I don’t know were you come off calling me a fool. I believe this is supposed to be a civil discussion and if you don’t agree with my position there is no need for name calling. Moreover, if you read my post correctly you would understand that I am not advocating for an all out government system. My position is that government is necessary, at least as a regulatory body, in any model that is implemented. I suggested a non profit model and that does not translate to government run insurance. Please make an attempt to understand someone’s position before attacking them.

*”But you wouldn’t include among them the 75% (!) who fail to graduate from public high schools in Detroit, 65% who fail to graduate in Cleveland, 65% who fail to graduate in Baltimore, and more than 50% who fail to graduate in 15 other major US cities. Or perhaps you would?”

I would. I did my first year of Highschool in Detroit at the Frank Cody Highschool. I got the education I wanted to get, a very good one. The 75% that fail out before graduating are generally getting the education they want and those that don’t are not failing because the school neglects them but because of other issues in their lives that make staying in school less rewarding than leaving it. I have never seen a public school student who really wants to learn fail the system.

*”Only to find that nobody has funded one for him. So he gets stuck with a minimum-wage incompetent. But as the cage door slams behind him, he’ll know he had his *rights* as declared by the politicians!”

When the alternative is no lawyer, even a bad one is a blessing. However bad the success rate of court appointed attourneis may be, the success rate of those who represent themselves is far far worse.

*”Just as all those kids in Detroit, Cleveland, etc., had a *right* to a quality public education!”

Yes. Just like them. And no one believes the year I spent at Cody was as good as a year at Cranbrook. But if the alternative is nothing, I wouldn’t have been able to afford to start Highschool. Nobody thinks that the post office is as good as DHL, but without it I never could have had my transcripts delivered to Germany to qualify for a fellowship at the Marshal Center.

*”Is the most cost effective way of dealing with this constant the status quo; [...] Or do we spend a fraction more, and provide a multiple of that level of care.

Now who’s dreaming about a free lunch?”

Can we agree that the number of people who come down with serious illness and get seriously injured is more or less constant and not affected by the type of healthcare system in place? You could argue “moral dilema” and say that if everyone had permanent health insurance then less would quit smoking or more would go skydiving, but … really?

So if the number of serious medical cases is constant, are you suggesting that fewer resources are needed to treat them if 30 million people don’t have the ability to pay for those treatments? An ER visit utilizes the same number of doctor hours whether the person is paying or not. That money has to come from somewhere either directly or as a revinue lost on time treating a non-payer that could have made money treating a payer.

45 million (including legal and illegal non-citizens) residents are uninsured, when they show up in the ER we treat them. You can’t make that cost disappear and then compare the cost of healthcare reform with $0.00. I will concede that the savings on treatment costs realized by allowing people to visit doctors instead of waiting until they need an ER does not mitigate the cost of insuring those people. But it takes a bite out of it and by the most conservative study it will save 18,000 lives a year.

*”Of course the status quo isn’t cost efficient — as noted earlier, because of the huge distortions caused by (1) the employer-tie cum inequitable & inefficient tax subsidy, as exists in no other nation;”

We agree on this.

*”And who imposed these gross distortions into the system? The government. Is the Democratic health care reform going to do anything about them?”

The government allowed the exclusion and business quickly utilized it to provide large chunks of subsidized payroll. The democratic HCR is designed specifically to fix the situation. By taxing health care insurance value above $9k, the incentive to offer bloated plans is mitigated. Revinue will be made off the taxes, but the real benefit is in forcing business and employees to work with the real value of their compensation (or at least much closer to it.). So you say companies will just drop their plans to one that costs $8999.00 and AHA there’s no gain from the tax! But the real problem is the huge number of healthcare dollars spread unevenly because companies can hand them out tax free. The market distorsion is caused by government interference and this plan aims to remove a portion of that interference.

*”So how, precisely, do you propose to get “a multiple” of today’s health care services for “a fraction more” spending, while cementing the grossest inefficiencies in place?”

Touched on this, but say 1 in 100 of us will get Cancer. It’s actually 1 in 3 but I’m talking about the kind that requires serious care. That means that out of the 30 million uninsured that the HCR bill would insure, 300k of them will need some kind of cancer treatment. Without insurance, they find out they have a tumor after the cancer has begun causing them pain bad enough to go to an ER. With insurance they find it when they have an exam, or notice something is wrong and get it checked out. If the tax payer is footing the bill in either case (we can’t just let them die), why would you want us to pay so much more for a system that begins treatment at stage 3 or 4 and results in a higher mortality rate? Yes, the CBO says the costs would be marginally higher than the current “uncompensated care” system (my fractional increase in cost). But the result is 18k fewer deaths a year(my multiple of todays care). Unless you think 18k less people dieing is not much much better care.

*”The taxpayer pays about $1.40 for every NYC subway ride. Would that city be better off without it then?”

Ha! And WHY is there such a large tax subsidy? Because the transit workers”

There is a large subsidy because the cost of any alternative would be absurd. Subsidizing a transit system $6B saves them many times that in lost revinue. And transit workers get paid alot and have little productivity oversight (though not bad overall productivity). But everything in NYC is done by union labor, the MTA isn’t unique in this. I agree that strong unions sap at efficiency, but there must be some value to the laws that empower them so or else people would stop doing implementing them.

*”And with the Metropolitan Transit Authority bankrupt, literally, due to skyrocketing labor costs, the union just helped itself to another 11% pay increase”
The union was given the raise that they had negotiated for but had been denied by the city due to economic conditions. Again, I agree that the power of the unions saps at efficiency in most cases, but they just got what the city had agreed to pay them.

But you are wrong about the cause of the MTA financial woes. Labor costs haven’t changed much since 2006 when “The MTA’s net cash surplus approached $1 billion at the end of fiscal year 2006 as the housing market boomed and pushed up real estate related revenues”-Moody’s (http://www.reuters.com/article/idUSN2753030920090327) The reason they are hurting is the same as all the other big companies that are hurting, we’re in a recession.

*”Result: A new MTA “bailout” via a regional payroll tax landing on communities up to 60 miles away from the nearest subway station, because the city itself is already taxed out, with the highest taxes in the nation.”

This portrayal of the MTA plan borders on dishonest. The payroll tax will land ONLY on the counties served directly by the MTA. It will land proportionately lighter on counties with less MTA service. So Dutchess County will pay a 2.5% payroll tax while NYC will pay 3.4%. As Steven Landsburg said in “more Sex is Safer Sex”, if the people living and working in NYC didn’t think it was worth the cost, they would leave.

It is indeed. That’s why the founders recognized that protecting ourselves from outside threats — protecting our ability to maintain our liberty — was one of the few core roles of federal government.

Look, I haven’t even been making a normative argument here against the health-care bill, or even one in favor of liberty. (Though I’m happy to make both if you want.) I’ve simply been making a point about rhetoric: One must be either uninformed or dishonest to co-opt language like “land of the free” — which has a distinct contextual meaning in American history — in advocacy of this legislation.

Jim Glass critisizes public education as a poor model for healthcare to follow:
“(Yes, that Professor citing public schools as the model to follow is bizarre.) “- A poor model indeed. American workers are some of the most productive in the world.

But you wouldn’t include among them the 75% (!) who fail to graduate from public high schools in Detroit, 65% who fail to graduate in Cleveland, 65% who fail to graduate in Baltimore, and more than 50% who fail to graduate in 15 other major US cities. Or perhaps you would?

Jim Glass said:
“Proclaiming a general human “right” to a good, service, or physical condition that must be provided using economic resources and organization accomplishes nothing.”

And I suspect he would feel differently if he were accused of a crime by the state funded lawyers who have nearly unlimited resources to prosecute him and great economic incentive to get a conviction. And since a service cannot be a “right” they tell him he’s on his own.

Ha, I am a lawyer, and I just love having the gov’t subsidizing my services at taxpayer expense!

But beyond that, if Benkyou Burito read more carefully he’d know I didn’t say a service can’t be declared a right, I said proclaiming a right accomplishes nothing towards actually providing the service.

Perhaps he will realize this someday when state funded lawyers who have nearly unlimited resources to prosecute him and great economic incentive to get a conviction come after him — but he is reassured by his knowledge that he has a solemn *right* to a top-quality legal defense. Only to find that nobody has funded one for him. So he gets stuck with a minimum-wage incompetent. But as the cage door slams behind him, he’ll know he had his *rights* as declared by the politicians!

Just as all those kids in Detroit, Cleveland, etc., had a *right* to a quality public education!

He goes on to say:
“OTOH, if the item can be provided economically, then it will be and there is no need to create a “right” to it.” And it seems as if holders of this view are forgetting the golden rule of “there are no free lunches”.

Of course there are no free lunches. But there is no shortage of economically provided lunches. I bet you enjoy them regularly!

Which means you don’t spend your time lobbying to create a “right” to lunch — or more generally even to food, although it is a heck of a lot more important to you than near anything else you can name.

People without insurance are going to get sick and injured, that is a constant. Is the most cost effective way of dealing with this constant the status quo; they wait till they can wait anymore and then go to the ER and get taxpayer funded organ transplants and funerals? Or do we spend a fraction more, and provide a multiple of that level of care.

Now who’s dreaming about enjoying a free lunch?

Of course the status quo isn’t cost efficient — as noted earlier, because of the huge distortions caused by (1) the employer-tie cum inequitable & inefficient tax subsidy, as exists in no other nation; plus (2) the McCarran-Ferguson Act, which cartelizes the health industry state-by-state and city-by-city, exempting it from anti-trust as well, so anti-competitive practices abound, (More detail), also as exist in no other nation.

And who imposed these gross distortions into the system? The government. Is the Democratic health care reform going to do anything about them? Nothing except cement them in place forever — because the big political beneficiaries of these distortions are Democratic constituency groups.

So how, precisely, do you propose to get “a multiple” of today’s health care services for “a fraction more” spending, while cementing the grossest inefficiencies in place?

It’s fun dreaming about a great free lunch to come, eh?

(And delicious watching the belief system: “The government has totally screwed up our health care system, so now we have to make it efficient by giving much more power over it to the government.”)

The taxpayer pays about $1.40 for every NYC subway ride. Would that city be better off without it then?

Ha! And WHY is there such a large tax subsidy? Because the transit workers via their monopoly gov’t union receive pay 50% above market rates via work rules like this (yes, double-pay overtime for sleeping at home!)

And with the Metropolitan Transit Authority bankrupt, literally, due to skyrocketing labor costs, the union just helped itself to another 11% pay increase taking federal stimulus funds — oops, no job creation from that part of the stimulus! Building the Second Avenue subway is put off for yet another lifetime.

Result: A new MTA “bailout” via a regional payroll tax landing on communities up to 60 miles away from the nearest subway station, because the city itself is already taxed out, with the highest taxes in the nation.

You ask, Would people be better off without that $1.40 per ride tax contribution? The people in an awful lot of those communities are saying “Hell, yes!” and inciting legislative revolt over that right now.

Yes, it does. Which is why I don’t use the rhetoric of freedom”

I would argue that there is freedom du jure, and fredom de facto. In Somalia, where there is no functioning government the people are, by definition, 100% free from government imposition. But in practice, the people are afraid to leave their homes. They are terrorized by domestic and foreign militias. And they die in their beds wanting the simplest medicines. But they do all of that without the yolk of taxation; does this make them free?

My point is that the taxes that you pay to support the military, which must protect all citizens even non-taxpayers, is a price for freedom. The price of a plane ticket to Somalia will exempt you from it.

The same greedy people and lawmakers argued most esoterically for the “freedoms” and the “younameits,” of the tobacco industry.
What a farce!

They are the people who must have things “PROVED.” And, “NOTHING” can be “PROVED” to them. They simply say, “NO!” As in, “NO! Kid, you must suffer for the “freedom” of the rich to get richer. You must suffer while “justice” is discussed. You must suffer while “capitalists” get more capital. You must suffer while religions and religious beliefs are argued.
What a farce!

Yes, it does. Which is why I don’t use the rhetoric of freedom if I’m arguing in favor of taxation and government dictates. And that was my point to Tom Lucas: There may be plenty of valid arguments to make to advocate government-run health care, but “because we’re the land of the free” isn’t one of them.

The point is that you don’t get to co-opt the language of liberty for stuff like this. Advocates of leftist projects already have plenty of their own relevant rhetoric — “justice,” “equality” and the rest. They’re welcome to use those. If you’re making a pragmatic argument, then you’ve got “costs” and “incentives” and the like available to you. But throwing “freedom” or “liberty” in there isn’t just inaccurate, it’s Orwellian. That bit of ammo is available to those who defend liberty, not to those who would — purposely or otherwise — erode it.

Thomas said:
“When you threaten me with force to demand I buy insurance, “freedom” is not one of the operative words involved.”
-You are threatened with force to pay for the services provided to free-riders all the time. Even the homeless receive the protection of our outstanding military and access to the court system that WE pay for. Does this make you less free?

Jim Glass critisizes public education as a poor model for healthcare to follow:
“(Yes, that Professor citing public schools as the model to follow is bizarre.) “- A poor model indeed. American workers are some of the most productive in the world.

Ken concurrs:
“As with public education, if public schools fail miserably, like they have here in Baltimore, you can’t get out” – This is either myopia or intentional obfuscation. Baltimore has one of the longest running and most extensive charter schools in the country. http://www.bcps.k12.md.us/School_Info/Charter_Schools.asp

30 private schools compete for student tuition in your city. So, no, if you don’t like your failing public school you are not stuck paying additional money. You go to a charter school and pay nothing. Baltimore schools have even begun creating magnet and specialty schools to compete with the charter schools for students.

Truthfully, the public ed. model is a great starting block. It’s true that drop-out rates are awefull and our math and science skills are sub-par, but I have never heard of a student who wished to learn being denied a quality education. I know many who wish they could afford the new heart meds because stantons make them unable to work (side affects are drowsiness).

In “More Sex is Safer Sex” Landsburg says that overcrowding is not an issue because the larger population will provide a larger pool of the geniuses that drive innovation. For that to be true, they all need access to an education. And keeping these “geniuses” tied down to a cubical farm because their wife’s asthma (or whatever) makes it impossible to get insurance isn’t going to lead to that innovation either.

Brown is saying that a plan that limits payments will reduce incentives to practice healthcare. And more dramatically that he is okay with doctors leaving the field because of it. I would restate the position by saying that the number of healthcare providers is presently artificially high.

I would say that the current system of tax subsidized employer provided healthcare has created an artificially large number of healthcare dollars into the hands of the working majority. Like all market interference, subsidizing wages leads to too much of it and since these are healthcare dollars, it leads to too much healthcare being produced.

The subsidy, in the form of a unique and unprecedented tax exclusion on employer provided insurance has driven up the prices charged to the point that the growing minority of Americans who do not have employer provided insurance could never afford medical care. And at these inflated prices, of course, more people have entered the field.

This is simple logic and S/D curves. So long as you have more people able to pay $1000 per hour of chemo. than you are able to produce hours of chemo, the people able to pay $50 dollars an hour are going to die. And because that group of people is statistically small (though numerically large) there is no real incentive to cater to it.