'll send to, say, The George W. Bush Presidential Library, if I link to the last thread on this topic, in this forum, in which I provided the addresses to the OECD studies which I am speaking of here. Of course, you are lying here, so you would lie about putting your money where your mouth is as well.

Finally, Paul B., intellectual titan, fails to understand that eventually everybody croaks, but everybody does not use the same amount of health care services prior to doing so. What a dolt. Of course, given that he cannot grasp the implications of having 100% of a population trying to receive health care services with very little rationing, as opposed to 75% of a population, some of whom are severely rationed, working to provide largely unrationed care to the sickest 25%, this is not surprising.

"Doug, Paul, tell me how much money you'll send to, say, The George W. Bush Presidential Library, if I link to the last thread on this topic, in this forum, in which I provided the addresses to the OECD studies which I am speaking of here."

LOL... Dear heart, why on earth should we play your silly little games? Either you can back up your assertions or you can't. That's a rhetorical statement, of course; we know you can't.

"Of course, you are lying here, so you would lie about putting your money where your mouth is as well."

ROFLMAO... Dear heart, do feel free to point out a single "lie" I've told, won't you?

"Finally, Paul B., intellectual titan, fails to understand that eventually everybody croaks,"

Yes, dear, I know. Did you have a point to make?

"but everybody does not use the same amount of health care services prior to doing so."

Yes, dear, I know. Did you have a point to make?

"What a dolt."

ROFLMAO... That was it??? That was your idea of a substantive response? My goodness, dear, you really are losing it.

"Of course, given that he cannot grasp the implications of having 100% of a population trying to receive health care services with very little rationing"

Dear heart, I asked you to support your assertions about "scalability." I told why your "scalability" was fatally flawed on its face. You have yet to provide a substantive response. I'm still waiting for you to back up any of your assertions. Knowing you, I'm not holding my breath. But hey, do feel free to keep posting; I'm loving your every post.

"I wonder if Will is smart enough to figure it out?"

I think we have the answer to this question.

Paul, you really don't understand what "scalability" means, do you? You really cannot grasp how a system may be able to have 14% (the actual percentage of the U.S. population receiving Medicare, idiot) of it's population, the sickest segment of the population, receiving care on the least rationed basis, mostly from the taxes of the healthier, more rationed, in some cases severely rationed, rest of the population, and not be able to expand the low level of rationing to the rest of the population, do you?

Sheesh.

"Paul, you really don't understand what 'scalability' means, do you?"

Yes, dear, I do, since I deal with it every day in my profession, which is why I know that your argument is crap. There is an argument to be made about rationing, but you're not making it, probably because to do so would require that you'd have to actually do your homework, something you clearly have not done.

"You really cannot grasp how a system"

Still can't come up with a substantive argument, dear, can you, much less a response to my own. Do feel free to come back when you've got some actual evidence, dear; we'll be here waiting.

You're not very good at your profession, are you?

And Will, I know the argument you're lamely trying to make. It's a bogus argument, which is why I'm not even bothering to address it. You're ignoring so many details with that hand-waving "analysis" of yours that it's just not worth the trouble to respond.

The reason you're having to resort to that kind of hand-waving is that your original argument was stupid. Just deal with it, let it go, and move on to a more substantive argument, one that actually does use facts and figures to back up your point.

"You're not very good at your profession, are you?"

ROFLMAO... Whatever you say, dear. You do realize that the constant stream of ad hominem attacks and the continual failure to actually back up your assertions are unmistakable signs you're losing, don't you, dear?

You don't? Oh, dear, I'm so sorry.

Hey, I wasn't the one who misstated the implications of scalability in having the same level of low rationing for 100% of the population as the sickest 14%. That was you.

"Hey, I wasn't the one who misstated the implications of scalability in having the same level of low rationing for 100% of the population as the sickest 14%. That was you."

ROFLMAO... Sorry, dear but the "misstatement" of "the implications" here is entirely on your side. Are you sure you understand the term?

As soon as you pay me to look up the OECD studies, which I've cited in this forum previously, all your lying aside, I'll do so.

"As soon as you pay me to look up the OECD studies, which I've cited in this forum previously, all your lying aside, I'll do so."

ROFLMAO.... Dear heart, since we both know that the OECD studies won't support your assertions about "scalability," why should I bother, even if I were inclined to play your silly games? Oh, and dear heart, I'm still waiting for you to point to a single "lie" I've told.

I repeat: You do realize that the constant stream of ad hominem attacks and the continual failure to actually back up your assertions are unmistakable signs you're losing, don't you, dear?

Here's another little free clue for you, Will: the Medicare program has already solved the two toughest problems of scalability. So go ahead, Will, give it your best shot and show me that you understand the term.

And just for the record, Will, I am not advocating that we expand Medicare, nor am I arguing that everything will be sweetness and light with absolutely no rationing required. I'm simply pointing out that your scalability argument is crap.

Uh, paul, I never said the OECD reports were pertinent to scalability. I said they had data which showed that non-poor retirees in the U.S. had health care services rationed less than was the case than non-poor retirees in countries which had health care delivery systems that kevin favored. Would you at least try to read the thread?

Now, is your understanding of scalability such that you really think that a system must be scalable to 100% of the population, if currently among the sickest 14% are being covered on a very lightly rationed basis from the taxes of the remaining population? Your grasp of scalability, applied to your profession, isn't going to get somebody killed, is it? Maybe you should consider a career change.

"Uh, paul, I never said the OECD reports were pertinent to scalability."

ROFL... Dear heart, I told you quite specifically, several times, just which claim of yours I was calling you out on. You repeatedly insisted that the OECD studies would back up your assertions. Nice to see you're backing down. Now all you need to do is back down on that stupid assertion and actually come up with a real argument.

"Would you at least try to read the thread?"

ROFLMAO... Oh, the irony of dear little Will trying to accuse me of reading comprehension issues. Dear heart, my reponses to you are all above for anyone to read.

"Now, is your understanding of scalability such that you really think that a system must be scalable to 100% of the population, if currently among the sickest 14% are being covered on a very lightly rationed basis from the taxes of the remaining population?"

No, dear, which is why I didn't say that. Do try to keep up, won't you?

"Your grasp of scalability, applied to your profession, isn't going to get somebody killed, is it?"

ROFLMAO... You really don't know anything about scalability, do you? I think you've answered my other question about your knowledge of the topic.

"Maybe you should consider a career change."

I'll be sure to give this advice the attention it deserves, dear.

I repeat: You do realize that the constant stream of ad hominem attacks and the continual failure to actually back up your assertions are unmistakable signs you're losing, don't you, dear?

Man, it just occurred to me that you really don't know just why your scalability argument was crap, do you? I had assumed that you just got caught saying something stupid and were too ashamed to back down when you got called on it. But you really don't understand; you genuinely don't know why the statement was dumb. Ouch....

Paul B., this post of yours refers to rationing, not scalability.

""PaulB, perhaps you should look at rationing for non-poor retirees in other countries as opposed to the U.S.""

"Will, perhaps you should point me to the research that supports your assertions? Or you could just admit that you, as usual, were simply making shit up."

Then there is this post of yours....

"If you're already covering the 25% most expensive recipients, scaling the program to cover the 75% younger, healthier, and cheaper individuals is a piece of cake. On a per capita basis, it will cost significantly less to cover those others. So much for "scalability."

.... in which, ignoring that you, in your state of abject ignorance, were off on the percentage of the population receiving medicare benefits by only 79%, imply that since the per capita cost was driven down, the system is scalable. Sheesh.

Of course, you also wrote this....

" nor have you provided any data as to why they would not be willing to accept some limitations so long as they knew that in doing so they would be extending what they have to their children and grandchildren."

and then, after quoting me thusly......

"nothing is going to happen, because people like you are so silly as to believe that you can convince non-poor retirees to give up something that they currently are getting other people to pay for."

....you wrote this

"ROFLMAO... Dear heart, since nowhere on this thread, or anywhere else for that matter, have I said anything even remotely resembling this, forgive me if I take this just as seriously as I do your other assertions."

I think I'll say good bye now.

"Paul B., this post of yours refers to rationing, not scalability."

Dear heart, do take a look at my first post on this thread and in the subsequent posts where I'm quite specific about the assertions I'm referring to. It's been "scalability" all along, dear, including the post you cited. Do try to keep up, won't you?

".... in which, ignoring that you, in your state of abject ignorance, were off on the percentage of the population receiving medicare benefits by only 79%, imply that since the per capita cost was driven down, the system is scalable."

ROFL... You really don't get it, do you? You really don't know anything about the term "scalability?" You simply don't understand why your argument was complete crap. You don't understand the problems of scalability and you don't understand why Medicare has already solved the two toughest problems.

"Dear heart, since nowhere on this thread, or anywhere else for that matter, have I said anything even remotely resembling this, forgive me if I take this just as seriously as I do your other assertions."

ROFLMAO... Dear heart, do you really not see why this point of mine was completely and totally true? And that the brief quote of mine that you cited does nothing to contradict this?

As for the rest, I'm not even going to bother. I'll simply state that you have, once again and as usual, completely failed to make your point. Just as you have once again, and as usual, completely failed to back up your assertions.

I repeat: You do realize that the constant stream of ad hominem attacks and the continual failure to actually back up your assertions are unmistakable signs you're losing, don't you, dear?

"nor have you provided any data as to why they would not be willing to accept some limitations so long as they knew that in doing so they would be extending what they have to their children and grandchildren."

For the sake of the reading-comprehension challenged, (Hi, Will!), let me walk through this:

1. Will claimed that: "In any case, the only thing that matters politically is what the most electorally powerful demographic group, non-poor retirees, wants"

2. My response was simply to point out to Will that he had not made the case that this "most electorally powerful demographic group" wants what he claims they want, that he had not made the case that this group would not be willing to accept some sacrifices.

3. I was not arguing that such sacrifices were necessary; I was not arguing that such sacrifices were not necessary; I was simply pointing out that, assuming for the sake of argument that Will was correct about the need for sacrifices, he had not made his case about what "that powerful demographic group" wants and what sacrifices it was prepared to accept or reject.

In short, when Will further claimed that "nothing is going to happen, because people like you are so silly as to believe that you can convince non-poor retirees to give up something that they currently are getting other people to pay for," my response was 100% accurate: "Dear heart, since nowhere on this thread, or anywhere else for that matter, have I said anything even remotely resembling this, forgive me if I take this just as seriously as I do your other assertions."

As usual, Will is wrong, both about my own arguments and about his own.

You do realize that the word "scalability" does not appear in the post of yours I reproduced, don't you?

You do realize that you implied that if per capita cost was lowered, as a system expanded, it was inherently scalable, don't you?

You do realize that....oh, forget it.

As to ad hominem, look at your own posts. Does it EVER occur to you that a civil tone will be responded to in kind? Are you completely lacking in self awareness? Do you grasp what the word "idiotic" means? Look at the people in this thread and others with whom I've had a civil conversation with. The common denonimator is that they adopted a civil tone with me. You, on the other hand, were insulting from the beginning, and then you find it notable that your tone was mirrored. Are you seven years old?

Yes, paul, you merely disputed whether it was established that non-poor retirees would be willing to give something up because you had no opinion on whether non-poor retirees would have to give something up. Or something. Maybe the guy who refers to "idiotic hand waving" can deliver another lecture on ad hominem rhetoric.

By the way, Paul, do you have an opinion on whether non-poor retirees will have to give something up?

"You do realize that the word "scalability" does not appear in the post of yours I reproduced, don't you?"

Dear heart, I was referring specifically to your claims. You do recall what claims you've made on this thread, don't you? You do recall that when I asked about "scalability," you responded with that drivel about "rationing," which then led me to point out that you had not backed up your claims. You do realize that I subsequently (twice!) pointed out which specific claim I was referring to. Reading comprehension really does seem to be a problem for you, doesn't it, dear?

"You do realize that you implied that if per capita cost was lowered, as a system expanded, it was inherently scalable, don't you?"

No, dear, I simply pointed out that this was one factor of scalability, a factor that you have carefully avoided dealing with. A couple of other critical factors for scalability have already been solved by Medicare. Alas, I fear that you know so little about this that you don't have the faintest idea what I'm talking about.

"You do realize that....oh, forget it."

LOL... Don't give up now, dear heart; I'm having a wonderful time picking your arguments to pieces.

"As to ad hominem, look at your own posts. Does it EVER occur to you that a civil tone will be responded to in kind?"

Yes, dear, but I'm also aware of the kind of debater you are and just how much of a waste of time it is to debate with you. I see no reason to be civil towards you, dear heart; you've posted too much here for me to pretend that you are interested in rational debate.

"Are you completely lacking in self awareness?"

No, dear, I know precisely what I'm doing and precisely why I'm doing. I assure you that it's quite intentional.

"Do you grasp what the word 'idiotic' means?"

Yes, dear, I do. I also know what "scalability" means. You should look it up.

"Look at the people in this thread and others with whom I've had a civil conversation with."

ROFL.... No comment necessary. Your posts speak for themselves.

"The common denonimator is that they adopted a civil tone with me."

Alas that this is a habit you do not share. You really should watch out for those stones, dear heart; your glass house is quite fragile.

"You, on the other hand, were insulting from the beginning"

No, actually, dear, I wasn't. My first post was quite civil. Your response, of course, made it quite clear that you had not changed your ways, so I felt no compulsion to maintain a facade.

"and then you find it notable that your tone was mirrored."

No, dear, I don't. Your posts speak for themselves, on this thread and on many others.

"Are you seven years old?"

No, dear, I'm not. Thanks ever so for caring, though. It's simply heartwarming.

"By the way, Paul, do you have an opinion on whether non-poor retirees will have to give something up?"

Why yes, Will, I do. Thanks ever so for asking.

You know the really pathetic thing about this? There really is an argument to be had about rationing (in terms of what is allowed or withheld, in terms of formularies, etc.), about costs (per capita costs, costs in dollar figures, costs in terms of percentage of GDP), about which specific national health care model is the most efficient, not to mention defining just what "efficient" means in this context, and so on. But because you got so hung up with your idiotic argument about "scalability," you never bothered to actually have that debate. Which, of course, means that you just pissed away an entire thread accomplishing nothing at all and convincing nobody of anything. Nice going!

"Yes, paul, you merely disputed whether it was established that non-poor retirees would be willing to give something up because you had no opinion on whether non-poor retirees would have to give something up."

ROFLMAO... Still can't read, can you, Will? You made the claim; I simply pointed out that you had not backed it up. You still have not backed it up. And instead of acknowledging this, you resort to the lame tactic of attacking the messenger. You may well be right, dear, but you can hardly expect me to take your unsupported word for it in light of your track record.

"Or something. Maybe the guy who refers to 'idiotic hand waving' can deliver another lecture on ad hominem rhetoric."

Q.E.D., dear; no lecture required when we have the example right in front of us.

Oh, and Will? A free clue, dear heart: there is a difference between disputing an assertion and asking for evidence that supports an assertion. Feel free to come back when you've figured out what that difference is.

"Yes, dear, but I'm also aware of the kind of debater you are and just how much of a waste of time it is to debate with you."

And since I know just how concerned you are about me, Will, I'll answer this question before you even ask it: why am I responding to you if I feel this way? Because I'm having fun.

And now, alas, it's time for me to go. TTFN, Will, dear. YHBT. HAND.

Here's a simple question Will, what if, instead of paying a billion dollars a week to slaughter the Iraqi people, we used that money to insure as many people as possible?

There are two downsides I can see though 1) you don't get to beat your chest while America kills people who were never a security threat (and whose lives have been made far worse by this unprovoked attack on their nation), and 2) fewer people will be uninsured and that's just not something you've demonstrated you want to see.

Well, tell us, paul, would non-poor retirees have to give anything up?

Now, here is my first post to Paul...

"PaulB, perhaps you should look at rationing for non-poor retirees in other countries as opposed to the U.S.. If such people endure more rationing than is the case in the U.S., might it not be because in those places they to scale their single payer system to cover the entire population? Of course, as the baby boom population bulge ages here, scalability for even retirees will increasingly become a problem."

Boy, that was a vicious personal attack, filled with ad hominem content, wasn't it? It was shortly after that Paul decided to get insulting, after which he found it notable that his tone was returned in kind. Paul, do you typically note that someone has mirrored your hostile invective? Do you not expect people to be insulting in response to your decison to insult them? If you are not actually seven years old, does your emotional development approximate that of a seven year old?

cmdicely, go blame the OECD for cherry picking; I just provided their website adress.

I may have misremembered who posted the cherry-picked specifics. Since you now claim not to have specifically supported your claim about rationing but merely waived your hand at the vast OECD website without pointing to any specific evidence of your claim about rationing, I'll accept that your argument is unsupported pending you actually citing specific evidence.

If you have something specific to assert, do so.

I specifically claim that you've not supported your claim with any evidence. And since you have admitted that, I guess we're in agreement.

Now, is your understanding of scalability such that you really think that a system must be scalable to 100% of the population, if currently among the sickest 14% are being covered on a very lightly rationed basis from the taxes of the remaining population?

Uh, yeah, if the healthiest 86% of the population is currently being served at greater per capita expense out of the pockets of the rest of the population, I would say that the best initial indication is that the public system is likely scalable to replace the more expensive system without increasing overall costs. Of course, if there is specific evidence or argument as to why the system is not scalable, whoever is challenging the scalability of the system would do well to present it rather than just asking if the system is necessarily scalable.

But that would require actually making an argument, rather than just being insulting and attempting to suggest the possibility that something might be a problem without actually presenting a reason to believe it would be a problem.

No, you are lying cmdicely, as is typical of you. I've previously cited the OECD studies in this forum. The fact that I won't take the time to do it twice does not support your specific claim.

Mybe you tell me again how the actual denotive meaning of words is of secondary importance when deciphering the meaning of a sentence.

Thought I'd check back in one more time before heading out. Glad I did, since I see Will decided to give me one last laugh for the night.

"Boy, that was a vicious personal attack"

Dear heart, you really do have trouble reading, don't you? I wrote: "Your response, of course, made it quite clear that you had not changed your ways"

I did not state that your response was a "vicious personal attack," now did I, dear? In this case, your response was completely unresponsive, providing no actual data and not addressing or supporting your specific claim or my challenge to it. Hence, it was an easy call to make that you were no more interested in a serious discussion of this topic than you have been in any other thread I've observed you in. I responded accordingly.

Your every post on this thread confirms the correctness of my decision, dear, which is why the debate you claim you want has not taken place and now will not. You will, of course and as always, blame everyone but yourself.

Oh, and dear heart? We're still waiting for you to back up any of your many claims on this thread. Do you really think that nobody has noticed that you have completely failed to do so? Even to try to do so?

"I specifically claim that you've not supported your claim with any evidence"

No, no, cmdicely, that's not the way things work in Will-World [tm]. You see, by stating this, you have disputed Will's claim, which means that it's your responsibility to prove that it's not true. Or something like that.

"Uh, yeah, if the healthiest 86% of the population is currently being served at greater per capita expense out of the pockets of the rest of the population, I would say that the best initial indication is that the public system is likely scalable to replace the more expensive system without increasing overall costs"

It's even worse than that. "Scalability" does not require that the costs not increase. Unfortunately, Will has made it pretty clear that he simply does not understand the term.

No, cmdicely, that isn't necessarily the case, even if it were proven true that the healthiest 86% were being served at greater per capita expense, (which you haven't done, by the way), because all variables may not hold as you expand the model from the sickest 14% to the remaining 86%.

"No, cmdicely, that isn't necessarily the case"

Dear heart, we're still waiting for you to actually make your case. Don't worry; we're not holding our breaths.

C'mon, paul, share your opinion with us as to whether non-poor retirees would have to sacrifice anything.

Also, please tell me why you found it notable that I adopted your insulting tone.

"even if it were proven true that the healthiest 86% were being served at greater per capita expense (which you haven't done, by the way)"

LOL... Oh, the irony of Will Allen, of all people, pointing out that someone has not supported their claim!

"C'mon, paul, share your opinion with us as to whether non-poor retirees would have to sacrifice anything."

Dear heart, have you really not figured out that I'm not playing your silly little games? You were the one who made the claim, dear. When you're prepared to back it up with hard data, we can talk. Until then, I'm having a great time continuing to point out that you have not, and will not, support your claim. Or the other claim about "scalability." And with your every post here, you amply confirm our opinion of y