Say hello to Granny Fed. She might be blind and mule-headed but if you manage to become her favorite she'll just whip out her magic checkbook and grant all your wishes.

Kennedy can afford to buy all the walking tracks in Massachusetts, but that hasn't kept him from being obese. Take a lesson, Teddy.

Oh wow. Uber FAIL.

Kennedy enlisted in the United States Army in June 1951.[7] Following basic training at Fort Dix, he requested assignment to Fort Holabird for Army Intelligence training, but was dropped after a few weeks without explanation.[7] He went to Camp Gordon for training in the Military Police Corps.[7] In June 1952, he was assigned to the honor guard at SHAPE headquarters in Paris.[2][7] His father's political connections ensured he was not deployed to the ongoing Korean War.[2][8] While stationed in Europe he travelled a lot on weekends and climbed the Matterhorn.[9] He was discharged in March 1953 as a private first class.[7][9]

Kennedy became a starting end on the Harvard Crimson football team in his senior year, working hard to improve his blocking and tackling to complement his 6-foot 2-inch, 200 pound size.[9] In the 1955 Harvard-Yale game, which Yale won 21–7, Kennedy caught Harvard's only touchdown pass.[9]

You do realize he's 77 and had brain surgery right?

ruuffles:

Leaving obesity aside, if you wanted to make the man look better you should've used ellipses-- the filler between your highlighted words is very uncomplimentary to Kennedy.

If the government is the only one allowed to pay, you're damned right that we are concerned about what the government will be willing to pay for.

If exercise is all so important, why isn't the government opening gyms for adults or giving me a tax credit for my Spa dues?

Teddy Kennedy's obesity isn't related to his age or his cancer. Could have something to with pork though.

"You do realize he's 77 and had brain surgery right?"

Yes, and I also realize he's obese, and has been for decades, even as he's possessed all of the wealth necessary to pay for the type of marvelous infrastructure he's advocating for the rest of us, further indebting generations yet unborn.

Look in the mirror, Teddy, and you'll see the logical disconnect, which no twisted rhetoric can mask.

Prof. Bernstein,

You were being sarcastic, but I think a very good argument can be made that what you said is largely true. When the government takes away so much money from the individual, the individual affected has that much less discretionary income that may have to be spent on ohter things, and that can eefectively function as a prohibition. The machine gun tax levied by the feds renders machine guns effectively "prohibited" to many people. Ditto for forfeiture statutes that effectively prohibit someone form hiring his attorney of choice, as Conrad Black found out hte hard way. See the dissent in Caplin and Drysdale v. United States .

You do realize he's 77 and had brain surgery right?

Not to endorse the snark, but...don't know of how much relevance it is to this discussion that more than 55 years ago, when he was in his late teens, early twentys, Kennedy was physically vigorous, nor that he first manifested the symptoms of a malignant brain tumor in the past couple of years. He has been overweight for a number of years, perhaps in part the consequence of too much caloric intake in the form of alcohol. He has long been an avid sailer, which unlike "stinkpotting," does entail some physical effort, however often he gets to it. (Not like the regular vigorous exertion of squash, which Senators Spector and Levin are known for.)

But advocates, including Senator Edward M. Kennedy of Massachusetts, defend the proposed spending as a necessary way to promote healthier lives and, in the long run, cut medical costs. “These are not public works grants; they are community transformation grants,’’ said Anthony Coley, a spokesman for Kennedy, chairman of the Senate health committee whose healthcare bill includes the projects.

You think this is facile and ridiculous? I expect much more commentary like this in the coming future.

If the government is the only one allowed to pay, you're damned right that we are concerned about what the government will be willing to pay for.

Was that in response to me? Your point is valid as far as it goes, but nobody is proposing that the government is the only one allowed to pay for anything, so it isn't really relevant to anything proposed here in the US.

What is truly amazing is their recent 're-working' of the kennedy bill, supposedly dropping the price tag from 1.6 TRILLION to ~ half of that. While still magically 'covering everyone or almost everyone'.

They downplay the key component of their 'new found savings' - reducing CURRENT Medicaid / Medicare payments by $ 600 BILLION. IOW - their plan is to take coverage away from people who have it now ( largely elderly and poor people ) and re-distribute it to OTHERS ( whoever they may be ).

Gabriel McCall

However, under single-payer health care, we do have a reasonable and legitimate expectation that the government is responsible for everyone's health care needs, so if the government doctors turn us away or can't see us for days then we are not getting the service we expect and are being taxed for.

That's true if you define "single-payer" as 100% socialized medicine. Not even Hillary-care proposals went that far, and the AMA won't let it happen now.

The funny thing is that the health insurance industry loaded the gun that's now pointed at its head by calling their service health CARE rather than insurance.

Dan28: nobody is proposing that the government is the only one allowed to pay for anything, so it isn't really relevant to anything proposed here in the US.

No, that isn't proposed as such here in the US. There are, however, a great many single-payor advocates who would have us emulate countries where the government while not be "the only allowed to pay for anything," leaves little room for non-governmental payors (private insurance) and providers.

heh its a beautiful synergy of people who don't trust the government to decide if i deserve to take aspirin.

So your argument is that he's not obese because he was in decent shape in the early 50s?

What I read, I think his point was Teddy was in shape for a little less than 2 years. It is interesting all the grief George W Bush got for his National Guard service, but I didn't know Ted Kennedy served less than 2 years in the Army, enlisting after the start of the Korean War and being discharged before it ended.

But I digress... As Rosetta pointed out, if we need to tax the rich to pay for parks and trails, then Senator Kennedy could bypass using taxpayer dollars and pay for a few parks and trails out of his own pocket.

Hey Coley, ask your boss for some money!

Well, it was a "statement," not an off-the-cuff remark, and I think it reflects a certain understanding of the way the world works.

What understanding is that?

Who else besides the public is going to pay for the upkeep of public property? Should Columbia Sportswear sponsor the Appalachian trial? Should we have user fees on walking trails?

I don't understand the point you are trying to make. If the gov't doesn't pay for these things who else is going to?

"The funny thing is that the health insurance industry loaded the gun that's now pointed at its head by calling their service health CARE rather than insurance."

Actually, although a gun was definitely loaded, you've misdescribed the armorer, and the targets.

Hillarycare was essentially an employer mandate. Remember? "I can't help it if those companies are undercapitalized... so let 'em crash!"

So the employers rightly pushed the muzzle of the socialist gun away from them, and Hillary slunk away and redid her hairstyle and brooded.

Now, as it's clear that employer mandates are a non-starter, the socialists are attacking the insurance providers, as you mention.

We'll see how they make out.

Geok:

Presumably people like yourself are willing to pay a premium in order to avoid taking the government insurance. And please hand me a tissue for the poor insurance companies reaping huge profits while dropping sick patients like hot potatoes, forcing the costs of their healthcare on the public, while conspiring to fix their payment rates below the market.

Other than every Democrat in Congress and our current President, I can't think of a single person who supports a single payer system. So why should I be worried.

Most countries with "single payer systems" - that is, systems in which the government ensures a baseline standard of health care available to all - also have private insurance companies who provide premium health insurance. France, Britain and Switzerland all have private health insurance available for those who want to pay for services beyond those provided by the government. Canada doesn't, but it's more the exception among single payer health care systems than the rule.

Of course, what we're talking about here in the United States is much less comprehensive than the plans offered in all of those other countries, which is what makes that particular talking point so utterly absurd.

If the gov't doesn't pay for these things who else is going to?

An example

www.inhf.org/inhfmission.htm

If the only reason you build a park is to keep people from becoming obese, I submit you are missing the point of parks. (And that you probably won't use them after they do get built.) Same with listening to Mozart to make your baby smarter.

Both recreational facilities and music are things I support and would like to see (or hear) more of. But why does everything have to be justified in terms of physical health and productivity? It's really annoying.

Take this stuff out of the health insurance discussion and put it where it belongs. What happened to the President's Council on Physical Fitness and Sports? Or basic town planning, which seems to have vanished heaven-knows-where during the real estate boom?

Does anyone have a plausible theory why no one—not even the conservative parties—in Canada, France, Switzerland, the Netherlands, etc. is calling upon their governments to adopt the current American health care system? I mean, I have a theory, viz., that anyone in those countries with room temperature IQ sees the superiority of the local system, whichever variation, to the American system.

Earlier this week I had to pay about $300 extra when my "insurance" company decided that my dentist uses better-than-necessary materials. Americans have the impression that these companies' principal drive towards profits comes by screwing the subscribers by fair means or foul. I do wonder why I am the only commenter on VC who seems to have his health care interfered with by private industry bureaucrats. Are all of you that healthy? Still on your parents' policies and not really up on the details??

There does seem to be a certain incongruence is funding streetlights and farmers markets with a healthcare reform bill, to the tune of 1.6 billion dollars per year, said funding left to the discretion of the administration. Senator Kennedy's aide claiming that a lack of funding is the same as a prohibition does reflect a sense of overweening self-estimation in the scheme of things, I think. Surely, street lights and farmers markets are among those items normally funded by local government, not health insurance premiums.

BTW, my lasting image of the Senator is from the William Smith trial, when the alleged rapist and his cousin enter the living room and encounter the inebriated Senator, cocktail in hand, dressed in shirt and tie but sans culottes.

What appears to be a substantive party spat is really over about which bill the spending should appear in. Kennedy/Harkin, etc. think the spending should be in a health care bill, because the projects improve health. Others argue the spending should appear in a separate bill. Most of the federal politicians agree that federal money should be spent on "community transformation" projects.
.
A brief search of the Congressional Record shows this general line of advocacy has been around for some time. "Trust for America's Health" has been advocating various get-off-your-ass programs, testified before Congress, etc., and itself lobbied to include this pork in a health care bill.

If the government will send me a free Bowflex, so I can once again be lean and sinewy, with six-pack abs, I promise to use it a few times for its intended purpose before it becomes a clothes rack.

Earlier this week I had to pay about $300 extra when my "insurance" company decided that my dentist uses better-than-necessary materials.

Funny you should use "insurance" in quotes. That is exactly how an insurance company should behave. You are confused about the difference between "insurance" and "care".

Earlier this week I had to pay about $300 extra when my "insurance" company decided that my dentist uses better-than-necessary materials. Americans have the impression that these companies' principal drive towards profits comes by screwing the subscribers by fair means or foul. I do wonder why I am the only commenter on VC who seems to have his health care interfered with by private industry bureaucrats.

And you think you're going to get the fancy materials for free under the govt plan? The differency between private and public beaureaucrats is that you get to choose the private ones.

Um, hello, entire embryonic stem cell research public debate? This idiocy is pervasive.

Again, the situations are not analogous because the reality is that federal money is entangled into every significant private or educational medical research organization. The practical barriers to setting up a research lab which does not have to follow the federal research regulations are incredible.

Free money is addictive, and we shouldn't blame the addicts. We should, however, try to avoid hooking new industries such a park development on our drug.

the difference is that under the public plan AJL won't have to worry that some well-off Republican somewhere is getting better treatment than he is.

The guy making 200K will still be getting better treatment. The difference is that the guy making 50K will be getting the same awful care as the guy making 20K.

they are community transformation grants."

Say what?

They're like my government-provided Bowflex: just having them will make us all toned if not tanned. I'd like to see your "public works" give you six-pack abs.

Can someone explain to me how government control of health care/insurance is going to reduce health care costs? Without dramatically limiting what it considers "health care"? And to more people? Who are higher risk? And less able to pay in to any system?

And all while the economy does its interpretion of Depression II?

...without taxing us all into oblivion?

Well, whatever we get, every single member of Congress and their families ought to have the exact same system, and care should be allocated through a double-blind system, and no more $ spent per capita on Congress and their families than the rest of the country.

Can someone explain to me how government control of health care/insurance is going to reduce health care costs?

Let Howard Dean give it a whirl.

Which serious commentators? You mean commentators like Ezra "V is for Victory Gardens" Klein and Brad "You Can't Handle The Truth!" DeLong?

I don't recall even suggesting that I was referring to them. I also don't recall saying anything about health care. If you've been reading, you'll note that Prof. Bernstein was arguing against a broad "understanding of the way the world works." Now, I don't think anyone actually believes the world works the way Prof. Bernstein is suggesting (that "if the Federal government doesn't provide funding for something, it is, in effect, prohibiting it from happening"). My point is that Prof. Bernstein should be arguing with serious people like himself, making serious arguments with which he disagrees. Instead, he attacks a worldview that nobody is seriously defending based on some stupid comment made by Mr. Coley.

AJL,

Maybe it's because those wise Canadians know they are freeloading twice off the American system--the first time by benefiting, like the rest of the world, by America's leading role in pharma and other medical innovation w/o having to pay much of the ost of that development, and secondly by living so close to the worlds longest undefended border so that they can also use American medical care directly if theirs is unavailable for whatever reason.

This nonsense about funding public parks is related to the fact that, if the government funds health insurance, it will effectively prohibit us from making our own medical decisions. Thing is, once the government starts getting involved, it so distorts the market as to force us to pay for things that we don't want nor care about (such as lights in a public park at night), which a) leaves us with less of our own money to do with that we will, and b) gives the impression that such things are the "government's job," which likely reduces charitable giving. Few sane benefactors is going to spend his money doing something that the government would likely do if you so lobbied it; most would choose to allocate their (still-limited, although large) resources to areas of greater need.

It is the first consideration that makes health care a problem. Few of us can afford to pay for our health care twice over - once in taxes, and once so we can get the care we want. So it's not just that the government is failing to provide something: it's doubling the free-market cost.

TT

I read the article by Dean, was not convinced that Dr. Dean really understood the ramifications of what he was proposing. He did a lot of handwaving, but really failed, I think in addressing the question of why a public "option" would save any money. And, most importantly, he failed to address the large amount of cross-subsidization already going on of those paid for by the government by those whose care is not paid for by the government. And he also failed to address the amount of fraud already existent in that system.

Can someone explain to me how government control of health care/insurance is going to reduce health care costs? Without dramatically limiting what it considers "health care"?

There are people who don't get treated for certain diseases. There are people who do. The difference between the two groups is economic.

Under government mandated system the decision on whether you will be treated or not becomes not a function of your economic status, but a function of the disease that you have.

Some people this that this is a good outcome.

The gov't insurer, as a large unit, can negotiate better pricing from drug providers

This fact will change the R&D cost recovery model for pharmaceutical companies all over the world; no doubt about it. EU governments will have to pay their fair share.

drew,

What makes you think that a government plan would actually perform that negotiation in good faith? As has been mentioned numerous times both on this thread and others, current government payouts are below actual cost of the provided services with the excess getting dumped off on those with private insurance and even more so on those with no insurance.

This fact will change the R&D cost recovery model for pharmaceutical companies all over the world; no doubt about it. EU governments will have to pay their fair share.

That's one theory. An alternate, and IMO more likely, outcome is that the EU governments don't pay their fair share and R&D spending is curtailed causing development of new therapies to stagnate.

That's one theory. An alternate, and IMO more likely, outcome is that the EU governments don't pay their fair share and R&D spending is curtailed causing development of new therapies to stagnate.

I attended a CLE in January that featured one of Obama’s health care reform advisors, Professor M. Maxwell Gregg Bloche who during the Q and A said that the one of best way of controlling health care costs was to slow the rate of growth of medical innovation because new drugs, devices, treatments, etc. are expensive (at least initially). The analogy he used was that he wasn’t upset that he wasn’t getting the sort of medical care that Dr. McCoy provided on “Star Trek” because it didn’t exist (yet).

If you can slow the pace of medical innovation and expensive new treatments aren’t developed, people are less likely to be upset because they don’t feel as if they lost anything. It’s sort of like Henry Hazlitt’s analogy about how when government takes your money through taxation and builds a bridge, people notice the bridge that was built but don’t think about what the money might otherwise have been able to be used for if it remained with its owners.

So I agree with you, slowing or curtailing medical innovation is the likely outcome of Obamacare but for its creators, that’s a feature not a bug.

So I agree with you, slowing or curtailing medical innovation is the likely outcome of Obamacare but for its creators, that’s a feature not a bug.

Of course, medical innovation is a means to an end, and that end is better health care outcomes. Even if it is true that you cannot create a health care system that provides for basic health care treatment for all without stifling innovation - I'm not convinced on that point but I'll concede that it is possible arguendo - if it turns out that widespread use of basic medical care is more important to overall health care outcomes than the development of the best new medical care for a small population that can afford it, then the public good might still be served with a egalitarian health care system. Given the performance of other countries that end up with better overall health outcomes at lower cost, I would suggest that is highly likely.

I'm basically a Rawlsian, so I see the conflict between the policy that maximizes overall growth versus the policy that maximizes a fair distribution of resources as inherent to a lot of policy decisions. That conflict should never be resolved simply in favor of one or the other; you have to balance those competing interests (IMO, the way you balance those interest is by looking for the policy that leads to the greatest absolute improvement in conditions for the poor).

While the full details of the bill haven’t been released yet but one thing is worth noting (and it’s been virtually absent from the popular press coverage) is that during the campaign Obama said that you could keep your private health insurance coverage only so long as it was as “generous” as the new government plan. When he talked about his proposed “public option” Obama talked about (a) benefits that would be covered by the taxpayer-funded plan (e.g. abortion coverage, “preventive care,” etc.) and (b) that too many Americans were “underinsured” because they had to pay a portion of their health care through deductibles, co-payments, etc.

Obama’s home state of Hawaii actually has a requirement that if you hire a Hawaiian citizen, that your health insurance must cover certain benefits and they put caps on how much they can be charged for co-payments and limits on how much of their health care costs they are responsible for (they got around ERISA by getting an exemption because their plan came out the same year). Our company learned this first hand when we were told that the health insurance we provide for our single employee in Hawaii had to be rewritten to conform to their State policies (or we could buy a new policy from an “approved” list).

If we take Obama at his word that private plans now to have to be as “generous” as the public plan, then it stands to reason that (a) we are going to see benefit mandates at the federal level (which unlike state benefit mandates wouldn’t be preempted by ERISA which is one of the reasons why self-funded health insurance plans that the majority of Americans use are so much cheaper than buying your own policy which have to cover state benefit mandates) and (c) limits on co-payments, deductibles and the like. Both of these will put an upward pressure on health insurance premiums because employer-sponsored plans will have to either drop any benefits that aren’t mandated by the federal government* or raise premiums.

Don’t kid yourselves, this is nothing less than a federal takeover of health insurance regardless of whether is called “single payer” or not.

* It might be even worse, a number of Senators (including Kennedy IIRC) have been upset that ERISA preempts State benefit mandates and there has been talk about eliminating that preemption. Which means that in addition to federal benefit mandates, employers could have to create a separate plan for each State (like Hawaii tried to make us do) which increases the cost of administration and compliance even further.

Can someone explain to me how government control of health care/insurance is going to reduce health care costs? Without dramatically limiting what it considers "health care"?

Many people do not have health insurance. Those people still get sick and go the ER, which must treat them regardless of their ability to pay. 50% of hospital bills are not paid in full.

The hospital must therefore raise prices 100% in order to compensate for their legal burden to care for the uninsured.

There are two solutions, in a purely free-market we could just let the uninsured with bad credit (e.g. those unable to get an immediate unsecured loan during a time when a lender might very reasonably doubt their future earning potential) just die for want of care.

Or we could force everyone to buy insurance, thus the large mass of healthy 20-somethings could subsidize the sick (both the small fraction of sick 20-somethings and the large fraction of sick 60-somethings.

Oren, that scenario does not "cut costs" it merely shifts them from one group of people to another.

Seeing how a huge proportion of healthcare spending is caring for the old and the dying, the only way to reliably reduce healthcare spending is to cut old people off.

Since old people vote, there will be NO cost cutting.

Oren, that scenario does not "cut costs" it merely shifts them from one group of people to another.

Actually, it will likely increase costs by increasing longevity. That's the problem with healthcare, you can't spend more now without having to spend a lot more later.

(No, I don't have a solution, but here are some nuns with the right idea -- Catholics have a pretty good reputation for respect for life, so maybe they can sell this better than liberals.)

Followup question, when evaluating the function "greatest absolute improvement for the poor", what discount rate do we apply to future benefits from improved technology? That's always my problem with Rawls (who I'm inclined to agree with) -- you can make the analysis come out either way by tweaking the discount rate just a tiny bit. 3% to 5%, for instance, makes a huge difference when applied to future GDP growth (or medical-tech growth).

That's a good question, and I don't have an answer for it and I don't think Rawls does either, to my knowledge. I think you can be a "Rawlsian" and take any number of positions on that issue. Which is good; theory should provide a framework to figure out answers to problems without becoming so rigid that it dictates all solutions to everything.

Funny you should use "insurance" in quotes. That is exactly how an insurance company should behave. You are confused about the difference between "insurance" and "care".

So, "care" is getting quality work, and "insurance" is getting shoddy, cheaper work that improves the insurance company's profits? I don't think so. You seem to be confused about the difference between "insurance" and "rip-off".

The prevalent explanation of why Europeans are totally uninterested in adopting American style health-care is that they are letting us support medical research. I doubt that. For one thing, our very high administrative overhead devoted to championing substandard care is hardly a contribution to medical research. But even if it were, shouldn't we than make them subsidize our health care system? Why should American health suffer because we have to pay out of pocket while others ride free?

But even if it were, shouldn't we than make them subsidize our health care system? Why should American health suffer because we have to pay out
of pocket while others ride free?

Difference in priorities? Americans have been willing therefore have carried the burden. That other countries have benefitted is just a side-effect not a primary goal of the system.

So, "care" is getting quality work, and "insurance" is getting shoddy, cheaper work that improves the insurance company's profits? I don't think so. You seem to be confused about the difference between "insurance" and "rip-off".

Rip off for who? Who's to decide if the fancy work is worth the extra money? If the person who pays the expense is the same as the person who gets the benifit, you don't have a problem. But once you seperate the two, there is no way to choose the most cost-effective solution. And that's true with both a govt plan and an insurance company. And the more choice you have over your insurance company, the better choice you will have.

I agree with rosetta's and the others harping on Kennedy's obesity: let's ridicule everyone who dares to advocate the benefits of something they haven't personally mastered.

I think you miss the point of rosetta stone’s initial comment.

The people who will utilize the “health promotion” boondoggles aren’t generally the people whose unhealthy lifestyle choices are leading to larger health care costs. People who already watch their diets and get regular exercise are the ones who are going to use a new federally-funded walking path. People who eat garbage and don’t exercise aren’t going to suddenly start walking because there’s a new walking path available.

RS’ point that Kennedy had these options and more available to him but chose not to use them and instead chose to drink and eat himself into the model of good health that he is today is illustrative of the folly behind “if you build it, they will use it.”

David Bernstein,

Thanks for the sarcastic post. What a fabulous contribution to the public debate! I don't believe you post these things for free.

Thorley Winston:

I think you miss the point of rosetta stone’s initial comment.

The people who will utilize the “health promotion” boondoggles aren’t generally the people whose unhealthy lifestyle choices are leading to larger health care costs.

Thorley, I don't think that was his point in bringing up Kennedy's obesity. He's too smart to believe argument by induction is logical, much less persuasive. Occam's razor suggests a lot of commenters on these threads just think ridicule is its own reward.

And the more choice you have over your insurance company, the better choice you will have.

There is one dental insurance, one vision insurance, and I believe three health insurance providers available through the University of California, a huge employer. (Some providers offer more than one plan.) In other words, there aren't a lot of people playing in this space.

What is it about the insurance context that provokes "free marketeers" to support shoddy work? Highly dubious denials of benefits? Improper accounting devised to reduce pay-outs (lawsuit ongoing, insurers losing). It's a little like casinos: they don't make a profit from bets that they win, they make a profit from all the bets they lose on which they pay out less than the true odds.

A liberal is a conservative who has gotten sick, and I imagine that may of you will sing a different tune after illness wipes out your savings.

AJL,

A liberal is a conservative who has gotten sick, and I imagine that may of you will sing a different tune after illness wipes out your savings.

And a conservative is a liberal who has gotten sick and been denied treatment by some apparatchik. See, two can play this game--innit fun? :-)

We also support roasting puppy dogs on spits - the cuter the better

Typical free market nonsense. You can breed them for cuteness or for taste. Each is at the expense of the other.

- and pushing down little old ladies. Then kicking them.

Another example of how free marketers are all talk when it comes to efficiency, having no idea what it actually looks like. If you kick the little old lady, she falls down by herself.