Over at Ricochet, via Instapundit, Paul Rahe argues that conservatives should prefer a government-run health care system paid for by higher taxes over an individual-mandate approach:
Government exists first and foremost for the sake of our protection. Without it, our lives and our property would not effectively be our own. Government exists also to promote our well-being. For its support, however, taxation is necessary, and we have tacitly agreed that, to be legitimate, these taxes must be passed by our elected representatives. By our own consent, we give up a certain proportion of our earnings for these purposes.
The money left in our possession, however, is our own — to do with as we please. It is in this that our liberty largely lies. Romneycare and Obamacare, with the individual mandate, changes radically our relationship vis-a-vis the government. The former presupposes that state governments have the right to tell us how we are to spend our own money, and the latter presupposes that the federal government has that right as well. Both measures are tyrannical. They blur the distinction between public and private and extend the authority of the public over the disposition of that which is primordially private. Once this principle is accepted as legitimate, there is no limit to the authority of the government over us, and mandates of this sort will multiply — as do-gooders interested in improving our lives by directing them encroach further and further into the one sphere in which we have been left free hitherto.
I’m curious: Did any conservatives express this view before President Obama embraced the individual mandate? Or at these sorts of arguments something that conservatives didn’t assert until long after the legislation was passed?
UPDATE: On April 3, 2010, a week or so after the individual mandate was passed, Rahe appeared to strongly endorse the following statement of Mark Steyn that was part of a broad criticism of the new law:
Whatever is in the [health care] bill is an intermediate stage: . . . the governmentalization of health care will accelerate, private insurers will no longer be free to be “insurers” in any meaningful sense of that term (i.e., evaluators of risk), and once that’s clear we’ll be on the fast track to Obama’s desired destination of single payer as a fait accomplis.
That’s the kind of criticism I remember at the time: Obamacare was really bad on its own, the argument ran, and even worse it was likely to lead to a government-run system in the future. As I recall, the thinking was that Obama really wanted a government-run system but didn’t get enough support for it outside the left, so he had to compromise with moderates and that resulted in the mandate.
health insurance as p.e. for adults says:
If adults can be forced to take p.e. in college (which they have to pay for the course) why can’t they be forced to buy health insurance?
December 29, 2011, 1:27 pmSeaDrive says:
The phrase “Taxation is theft” long pre-dates the mandate.
Rahe’s argument makes no sense to me. He seems to think it matters a lot whether $$ his health insurance premiums are paid by the gov’t via taxation, or paid by himself via a mandate. Surely it’s the amount that leaves his checking account that is important, along with the quality of the insurance provided.
December 29, 2011, 1:28 pmAnonymous says:
I first came across this idea after a talk by Bob Levy of the Cato Institute. It was just on the heels of the passage of PPACA (within a few months). I asked him if he thought the government would be on more solid constitutional ground with a single-payer government-run plan and he agreed with some enthusiasm (although I’m not sure he supported the idea). This was a conversation focused on the Commerce Clause issue and thus a bit more narrow in scope, but it seemed like the argument was already floating around.
It’s a good question – thanks for posing it.
December 29, 2011, 1:32 pmKazinski says:
I’m against Government run health care, but I do support single payer catastrophic insurance. I think that will keep the Government out of the lions share of the health insurance market allowing the free market to work. Especially since it will make going without other insurance a viable option for most Americans.
One thing I wonder is why don’t physicians offer a contract requiring binding arbitration to patients, or even their insurance companies impose it upon the consumer in return for lower rates from the physician? It seems that would solve the Medical malpractice problem, and reduce the need for defensive medicine which drives up costs considerably.
December 29, 2011, 1:34 pmHouston Lawyer says:
I had not heard of this argument before. We already have mandates for things like car insurance and I never heard anyone arguing that the government should step in and take over that market.
Now the idea of taxing everyone for healthcare is appealing, but how is that working out for Medicare? Healthcare that is essentially free to a majority of the people will have to be rationed somehow.
December 29, 2011, 1:40 pmJaimeInTexas says:
How does Medicare exactly work?
Does it really matter one way over the other?
Does the text of the Constitution grant such power/authority to the FedGov to get into the health insurance industry? I don’t think so.
Yes, some conservatives hold such views. I think it is called, today’s conservatives are last year’s liberals. Ask Gingrich about FDR.
December 29, 2011, 1:41 pmMeyers says:
Buying health insurance is like paying to take p.e., its just another civil duty?
December 29, 2011, 1:41 pmAnonymous says:
True, the amount is important. But I do think that by allowing a mandate we add a new congressional power that would almost certainly be exercised again. Taxing and spending for the general welfare is one thing; forcing participation in a private market is quite another. The single-payer system can operate on the same principle as Social Security and even if it’s a terrible idea, at least it doesn’t create an entirely new power. Our common law system (by way of precedent) would make the upholding of PPACA more dangerous than what would basically be a (huge) expansion of Medicaid.
December 29, 2011, 1:45 pmHenry Clay says:
On logical grounds, the fact that the “mandate” isn’t actually a mandate but rather tax policy surely makes some difference. On the “freedom” argument, I don’t see a huge difference between the government saying “those who have health insurance are exempted from this surtax” and “those who have health insurance are eligible for this tax credit effectively exempting them from a surtax”.
December 29, 2011, 1:46 pmLaura S. says:
Houston Lawyer writes:
There isn’t a mandate for (car) liability insurance to be purchased. You are always at your liberty to post to the DMV proof that you have $15,000 secured assets to self-insure. Lets put the nonsense about automobile insurance being a parallel to rest.
I’d also advise against drawing parallels between state and federal actions. Those kinds of arguments won’t persuade anyone but the faithful.
December 29, 2011, 1:48 pmSteveL says:
I hate the idea of a single payer plan, but it would be better than what the PPACA has left us with, a system designed to fail in every respect. If Medicare is Constitutional, then a single payer system funded by taxes is. Under current jurisprudence, that’s a yes. Clearly many people would say even Medicare is not authorized.
Kazinski brings up an excellent compromise. The fundamental problem with government involvement in healthcare is the political influence. In MA for example, all fertility must be covered, along with chiropractic care. These are the results of lobbying and the usual money changing hands, at the expense of most citizens. But if we had truly limited government catastrophic care coverage, that did not cover routine visits or procedures, and which required super-majorities to expand, that could be effective.
December 29, 2011, 1:54 pmJoe says:
I’m with the first comment.
The current system tells you that you can have government health insurance in various cases, including by making so little money that you get Medicaid, while (under PPACA) you pay the government extra money if you don’t have insurance in some cases.
You have various options there. You have less options if money is taken from you to pay for a BIGGER government system, one which will mean more government regulations that will affect your choices (the doctors more likely regulated, after all, since the government has more control over the health system).
The government is still taking money out of your pocket & telling you how to spend it (which they do in any number of ways) — you have to give it to them. Under the PPACA, you often don’t have to do that. You can give it to various insurance companies. Again, “everyone” doesn’t have to decide, since various people (such as the poor) don’t have to worry about the fiscal consequences of not having private insurance.
As to public v. private, if the feds are running something like health care which some think is not their job, in fact, is the job of the private insurance market, how does that help there? Finally, if the government is for our protection, why can’t it set up various options, somehow enforced via the tax system, to promote public purposes? Again, why is it less ideal to have a private/public mixture, which lessens the reach of government and can be more efficient or practical in various instances?
Sometimes, even taking questionable arguments at face value, they don’t seem to work.
December 29, 2011, 1:55 pmMartinned says:
That depends on whether the question concerns the morality of a mandate or its constitutionality.
December 29, 2011, 1:57 pmyankee says:
No.
December 29, 2011, 2:04 pmCalderon says:
I’m probably just confused, but I don’t understand the title of the post. Where does Rahe argue that single-payer or government-run health care is preferable to a mandate? I skimmed the linked article to find his argument, but did not see it.
{OK Comments: If you follow the link, the Rahe column is a response to a commenter who asked why the individual mandate is worse than raising everyone’s taxes to pay for health care for everyone, with a credit if you buy private insurance. That seems to me to be describing a government-run health care system, and Rahe’s response seems to assume that, as well. But of course, if you read that differently, that’s helpful to know and I’d be interested to know if others agree.]
December 29, 2011, 2:05 pmBob from Ohio says:
Like we should prefer being stabbed over being shot?
December 29, 2011, 2:06 pmgoodspkr says:
Err, you aren’t paying attention. I don’t have to go to a college that requires p.e. In fact I don’t have to go to college. You appear to be trying to put a new spin on the fact that states require people to have automobile insurance. It’s not an analogy that works.
December 29, 2011, 2:09 pmSteve says:
“Raising taxes to reward free riders is, of course, objectionable. We should oppose it on principle. But it does not in and of itself narrow in any significant fashion the sphere of our liberty. It is a question of the proper use of the public purse. The individual mandate sets a new precedent. It extends government control to the private purse.”
December 29, 2011, 2:11 pmAlan G. Kaufman says:
I find it intriguing that when gov’t run health was proposed in the 1990s, the conservative Heritage Foundation suggested an individual mandate, and now that there is an individual mandate, they hate it…and a conservative says gov’t run health care is preferable. Fascinating
December 29, 2011, 2:16 pmCrunchy Frog says:
To answer the question in the post title – no. Just because Option A sucks, and option B is an alternative, does not mean that option B sucks any less.
Conservatives have been unanimous in saying that government-run health care would be constitutional if passed, not that it would be beneficial.
December 29, 2011, 2:19 pmTed says:
Citation please. And why would be self-insured liability insurance be so incredibly lower than minimum liability limits. in my state it’s 100K/300K I believe. And is that 15k per car, per person, or per household?
December 29, 2011, 2:26 pmtoadstool says:
most high schools and colleges don’t require electives (like p.e. and foreign language) and most countries don’t require you to buy health insurance or support public doctors and hospitals. if you don’t want to buy health insurance nove to another country.
December 29, 2011, 2:26 pmDilan Esper says:
Yep.
There’s also an example with Medicare. Even now (Paul Ryan), many conservatives support making Medicare MORE like Obamacare. And that has been the case for years. I can’t remember ANY conservatives extolling the virtue of Medicare as a single payer system. It was always “we have to get the private sector involved and give seniors a choice of private insurance plans with their Medicare money”.
I think Professor Kerr has the conservative movement dead to rights here.
December 29, 2011, 2:30 pmanon says:
I am pretty sure that Houston Lawyer is not really a lawyer….
December 29, 2011, 2:32 pmThomas Sewell says:
Some conservatives are big government conservatives. You can probably find a rare liberal progressive to be against single-payer, they’re certainly out there against “Obamacare”.
That doesn’t change the fact that the law as passed with the mandate is beyond the powers intended to be granted the federal government in the constitution. Single-payer is also, but you’ve got a more relevant history of Supreme Court precedents that the current Court would be loathe to throw out in order to call it that.
I’m sure there are many others than myself that have been consistently against both for as long as the issue has come up. Think back to the Hilary Care debates.
December 29, 2011, 2:43 pmscattergood says:
So the basic argument against the conservatives is that when faced with total government take over of the health care market (single payer), they suggest a mandate that will keep private health insurance companies alive. And that now when the mandate is passed, they don’t support it so they are called hypocrites.
This seems like when faced with the choice of being punched in the head or punched in the stomach by an assailant, I might chose the stomach thinking it won’t be as bad since I won’t get any broken bones and the hit will be hidden. And then when the assailant say’s ‘ok, I’ll hit you in the stomach’ and I say, well, how about not hitting me at all, he then calls me a hypocrite for not agreeing to be punched in the stomach.
[OK Comments: No. No one here is criticizing opponents for opposing the mandate, which is pretty unpopular at this blog. This post is about the relative desirability of two undesirable options, not whether the options are desirable. Similarly, your analogy is false because in your analogy you have consistent preferences -- you consistently want less damage. In contrast, the issue here is which option would cause less damage, which involves two different positions that cannot be held at the same time]
December 29, 2011, 2:45 pmragebot says:
What a lot of these posts ignore is the political reality of how Obamacare was passed. Ben Nelson was basically the deciding vote and he just announced he will not stand for re-election mostly because of how unpopular that vote was. The 2010 election was a disaster for dems in the house, again because of supposedly moderate dems who voted for Obamacare losing.
Sure it might make more sense, all else being equal, to set up Obamacare as a tax instead of a mandate; problem is even guys line Nelson and the moderate house dems would never have voted for a straight up tax.
As for conservative think tanks supporting something other than Hillarycare back in the day, is anyone surprised conservatives were against Hillarycare and suggested an alternative.
It would be nice if both sides did things logically, but that simply is not the case.
December 29, 2011, 2:45 pmCalderon says:
Maybe I’m just dense, but I still don’t see anything there that is an endorsement of government-run health care, either in absolute or comparative terms. He says raising taxes to provide free riders with health care is objectionable, but not as bad the individual mandate. There’s nothing I see in the statement about government-run health care. One could raise taxes to give money to people to buy insurance on the free market (a proposal which some conversative economists favor, and which McCain adopted), and I doubt many people would consider that a government-run health care system.
December 29, 2011, 2:47 pmAnonimus says:
Moe important, there isn’t a mandate for everyone to buy auto insurance, only people who use public roads. So there’s no analogy to Obamacare.
December 29, 2011, 2:47 pmAdam says:
This argument might make some sense if the income tax system hadn’t been used (by liberals and conservatives) as a reward/punishment for certain behaviors, rather than a way to raise revenue. But it has.
December 29, 2011, 2:50 pmSteve Donweber says:
I’m not so sure that this is a “fact,” as you say. A matter of interpretation, perhaps, but certainly not a fact.
December 29, 2011, 2:56 pmegd says:
I think this is a valid argument, that the Conservative position should favor government control of an industry over mandating participation in an industry.
Similarly like the Liberal position should be in favor of banning abortions over banning all forms of contraception.
That doesn’t actually get us anywhere, does it?
December 29, 2011, 3:07 pmSeige says:
Government administered catastrophic health insurance seems the better alternative to a gross expansion of government power. Unfortunately, how would you define “catastrophic”? A laborer’s broken arm could be the difference between homelessness and just getting by.
December 29, 2011, 3:08 pmI think the mandate is unconstitutional, but beyond that, it kicks the can down the road. Cost remains an unresolved issue.
Most Americans think some kind of affordable healthcare should be available to all Americans. But we won’t get it in a market driven to provide the most healthcare an insurance company is willing to pay for, which is dictated by the costs an employer is willing to pay to provide health insurance for its employees. With the market so separated from the user of its services, market forces are severly attenuated leading to very expensive mediocre care.
In my view, base level government care with individually, not company, purchased supplemental insurance is the best long term option.
Jardinero1 says:
“Government exists first and foremost for the sake of our protection. Without it, our lives and our property would not effectively be our own. Government exists also to promote our well-being.”
You have to accept the above premise to accept the argument. I for one do not accept the premise. Let me restate the premise to reflect the truth about government:
“Government exists first and foremost to confiscate the lives and property of others to further its own ends. Without it we would be able to keep the entirety of our lives and property without fear of confiscation by those who claim a monopoly on violence and coercion. Government exists to promote its own well-being and the well being of the useful fools and toadies who facilitate its monopoly on violence and coercion.”
Having restated the premise to reflect the truth. I can state, categorically, that I don’t think anyone should favor a government run healthcare system.
December 29, 2011, 3:16 pmAdam S says:
It is less ideal to have a private/public mixture because you lose 1. government accountability, 2. lose the benefit of laws which apply only as against public bodies (a. freedom of information laws, b. constitutional restrictions)
As to whether there would be more or less choice-affecting regulations under a single payer or mandate system, I don’t think one can safely say either way. Sometimes there is more regulation when the government isn’t a market participant because the government might have a fear of private enterprise operating without oversight. Empirically I don’t know enough to say under which system there would be more choice/freedom.
One thing I will say for certain though is that freedom depends on more than just the quantity of money that the government is directing.
December 29, 2011, 3:16 pmAJ says:
I think it was Regan v. Taxation with Representation that said that tax credits (reducing one’s tax liability) are like spending subsidies and must satisfy the judicial check on whether someone’s due process is being trampled. On the other hand, a tax increase must be a Constitutional tax and satisfy that tax’s requirements. PPACA fails on this count.
December 29, 2011, 3:18 pmragebot says:
WARNING: RANT ALERT
Instrument Design 101 teaches us that if you ask the question “Are you in favor of pie in the sky by and by” there will be a huge positive response. If you reword the question to “Are you in favor of spending the coin of the realm in your pocket to pay for pie in the sky by and by” there is a huge drop in that positive response.
Health Care Planning 101 teaches us that health care resources are scarce and must be rationed. Traditionally the US has rationed health care by price; e.g. you have to pay for health care some how, or in the alternative wait in line a long time for what is often inferior and incomplete health care, if you get it at all. Many European countries ration health care by time, often with long waits and restrictions on expensive treatments for low yield patients.
The problem with your proposed solution is not that it is an irrational solution, rather that it requires folks with more money to pay for health care for those with less money; and most folks want to keep their money.
Disclaimer: I took both Instrument Design and Health Care Planning as an Urban Planning student.
December 29, 2011, 3:23 pmAnderson says:
What a lot of these posts ignore is the political reality of how Obamacare was passed.
You mean, pursuant to Article I of the Constitution?
December 29, 2011, 3:26 pmMartinned says:
Most folks want a lot of inconsistent things. It’s not clear to me why you think “I want to keep my money” should win out. (It might, in a given case, or it might not. That’s what we have legislatures for.)
December 29, 2011, 3:30 pmFloridian says:
I’ve never been sure why people make a distinction between a state (or local) and a federal manadate. I thought the libertarian argument is that it’s all about the individual’s freedom.
My municipality mandates that everyone in the city pay for a garbage collection service, no matter how much trash one generates or if one has nothing to dispose of at all. You don’t even get a choice of garbage collection companies. Why should I care whether the manadate comes from my city, state or federal government?
December 29, 2011, 3:30 pmragebot says:
I meant the way Obamacare ignored regular order to bypass the normal operating procedures on Capitol Hill — the “regular order” of subcommittee and committee hearings, committee markups of legislation and vetting and amending through floor debates before a final vote.
Those who forget history are condemned to go to summer school.
December 29, 2011, 3:30 pmStephen Lathrop says:
That reverses my understanding of insurance, which is to generalize and spread risk. Evaluate risk accurately enough and everybody pays exactly what he would pay anyway—and nobody gets any insurance at all.
That, by the way, is the obvious trend in today’s health insurance marketplace, even under the PPACA. The whole thing is going catastrophically over the cliff, while the insurance companies throw themselves a gigantic going-out-of-business party funded by massive rate increases. What a mess.
I’m fine with fixing it with single payer, or with a functioning market solution, either one. Whatever works. But I think the market solution is a pipe dream: too much contingency, too little availability of pricing and coverage information. Ordinary consumers are not going to be able to make informed choices that would depend on actuarial data they will never have (or be able to evaluate if they did). And then there is the near certainty that the market would moral-hazard its way to covering exclusively the least risky market segments, dumping the others onto the public purse anyway.
Unless market fans are fine with simply denying health care to half or more of the population, I think they better get used to the idea of single payer. After that it will just be a matter of what costs the least, and that will turn out to be more government intervention, not less. The less expensive model is going to be the VA system, not Medicare.
By the way, why did the nation let so many private insurance company leaches into the medicare system? I just turned 65, and found out first-hand why that poor benighted Tea Party guy was railing about keeping government hands off his medicare. There are so many private intermediaries trying to get between you and your doctor that it takes genuine alertness to perceive the thing as a government program at all. It seems to be a system designed to combine the regimented uniformity of a government run system with plenty of gratuitous extra overhead supplied by the private sector. What a mess.
December 29, 2011, 3:32 pmJardinero1 says:
I sell insurance in Texas. Insurance is not required in Texas, proof of financial responsibility is. Most people in Texas choose to buy insurance to fulfill the requirement. There are other lawful ways to fulfill the requirement.
The free-rider problem only applies to public goods. Healthcare is a business not a public good. Example of public goods are roads or national defense.
The free rider problem does not apply to healthcare anymore than it applies to autocare or the grocery business. The issue in healthcare is the same as in any business; occasionally you have a customer who won’t pay. The solution is simple, refuse to provide service or sue the customer.
December 29, 2011, 3:33 pmragebot says:
It’s sorta why we have elections as well, if a bunch of dems vote for Obamacare and then lose control of the house; not to mentions predictions they will lose control of the senate and possibly the prez as well that seems to be an indication that the voters are unhappy with the way the legislature is spending the voters money.
December 29, 2011, 3:35 pmragebot says:
Some kinda police power thing granted to the states but not the feds.
December 29, 2011, 3:37 pmMartinned says:
The definition of a public good is a good that is non-rival non-excludable. While health care fails the first one, as a matter of actual policy it meets the second criterion. No one is excluded, even if theoretically they could be. For goods like this, we have the label “semi-public good”.
December 29, 2011, 3:37 pmMartinned says:
Again, you’re (deliberately) confusing things by mixing up the morality question and the constitutionality question.
December 29, 2011, 3:38 pmMartinned says:
Wait, what? Legislators are now supposed to vote by opinion poll, anticipating elections that won’t be held yet for more than a year? If the American people hate Obamacare so much, they can elect enough Republicans to repeal the thing. Until they do, I’m not sure what you’re getting at.
December 29, 2011, 3:41 pmragebot says:
Did you miss my regular order post? Did you forget Nasty Nancy said we have to pass Obamacare to find out what it says? Did you forget the congressional phone system crashed due to the number of calls about Obamacare? Did you forget the graft promised to legislators in return for their votes?
The bottom line is there was a lot of opposition to Obamacare and the only way it passed was on a middle of the night vote with several key votes coming from guys/gals who knew they were voting against the wishes of those who elected them. That’s what I am getting at.
December 29, 2011, 3:46 pmAdam says:
Public catastrophic insurance does sound good, but I doubt it will let the free market reign in a way likely to bring down costs. The catastrophic level would probably be set at a few thousand dollars or so, which is a lot of money to most Americans. The vast majority of people won’t hit that level in any given year, who will just go to the doctor a couple times a year. So you’ll have a free market in basic primary care. But healthcare spending is highly concentrated in any given year (5% of people incur half the costs, 50% incur 3% of costs- http://www.ahrq.gov/research/ria19/expendria.htm). If you trip the catastrophic level, that means you likely have something seriously wrong that year, so that you’re in the hospital and/or using a lot of specialists. Indeed, probably nearly all people in-patient at the hospital and certain specialists will be in catastrophic level. So, the catastrophic segment, which is 80% of so of healthcare costs, and almost no one else, are using hospitals and specialists, so their revenue is entirely from third party payors. You then end up with all the cost control problems we have today in most of the market.
December 29, 2011, 3:50 pmMartinned says:
Yes, I got that. I just don’t get why that is a problem. If you believe in government by opinion poll, why not abolish the legislature entirely and cut out the middle man?
December 29, 2011, 3:52 pmjoin up says:
buying health insurance is like serving in the military, its a small sacrifice that greatly benefits your fellow man
December 29, 2011, 3:54 pmTed says:
What part of the constitution places socialized health care outside the powers of the federal government? Do those provisions apply to Medicare?
December 29, 2011, 3:57 pmLaura S. says:
Its not a first principles argument; its a constitutional distinction. Only the states hold a general police power. Its generally understood that the federal government cannot promulgate a Federal Motor Vehicle code for instance. This is the same reason a general law against murder is unconstitutional at the Federal level.
December 29, 2011, 4:02 pmMartinned says:
You will note that this thread is not about the constitutionality of the mandate, but about its desirability as a matter of policy.
December 29, 2011, 4:07 pmNaG says:
Based on all of this, does that mean that there might be bipartisan support for a universal baseline government-provided catastrophic insurance that is funded through a tax on income over, say, $100,000/year? While blatant wealth transfers are unpopular, here the wealth would only be to cover instances when someone suffers a catastrophic injury or loss–much more palatable. Plus, even the rich could use it, and could think of their tax as the premium. Just thinking out loud.
December 29, 2011, 4:10 pmcaptcrisis says:
I don’t know why conservatives are so afraid of the federal government. Not when 40 conservative senators, representing 10% of the general population, can stop any legislation. And if the Senate goes Republican next year, their senators will represent only 25% of the general population, and yet they will set the federal government’s agenda.
You’d think liberals would be more afraid of the fedd, or at least feel more frustrated.
December 29, 2011, 4:12 pmJoe says:
Adam S says:
It is less ideal to have a private/public mixture because you lose 1. government accountability, 2. lose the benefit of laws which apply only as against public bodies (a. freedom of information laws, b. constitutional restrictions)
The mixture would entail government accountability since you still have the two systems intermixed with government oversight involved. The government can also require freedom of information and other things, such as equal application of insurance. Private companies provide various necessities in this country.
I am, it should be noted, trying to look at it from the critics p.o.v. A single payer system very well might be more ideal than what we are left with here. The critics think the matter should if anything be more private, e.g., so having the same constitutional limits apply would not make sense to them.
As to whether there would be more or less choice-affecting regulations under a single payer or mandate system, I don’t think one can safely say either way.
This might be the most cautious approach but I tend to doubt it. Others btw note “mandate system” is arguably misleading.
Sometimes there is more regulation when the government isn’t a market participant because the government might have a fear of private enterprise operating without oversight. Empirically I don’t know enough to say under which system there would be more choice/freedom.
It is not a matter of “without oversight,” since there would be some here. It would be scale. And, I doubt that if the government is running the show, at least here, there would be LESS. And, “government accountability” includes less discretion — those w/o accountability tend to have more discretion to act.
One thing I will say for certain though is that freedom depends on more than just the quantity of money that the government is directing
Yes.
December 29, 2011, 4:15 pmHal Duston says:
In Missouri, the financial responsibility requirement may be met in one of three manners. A liability policy with limits of 25K/50K/10K. A certificate of self-insurance (for a company or religous organization). Proof of financial responsibility filed tith the department of revenue. The third item may be a $60K surety bond, a real estate bond of at least $120K, cash or negotiable securities of at least $60K
December 29, 2011, 4:20 pmBen P says:
I’ve done a number of cases in a closely related area, that is lawsuits against nursing homes for malpractice/negligent care and I can tell you the reason Physicians don’t often do this is twofold.
1. A number of states have found contracts requiring binding arbitration in the healthcare context to be per se unenforceable as against public policy. Although I’m more inclined to agree with you on this point, the Plaintiff’s bar’s arguments that the contracts are binding and it is fundamentally unfair to limit remedies for medical malpractice seems to usually win the day on this one.
2. You have some consent issues anyway. Healthcare aside, arbitration clauses are in that class of provisions (also like clauses limiting liability for your own negligence) that courts often require to meet higher standards (ie. “clear, obvious, set out in higher text) and they can get tossed if the contract was an adhesion contract or there’s some other issue with it.
On a related note, assuming this is the case how do you address emergent situations. Particularly for the poor a lot of medical care is treated on an emergent basis and when someone is unconscious or rolling around in pain, any contract signed is likely to be invalid.
December 29, 2011, 4:29 pmAJ says:
A federal insurance mandate is bad because it hides the costs of the system off budget. In effect, the regulatory requirement to purchase is the equivalent of the tax that Congress would have had to raise to provide the benefit (modulus the government overhead). So if I am made to go off and buy a policy, then that is $3k that government does not have to raise in taxes to provide the benefit. This would be similar to government mandating everyone invest into a government-approved mutual fund so it does not have to raise taxes to cover social security. Now government does pass off some costs onto people via voluntary regulation and because of citizen duties (buying a stamp to mail one’s tax or bus fare to do jury duty) but an insurance mandate is an entirely new means of government getting access to a citizen’s wealth. Cash-on-hand that is not currently being used is similar to real property that is not being used to make income. Trying to get to it requires a direct tax. The mandate approach circumvents the requirements of apportioning this tax and makes protecting my wealth more difficult. I believe that protecting wealth was a key element of differentiating direct and indirect taxes in the Constitution.Forcing Congress to craft a legitimate tax or a legitimate tax credit makes it clear that the government is using its powers properly.
December 29, 2011, 4:37 pmJHW says:
Dear conservatives and libertarians: if you would rather have single-payer than the PPACA, you can make it happen. Most liberals would rather have single-payer than the PPACA, too.
December 29, 2011, 4:41 pmCornellian says:
I applaud the use of French but there is no “s” at the end of “fait accompli.”
December 29, 2011, 4:43 pmTed says:
Good to know, Hal. So true self-insurance is limited to organizations. And quasi-self-insurance via a bond is actually higher than the minimum liability policy.
I’m not amazed that states allow self-insurance; I’m amazed that Laura’s state would allow self-insurance with such a miniscule reserve or bond. 15k is like PIP coverage (no-fault personal injury protection coverage pays your own medical to the limit in case of an accident), and it’s hardly “insurance” for an MVA requiring medical treatment.
AS to the OP, conservatives should advocate for the single-payer system, because it’s better for the country than the mandate.
December 29, 2011, 4:43 pmAnonimus says:
Conservatives will advocate for personal freedom and responsibility, because it’s better for the country than a mandate or socialized medicine.
December 29, 2011, 4:46 pmCalderon says:
Ben P said:
Really? While arbitration is not one of the areas I practice in regularly, my understanding was that the Federal Arbitration Act and implementing case law prohibited state courts from treating arbitration provisions differently from other provisions in contracts. See http://en.wikipedia.org/wiki/Federal_Arbitration_Act. (I know, it’s Wikipedia, but I believe it interprets case law under FAA Section 2 correctly.) Or is the idea that all limits on medical care liability are against public policy and so arbitration is treated the same as other provisions in this context?
December 29, 2011, 4:47 pmBen P says:
Some of this is overstated, some is not.
You have a point that the amount of healthcare we can have is limited by the amount of resources we, as a society (whether by an invisible hand or some sort of command economy) are willing to dedicate to it.
But at the same time you’ve got two distinct problems.
1. This concept doesn’t account for the fact that we spend substantially more on healthcare but don’t achieve substantially better results. There may be other causes for these problems, but there should be some pretty serious question as to why the US’s peer countries in these measures are third world countries.
2. It doesn’t really address the truly huge amount of overhead built into our healthcare system. Much of the spending that places us far and away at first place doesn’t go to direct care, but to insurers and other middle men. It affects doctors as well, even a small family practice doctor often has an employee or two dedicated to nothing but dealing with insurers and ensuring the doctor gets paid for work he does.
December 29, 2011, 4:51 pmrob bob says:
In a vacuum, I do believe that single payer could be better than Obamacare. That doesn’t mean I am going to push for that now. I want free market health care. I believe that if single payer were adopted now, something like the status quo would continue and provide baby boomers with very good heavily subsidized health care, and it would provide people my age with oppressive taxes/premiums and a greatly increased national debt. The system, obviously unsustainable, would finally get the necessary deep cuts to benefits around the time I am supposed to start getting them. At that point single payer would finally resemble a system that made more sense than Obamacare. With no market whatsoever, hope for lots of innovation and cost-cutting through competition (the latter of which we don’t have at all now) would be totally gone and we would be left with just relatively poor care, BUT cheap and available to everyone (though the tiny group of super rich would still have great stuff). Obviously, we aren’t going to get single payer and make it feasible like this right off the bat. It will take a while.
I don’t think it’s inconsistent that I was against Obamacare in part because it could lead to single payer. Obamacare takes those things that have festered for decades, becoming entirely responsible for the problems regarding health care costs, and further entrenches them. Aside from the fact that Obamacare is a move toward socialized medicine on a practical level, making the problems of health care costs far worse is an Alinsky-ish way of bringing about a completely socialized system.
Rather than pushing for single payer, I would like to see a free market for health care, in which a modicum of effort would finally be applied to cutting costs. The entire system is chock full of inefficiencies.
December 29, 2011, 4:51 pmadjunct says:
The concern expressed by Rahe is in no way new.
Here’s a Republican document written in in April 2008 on the subject.
http://rsc.jordan.house.gov/UploadedFiles/PB_043008_Individual%20Mandate.pdf
Quote of note:
The broader concerns surrounding an individual mandate focus on its significant new intrusion by the state into the lives of all Americans. In critiquing the proposals by Sens. Clinton and
Obama, former Clinton Administration Secretary of Labor Robert Reich conceded as much, noting that a mandate is “to many Americans, the least attractive [aspect] because it conjures up
a big government bullying people into doing what they’d rather not do.”
Secretary Reich’s description of an individual mandate closely mirrors that of F. A. Hayek, who in his landmark work The Road to Serfdom discussed the inherently arbitrary nature of central government planning and the ways in which its growth tends to undermine personal liberty and freedom. Some conservatives, reflecting anew upon Hayek’s warnings more than half a century ago, may believe that “bullying” the American people into purchasing health insurance, to the extent to which such a mandate would actually be effective, is inconsistent with a belief in individual
liberty.
*********************************
Two months earlier, of course, Obama had stressed in debates that he, unlike Hillary Clinton, opposed an individual mandate. And the study document noted that, at the time, “Sen. Barack Obama’s plan will require that all children have health care coverage,” but does not advocate a mandate for all individuals—although he has indicated an openness to consider one in the future should large numbers of adults choose not to purchase insurance.”
**************************************
So I think that answers the question regarding whether conservatives were concerned about this issue well before Obama jumped on the mandate bandwagon.
[OK Comments: I fear you have misunderstood the post. The issue is not whether conservatives were concerned with a mandate -- obviously most were, although there are notable exceptions like Newt Gingrich, who embraced the mandate idea at the time. The question is whether conservatives expressed the view that a single payer system was better than an individual mandate. ]
December 29, 2011, 4:54 pmAnonimus says:
What measures?
December 29, 2011, 4:54 pmBen P says:
This is an article on a recent case in Florida that struck the contracts down
My state (AR) has been somewhat more willing to uphold the arbitration agreements, so honestly I’m not sure of the impact of the FAA on these agreements, but the description of the Florida case in the article above makes me want to look into it more deeply because the ruling that a judge rather than an arbitrator must decide the validity of the contract seems directly contrary to buckeye check cashing
December 29, 2011, 5:03 pmrob bob says:
A mandate for catastrophic insurance only wouldn’t be so bad without all the other crap that Obamacare does, and the other crap that we already had. A mandate in these circumstances is terrible. And possibly the political situation is such that it could never be good. Things change over time and new implications arise. However, single payer is only “better” in a very theoretical, hypothetical way. I don’t support it.
December 29, 2011, 5:17 pmCalderon says:
Ben P — thanks for the article. I found the Fla. Supreme Court case (http://www.floridasupremecourt.org/decisions/2011/sc08-1774.pdf) and skimmed it. On initial read (which is in no way thorough and may be incorrect), my understanding is that the court’s ruling was that the waiver of punitive damages violated public policy, and because that waiver was so integral to the rest of the arbitration agreement, it was not severable and so the entire arbitration agreement was invalid. Thus, setting aside whether the court’s decision is correct, on its face (and without attributing hidden motives to the court) the issue appears to be more about limiting remedies than arbitration per se. Presumably, if there was no limit on the remedies, the court would not have had any hook to strike down the arbitration provision.
December 29, 2011, 5:27 pmleo marvin says:
Trust me, I feel plenty frustrated.
December 29, 2011, 5:29 pmTed says:
“Why would you lie about something like that?“
December 29, 2011, 5:31 pmTed says:
Wouldn’t limiting punitive damages (or non-economic damages) be the primary goal of including arbitration agreements to limit malpractice awards? Or do you think merely the cost difference of civil litigation vs. arbitration is significant enough to make doctors more comfortable with malpractice exposure.
December 29, 2011, 5:38 pmAdam says:
“Alan G. Kaufman: I find it intriguing that when gov’t run health was proposed in the 1990s, the conservative Heritage Foundation suggested an individual mandate, and now that there is an individual mandate, they hate it…and a conservative says gov’t run health care is preferable.Fascinating”
I find it intriguing that when Hillary and Edwards proposed individual mandates during the 2008 campaign, Obama opposed it because he said it wasn’t necessary. And then when he became President, he said it was necessary and pushed for it to be part of the law. Fascinating.
People change their minds.
December 29, 2011, 5:39 pmSigivald says:
Perhaps more apt version of the headline:
“Should conservatives prefer a douche to a turd sandwich?” (ref)
Rather than asking them which they should prefer, of the two, shouldn’t it first be established that:
A) One of the two is acceptable at all to “conservatives” as such.
and/or
B) There isn’t any practical way to have neither the douche nor the turd sandwich.
and/or
B2) That whatever alternative there might be is even worse.
I’m not even a conservative, and I don’t buy option B, and I’m not sure that option A fits for conservatives any better than libertarians.
I mean, sure, maybe if you really have to have the douche or the turd, you might have reason to prefer one or the other – but I think in the case of “national health care”, we can reject that dichotomy. After all, we’ve had neither the douche nor the turd since the founding of the Republic.
December 29, 2011, 5:41 pmKazinski says:
The problem with health care is someone has to pay for it. But almost everyone wants that “someone” to be someone else. People who can afford to pay for their health care should. And that includes most of us. That’s why I think a system that provides a safety net like single payer catastrophic insurance, but encourages us to pay for most health care out of pocket is the best solution. Coupled of course with malpractice reform to take the costs of defensive medicine out of the system.
That of course is why I think Obamacare was much more a power grab than a real effort to reform health care. By outlawing catastrophic coverage insurance plans the are outlawing people self insuring their routine medical costs (under say 5000 a year). By not implementing malpractice reform they didn’t do anything to change the cost curve.
December 29, 2011, 5:41 pmJardinero1 says:
Martinned: The definition of a public good is a good that is non-rival non-excludable. While health care fails the first one, as a matter of actual policy it meets the second criterion.
December 29, 2011, 5:51 pmTed says:
I would say that many people would like “everyone,” as opposed to “anyone else,” to pay for it. I’m certainly not opposed to contributing to my own health care, and I certainly don’t “anyone else” to pay for all of it. But if something serious happens to me, and it exceeds my ability to pay for it, I would appreciate it if you all cover the difference. Thanks in advance.
December 29, 2011, 5:52 pmThomas Sewell says:
That’s the wrong question to ask and betrays a lack of understanding of the framework of the constitution itself. Instead, you must answer the opposite, where in the constitution does it grant a specific power to socialize health care?
December 29, 2011, 5:57 pm“The powers delegated by the proposed Constitution to the federal government are few and defined. Those which are to remain in the State governments are numerous and indefinite.” – Hamilton, in Federalist #45
“The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.” – 10th Amendment, put in just in case someone thought like you apparently do.
The Constitution was, from its very origin, contemplated to be the frame of a national government, of special and enumerated powers, and not of general and unlimited powers.
—Justice Joseph Story (1833)
The Tenth Amendment was intended to confirm the understanding of the people at the time the Constitution was adopted, that powers not granted to the United States were reserved to the states or to the people. It added nothing to the instrument as originally ratified…
—Justice Owen Roberts (1931)
Steve says:
Defendants may believe that an arbitration panel is less likely to award punitive damages or non-economic damages than a jury, but there’s not an actual structural limitation that prevents the arbitrators from doing so. In fact, I’ve seen arbitrators get away with awarding punitive damages in a situation where state law didn’t even allow for them.
December 29, 2011, 5:57 pmCalderon says:
I think getting in front of an arbitrator rather than a jury would make doctors and their insurers more comfortable with malpractice exposure. An arbitrator is less likely than a jury to impose pain and suffering damages or punitive damages that are many multiple of compensatory damages, find liability simply to compensate a sympathetic plaintiff regardless of the doctor’s fault, etc.
Anyway, we’ve wondered far afield from the OP, so I won’t post against about arbitration. I’m still interested in seeing a conservative argument for government-run health care over a mandate, but with respect to Prof. Kerr and many commenters Rahe does not appear to be the droid they are looking for. For that reason, Prof. Kerr’s update that leaves the impression that Rahe is a hypocrite along with the comments claiming that conservatives generally are hypocrites on this issue seem misplaced.
December 29, 2011, 6:00 pmSteve says:
Actually, no, I think it’s perfectly appropriate to start by asking if you believe Medicare is unconstitutional. You can certainly make such a case if you want to start from first principles, but because the constitutionality of Medicare is not seriously in dispute at this point, asking that preliminary question helps to establish whether the debate is going to be purely academic.
December 29, 2011, 6:00 pmAdam says:
“I would say that many people would like “everyone,” as opposed to “anyone else,” to pay for it. I’m certainly not opposed to contributing to my own health care, and I certainly don’t “anyone else” to pay for all of it. But if something serious happens to me, and it exceeds my ability to pay for it, I would appreciate it if you all cover the difference. Thanks in advance”
Would you be opposed to paying a certain amount of money monthly, the amount of which would be determined by evaluating your risk of having something serious happen, without “everyone” chipping in to help pay that amount? Let’s call it, I don’t know, a premium.
December 29, 2011, 6:05 pmTed says:
Aww, dangit. I was hoping for a discussion about the text of the constitution. All I got was a few cherry-picked comments. Tasty as those are, how literally and to what extent are willing to apply them? Do they, perchance, begin where you want and end where you want?
December 29, 2011, 6:10 pmTed says:
Not out of principle, no. Practically speaking, however, I would object if that amount exceeded my ability to pay it. Such a “premium,” as you call it, would make significant health care costs inaccessible to me in that circumstance.
But I have a question, would you oppose risk pooling with your neighbors or co-worker in order to more-evenly distribute risk and obtain a lower premium? Would you be opposed if that pool included both neighbors, friends, and coworkers? What if it included the entire neighborhood? County? City? State? Nation?
December 29, 2011, 6:14 pmTom Rigid says:
What a bunch of bloviate nonsense! Constitutional or not (only Mr. Kennedy knows for sure), it’s the first thing we’ve passed that might resemble universal coverage, which is a prerequisite of an equal-opportunity society.
The form of it is kludgy by necessity; every health care solution more cost-effective and elegant was clearly unacceptable to Messrs Lincoln, Nelson, Lieberman and the rest.
A hypothetical Conservative preference for single-payer over mandate is the purest mendacity, a roundabout attempt to communicate the extremity of their scorn for the form of this new law. What is actually communicated, however, is their commitment to an outmoded and discredited perspective which resembles nothing so much as social Darwinism.
December 29, 2011, 6:26 pmAdam says:
“But I have a question, would you oppose risk pooling with your neighbors or co-worker in order to more-evenly distribute risk and obtain a lower premium? Would you be opposed if that pool included both neighbors, friends, and coworkers? What if it included the entire neighborhood? County? City? State? Nation?”
So long as the premiums had some acturial relation to each individual’s risk, and each individual were required to pay the full amount without subsidy, I wouldn’t object. That is, after all, how private insurance works when premiums are not set/capped/subsidized by the government.
December 29, 2011, 6:29 pmStephen Lathrop says:
Another point for those longing for free market solutions: you are not going to get them. To see why, look at the present market for small group policies.
Each one is a custom original, with services aggregated kaleidoscopically, and prices experience rated for the group in question. Doing it that way makes price competition impossible, because consumers can never do apples-to-apples comparisons of policies to discover who offers the better price. Insurance companies are free to use actuarial tricks and contingency pricing of various sorts to further fuzz up the picture, and to extract maximum money from customers. The practical limit on what the customer will pay becomes the amount the customer could manage to pay if he were uninsured, and suffered a catastrophic health event each year. That is just about where these strategies have delivered the small group policy market now.
Using computers, insurance companies are perfectly capable of doing the same thing on a person-by-person basis, and that is what they will do in any unregulated market. You can call that freedom for customers if you want to, but it will not deliver many of the freedom benefits so enthusiastically touted for free market solutions. If you want price competition for health care, the only way to get it is to mandate uniform services, and there goes your free market. Either that, or abolish health insurance altogether.
December 29, 2011, 6:35 pmSeaDrive says:
Everyone in the system has been trained to think that no one pays for his own health care, at least beyond the $100 office visit. Doctors are used to getting stiffed by self-pay patients. I think you’ll find that most docs are not enthusiastic about high deductible plans since they get stiffed by a high percentage of those patients too.
December 29, 2011, 6:36 pmTed says:
What do you mean by actuarial relation to each individual’s risk? Can you give an example? As far as I know, group health plans do not consider the actuarial data of individuals, but are based on the actuarial traits of a group as a whole.
Once you begin to expand or extrapolate the idea of risk pooling, you either end up pooling everyone together, or you exclude people based on the likelihood of getting sick. The more accurate your tables the more sick people are excluded. Because they are excluded, their costs for coverage go up. Resulting in the highest risk group being the least likely to afford coverage. That seems like a very bad result to me.
But is that what you’re advocating for? That the people most likely to get sick should be least likely to be able to pay for and acquire medical care?
December 29, 2011, 6:55 pmMorat20 says:
He’s not even from Houston.
It’s DPS in Texas, not DMV. Furthermore, the minimum liability is a lot more than 15k and I am unaware of any bonds or otherwise youc an post to avoid it.
It’s particularly strange for a lawyer to not only get his state law wrong, but to assume all 50 states have the exact same criteria for a law that is, in fact, purely the state’s.
December 29, 2011, 7:01 pmRichard Riley says:
Randy Barnett has strongly implied that he, at least, believes a government-run single payer system would be worse policy than the mandate.
I can’t remember if it was in his and Orin’s (great) videotaped FedSoc debate on the mandate (there’s a link in one of Orin’s posts from last January), but certainly in other forums Prof. Barnett has been asked, wouldn’t eliminating the mandate just make it more likely that a governmental single-payer system would be enacted? I don’t think Barnett has ever said, “Sure, that’d be better than the mandate!” I believe his response has always been, “It’ll never happen politically.” That is admittedly coy as to whether he thinks it preferable to the mandate as a matter of policy. But certainly he implies single payer would be worse policy than the mandate and jumps to explaining why overturning the mandate on Constitutional grounds would NOT lead to single payer.
December 29, 2011, 7:05 pmKazinski says:
That is what my proposal single payer catastrophic insurance would do. Unfortunately Obamacare and Universal Single Payer insurance are much more intrusive and controlling. But to them that is a feature not a bug.
December 29, 2011, 7:20 pmAlso anon says:
What’s your point, Orin? I mean the fact that some people were for something, then weren’t, or said one thing, and now say another, is pretty common in politics. Do you want an individual mandate? Why or why not? Those types of postings are what make this blog worth reading – not what you just posted.
December 29, 2011, 7:22 pmMartinned says:
Actually, I think politics excessively penalises “flip-flopping”. Look at how Romney and Gingrich are being attacked using their own past statements. (And how they are unable to defend themselves by saying they changed their minds, since that is for some reason not an acceptable response.)
December 29, 2011, 7:29 pmadjunct says:
[OK Comments: I fear you have misunderstood the post. The issue is not whether conservatives were concerned with a mandate — obviously most were, although there are notable exceptions like Newt Gingrich, who embraced the mandate idea at the time. The question is whether conservatives expressed the view that a single payer system was better than an individual mandate. ]
Sorry if I didn’t get what you were after. You wrote, after all, “Did any conservatives express this view before President Obama embraced the individual mandate?” I understood “this view” to refer to Rahe’s condemnation of the mandate.
So I showed you a 2008 document condemning it years before Obama came up with his mandate.
Now I understand you to be saying something quite odd: namely, that Rahe said “that a single payer system was better than an individual mandate.”
What? Who has said this? Not Rahe, that’s for sure.
Can you show me anywhere where Rahe wrote that he prefers universal health care coverage to be provided by the government rather than have it done by mandate? That view certainly isn’t in the article you quoted.
Rahe states that “Raising taxes to reward free riders is, of course, objectionable. We should oppose it on principle.”
Hmmm– that sounds like a rejection of high taxes. I don’t see anything here about preferring a universal coverage system: do you?
Then he says “But it does not in and of itself narrow in any significant fashion the sphere of our liberty. It is a question of the proper use of the public purse. The individual mandate sets a new precedent. It extends government control to the private purse.”
OK, I see here how Rahe is saying that the individual sets a “new precedent” that permits a new evil. I suppose this may or may not be worse than the old evil — new taxes — in some situation.
I don’t see, though — and I think that’s because it’s nowhere to be seen — that Rahe ever says that he’d in any way prefer the US government to run health care coverage universally rather than the individual mandate.
Where do you see that statement?
December 29, 2011, 7:44 pmTed says:
Sure. What’s your deductible? Don’t you worry that it might be more cost effective (economically speaking) to cover preventative care as well as emergency/catastrophic care? It seems like the persons unable or unwilling to pay for routine care, will forgo care, which may turn ordinarily inexpensive preventative care into catastrophic, expensive care. I would think poor persons with chronic illnesses that need to be controlled would fall into this category.
December 29, 2011, 7:48 pmTed says:
You forgot to add the part that makes the penalty excessive. No problems with changing one’s mind, it can even be a laudable sign of a willingness to listen and learn. But it’s not always, or even usually. In politics particularly, I think people change their minds because they think that it will garner votes, not because they have learned something, or have a adopted new reasons for their positions. I would be all for a politician saying, “I thought X before. Since then, I learned Y, which leads me to conclude that Z is the answer.”
P.S.: To be persuasive, Y can’t be “that’s what my handlers told me to say.”
December 29, 2011, 7:57 pmAJ says:
Single payer means no market options and the usual government efficiency. Mandate means government-approved insurance options, including levels of insurance that you may not desire, or penalty for not playing. Both methods maintain a disconnect from how much health care one consumes and the price he/she pays. There are other options including capping premium costs for those entering with pre-existing conditions, taxing health care benefits, disconnecting health insurance from employment, providing tax credits based on levels of insurance, allowing purchases across state lines with minimal regulation, greater pooling, etc. This whole line-of-thinking that conservatives have to take this loser option because it is the best they can possibly get is based on what exactly? What poll says single-payer is inevitable or even popular? Single payer may be constitutional but this choice still amounts to choosing one’s jail cell. A poke in the eyes or a poke in the groin…I say no thanks.
December 29, 2011, 7:59 pmTed says:
Don’t look at the legend, and see if you can tell what this map shows…
What do you think we have in common with the poorest African nations and the poorest European nations, the poorest South American nations, and the poorest Asian nations? What would you WANT to have in common with these countries?
December 29, 2011, 8:27 pmleo marvin says:
I agree. I’d add that the cost exacted for flip-flopping obscures another useful piece of information, i.e., which politicians would candidly admit they were ever wrong in the first place if the flip-flop itself weren’t politically toxic.
Are European politicians also punished for changing their minds?
[Edit: I see Ted raised the same issue I did. I excuse him for doing so more persuasively.]
December 29, 2011, 8:27 pmragebot says:
There is not complete agreement that the US lags behind the European countries in results. One common example cited by guys who claim so is infant mortality. Problem is in Europe a live birth is defined as a birth where the child lives a week, where as in the US a live birth is a live birth even if it a premature birth and the infant is put on life support and dies later on. The US also has a much better survival rate when treating lots of diagnosed cancer, especially in older patients who often have to go to the back of the line in many socialized systems. But the most cited example is the number of folks who come to the US for medical care. There is clearly some disparity between what I will call first rate medical care in the US and the bottom tier medical care; but that does not mean that the US is behind Europe in medical care, just that the distribution is uneven.
I sorta agree about the price structure, but would also point out six figure malpractice insurance yearly premiums are the norm and insurance companies often settle nuisance suits because it is cheaper than going to court. Before he retired my dad was a medical doctor and I had to listen to horror studies from him, including how he had more clerks than nurses in his office. But I don’t see Obamacare reducing paperwork in any case.
December 29, 2011, 8:31 pmMartinned says:
Absolutely. The only difference is the manner of campaigning.
I remember a few years ago a popular pop singer and radio-DJ was elected to Utrecht city council as the leader of a new populist party. During an early debate, he surprised everyone by telling the minister (what do you call a member of cabinet at the city level?) that he had been convinced by his opponent’s arguments, and that he would support the proposal. They still don’t know what to make of that, and to my knowledge such a thing hasn’t happened before or since in Dutch politics.
December 29, 2011, 8:33 pmElliot says:
I don’t recall any. But it didn’t become an issue until it was embraced. That led to a more focused discussion. I’d also note that option A may be preferred to option B, but both may undesirable.
The continuing focus seems to be a function of most effective legal strategy for defeating ObamaCare in the courts. That would include bringing the mandate into a general public discussion.
December 29, 2011, 9:26 pmArthur Kirkland says:
Conservatives’ failure to address, let alone solve, health care issues — including the unsustainable trajectory of the current system; the unfairness and job-killing, market-warping elements of tying health insurance to (certain) employment relationships; and the ridiculous rollercoaster pricing (providers) and abusive practices (insurers) — when they had the chance?
December 29, 2011, 9:46 pmscattergood says:
OK, I believe you are incorrect. Here is the kind of comment I was referring to:
Clearly the above poster was belittling the conservative opposition to the Mandate based on the shifting of the position.
As to my analogy, again I believe you are incorrect. I was commenting on the attack on conservatives not on which option is better / worse.
Setting up the argument as which is better or worse, single payer or mandate too narrowly defining the issue. The conservative position is / should be none of the above. However politics are the art of the possible, and it may not be possible politically to articulate that position successfully. So instead, conservatives rightly take the ‘possible’ path. So when the choice is single payer or mandate, politically it is better to be on the mandate side. When the choice is mandate or no mandate, it is politically better to be on the no mandate side.
December 29, 2011, 10:26 pmscattergood says:
Following up on that, from the Angry Bear blog, if one takes out murders and traffic accidents from the health care longevity analysis:
We have way more murders and traffic accidents than most OECD countries, especially among Blacks which hits our life expectancy. Kind of hard to pin that on bad health care and health care outcomes.
December 29, 2011, 10:34 pmDavid Schwartz says:
If I force you to get married to Carla rather than Jackie, the moral rightness of my decision does not hinge on which of them would make the better mate for you. It hinges on whether such a decision is within my just scope of authority.
Who gets to make the decision is just as much a moral question as what the decision should be. That the States have a police power and the Federal government does not makes it immoral for the Federal government to do things that require a police power. Making a decision outside of one’s scope of moral authority is immoral (subject to a few exceptions not relevant here), even if one makes the “right” decision.
Absent an argument that a mandate is or should be within the scope of the Federal government’s power, it would be immoral for the Federal government to impose such a mandate. (Again, assuming that none of the exceptions applies, such as forcing someone to be rational in a bona fide emergency.)
December 29, 2011, 11:18 pmtherut says:
Being a physician, I see things from the front line. Right now the .gov is increasing our overhead tremendously. The EMR systems are not useful. They are expensive and add not one thing to better medical care. Hospitals are spending millions and even small group rural practices like mine had to spend 250,000 for a system that just will never work. There is no way I can spend time putting info into the computer for 40 paients a day. The .gov says too bad we will dock your Medicare pay by 1-2%. Considering Medicare pays me about 32.00 for a visit and I see about 60% Medicare patients and have a overhead of 70% due to .gov rules and regulations I see a very bad future. And until patients have to bear the cost for their demands there is NOT going to be any cost savings. The.gov is more or less trying to run a .gov HMO and it is going to be a big mess.Two examples. A 93 year old patient in the Nursing home complains of knee pain and X-rays show arthritis. The family demands I order a MRI. So I do. Does anyone think this is going to change anything. This patient has dementia and is NOT a surgical candidate but the family demands to know more or they wil sue. A Medicaid patient went to the ER for a sore throat. Came to see me the next day. She was upset cause she had to wait 4 hours in the ER and only got some antibiotics. I asked her why she went to the ER with a sore throat and she looked at me like I had grown two heads. Now , all this was totally FREE to both patients. Change these things and I might listen to a PLAN.
December 29, 2011, 11:19 pmRalph Baskett says:
Apparently, even most conservatives do not understand what a truly conservative remedy to our healthcare disorder looks like. Perhaps it would be helpful to keep this example in mind:
December 29, 2011, 11:45 pmCurrent law makes employer-provided healthcare tax deductable for the employer. If healthcare was tax deductable for the individual as well–including their health insurance–most employees would insist their employer deposit what they spend per employee in their own personal health savings account (HSA). Then, most individuals would choose inexpensive high deductable health insurance and pay the minor healthcare expenses themselves. Most would substantially reduce their healthcare cost and accumulate the savings in their HSA for future emergencies. Individuals would learn to manage their own healthcare with a view to their own needs and priorities, since it is in their self-interest. This solution aligns self-interest (getting a tax deduction) with the virtues of moderation and prudence. It also uses the free market to efficiently allocate scarce resources.
The essential questions are whether the individual can do a better job taking care of himself and do it more economically than the Obamacare bureaucracy? And, are these bureaucrats more concerned about your well-being than you are?
Marvin says:
Your question in this post’s title is a trick question. It compares to asking: When did you stop beating your wife?
A Conservative should want neither government funded/run healthcare or an individual mandate to buy health insurance.
A hospital or a doctor should be allowed to refuse non-emergency (life-threatening) patients who can not pay.
Our Constitution does not convey a ‘right to healthcare’.
Individuals should be responsible for their own healthcare. Employers could then attract better employees by offering better healthcare plans to their employees.
December 30, 2011, 12:57 amJoe says:
Most would substantially reduce their healthcare cost and accumulate the savings in their HSA for future emergencies.
How many will have “saving accounts” to pay for the costs of procedures like cancer treatments or some such very expensive “emergency”?
The essential questions are whether the individual can do a better job taking care of himself and do it more economically than the Obamacare bureaucracy? And, are these bureaucrats more concerned about your well-being than you are?
Or, more concerned than insurance companies who denied care to those with various conditions, charge high costs (including to cover redundant overhead) since they are for profit and so forth. Do senior citizens dislike Medicare too?
PPACA also aligns “self-interest” with tax policy. The insurance companies have more restrictions, such as required to supply more care at a lower price than some wish to use, while the costs are balanced off to some extent (which can be tweaked as experience demands, both parties working together, not one saying “don’t want to play!”) by more customers and various methods to reduce costs, including subsidies and other aspects that we never hear much about when everyone focuses on one part of the law.
And, individuals need not have private insurance. Those not poor enough to qualify for Medicaid are likely to have the means to pay the fifteen dollars or so a week the tax penalty amounts to. In return, they still have emergency care available and can get insurance when needed, such as after an unexpected pregnancy.
Self-interest might lead many to get insurance, and in return get what amounts to a tax deduction, while others rather not.
A hospital or a doctor should be allowed to refuse non-emergency (life-threatening) patients who can not pay.
Our Constitution does not convey a ‘right to healthcare’.
Why should they not be allowed to refuse anyone? After all, there is no “right” to health care, correct? And, a hospital or doctor can refuse non-emergency care in various respects, though it is against state policy in various places, especially when “patients” like children are involved.
Individuals should be responsible for their own healthcare.
Let’s say someone has no money for cancer treatment. It’s not “life threatening.” Just leave them to suffer, easing things a bit when they are about to die?
PPACA leaves many individuals responsible for their own healthcare, including paying when they get various benefits (like emergency care and bankruptcy protection and a healthier society for the additional care provided by the government for various needy people) but are higher risks to the rest of us because they have no insurance. This seems reasonable to many of us.
December 30, 2011, 1:52 amAlan K. Henderson says:
I paid roughly the same for LASIK and an MRI. (Most people pay less for LASIK than I did because their vision prior to surgery isn’t as bad as -6.25 like mine were.) Considering that the former is performed by a surgeon and the latter by a technician, and that carving someone’s cornea is a bit more involved than putting someone under a giant electromagnet to take a picture, the MRI should cost less. But that’s in a sane medical market.
A lot of these medical schemes do nothing but play musical chairs with who gets the medical bill, rather than try to do anything about what’s causing the market distortions. Paul Rahe’s “head I win, tails you lose” choices don’t fix anything.
AAPS isn’t too fond of the choices, either. Lee D. Hieb, M.D debunks claims that government health care reduces health costs. I don’t need an MD or W. Edwards S. Deming or even a weatherman to tell me that adding extra layers of administration increases industry variable costs. That should be common sense. Unfortunately, a lot of people who make medical policy are just too daft to see it.
In a November 20 LA Times article, LA Care bigwig Walter Zelman offered a “conservative case” for the mandate. AAPS Executive Director Jane M. Orient, M.D reacted:
Y’all can guess her alternative: “Most bills should be paid at the time of service—by the person who receives the service, not by a third party. Medical services should be purchased in a competitive marketplace, with transparent prices.” Reform shouldn’t stop there, though. There need to be a thorough examination of costs associated with health care, including (but not limited to) med school and tort costs.
My MRI cost that much because the hospital shifted onto me expenses that had nothing to do with the procedure. An auto mechanic could not legally do something like that.
December 30, 2011, 2:19 amAndrew J. Lazarus says:
I was under the impression that the EMR systems are one of the least controversial parts of the law, one that even its overall detractors thinks might be worth keeping. I find your complaint somewhat counterintuitive. You aren’t keeping those 40 records per day on index cards, are you? I mean, my sons have been treated for injuries that occurred in rural areas, and the bills looked computerized to me. (One clerk confused his ankle with his wrist, and rather than re-bill insurance the hospital tried to get us to pay the difference. Nice try but I didn’t fall for it.) You aren’t billing your existing insurance carriers with snail mail; I simply don’t believe that. And even if you are, you won’t be in a few years, because the carriers don’t want to open the envelopes, they want it electronically.
As far as I can tell, my (urban) doctors’ are doing everything with a computer (or, rather, their staff are), but different insurance companies have different software and different parameters. A little standardization sounds like a good thing.
December 30, 2011, 3:34 amRicardo says:
PPACA allows insurance up to a maximum deductible of $2,000. So can you please let us know the deductible threshold between “power grab” and “real effort to reform health care”? Exactly $5,000? How about $4,999? Or $3,289?
December 30, 2011, 5:09 amRicardo says:
And doctors and hospitals will charge self-insuring patients fair prices because, umm, they are nice people? Where is the economics here? Paying out of pocket for routine care is fine — in fact, many people do it already. But the key to understanding health care is that most actual health care dollars do not go to routine care. They go to treating chronic conditions or to emergencies.
You can shop around for the best deal on LASIK if you want. You can’t shop around for the most affordable anesthesiologist when you get into a car accident and have to undergo extensive emergency surgery costing tens of thousands of dollars. Even when I once paid out of pocket for a root canal, it was impossible to get a single price estimate in advance even though I asked for it — there are sometimes complicating factors that come up in the course of treatment that affect the price.
December 30, 2011, 5:21 amStephen Lathrop says:
And once again, there is never going to be a free market for healthcare services in which patients can discover and compare prices on an apples-to-apples basis. There is too much contingency in medical care to permit that.
That means so-called free market price competition will be either non-existent or extremely inefficient. Commenters here who think otherwise should follow Ricardo’s lead and get out and start pricing medical services. I tried it too. You get nowhere.
Paradoxically, if you want free price competition the only way to get it seems to be to regulate insurance, forcing each insurer to cover the same package of benefits and take all comers, and then let them compete for customers. If you don’t think that will work, then you can do one of two things: (1) Default to single payer government-run solutions to get the best prices, and give up on the free market altogether; or, (2) Hand it all over to insurance companies and let them do what they want, accepting that a large fraction of the population is going to be priced out of health care and go without.
Those are the practical choices. Free market utopias are not part of the picture. If they were, they would have materialized already, and mooted this debate.
December 30, 2011, 6:02 amSDGLaw says:
Adults cannot be forced to go to college.
December 30, 2011, 6:40 amSDGLaw says:
People who are the recipients of stolen property are probably not the best ones to ask. Let’s ask the people paying for it.
December 30, 2011, 6:47 amLee Moore says:
Like Calderon, I’m struggling to see that Rahe and his correspondent are necessarily talking about government run healthcare as the alternative. “Government run healthcare” is not in any case a precise term with an agreed meaning. A system of taxes financing GOVERNMENT PROVIDED health care to everybody, but with credits for people who opt out and buy private insurance for private care obviously involves far more government running of healthcare than a system of taxes financing PRIVATE BUT REGULATED health care to everybody, but with credits for opt out etc. Some government running is inherent in government financing, and more is inherent in government regulating, and yet more in more detailed regulation and so on. But both are less “government running” than when the government actually owns the hospitals and hires the doctors, and determines which treatments to offer to whom (as in the UK NHS.)
A system of taxes with the government merely financing and regulating private health care to everybody (with credits for private insurance) could turn out, depending on the numbers, to be indistinguishable from an individual mandate, other than on formalities – ie whether the compulsion is formally tax, with credit for approved expenditure, or compelled expenditure. In such a case I see some weight in Rahe’s point. Compelled expenditure is a different formal category from taxes and a dangerous one, and people worried about the growth of the state should oppose it on principle. (Though it is hardly new, at least in Europe – regulation of businesses is commonly used to reduce the formal tax cost of welfare programs. For example, builders are given permits to develop land, with conditions that they build x% of subsidised low cost housing for locals; utilities are required to continue to supply people who don’t pay their bills. These are just two of hundreds of examples. The point is that the cost to the business and the benefit to the politician’s client does not pass through government books as tax and spending, and so is much less politically controversial. Which is why compelled expenditure is worth opposing as a matter of principle – it allows big state people much more scope to muddy the waters. If you have to expand the size of government with a tax, voters can see what you are doing.)
Returning briefly to the point, however. If Rahe is talking about a tax and credit system, with the government merely financing private healthcare provision, and if the numbers all add up to be equivalent to an individual mandate, then I agree that the formal breach of the compelled expenditure provision makes the individual mandate worse. But if he is talking about taxes to finance government provided healthcare a la UK NHS versus the individual mandate, then I agree that the individual mandate is better, even at the cost of breaching the compelled expenditure principle. But it is not obvious to me that Rahe is talking about an NHS style system.
December 30, 2011, 7:21 amLee Moore says:
I don’t find Stephen Lathrop’s last comment very convincing. Free markets do not require perfect information to function. Perfect information is simply a theoretical assumption in analysing economic effects, it is neither essential nor indeed possible in real life.
Though lots of markets, including healthcare provision, do not involve millions of identical transactions that does not stop them operating tolerably effectively. Where the price of widgets cannot be compared directly other market mechanisms operate nevertheless. Suppliers who trade on their reputations to become high priced rip off artists get undercut in due course, as a cheaper supplier builds a reputation.
The main reasons why free markets have not solved all Mr Lathrop’s problems are
1. healthcare and healthcare insurance markets are already heavily regulated and so are miles from being free markets
2. the poor are on average sicker than the rich, hence market clearance would in a free market be achieved at levels of healthcare provision which would leave many people untreated – ie we wouldn’t like the political and moral look of the market answer.
Hence the real problem is a welfare problem, not a problem with how free markets operate. How do you provide health care to those who can’t afford it – or who have other preferences for how they spend their money ? A number of answers have been offered including scrapping the market system entirely and moving to rationing, to the individual mandate. My preference would be to leave it to charity.
December 30, 2011, 7:40 amAPC says:
I don’t see anywhere in that article where Rahe advocates for a single payer system. At best, you could say it comes where he advocates for taxes to pay for our protection, but if you read the whole article, he clearly means for the protection of our natural rights. Thus, I don’t think this post is a fair characterization of Rahe’s article.
Incidentally, I think there is one decent to good conservative/libertarian argument that would favor single-payer over an individual mandate–not as a matter of policy, but as a matter of political accountability. In a singer-payer system, it is much easier to place blame at the feet of the right politicians, and so in that way it may be easier to check or repeal. With an individual mandate, accountability becomes muddled. When something bad happens in the system, who is to blame? Could be the feds, could be the states, could be the “private” insurers. Of course, as matter of policy, both are bad.
December 30, 2011, 7:55 amMartinned says:
That’s what they did here in the Netherlands a few years ago. (Switching from a system where the poor half of the people were government-insured.) It works fine, except that too few people switch insurers in any given year to create the right incentives for insurance companies. (I, too, have had the same insurance company for the whole period this system has been in place, because I don’t think the benefits of switching will outweigh the costs of doing the research and the paperwork.)
December 30, 2011, 8:46 amAJ says:
Lee Moore states the problem well. Can Ted create a universal coverage/care system that is both affordable and provides timely and effective service? I believe that someone who has a pre-existing condition who has not elected to get insurance should be allowed to enter the health insurance market but at a higher premium, let’s say 2.5x the average cost of a premium of a similarly situated individual (like the mandate penalty, this incentivizes getting insurance before the need arises but maximizes choice). If we couple that with tax credits to encourage the young and healthy to adopt some level of insurance (more tax credit for higher premium policies), you get more individuals into the health insurance pool. Incentivize Health Savings Accounts so that there is some benefit to not over-using the system. Add in getting rid of insurance being tied to jobs and employers only getting tax deductions for providing insurance and a pretty good blueprint for reform emerges, without a mandate or government taking over the insurance function. You must have an inherently greater trust in the efficiency and effectiveness of government run insurance than I do. I think this basic assumption then drives your opinion on all other options which you discount without much analysis.
December 30, 2011, 9:18 amPettifogger says:
Before Obamacare, did conservatives object to an individual mandate?
Not to my knowledge. I suspect many people did not think through the idea of an individual mandate until they were confronted with one. I know I had not.
December 30, 2011, 9:55 amPettifogger says:
Before Obamacare, did conservatives object to an individual mandate?
Not to my knowledge. I suspect many people did not think through the idea of an individual mandate until they were confronted with one. I know I had not.
December 30, 2011, 9:55 amPettifogger says:
Before Obamacare, did conservatives object to an individual mandate?
Not to my knowledge. I suspect many people did not think through the idea of an individual mandate until they were confronted with one. I know I had not.
December 30, 2011, 9:55 amSarcastro says:
[market efficiency in health care means many many poor people dying so one rich guy gets another year.]
December 30, 2011, 9:59 amJoe says:
1. healthcare and healthcare insurance markets are already heavily regulated and so are miles from being free markets
Why are they heavily regulated?
2. the poor are on average sicker than the rich, hence market clearance would in a free market be achieved at levels of healthcare provision which would leave many people untreated — ie we wouldn’t like the political and moral look of the market answer.
These are vague lines. The poor, for instance, might spend more times in emergency rooms or have certain chronic ailments like asthma, but the biggest concern often are expensive care while often the poor don’t need such things.
But, yes, like police and fire services, we don’t want merely the market to provide what at some point is deemed a privilege in civilized society. This privilege’s cost are spread around since not merely “the poor” might at some point need it w/o having the means to pay.
Hence the real problem is a welfare problem, not a problem with how free markets operate.
A general welfare problem. If a middle class person with kids was in need of police services because one of the children was kidnapped, the amount of money spent could be quite high & even if not “poor,” they would not be able to pay if such services were purely “market.” Even with “police services saving accounts.”
We spread the costs via “police insurance” that provides police services when necessary.
How do you provide health care to those who can’t afford it — or who have other preferences for how they spend their money ? A number of answers have been offered including scrapping the market system entirely and moving to rationing, to the individual mandate. My preference would be to leave it to charity.
There isn’t a need to “scrap the market system entirely” or to have rationing etc. [OTOH, as to "rationing," as expensive technology expands, some degree will be put in place ... every 80 year old, e.g., might not get to have limited very expensive care. The same applies to let's say police services or the ability to use public parks. Limited goods means some limits.]
Charity will not — surely not evenhandedly — cover the needs of the less well off cancer payment or child with some expensive condition. Years of experience has shown this.
Your preference is duly noted.
A lack of “trust in the efficiency and effectiveness of government run insurance” is noted. Yes, looking at how private run insurance is run in this country vis-a-vis other Western nations, yes, mistrust in the private sector is present. OTOH, the alternative offered includes various government requirements (e.g., forcing insurance companies to take certain people they rather not), which “runs” things to some extent too. Choosing one’s jail cell?
December 30, 2011, 10:06 amragebot says:
I am not aware of the economic definition of a “fair price”; but I do know that lots of medical doctors charge self insurers much lower prices than the prices charged to patients who require the doctor to hire a clerk to deal with the insurance paperwork.
I am curious about your dental work blurb. I get my dental work done at the UF dental school (my understanding is that all major dental schools have similar programs) where I was required to get a screening examination where both the intern and dept head approve of my personal dental hygiene before accepting me as a patient. They then come up with a dental plan which includes what work will be done when with exact prices for the services. I knew to the penny what my root canal would cost and had to pay 1/3 up front (I paid the whole thing at the time the services were rendered). For the last five years or so my treatment has consisted of bi yearly cleanings and yearly x-rays only.
Which brings me to my point that this type of pro-active care not only reduces cost but results in a healthier patient. Even a small expenditure in routine care can save big bucks in the long run. As for where most health care dollars go; my understanding is that in the US the largest single bucket is for diabetes. This is a chronic condition and the best way to treat it is by diet and exercise, both of which are basically no cost options. Instead big bucks are spent on testing and drugs which basically prolong this chronic condition which is really more of a life style choice than an illness.
December 30, 2011, 11:23 amenoughalready says:
she never said this in the context its been strewn about on the airways and internet!!!!!! SHe was specifically asked about the senate version of the bill. Of course it would need to pass before the house could see what was in it!
December 30, 2011, 11:34 amTed says:
Yes. I think government run health care is both more efficient and effective that private health care for people who cannot afford private health care or who cannot afford private health insurance private. You disagree?
December 30, 2011, 11:37 amTed says:
Can I? I doubt it. I’m trained in philosophy and law. But I could probably design a hypothetical system that could provide a rough basis for such a system.
But it’s pretty obvious to me that many people could design just such a system. It’s done in all but three industrialized nations. And none have collapsed…yet. Although some think it’s inevitable. Personally, I think the US is more likely to collapse from a catastrophic gopher infestation than from providing medical care to its own people. Priorities, I guess.
December 30, 2011, 11:46 amMartinned says:
Which would make sense, given that Medicare/Medicaid is the most efficient part of the US health insurance industry. The least amount of waste through paperwork and the lowest cost of health care provision.
December 30, 2011, 11:54 amLee Moore says:
Hi Joe
1. You would have to ask politicians why they choose to regulate so vigorously. Presumably few of them are enthusiasts for free markets.
2. Not really sure what your point is here.
3. Low probability high cost (if they strike) risks are quite well dealt with by an insurance market, as it enables people of modest means to deal with high cost events. Only the poorest cannot afford insurance against such risks – so it’s a welfare of the poor problem, not a general welfare question. Of course some people who could afford insurance will choose not to buy it, but if and when disaster strikes such people, they have merely reaped what they have sown. Which is not so say that we should leave them to die in a ditch. But the appropriate mechanism for help is charity. Aside from any considerations of morality – forcing the prudent to bail out the imprudent via taxation – economic considerations of moral hazard loom smaller when your imprudence places you in the position of a mere supplicant, rather than as the holder of a legal right.
4. Charity may indeed not step up to the plate, or not as well as you would wish. But that’s a chance I’m willing to take. Decades of experience in the UK has shown that government provided health care often fails to step up to the plate too.
The reality is that it’s a welfare for the poor issue. We get advocacy of single payer systems, or public provision, or rigged insurance markets with mandated cover and with insurers being forced to take people with pre-existing conditions etc etc not because they solve the welfare issue better than mere cash welfare payments in a private market, but because they conceal the real cost of the welfare for the poor. If you did it with cash and taxes, the cost would be revealed as so startling that you’d never get the votes for it. So you muddy the waters. Unfortunately, if you successfully muddy the waters to conceal the real cost of the welfare provision, you also successfully wreck the main contribution that markets make to economic efficiency – revealing market prices. So it’s perfectly possible for a politically rigged insurance system to be even more wasteful than a full government run health care system.
December 30, 2011, 12:16 pmRalph Baskett says:
When my wife and I had our children in the early 1980′s, most insurance plans did not cover the hospital costs for delivery. As a result hospitals had to compete because customers choose based on the cost. Thus, the hospital we used charged a flat rate of $2500. 25 years later most insurance plans cover at least part of these costs. When my daughter asked the hospital what the cost would be, they refused to even give her an estimate.
December 30, 2011, 12:30 pmNobody can have any idea how much more efficient our healthcare system would be if it was based on a market system where the customer has complete control of their own healthcare dollars. Customer control of their own healthcare dollars is the most efficient way to “regulate” the healthcare system to serve the customer’s needs. Government interference, however well intended, reduces efficiency.
If we had a well-ordered market-based healthcare system where an individual could contribute up to $10,000 per year (employers average expense is over $8,000 per employee), tax-deductible, to health savings accounts (HSA) and insurance premiums could be paid out of the HSA, most citizens would be able to take care of themselves and accumulate a substantial sum in their HSA for emergencies. Healthcare would be less expensive and the tax deduction would lead to more citizens being able to take care of themselves. Thus there would be far fewer citizens that would need help.
It is laughable to claim that giving control of your healthcare to a massive Obamacare bureaucracy will provide better service. If this were true, government control healthcare advocates would be willing to let citizens choose an HSA option and opt completely out of Obamacare. But Obamacare needs to extract a big premium from the 99%–the healthy–to support their massive bureaucracy so that they can dictate and control every aspect of our healthcare so that everyone gets an equal amount. Thus, a substantial amount of our health care dollars will be feeding the bureaucracy rather than providing healthcare services.
The bottom line. How can a massive bureaucracy take better, more economical care of you than you can take care of yourself? Do you think these bureaucrats will be more concerned about your well-being than reducing their costs per patient? Will their promotion be based on how “efficient” they are?
Ted says:
Right, so we leave the charity to leave the sick to die in the ditch? I like how you sooth your conscience by diversion, without actually addressing the problem. Are you Catholic? If not, you might consider converting, they have this thing called confession; right up your alley.
December 30, 2011, 12:46 pmTed says:
Well, sounds like you have the problem solved! Umm, just one point of clarification. I missed where you covered the people without an HSA, or who have declined private insurance. It must be in there somewhere, and I just missed it while drooling over with all the talk 10k/year HSAs (why limit it?). That all sounds great, but I’m not sure the primary concern with health care in this country is about people who can save 10k/year (or more). Is it?
December 30, 2011, 12:57 pmzuch says:
So does “property is theft”.
Cheers,
December 30, 2011, 1:02 pmSeaDrive says:
One reason that health care is an expanding part of GNP is that it’s offering more and better services than it used to. We live in a very fertile time of innovation in the bio-medical field. It’s easy to compile a list of services that didn’t exist or weren’t commonplace a decade or so ago: LASIC, joint replacements, organ transplants, etc. It’s true that some innovations save a lot of money, but some cost a bundle.
It’s the kind of growth we’ve also seen in telephones. Twenty years ago, a family might be spending $300/year on a land line. Now, they may be paying the same $300, plus $1000/year for an iPhone (or two). Are we worried about the increasing burden of phone costs on the economy?
But Rep Ryan wants to cap health care expenditure, and he’s about as likely to succeed as King Kanute was in holding back the tide.
December 30, 2011, 1:04 pmLee Moore says:
Ted : “Right, so we leave the charity to leave the sick to die in the ditch? I like how you sooth your conscience by diversion, without actually addressing the problem. ”
I don’t follow you, Ted, I’m afraid. I’m quite willing to contribute charitably to finance healthcare for the poor – and in fact I do so. Particularly the poor in the poor bits of the world, as the Western world’s “poor” are quite rich by world standards. I have addressed the problem thus – charity solves a lot of the problem of lack of health care for the poor, but I recognise that like all human institutions, charity sometimes fails. The fact that it sometimes fails does not lead me to prefer government healthcare. Another human institution which sometimes fails. And not only does it sometimes fail, but it also inflicts a lot of collateral damage to private provision, which charity does not inflict but instead supports.
December 30, 2011, 1:07 pmTed says:
Sounds like you have it figured out. But I missed where you discussed health care for those who can’t afford it. You know, the whole point of the health care issue… I’m not entirely sure, but I don’t think people socking away 10k/yr in HSAs or people paying health insurance premiums are the demographic usually focused on when discussing health care reform.
Do you have a plan to cover those who can’t afford health care, private insurance premiums, or decide not to sock away enough cash?
December 30, 2011, 1:21 pmzuch says:
So letting people opt out will “keep the Government out of the lions share” and will make other private insurance “a viable option”? How about those that don’t bother to pay (or get treated) until they are faced with catastrophic bills? Healthy (young) people “opting out”, leaving the price of non-catastrophic (but drug-benefit-paying) insurance to soar. Other potential problem areas occur as well. I think you need to think this through more closely.
Cheers,
December 30, 2011, 1:32 pmTed says:
Can we agree that charity existed prior to government regulation of health care? If so, do you think people were healthier or less healthy before government regulation of health care? Not to say that more regulation is necessarily better per se, but you might consider whether the health benefits of charity and government regulation are cumulative, rather than exclusive.
Further, your charities-alone theory has been tested thoroughly, and it has failed to provide the best system of health care for a large industrialized nation. If it did, don’t you think a some industrialized countries would have kept the charity-only system (is, after all, the default system)? Yet, not a single developed country relies on a charity-only system of health care, not one. All developed nations provide some form of government health care to some demographic of the population? Why, because it’s more inclusive, more efficient, and more moral.
December 30, 2011, 1:35 pmAnonimus says:
[market efficiency in food distribution means many many poor people dying so one rich guy gets another meal.]
As we know, the “poor” in America are all starving…
December 30, 2011, 1:44 pmrpt says:
The most frank answer yet; the mandate didn’t become an issue until it was embraced by Obama. The continuing focus is how to defeat it/him in court.
December 30, 2011, 1:57 pmRalphBaskett says:
The plentiful supply of food is a good example of how markets work. We need to see how well the market remedies this government caused disorder. Designing healthcare for the worst case is akin to requiring that all autos be equipped for legless drivers. Very expensive.
December 30, 2011, 2:07 pmrpt says:
Strong words from a guy who didn’t go to public school, drive on public highways, fly on FAA certified planes, use gasoline sold by subsidized oil companies, etc., etc.
December 30, 2011, 2:09 pmSarcastro says:
Yeah, food in America is a great analogy, what with it being rationed and all in America. And food is completely free-market – there’s no food safety net!
This is why privatized police and fire make sense!
December 30, 2011, 2:22 pmLee Moore says:
Hi Ted
1. Of course health care is better now than in the past. So are automobiles and computers. Comparing health care a hundred years ago, when the poor had to fall back on charity, with health care now when there are all sorts of government programs to help them tells us nothing about the relative effectiveness of charity and government programs. It tells us that we have got richer and medically better informed over the past hundred years.
2. No modern government relies on charity for health provision to the poor because there is never a shortage of votes for providing benefits to the poor from the pockets of the rich. There are more poor than rich. That government welfare is more inclusive and efficient than charity I doubt. But more “moral” ? ! There is nothing morally praiseworthy in voting to compel others to pay for what you do not choose to pay for yourself. (Relatively few who vote in this way have protected themselves against a charge of hypocrisy by giving away all their worldly goods before pulling the lever.)
December 30, 2011, 2:27 pmMartinned says:
Yes, that’s the reason why there’s so much socialism in America!
December 30, 2011, 2:44 pmAnonimus says:
Yes! If you drive on a highway, you must support the whole Marxist program! No dissent!
Exactly my point. Thanks for agreeing.
Again, we agree – the government involvement in health care should be rolled back by a large percentage, to only offer a safety net, a role no greater than that for food.
And an analogy between police protection and dinner could not be less apt. *LOL*
December 30, 2011, 3:02 pmTed says:
Perhaps I wasn’t clear. My point is that relative effectiveness is only important if you are concerned more with efficiency than inclusiveness. I don’t want to live somewhere that people die in the streets. I’ve been to such places, they’re not good.
Charity and government assistance are not mutually exclusive remedies. They can both contribute to health care, and to the extent they do so, the total overall health of the population is increased. This is good.
I don’t know what you mean by “modern government,” but there are many countries today that rely primarily on provisions of health care through primarily charitable means. I posted a map above, that shows most of them. Note that they have no shortage of poor people (except one), and some are even democracies! Generally, they are the creme-de-la-creme of the poorest people on each continent, except for North America, of course. By your reasoning, shouldn’t these countries have simply voted for universal healthcare or less reliance on charity? I wonder why they haven’t done that? Think its their morality that prevents them from doing so?
So the only morally praiseworthy vote is a vote for anarchy? I mean, do you think it’s moral, immoral, or amoral to vote to have other people pay for roads, education, military, law enforcement, fire protection, courts? I do not choose to pay for these things myself, neither do you.
Or are you saying that the entire notion of voting is simply an amoral? I guess we could discuss whether democracy as a form of government involves issues of morality at all, but I find it hard to believe that you think “voting to compel others to pay for what you do not choose to pay for yourself” is actually immoral.
December 30, 2011, 3:06 pmTed says:
Well, giving $668/mo for health care coverage to a family of 4 would certainly be a start… is that what you advocate? Giving every family of 4 in need $668/mo toward an insurance policy? Not a bad idea, ‘Nony.
December 30, 2011, 3:13 pmSarcastro says:
Word. Medicare for all!
December 30, 2011, 3:18 pmAnonimus says:
Just like the government buys everyone’s groceries every week!
I don’t think the government should be passing out $668 of other peoples’ money like that for food either.
December 30, 2011, 3:24 pmTed says:
Oh, so when you said “a role no greater than that for food,” you meant some hypothetical role, non-existent role that you approve of, not the current, existing role the government plays in provided a food safety net. Yeesh, why do I try? Why?
December 30, 2011, 3:29 pmAnonimus says:
Do you really believe the government role in health care is currently limited to the same demographic as food stamps? Most Americans don’t get food stamps.
December 30, 2011, 3:37 pmTed says:
No, but we can fix that. Watch:
45M people are on food stamps. 20M people are on Medicaid. 47M people on Medicare. If we shift all the old people that can afford their own health insurance, can we get that 67M number close to the 45M number? I think so, because the qualifying criteria would be very similar, based on ability to pay.
Deal?
December 30, 2011, 3:53 pmSarcastro says:
Because food costs have been spiraling up just like health care. That’s why you see so much food-related bankruptcy.
December 30, 2011, 3:57 pmAnonimus says:
Wow, the Democrats have really made a big mess of America.
Exactly, more government meddling = higher costs. Again, we agree.
December 30, 2011, 4:09 pmTed says:
Sigh. “Why would you lie about something like that?”
December 30, 2011, 4:22 pmBen P says:
Setting aside the absurd characterization that politicians promulgate regulations simply because they are not “enthusiasts for free markets.”
The state of the healthcare market resulted in part from a number of small regulations, each of which independently are not terribly objectionable, together creating a morass that was not intended by the regulators.
I’ll give you a couple examples.
1. Financial reserve requirements (i.e. regulations require insurance companies have to keep financial reserves commensurate with their liabilities)
Ever dealt with the collapse of an insurance company? I worked on a case involving one a few years ago. It isn’t pretty, and lots of people who have paid substantial premiums suddenly find themselves personally liable for a lot of medical expenses they thought the insurance company would pay.
I imagine that only had to happen a couple times before people wrote letters to their representatives saying “this is horrible, I thought my insurance company would pay all this, but now they’re bankrupt and I owe all this money” before legislators got together and said “how do we fix this.” They came up with requiring the insurance companies to have sufficient reserves that patients aren’t supposed to be left high and dry if the company founders.
2. Prohibitions on lifetime caps.
Same story. Someone has a very sick parent, child, or themselves etc, and needs a very expensive procedure. Suddenly the insurance company declines to pay for it, pointing to a policy provision that says their entire obligation under the policy is limited to X dollars, and Plaintiff has reached that amount.
This certainly makes sense for a carrier to try to limit its potential exposure, but surely you can see the political unpopularity of telling a dying person (or worse the parent of a dying child) that they should have read their policy a little more closely and sorry, they have to come up with $100,000 for the surgery themselves.
Again, legislators get together and say “how can we fix this?”
Each of these are clear scenarios where making a “free market” or freedom of contract argument is horribly unpopular, “you’re telling me you want the kid to die?!” Particularly when as a matter of course there’s little negotiation in purchasing such a policy in the first place.
Enough of these regulations pile up, and you get insurance companies that can’t make a profit doing it and get out of the business, or have to raise rates to very high levels to pay for things like the $100,000 surgery they can’t except out of their contracts.
December 30, 2011, 4:27 pmSarcastro says:
Yeah, health care costs are ’cause of government meddling! If only the free market ruled, new technologies would magically become inexpensive!
December 30, 2011, 4:35 pmAnonimus says:
That’s why personal computers cost $10,000 each, and only you filthy rich capitalist pig one-percenters can afford one!
[I paid extra for mine, it has a second 5-1/4 inch floppy drive, and an extra 64K RAM!]
December 30, 2011, 4:40 pmTed says:
Yez! Without gummit reglation allbody could go to doctor skool, to! Or just be uh surgin without skoolin!
December 30, 2011, 4:42 pmSarcastro says:
Yes, because personal computers are just as needed as getting to live. Totally the same market forces!
December 30, 2011, 4:47 pmAnonimus says:
Yes, like food, which also increases every year faster than inflation! But then, nobody really needs food, any more than they need a faster CPU, right?
December 30, 2011, 4:58 pmSarcastro says:
Ah, well if not computers, then surely food is an analogous market!
Because technological increases in food increase the accuracy and efficacy of Big Macs, not the supply. That’s why, just like health care, there is such scarcity of food in the US, and all that rationing.
December 30, 2011, 5:04 pmAnonimus says:
There’s rationing of health care in the US? I thought Obama’s Death Panels hadn’t been implemented yet…
December 30, 2011, 5:33 pmSarcastro says:
yeah, HMOs never deny people nothin!
December 30, 2011, 5:59 pmAnonimus says:
“My HMO won’t pay for anything/everything I want” = “rationing”!
“I can’t afford filet mignon and lobster every night, therefore food is ‘rationed’”!
December 30, 2011, 6:49 pmSDGLaw says:
You’re making the same argument that idiot in Massachusetts was making, right? The woman running to be the senatrix?
December 30, 2011, 7:09 pmrpt says:
As compared to whom; you?
December 30, 2011, 8:02 pmJoe says:
SDGLaw says:
Joe: Do senior citizens dislike Medicare too?
People who are the recipients of stolen property are probably not the best ones to ask. Let’s ask the people paying for it.
The term “stolen” here is being used in a specialized fashion, is it? It is not what many of us (including the government, but well, what do they know?) use to define it.
December 30, 2011, 8:28 pmJoe says:
Lee Moore says:
Hi Joe
Hi Lee.
1. You would have to ask politicians why they choose to regulate so vigorously. Presumably few of them are enthusiasts for free markets.
“Free markets” have lots of regulations in them generally since that is part of what government entails. My thought is that it is regulated for various reasons, including the special needs involved leading people like AJ to suggest the solution is well different types of regulation than we have now.
3. Low probability high cost (if they strike) risks are quite well dealt with by an insurance market, as it enables people of modest means to deal with high cost events.
As with car insurance, some sort of pressure is sometimes required to encourage people to have insurance. Thus, the tax penalty here.
Only the poorest cannot afford insurance against such risks
Some choose not to have insurance, even when able to pay, some are denied coverage because they are deemed bad risks (insurance companies are also known the game the system to deny such people care). Others who are not poor can obtain only limited coverage.
so it’s a welfare of the poor problem, not a general welfare question.
not just the poor fall between the cracks or only do not because of government regulation; health care is a general welfare problem
Of course some people who could afford insurance will choose not to buy it, but if and when disaster strikes such people, they have merely reaped what they have sown.
And, they will cause costs to others, including unpaid bills, unsecured debt and problems for family members, including children. Thus, the push to have them have insurance or pay more in taxes to help pay for the risks to others.
Some actually could afford insurance, but couldn’t get it for some reason or though not “poor” are only able to pay for part of their health care under current insurance policies.
Which is not so say that we should leave them to die in a ditch. But the appropriate mechanism for help is charity.
Which is a limited help that is selectively provided.
4. Charity may indeed not step up to the plate, or not as well as you would wish. But that’s a chance I’m willing to take. Decades of experience in the UK has shown that government provided health care often fails to step up to the plate too.
So, you are willing to leave some at the ditch. Experience has shown this to be the case. The fact the safety net provided by the government is imperfect shouldn’t concern you. Charity is there to save the day, correct?
The reality is that it’s a welfare for the poor issue.
The general welfare is interconnected. The welfare for the poor, the not so poor, the maybe one day poor etc. included.
We get advocacy of single payer systems, or public provision, or rigged insurance markets with mandated cover and with insurers being forced to take people with pre-existing conditions etc etc not because they solve the welfare issue better than mere cash welfare payments in a private market, but because they conceal the real cost of the welfare for the poor.
If insurers are not required to insure people with pre-existing conditions, not just “the poor” would be the problem here though ultimately more will be poor as their resources dry out. As to concealing, perhaps, rather, all the nations that have those systems have found it is better for the general welfare? I often find that better than theories about tricks like something is being “concealed” being the reason.
If you did it with cash and taxes, the cost would be revealed as so startling that you’d never get the votes for it. So you muddy the waters.
The system does use cash and taxes — just in a different fashion. Hoping for charity to solve things “disguises” things too in a fashion. You can pretend that will deal with the situation though history has shown it does not in a way society finds satisfactory.
So it’s perfectly possible for a politically rigged insurance system to be even more wasteful than a full government run health care system.
It’s possible, and many experts say so, but not quite for the reasons you offer.
December 30, 2011, 9:04 pmLee Moore says:
Hi Ben P
Even though you object to my suggestion that politicians regulate heavily because they are not enthusiasts for free markets, your longer and more detailed illustration amounts to much the same answer as mine. An enthusiast for free markets understands why free markets (ie the absence of political instruction) generally produce better solutions than unfree ones (the presence thereof.) It’s all to do with dispersed information, unintended consequences, Frederic Bastiat’s seen and unseen, the price discovery mechanism and so on. It is easy to see the direct and beneficial effect of a proposed regulation. It is hard – indeed impossible – to see the secondary and indirect effects.
A politician who is an enthusiast for free markets has to be willing to stand up and say – “yes, I can see that that regulation might, if it works, have this good effect; but there are other effects like this and that that may be bad. Moreover, there are many other effects which I can’t predict because I don’t have enough information.” Such a politician is easily outbid by one who sticks to the obvious. How free markets work better than political direction is far from obvious. Regulation is obvious. It is an appeal to economic naivete, and it almost always works (the appeal I mean, not the regulation.) Politicians are seldom enthusiasts for free markets because public support for free markets is limited. I doubt even Tea Party folk are in favor of free markets per se. Their objection to government interference is not a free market objection – that even benign interference in commerce by saintly politicians is likely to make things economically worse. It’s the all-politicians-are-crooks objection, which is quite different.
Plus politicians like to “do things” – that’s why they go into politics. Who goes into politics to try to prevent things from being done ? But that is what a free market enthusiast’s ambitions are. (OK, given the starting point, a free market enthusiast has many years of repeals to get through.)
It’s not an accident that the two most obvious and spectacular successes of free market policies in the 20th century were achieved in places where normal democratic politics did not operate in the usual way. Hong Kong’s spectacular growth was nurtured by an unelected civil servant, Sir John Cowperthwaite, who refused to allow his officials to collect economic statistics, lest they then tried to use them for economic planning. And Erhard’s bonfire of controls in West Germany involved the scrapping of regulations imposed by foreign occupiers, and did not figure in any domestic election bidding war.
Pro free market politicians are as rare as hen’s teeth, and in that they accurately represent their electorates. And they regulate because they think it will be popular. And because they think it will work. OK, and because it is a good way of shaking down businesses – but that’s not the only reason, whatever the Tea Party thinks.
December 30, 2011, 9:20 pmzuch says:
Never have I see a “straw man” so clearly explicated. You lay out the mechanics beautifully. Well done.
Cheers,
December 31, 2011, 12:07 amChris Travers says:
I don’t consider myself liberal or conservative really and I tend to draw ire from both sides here on VC. However, here’s my take.
I think Rahe is right. The fact is, the PPACA system will not only fail, but it will do so catastrophically with probable cascading failures into our financial sector. The reason is not hard to see. Congress has failed to do anything to increase supply of care, and thus increased demand will result in only one of two things: increased costs or increased rationing. There are no two ways about it. Moreover the requirement to purchase insurance comes as a competing requirement to pay the mortgage (at least this is how Elizabeth Warren frames the rise of middle class uninsured in her lecture “The Coming Collapse of the Middle Class”). In the past paying the mortgage always won out, but now it isn’t clear. More folks paying the insurance will mean greater risk for defaults on mortgages, which means a minor economic upset places the banking sector in greater risk.
So we have a problem. That problem can only be solved one of two ways: The first is increased competition (something neither party wants) and the second is for the government to be the primary insurer and hence the one to stand up to big pharma over prices and supply. And so you have the untenable idea that somehow we can lower prices without taking on the monopoly-driven system we currently have (I am talking patents and monopolies on medical school accreditation in particular). Either the state can do this as a collective representation of the people, or the people can be empowered against corporations. However what we have here is the empowerment of corporations against the people and I don’t think there is any question how that will turn out.
The problem is, nobody wants to really tackle say compulsatory licenses on patents when used in medicine, or chartering competitors to the AMA. So what we have is not a free market. It’s a market of government created monopolies, now with a mandate to participate. Nothing can be worse than that.
December 31, 2011, 1:20 amSDGLaw says:
It is a bit of hyperbole, although, in my opinion, accurate. Taxes are a form of legalized theft. If you did what the government did (i.e., take another’s property by threat of force)you would be arrested.
More seriously though, the point is that asking the recipient of a wealth transfer if he supports it is ridiculous. He is receiving a benefit with no corresponding burden. It would be like asking the drug cartels in Mexico whether they support our drug policy in the US. Of course they do. Our idiotic prohibition policies are causing their products to be dramatically more valuable.
I think a good policy would be to only let citizens vote who are tax payers that are not receiving any welfare.
December 31, 2011, 11:06 amtomemos says:
That’s a contradiction. I’m not trying to be pedantic; I point it out because it makes it unclear to what extent you want us to take seriously what you said.
Well, there are two responses to this. One is that, if I tried to print money, or bomb Libya, I would also be arrested. That doesn’t mean that the government’s currency powers are legalized counterfeiting, or that the government’s war powers are legalized murder/terrorism. There are many actions which are legal only because the government does them, but that are nonetheless just and legitimate because we live in a constitutional republic.
The other is that you get something from your taxes, just like a renter gets something from his or her rent check. You get the use of the roads, schools, police and fire services, etc., as well as, more generally, the right to live in a stable society protected from external threats.
The obvious response is that, as I said above, *everyone* is receiving the benefits of the roads, of the police, of the military, of the regulations that keep our food safe, etc. But a more interesting thing to note is that, if your modest proposal was enacted in the spirit that you mean it, the largest disenfranchised group would probably be senior citizens, who almost all receive Social Security and Medicare—and who tend to be much more conservative than the general population. So your proposal might have the effect of a bigger welfare state, not a smaller one.
December 31, 2011, 12:34 pmAnonimus says:
Strawman. As you well know, those aren’t the things advocates of limited, constitutional government object to.
December 31, 2011, 12:41 pmFran says:
Braveheart logic: The problem Scotland; it’s full of Scots.
Just substitute society and people.
December 31, 2011, 2:14 pmAndrew J. Lazarus says:
Anonimus has really outdone itself this time. (I say it, because of the repeated failure on the Turing Test.) At 5:33, it, never having heard of the basic economic concept of rationing-by-price, implies that Obama Death Panels, if implemented, will constitute genuine rationing. However, when Sarcastro refers to HMO’s cutting off care, Anonimus ridicules the idea that being refused something you want is rationing. In other words, after Obamacare, if you are refused life-saving treatment that you “want”, it is rationing, but until then, it is the HMO exercising its prudent judgment that you dare not question.
That’s not because they have discovered the magic answer to exactly how much government is correct, but because they have an understanding of how badly they would fare in the world outside Mommy’s basement without them.
December 31, 2011, 2:22 pmJoe says:
SDGLaw says:
It is a bit of hyperbole, although, in my opinion, accurate. Taxes are a form of legalized theft. If you did what the government did (i.e., take another’s property by threat of force)you would be arrested.
tomemos says it well.
Some things can only be done by certain individuals. Paralegals, e.g., cannot give legal advice to clients. By definition, to be “legal,” a special class has to do it.
And, taxation is consensual. We elect the people who tax us and they have to follow rules set in place, again by the people. We don’t elect those who rob us in a dark alley. As t. notes, taxation is also quid/quo — we get something back. “Stealing” might entail that, if the thief was nice enough, but not usually.
More seriously though, the point is that asking the recipient of a wealth transfer if he supports it is ridiculous.
That’s a bit curious, if only to the extent that s/he might think it is badly crafted in some form.
He is receiving a benefit with no corresponding burden.
The benefit has no costs to him/her or someone they care about, such as their children and grandchildren?
It would be like asking the drug cartels in Mexico whether they support our drug policy in the US. Of course they do.
That’s an extreme example, but I’m not so sure, and to widen things a tad, perhaps you can ask their family members or those whose former husbands etc. were murdered because of the system in place. If the alternative was a rather lucrative but safer system with more customers with long term benefit to them, they very well might appreciate it.
Our idiotic prohibition policies are causing their products to be dramatically more valuable.
In various cases, clearly, the beneficiaries are not the best to ask, but I’m not sure if our senior citizens are on the level of murderous drug lords.
I think a good policy would be to only let citizens vote who are tax payers that are not receiving any welfare
Hard to find someone who doesn’t pay any taxes or someone w/o some sort of welfare. Middle class and richer sorts, e.g., have various types of government benefits, even beyond those roads etc.
The people that receive some benefit also might have important knowledge, serve the public in various ways and so forth. Thus, a veteran on a fixed income of SS would not vote while some good for nothing who pays a bit in taxes because s/he works at a family business would vote. Doesn’t seem to work well.
December 31, 2011, 2:59 pmJoe says:
tomemos says it well at 12.34.
I would only add that it is a curious test when a knowledgeable vet who serves the public in various ways can’t vote because s/he is on a fixed S.S. income while some boob who does little but pay a bit in taxes gets to choose who governs people.
The vet does pay sales taxes etc., but then if we add that plus all the “welfare” (if we define the term fairly) middle class and rich people have, the test does become a bit more complicated.
December 31, 2011, 3:10 pmAnonimus says:
Ignoring the usual puerile insults, the difference between having limits on an offering by a private provider, vs. limits imposed by government edict, should be quite obvious.
If McDonald’s doesn’t offer the type of burger I want, that’s fundamentally different than the government prohibiting by law which foods I may legally eat.
December 31, 2011, 3:28 pmtomemos says:
I don’t think I was responding to an “advocate of limited, constitutional government,” but to someone who believes that “taxation is theft.” If SDGLaw does believe that it’s immoral for the government to collect any taxes at all, and if he’s against “wealth transfers” of any kind—such as, say, my tax dollars going to fund the FBI or the construction and maintenance of interstate highways in other states—then it’s reasonable to respond by mentioning the benefits that he and all other citizens receive by paying those taxes.
So in other words, it’s not a strawman, because SDGLaw’s position really is absolutist, or inconsistent. Once you agree that the government has the power and right to collect taxes, then we’re just dickering over price.
December 31, 2011, 4:05 pmAnonimus says:
Fair point.
December 31, 2011, 4:33 pmleo marvin says:
Are you pro- or anti-”puerile insults?”
http://volokh.com/2011/12/22/libertarians-and-ron-pauls-racist-newsletters/comment-page-9/#comment-1350293
December 31, 2011, 5:02 pmAnonimus says:
Anti.
December 31, 2011, 5:22 pmtomemos says:
Thanks. I certainly don’t presume that SDGLaw speaks for most (or hardly any) conservatives.
December 31, 2011, 5:34 pmStephen Lathrop says:
Nonsense. It will be worse tomorrow. Which is an important point. This is going to disintegrate faster, and more consequentially, than most commenters here seem to assume.
I just signed up for a medicare supplement. Apparently there is some regulation that requires the supplement sellers to read you a lengthy caution about what a bad deal it probably is to trade group coverage for medicare and a supplement. But changes to the family group policy last year made nonsense out of that caution. If other people have similar insurance, as they probably do, there will be a stampede of people dropping those group policies as fast as Medicare makes it possible.
December 31, 2011, 5:47 pmleo marvin says:
I’m glad, if somewhat surprised, to hear it. How do you square your opposition to puerile insults with your prolific use of them (see my link above)?
[Edit: To avoid any possible confusion I'll repeat the link here: http://volokh.com/2011/12/22/libertarians-and-ron-pauls-racist-newsletters/comment-page-9/#comment-1350293 ]
December 31, 2011, 5:47 pmAnonimus says:
Simple. I reject your premise.
December 31, 2011, 6:22 pmleo marvin says:
I suppose anyone not already familiar with your body of work, who follows the link to your recent comments, will decide for themselves how seriously to take that rejection.
December 31, 2011, 6:32 pmAnonimus says:
Comments taken out of context don’t mean much.
I will agree that taking the time to search for and compile a list of quotes then listing them out of context is puerile.
December 31, 2011, 6:37 pmAndrew J. Lazarus says:
Neither before nor after Obamacare would you be prohibited from obtaining treatment that insurance refuses to pay for, assuming you hit the lottery and could in fact do so. The difference between dying from lack of treatment refused by a private insurer vs dying from lack of treatment refused by a government agency escapes me, but, then, I don’t believe in an afterlife. Perhaps in your construction, the former gets to go to Heaven and the latter is reincarnated as a Republican.
December 31, 2011, 6:37 pmAnonimus says:
I’m sure it does escape you. That’s entirely your own failing.
December 31, 2011, 6:58 pmChris Travers says:
Agreed on the counterfitting portion but think you need to define “terrorism” before making that conclusion there.
December 31, 2011, 7:50 pmChris Travers says:
Not sure what “It” is. If you mean the PPACA, I agree. I think we will see an increase in health insurance premiums because consumers have been told they no longer have the one power they previously had, and we will see an increase in home foreclosures as a result of that financial stress. Housing prices will fall further, and as a result, we will need another trillion or so dollars in bailout for banks.
This will unravel fast, and I think it may indeed cascade to an unraveling of our financial system as well if we aren’t careful.
Our old system was in crisis too, but what the PPACA does IMHO, is exacerbate that crisis and make it more consequential.
December 31, 2011, 7:56 pmjukeboxgrad says:
anonimus:
These comments …
I know you’re a vulgar lowlife.
your juvenile jack-assery is not evidence.
You are one very sick individual. Bigotry does that to people.
That’s really sick stuff. But not at all a surprise.
There is no answer to your lunatic babbling, except maybe a shrink.
Speaking of the need for a psych evaluation…
You should stop whining like a little girl.
Now put some pants on, before your mom walks in.
why do you act like an immature child here?
Written like a 10-year old.
Wow, that really showed me! So clever! Maybe you can call up from the basement and your mom will bring you a cookie!
I’ll bet the other 10-year-olds think that sort of stuff is hilarious.
I don’t think there’s much confusion about your idiot status
Non-imbeciles know exactly what I meant. Thanks again for the confirmation.
Your inability to comprehend is no surprise.
You seem to have some sort of inferiority complex. Are you a short person? Maybe a good shrink could help you. I don’t think I can. Have a nice evening.
… are puerile insults in their original context.
December 31, 2011, 8:23 pmAnonimus says:
Speaking of puerile…
December 31, 2011, 8:30 pmjukeboxgrad says:
“I’m rubber, you’re glue…” Very mature.
January 1, 2012, 1:02 amChris Travers says:
Who knew that tu quoque was a spectator sport?
January 1, 2012, 7:34 pmKanageloa says:
I would vote neither. Both are government run and inefficient programs. Less government intrusions into our lives is a gift but only those with their eyes open realize it.
January 21, 2012, 11:01 am