Comments Posted By michael reynolds
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CBO ESTIMATES ON OBAMACARE TOP $1 TRILLION
Mike:
We can only go by the historical lack of innovation in government run programs, and the history of smart innovation by the market when left alone. Finally, regarding service, look at the airlines for the history on service and how competition affects the market — study People’s Airline, then you’ll see the computer industry will be affected by the same principles.
Government has run the defense industry and our defense has been incredibly innovative. Government also runs the space program which, while not perfect, has certainly done some amazing things. Government runs the army, it runs the service academies, it runs the Centers for Disease Control, the VA, the National Park Service.
So again, what you have is a quasi-religious belief that applies in many cases, but is not universally or necessarily true.
And you don't really mean to point to the airlines as models of anything, do you?
Comment Posted By michael reynolds On 18.05.2009 @ 09:41
Mike:
Defense could not be handled by private industry because their motivations are fundamentally different. Private industry seeks profits. By definition. So if a battle became unprofitable a private enterprise army would disengage. They'd have to by the logic of the free market.
Similarly in health care private enterprise must seek profits at the expense of other considerations. Government is not required to seek profits so they can make a different set of decisions.
If you turned the entire thing over to government you'd eliminate the profits taken by business -- many billions of dollars. You'd eliminate duplication of paperwork and administration -- many billions of dollars. None of these expenses are evil, they are the warp and woof of competing businesses. But the government would have neither.
The government might be highly inefficient, that is certainly possible. But there is no law of nature forcing them to be inefficient.
There's a misunderstanding that free enterprise is necessarily efficient in the delivery of services: demonstrably untrue. Their aim is not efficiency but profit, and profit may sometimes be improved by an inefficient delivery of services. For example, the computer industry is notoriously awful at delivering customer service. Service is expensive, and since sales don't depend entirely on service, the computer company may profit by delivering lousy service. (I'm looking at you, Dell.)
So there is simply no reason to assume that private industry would deliver better health care. Or the inverse. And given the awfulness of our current system it may be time to try something very different.
Comment Posted By michael reynolds On 17.05.2009 @ 20:16
Mark:
There will always be some version of rationing. We have rationing now. We'll have some form of rationing going forward.
Comment Posted By michael reynolds On 17.05.2009 @ 20:07
Mike:
In a free market there will always be a company which will provide coverage, and, if not, there will be charity hospitals which will likely provide better service than the government is prosposing for everyone.
That's a statement of religious faith. It is irrational, not based in fact but in your personal convictions.
In fact the government already runs a health care service called the VA. It is not less efficient than private health care, it is generally rated more efficient.
There is no law of nature that dictates that a free market is best for all things. It is best for many things. But I don't think you'd want the free market running our national defense, for example. That is run by the government and is the best in the world.
We need to have reason not faith.
In point of fact I am currently unable to get health insurance despite being well-off and currently healthy. In order to game the system I have to form a corporation. This is absurd. And the only reason that dodge works is because of a quirk of California law.
The fact is our system is a mess. It was not broken by the government, it has been broken by our reliance on a work-based health care system that is now utterly obsolete. We need to change it.
As for "charity hospitals" large swathes of this country have only a single hospital, not mutiple. That single hospital may be 50 miles away. The nearest tax-supported hospital -- which is what I suspect you mean by "charity" may be hundreds of miles away.
Even here in Orange County, CA -- not exactly Nebraska -- I know of no "charity hospital." We have a county hospital but if I show up there sick the care isn't free. I'm billed. And in the absence of insurance I could quite easily be bankrupted.
That's the reality. You are defending a massively screwed up system on the basis of nothing more than quasi-religious beliefs.
Comment Posted By michael reynolds On 17.05.2009 @ 17:47
Mark:
I think people should pay by ability to pay. If you're wondering, yes: that means I would pay more.
A system that charges more based on health factors opens the door to penalizing those already penalized by nature. Let's say you have a birth defect that limits how much work you can do. Should you then, in addition to your disability, have to pay ten times more for insurance?
How about if we find that you have a gene for Alzheimers? Or breast cancer? Are we okay with a system that creates huge economic incentives for aborting girls with a breast cancer genetic marker?
Taking your "couch potato" example, do you have sufficient knowledge to know who is at higher vs. lesser risk? Only to a very limited extent. So you might be going along and enjoying your "healthy lifestyle" discount and then we discover via new testing that you are likely to get cancer.
Do you mind if just as you get this news we triple your insurance rates? Or better yet, can we simply cut off your insurance at that point? You pay for 20 years and then get cut just as the risk becomes clear? So that you end up bankrupt and on the taxpayer nickel?
In fact, what you're pointing to is the fact that private insurers already ration. They just ration without regard to the health or well-being of the patient and ration instead for the benefit of their stockholders.
Comment Posted By michael reynolds On 17.05.2009 @ 15:58
Mark:
Yes, we should provide health care to everyone. I know that's not how you framed the question, but it is the actual question. Every other wealthy country manages to do it.
As for the health insurance companies denying coverage for reasons of profit, that's precisely why we shouldn't leave the matter in their hands. If we can cover everyone and keep the companies, okay. If not, then we get rid of the companies and good riddance.
Comment Posted By michael reynolds On 17.05.2009 @ 14:48
Mike:
It's not cynical in any way. The free market is required by its own internal logic to seek to maximize profit.
The same expense pressures may apply to government, but that's a very different question. The government is not required by its own logic to maximize profits. It doesn't make profits, it responds to different imperatives. So government will not throw people off the insurance rolls in order to make more profit while private industry, unregulated, would have no other practical choice.
Comment Posted By michael reynolds On 17.05.2009 @ 14:45
Mike:
The answer to what the private sector would do is obvious and set by the logic of the marketplace: they'd cherry-pick the most profitable policies and exclude as much risk as possible.
They have no choice: that's what shareholders demand. Would you buy stock in a company that deliberately took on riskier, less-profitable policies?
There really are some areas where the government can do a better job. This is not a place where profit-seeking is helpful. The needs of shareholders should not be the determining factor in who gets care or what kind of care they get.
Comment Posted By michael reynolds On 17.05.2009 @ 14:12
What are the costs of a pregnant woman getting inadequate pre-natal care and giving birth to a child with serious, lifelong health issues?
What are the costs of diabetes going undiagnosed and untreated? Or of missing a heart disease issue that could be dealt with early my 4 or 5k in meds or later with 100k worth of surgery followed by those same meds?
What are the costs in man hours and dollars of millions of people having to game an absurd system whose core raison d'etre seems to be to refuse to pay for treatments it has agreed to pay? Likewise for the doctors themselves who are pushed to play the system rather than treat the patient?
Obama is trying to find a moderate path that keeps most of the health insurance establishment in place. Many of us are so pissed off at the system you're defending that we'd like to see health insurers replaced in toto by a French-style system. The question is not whether we are going to have a major revamp of health insurance, but how broad and extensive that change will be.
As for a trillion dollars, if in the end we have a healthier population then there will be un-accounted benefits. As opposed to the same trillion spent on Iraq (without objection raised from the GOP) where we end up with un-accounted problems.
On the separate issue of the military, I was pushing for more men back when Republicans were all claiming that Rumsfeld was a genius. So yes, we need more men and especially more unconventional warriors. We do not however need more F22's. We have complete dominance in the air over every conceivable enemy force or combination of enemy forces. We should continue to develop new technologies so as to keep that edge, but that research does not require purchases of vast numbers of aircraft.
Every current enemy is lo-tech. Al Qaeda does not have an air force or a navy. The only hi-tech enemy we are likely to face in the next generation is China. We should certainly keep an eye on them and respond as necessary.
Comment Posted By michael reynolds On 17.05.2009 @ 12:06
RJC:
Since you identify yourself as "single issue" I think you concede that this is a litmus test for you. However, I take your broader denial of litmus-testing at face value.
I am all for controlling the borders. (Cubans of course are not: they have a special exemption that allows them something very close to free entry into the US.) We have a basic right as a country to decide who comes in. Period.
I agree it's an important issue.
It's also an issue where the methods Republicans have proposed, and the rhetoric they have used, have turned off the entire Hispanic population. Inevitably when you build a wall to keep people out you end up insulting the friends and relatives of the people thus excluded.
I personally have no objection to a wall, but I also enjoy a the occasional laugh at the expense of Republicans who have managed to use this issue to alienate the one growing voter bloc they should have been able to corral.
If you want to be able to come at issues like this and not suffer the electoral consequences you need to learn to stifle your radio loudmouths who turn a reasonable desire for control of the borders into xenophobia. Yet another issue where genuine conservatives would do themselves a favor by severing partisan relations with the wingnuts.
Comment Posted By michael reynolds On 16.05.2009 @ 11:05
