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Subject: Re: Imagine the America you want to live in #6
The first five questions in this series focused on general societal issues. The next set of questions, starting with this one, look at some more specific policy questions.I support a single-payer universal health care program. I've written at some length why here.
What would be the impact on my life if we had such a system? I would have health insurance under such a system. I have not had health insurance since 1999. Parts of that time were spent unemployed. But I was also employed in part-time jobs from 2001 to mid 2002 and was a student at a community college from late 2002 to this summer. Neither my employers nor my school provided health insurance as a benefit. Employers often do not to part-time or temporary workers.
I'm lucky that I'm still relatively young (30) and in good health. I don't need to go to the doctor except for regular checkups. I can get by without more, for now. But if I had a serious health condition, I would not be able to afford the medical care I need. The last time I went to the doctor, I had a half hour checkup and some blood work done. The cost for both together was about $300. Where does an unemployed or underemployed person find that kind of money? And like I said, that was just for a simple checkup and a blood test. What if I needed care?
I think that it is a moral obligation of a society to provide basic health care for all its members. There are three things that I think are the most basic and fundamental services a government should and must provide for its people and those are health care, education, and a justice system.
Subject: Re: Imagine the America you want to live in #6
I haven't really thought much about it but universal healthcare in the abstract is something I would like.Regarding impact on me personally, none whatsoever up till now. I have had good medical coverage wherever I have lived. But obviously the situation could change tomorrow.
Subject: Re: Imagine the America you want to live in #6
I gather from your own response that you're talking about a socialized medicine system such as the UK's National Health Service.
I work in the software industry, which is already in pretty shaky condition--I've already narrowly escaped being laid off from one of the largest and most stable software companies. If the US had something like NHS, the damage to the economy would almost certainly result in my losing my job, with no hope of getting a new one. I would then live out the remainder of my life in a cardboard box someplace--unless my sense of dignity overcame my natural cowardice long enough for me to kill myself first.
Subject: Re: Imagine the America you want to live in #6
I am American but I live in a country where there is universal health care (France). On the positive side, I have to say alhamdulillah, I am tremendously grateful that I have coverage. I have various health conditions that would have cost me tons of money in the US, but here they are taken care of.On the other hand, there are many problems that come with a national health care system. For certain surgical procedures you have to be on a seemingly eternal wait list. Also, many wasteful unnecessary treatments are given because the doctor gets paid by the government to treat you, so he slips a med or a procedure in your program even though you might be better off without it. (This happens in America as well, but here it's free for you so they don't have to try as hard to convince you to undergo it.)
I had a knee problem not long ago, and a doctor here was proposing to surgically break both my legs and "straighten" them out because he said I was bow-legged. Sick with fear, I went to a different doctor that handed me a prescription for physical therapy. I am undergoing the therapy and am fine...it was a simple problem in my walking gait, that's it. Needless to say I'm quite resentful of the person that wanted to "improve" my quality of life by breaking my knees and gluing them back together. But think about it...with the rehab and the recurring problems ensuing after that kind of surgery, and virtually no objection to treatment by the government, the man would be made in the shade for the rest of his greedy miserable life as I hobble around pitifully. That's what kind of situations national systems breed.
Zafira
Subject: Re: Imagine the America you want to live in #6
Ken, I trust that you are joking. The thing about the single payer system is that the expenses are instead of rather than in addition to the current expenses. As far as I can tell, although I haven't examined the details, most of the plans on offer that involve simply extending the current system will involve additional expenses, to be borne by the employer. By contrast, the single-payer system would involve a redirection of the money that is already being paid into the health care system, and the costs would be shifted away from employers.Zafira, the points you have raised are good ones. However, right now I am not seeing a doctor at all because I can't afford it and am praying that I don't become seriously ill or get in an accident so that I need to see a doctor whether I can afford it or not. The one thing I know is that if we agree that everybody should have access to health care, America's current system is not working. Single-payer may not be ideal but it seems to offer better health care than the current system. There's a saying about letting the perfect become the enemy of the good. Let's not hold back from doing something that brings more benefit than the current situation, just because there's no perfect solution.
I'm really sorry to hear about how that doctor acted to you. Hopefully, the system would be set up to make sure that patients have access to a second opinion and there are procedures for dealing with complaints against doctors.
Subject: Re: Imagine the America you want to live in #6
No, I'm not joking.
You raised a couple of points which I'd like to comment on:
The thing about the single payer system is that the expenses are instead of rather than in addition to the current expenses.That may be true, but not necessarily--it depends on the specifics of the system. I think this would be a worst-case scenario, because it would mean that private health care had been criminalized. If I managed to remain employed, I would certainly pay for private health care if that were an option.
...the costs would be shifted away from employers.I don't see how that would be the case. Currently the costs are born by the employee, not the employer (of course many people are self-employed and count as both). Such a system would be paid for the same as any other government program--through a combination of taxes, borrowing, and inflation. The costs would thus be shifted to everyone, with the exact burden depending on how the government chose to pay for it.
Subject: Re: Imagine the America you want to live in #6
Hmm, blockquotes show up in the comment preview but not in the actual comment. Hopefully the above comment isn't too unclear...Subject: Re: Imagine the America you want to live in #6
The preview displays whatever HTML is typed into the comments field, but MT has a built-in filtering system that strips out all but certain HTML before storing the comment in the database. This is to prevent people from posting malicious code.It appears that the blockquote element is not on the approved list. Most people use italics to indicate what's a quote. Sorry about that.
Subject: More govt healthcare = less responsibility
The main problem with any government provided service is that it reduces personal accountability on the part of the people. One telling omission from most studies that promote the virtues of a universal healthcare system is the proportion of preventable health problems caused by poor lifestyle choices, such as unhealthy eating, smoking, and lack of exercise. Yes, there may be more government can do - isn't there always? - but, until people take charge of their health - physically, mentally, and, finally, financially - universal healthcare will merely shift the same problems we have today to a different system that further diminishes the importance of the individual being primarily responsible for their own life.Subject: Re: Imagine the America you want to live in #6
Though cases of preventable health care may indeed rise with a universal health care system, don't we really need to focus less on what may happen and more on what is already happening in a country where the many have inadequate health care and an even greater majority have no health care whatsoever. America is rife with overweight, smoking, alcoholics - that alone should indicate that it's not the proposition of a universal health care system that we should be intimidated with, but rather the consequences of not having one. I would much rather see all those overweight smoking alcoholics getting decent, affordable coverage than to dismiss them outright as leeches on the system.I [currently] have no health insurance. I would gladly pay out of my own pocket to support a universal system.
It's our duty to help one another and sometimes doing so means being discomforted in one way or another. Sure, all socialist programs have their downfall, ie. someone has to pay for them, but the best and most successful have ridden out the pains of growth [not to mention the knockings from critics] and are now public institutions - libraries, park services, the postal service...these are all socialist endeavors that have succeeded and continue to give to our society [problems with library funding nonwithstanding].
Eventually you won't even notice the $1.25 a check [or $5, or $10] that's taken out for UHC.
Subject: Re: Imagine the America you want to live in #6
People aren't smoking, overeating, and drinking too much because they do not have enough or any healthcare - those are lifestyle choices and I cannot find any logical linkage between the two (infact, the inverse would be more appropriate: due to lack of healthcare, one would live a healthier lifestyle, no?). As for libraries, parks, etc., these are services with little fluctuation in costs and needs of the people (whereas health care needs are greatly influenced by the population, ie, aging). Taxpayers are already subsidising the two sickest and more fragile populations - the elderly and the poor (sometimes one and the same) with Medicare and Medicaid, along with Social Security, which benefits the elderly and the disabled. Add the subsidation of non-profit hospitals and taxpayers are already paying an enormous amount of healthcare in this country every paycheck; a UHC would only add to that tax burden, with little noticeable change in preventable healthcare problems, overuse of medical technology, malpractice reform, and other issues that are equally, if not more, causes of the high costs of healthcare.As for the overweight smoking alcoholics, there are numerous programs (usually free or at reduced price) by private organizations, health systems, governments, and, yes, insurance companies, to help these individuals and many people use these programs to improve their lives; hopefully, more will.
It's not about accusing people of leeching off the system, it is just human tendency to overuse something when it is perceived to be 'free'.
Subject: Re: Imagine the America you want to live in #6
I moved to America from Canada where we do have universal health care. All-in-all, the Canadian system is just as good as the American system, costs less and covers everyone. In addition to experiencing both systems, I used to be actuary (the people who work at insurance companies who set premiums and things like that) and I have been meaning to write an article on my own blog debunking some of the myths of Canada's health care system.Subject: Re: Imagine the America you want to live in #6
also in terms of your health insurance...have you considered catastrophic health coverage? I have such a policy and it costs me about $42/month and starts covering me after I pay the first $1000 out-of-pocket. Nothing fantastic, but it does ensure that if something really bad happens to me that I'm covered..though I do have to pay out of my own pocket to a large degree.Subject: Re: Imagine the America you want to live in #6
Manish, thanks for sharing your thoughts. I look forward to reading more about the Canadian system from someone who actually knows something about it.Regarding your suggestion, I'm afraid that $42 a month on health insurance would be $42 a month that I have to take from something else that needs to be paid. And $1000 would break me. I do have health coverage of a sort: if I were to be injured or become seriously ill, my parents would pay for it. Fortunately, I have a family who are relatively well off and are willing to help me through this difficult time. Not every one is so lucky.
Iggy also made a good point. I would rather have a system where there's some indulgence of hypochondriacs than a system where people are ill and in pain or even dying because they can't afford healthcare. To me, this is ultimately a moral issue. How can we have so much and not share it to help those who have less? How can we see that people are suffering and we have the power to help them, but we don't? That's not the kind of person I want to be and that's not the kind of society I like to live in.
Subject: Re: Imagine the America you want to live in #6
My health insurance is detucted from my paycheck each month. I would rather have a universal heathcare system. The money will be detucted either way-whether through taxes for an UHS or through my employer. If we had a UHS then we would no longer need Medicare and Medicade so we wouldn't be taxed for both Medicare and UHS. I do have a question- does anyone think that the doctors, who make a lot of money off the present system, will support an UHS?Subject: Re: Imagine the America you want to live in #6
Actually, I suspect that it's insurance companies that really make most of the money off the current system.In any case, 8000 doctors recently endorsed a national healthcare system. Articles in favor have recently been published in the Journal of the America Medical Association and by the New England Journal of Medicine and Harvard Medical School. The latter two organizations published studies showing that national health care would actually save $200 billion a year.
As I mentioned above in response to Ken, the thing that people seem to miss is that a single-payer national health care system would be in replacement of rather than in addition to the current system.
Another thing to consider is that even when people don't have health insurance, if they get in an accident or fall seriously ill, they will probably end up in the emergency room and they will almost certainly be treated there even if they can't afford to pay for it. That is a cost that the hospital or its insurance company must swallow. It means that in effect we are already paying at least in part to cover uninsured people, they're just not getting the coverage.
What we have right now because of Medicaid and Medicare is a mixed system with both the government and private insurers involved. The government can easily subsidize itself to provide services at lower cost than other entities can. This makes it difficult for those other entities to compete. They may have to get out of the business entirely. The fewer suppliers there are, the higher the prices go. That's basic Econ 101 stuff.
A libertarian like Ken will argue that the government should get entirely out of the market, and that is certainly intellectually appealing. But there is no evidence that private insurers alone will be able to provide universal coverage. Why should they provide coverage to people who can't afford it? The only way to provide universal coverage is to take surplus from the rich to cover the costs of the poor. Maybe we should have a sliding scale in which the wealthier you are, the more you pay for your health coverage - yeah right. That's not going to fly either.
Given that a mixed market is an economic disaster and that a purely private market will not provide universal care in my or anybody's lifetime, the only workable solution for those who believe that universal care is a priority is to get the private insurers out of the market entirely and leave it to the government. Even though that's "socialism". The government can tax the wealthy proportionally according to their wealth and use that money to cover the poor. We may not like it, but we accept that as something that governments are allowed to do.
I believe that from an economic standpoint, the government is the most effective entity to provide services that are considered by society to be necessary for all people. I also believe that the provision of such services is one of the legitimate and proper functions of government.
Now of course, some people are not convinced that universal healthcare is a good or desirable aim. But that is an seperate question. If you don't believe that there should be universal healthcare, then a private solution is no doubt best. But if you do believe in universal healthcare, then you need to think about what is the most effective way to deliver it. I get the feeling that some people in this thread are arguing with me over methods (private, government) when what they really object to is my premise that universal health care is a moral obligation. Let's keep things clear here.
Subject: Re: Imagine the America you want to live in #6
You're right about my position on getting government out of health care. I'm not going to argue it, though, since "should there be a single-payer system" wasn't the question. :-)Subject: Re: Imagine the America you want to live in #6
The question posted is really just a starting place. I'm quite enjoying this debate; it's by far the most interesting that my dialogue series has generated so far.I think that we both agree that there are two separate questions, one about universal health coverage as a goal or ideal, and one about methods. I support universal health coverage as a goal (which as you noted is the actual question posted) and believe that single-payer is the most workable way to provide it. That doesn't mean it's ideal. Zafira and others have pointed out problems with it. But I feel that the problems are less than the problems in the current system and I don't believe that a private-only system is capable of providing universal health coverage, which is my goal.
Do you believe that a private-only system is in fact capable of reaching the goal or do you not believe that the goal is the right one? That is your answer to the original question.
BTW, I agree that a private-only system will usually provide the best healthcare. It's just that it doesn't provide it to everyone. As I said before, it's not meant to. And as I said, I think that we have a fundamental difference in outlook.
Subject: Re: Imagine the America you want to live in #6
Do you believe that a private-only system is in fact capable of reaching the goal
Yes, absolutely. Keep in mind that a private system would be at least as different from what we have now as the NHS model is. Currently the American health-care industry is something of a confused mess. It's heavily fascist, even more so than most industries, with socialist elements such as the Veterans' Administration.
Removing the regulatory burden would have several positive effects on the availability of health care: Prices would come down as the costs were reduced by eliminating the expense of regulatory compliance. Supply would increase as doctors would no longer be driven from the profession by the bureaucratic hassles. Sole practitioners and small practices would become more viable as doctors would no longer be forced into large organizations and HMOsin order to shift the paperwork burden. More choices would be available with the removal of bureaucratic and political obstacles (for example, cloning, stem cell research, and drugs like RU486). Patients who are in pain would be able to get adequate pain medication.
These changes would all lower the cost and increase the availability of health care for everyone. That by itself would take care of many of the people who want insurance but can't afford it, just by lowering the bar. For people who haven't got jobs, the costs would be lower for their family and/or friends. For people who haven't got jobs, family, or friends, there are charities.
or do you not believe that the goal is the right one?
I don't think goals are right or wrong per se... they just are. However, I have a different idea of how to state the goal. To me, universal health care is something that's available for purchase on demand everyplace possible. Think of it this way... in America we have "universal food." That is, you can buy food anywhere there's a population by walking in and paying for it--nobody has to stand in govement bread lines to get food. That's what health care should be like.
Note that an NHS-style system would actually make health care less available than it is now in some cases. For example, suppose someone just discovered he needs some life-saving surgery. Even in the current anything-but-free system he can just call the hospital and make an appointment for the surgery next week. Under an NHS system, he goes on a three month waiting list --and he may be in worse shape because of delays in getting to see a specialist to determine what was wrong. In such a case, is it fair to say that health care is universal under the second system?
Subject: Re: Imagine the America you want to live in #6
Thanks for sharing your thoughts, Ken.As long as the people who need care do not have to pay the cost of it, or mostly do not have to pay the cost of it, they will tend to seek out care more often than they would otherwise, even for minor ailments. One of the earlier commentors alluded to this. It's a problem in the current system and it would be a problem in a universal health care system. The only way that I can see that it would not be a problem was if everybody had to pay the full costs of whatever care they were seeking. Of course, people like Bill Gates are so rich that even the most expensive care would still be a minor expense to them, so even then you'll have some exploitation of the system.
Current healthcare costs are outrageous, I think we're all agreed on that. There are lots of ways to bring them down, some of which you've mentioned.
But will they ever be brought down low enough that a person making minimum wage can afford them? What about a person who's been laid off and is on unemployment? There's a certain price that healthcare providers have to charge just to cover their own expenses and I doubt that price will ever be low enough that low-income people can afford it.
We have plenty of food in this country, but there are people who go hungry because they do not have enough money to purchase as much as they need. According to your model, we will have plenty of health care in this country, but there are people who will go without because they do not have enough money to purchase as much as they need.
That may be your definition of "universal health care", Ken, but I doubt that it is what most other people understand by the term.
I am talking about making healthcare available like public schools are available. Available for everybody, no matter how rich or poor they are. The current system does not provide that and your private-only system will not provide that for the reasons I stated above.
No, single-payer is not perfect. No system is. But I believe that the drawbacks are less serious that the drawbacks of the other alternatives. It may never be truly universal but I think it can get closer than the alternatives.
Subject: Re: Imagine the America you want to live in #6
But will they ever be brought down low enough that a person making minimum wage can afford them?
If Manish's $42/month figure is accurate (and I've heard that number elsewhere), a minimum-wage employee can already afford them.
What about a person who's been laid off and is on unemployment?
People who truly can't afford their own health care can seek help from their family, friends, or charity.
There's a certain price that healthcare providers have to charge just to cover their own expenses and I doubt that price will ever be low enough that low-income people can afford it.
Without the cost of regulatory compliance, I'd expect to see prices fall to about half what they are now. And that's without considering indirect factors such as an increased supply of doctors, and technological improvement. At that point prices are low enough that only people with no income at all (or with low-income jobs that are also part time) would be unable to afford it. And then there's the family, friends, and charity.
We have plenty of food in this country, but there are people who go hungry because they do not have enough money to purchase as much as they need.
Food is extremely cheap--I lived for years on $60/month for food, and half of that was luxury items. People who can't get enough money to pay for it themselves (and we're basically talking about homeless people who are either mentally ill or have too much pride to panhandle) get food from homeless shelters and the like. There are free clinics for such people as well, often run by the same groups.
In any case, by describing my idea of "universal health care," I was trying to make the point that if the health care isn't available when you need it, is it really universal?
Just out of curiousity, what about people who don't want health insurance? I'm in that category myself--I presently have it, because as a regular employee I'm forced to by California law (I'd rather keep the $500/year), but during my periodic times as a contractor I haven't had it. This is very common in the computer industry, where most people are young and healthy--the only people I know who do get health insurance as contractors are the ones who are in their 40s (or older) or have families.
Subject: Re: Imagine the America you want to live in #6
Just a couple quick notes.1) Have you ever work for an organization that provides social services to low-income people? Even for something as non-essential as legal services (which is what I currently do) there is at least ten times more demand than can be met. Why? Lack of funding.
2) It's not a question of who can afford $40 a month. It's a question of who can afford $40 a month more than they are already spending. And that's for catastrophic coverage only, not for regular health care.
What you're saying sounds great in theory. It really does. But it doesn't match with my experience of how things actually are. I would like to see some hard numbers. How many people would your plan actually cover and how many would it leave uncovered? How much coverage could non-profits and family/friends actually provide and would it be enough? Show me the numbers, and I'm willing to be convinced. But right now I'm not convinced.
Subject: Re: Imagine the America you want to live in #6
Even for something as non-essential as legal services (which is what I currently do) there is at least ten times more demand than can be met.
That's a problem anytime someone is offering a service the person who benefits doesn't have to pay for. But where would the problem be more severe? In a free clinic for poor people where the doctor is free to turn away those who don't really need a doctor, or in a NHS system where everyone in the country can show up?
It's a question of who can afford $40 a month more than they are already spending.
That's up to the individual. It will also be a question of what less-important thing can they do without to pay for the health insurance. If, for example, someone feels that a six-pack of beer every weekend is more important than health insurance, that's his choice to make. My interest is only in whether he has the choice, not whether he makes the same choice I would (personally, I don't drink alcohol but I'd rather have a cable modem than health insurance).
I would like to see some hard numbers. How many people would your plan actually cover and how many would it leave uncovered? How much coverage could non-profits and family/friends actually provide and would it be enough? Show me the numbers, and I'm willing to be convinced.
This is a theoretical discussion of something that hasn't happened yet. I wish I could get hard numbers on it... if I could do that, I'd check the upcoming lottery winners while I was at it. :-) In a free system, though, there would always be some people who didn't have health insurance by choice, and I get the impression you don't want anyone to be unisured no matter the reason.
Subject: Re: Imagine the America you want to live in #6
People are turned away from social services organizations not because they don't have a real need, but because the existing staff and facilities cannot handle even those who do have a legitimate need. That was what I was trying to say and I apologize if that was not clear. You were arguing that charities would cover what private health care providers would not and therefore your plan did provide for poor people. I responded to say that charities are unable even to handle all the poor people who have legitimate needs, because they don't have enough money to hire sufficient staff, etc. If charities are unable to serve even those with legitimate needs, then your plan does not in fact provide for poor people.Re the second point, there are also people for whom spending $40 means giving up on something necessary. That's the point I was trying to get at. Again, I'm sorry if I was not clear in what I wrote.
Let's move forward to choice in how to spend our money. You seem to be saying that taxes are a form of coercion. In a representative democracy like the U.S., people express their consent through Congress, which would be the entity to enact universal health care. Most people would say that if the voters elected enough people to Congress that Congress could pass universal health care, it would be clear that the voters did in fact want universal health care and were willing to spend their money on providing it.
If you still do not consider it to be legitimate even in that circumstance, then apparently you do not consider our government to be a legitimate representation of the people's will? Or have I misunderstood something?
If you're an anarchist and believe that all governments are illegitimate unless each and every person has consented to their each and every action (which of course is impossible, making all governments illegitimate, hence the anarchism), please do say so.
Subject: Re: Imagine the America you want to live in #6
You seem to be saying that taxes are a form of coercion.
I did? I wasn't really addressing taxes at all, unless you consider my brief mention that taxation is one of the ways government pays for things. You're pretty close to what I would have said, though--I'd have said "taxation is theft." But t wasn't particularly relevant to the subject so far, so I didn't. :-)
In a representative democracy like the U.S., people express their consent through Congress...
That's not quite how the philosophy behind our government works. The government "derives its just powers from the consent of the governed." The people may at any time withdraw their consent and "alter or abolish" the government. They don't express their consent through any particular branch of government--rather, they delegate some of their power to the government and allow it to exercise that power on their behalf as long as the government doesn't overstep its bounds.
Most people would say that if the voters elected enough people to Congress that Congress could pass universal health care, it would be clear that the voters did in fact want universal health care and were willing to spend their money on providing it.
If that were true than there would be more than enough money given to charities for those who need it, so I'm guessing you're not one of the people who would say that.
However, looking at it more generally, that is not how the US government works now. Sure, sometimes Congress passes things now that have the support of the people. However, most of the stuff that they pass the people have no idea about until it's too late. And it's a popular trick for Congressman to hide things that the public objected loud and vigorously to inside massive bills that nobody reads, in the hope that something that couldn't pass on its own will slip by under the radar.
What's more, that's not how the US government is supposed to work. In our system, the people delegate certain specific powers to each branch of the government--in the case of Congress, those powers are enumerated in Article I, Section 8. Congress may not legally do anything that the Constitution does not give them the power to do, so it wouldn't make any difference if most voters wanted it. That's the idea behind the Constitution--to protect the minority from the tyranny of the majority. (Obviously all this has nothing whatsoever to do with the way things actually work in Congress.)
If you're an anarchist and believe that all governments are illegitimate...
I'd say I'm an "anarcho-capitalist," but that doesn't mean that all governments are illegitimate. For example kritarchy, such as Somali xeer or the fictional society of Heinlein's The Moon is a Harsh Mistress, is compatible with a philosophy which holds that it's wrong to initiate force.
For that matter I'd be willing to accept the US Constitution as a reasonable temporary compromise between my preference and what we have now.
Incidentally, this touches on two of my three reasons for opposing a socialized medicine system. First, it's immoral to take money from one person against his will and give it to another person. Second, it's illegal--the Federal government has no power at all regarding health care (note that a State government is a different matter). The third reason has nothing to do with my political beliefs or philosophy, but with my experience with HMOs. They're bad enough now, I certainly don't want to belong to the worlds largest and least accountable HMO, run by the people who brought us the DMV, public schools, and post office!
Subject: Re: Imagine the America you want to live in #6
Perhaps I was sloppy in what I wrote or trying to be too clever, in which case I must apologize again. I certainly did not intend my post to be taken as a complete philosophy of government.Congress, as the branch that makes laws, will be responsible for setting up any national health care system. That is why I focused on it and did not address the larger question of how our government is structured. The point I was trying to make (obviously poorly) is that in order for a national health care system to be passed, its supporters would necessarily have to form a majority of Congress. Theoretically at least, this means that supporters of the plan also form a majority of the population. And one of the basic ideas of our government is that the majority can make decisions for the whole and those who don't agree with the decision are nonetheless expected to abide by it. If you are saying that even in such a situation, it is wrong for people to be forced to do what they don't want to do, then you would seem to have a problem with one of the basic assumptions of America's governmental system. That's why I wandered off into talking about anarchism (or anarco-capitalism, if you prefer).
Also, the reason I mentioned taxes is that a national health care program by definition is funded by taxes. I assumed that it was the coercive nature of taxation that you didn't like, since you have been arguing that people should only pay for what they want to have and not pay for what they don't want. Taxation takes that choice away from them.
I want to stress again that I am not touting national health care as some kind of ideal. I have dealt with my share of bureaucracies and I have no love for them (although I have to admit that my experiences dealing with some very large corporations is not much better). I have said repeatedly that I think it is the least bad solution. It has drawbacks, definitely, but to me they are fewer and less severe than the drawbacks of other systems. I would certainly be willing to wait if it meant that I had health coverage. Getting it late is better than not getting it at all. We can easily get caught up in arguments about what is better and what is worse for people who already have health care. But for me the main point is to get health care for people who don't currently have it. As I said, getting it late is better than not getting it at all.
I'm now going to stray off topic again, because I hope that it will explain better where I'm coming from in talking about these issues.
You mentioned that taxation was a form of theft. If somebody stole your property, would you consider it theft for you to take it back? Or does the thief have no legitimate right to the property because he took it by force and therefore the use of force in taking it back is permitted? Usually, we do consider it wrong for the victim to take it back directly, but we permit him to use the police and the courts to get it back and for these entities to use coercion in doing so.
What I'm trying to get at here is that property rights have a moral basis. In terms of wealth, we have a right to our money because we earned it. If we took the wealth by force or fraud, we do not have a right to it and it can justly be taken from us and restored to its rightful owner.
I don't know how familiar you are with geolibertarians or Georgists. They believe that since no one worked to produce the land, the land cannot be rightfully owned by any individual person. To do so would be to take it away from others who have just as much right to it. The geolibertarians/Georgists believe that if a person does want to have exclusive control over a piece of land, they must compensate those whom they are taking it away from. The money would be collected by the government and distributed to the rest of society as a dividend or it could be spent by the government on things that society had agreed that it should be spent on. In the latter case, this is basically a form of taxation.
So geolibertarians agree with you that taxation on wealth earned by labor is a form of theft, but they allow taxation on wealth in the form of land. Basically, they feel that because ownership of land is not fully legitimate, taking some of it away in the form of taxation is legitimate.
I would take it a step further than that. Money that we earn is the result of our labor, but it is also a result of other factors beyond our control. I could work for many years on some project, only to have it wiped out by a natural disaster or other ill luck. Or I could stumble by chance upon something and need to put very little work into it at all. If it were completely under my control, everything that I was willing to work hard for would always come to pass. It doesn't. That's how life is. A religious person (as I am) believes that these things happen by the will of God and that our wealth is a gift from God. If He did not choose for us to have it, events would occur so that we did not have it (as in the natural disaster scenario).
In any case, under this argument, even wealth from labor is not fully and completely ours. There is always a degree to which it is unearned. And that is a degree to which it can be justly be taken without being theft. As a religious person, I bring God into the discussion, but this is not necessary, anymore than it's necessary in discussing land taxes (as a religious person, I believe that the land was produced by God and as such He would be the rightful owner).
We can make a purely secular argument like the geolibertarian argument about land. In regard to earnings, we are not taking away anybody else's right to anything so we would not necessarily have to give the money to those people. But overall, the same argument does apply. Wealth can be legitimately taken from what is earned by labor and spent on such things as society would like to spend it on just as it can legitimately be taken from what is in the form of land and spent on such things as society would like to spend it on.
I don't expect you to agree with me about this; you have given me a moral argument and I want to explain the moral basis for my own views. It's an attempt to explain rather than persuade.
I've already gone on long enough (yes, I tend to be long-winded at times) but I wanted to address one more point that you made. You said that if a majority of people really wanted to spend money on health care for the poor, they would already be doing so.
As any Econ 101 textbook will tell you, it's not that simple. There are a lot of things that people would like to do and are even willing to spend their money to see done, but that don't get done. Most often, they don't see how their own individual contribution would bring about any change. My econ text refers to these as transactional costs, the costs of arranging an agreement or contract or exchange of goods or money. If the transactional costs appear to be greater than the anticipated beneft to the individual, that person will not take action, even though they would be willing to.
You may be right, but it doesn't necessarily follow from what you said.
I haven't addressed all of your points, but I think that this comment is already too long as it is. Thanks to everybody who had the patience to read through the whole thing.
Subject: Re: Imagine the America you want to live in #6
And one of the basic ideas of our government is that the majority can make decisions for the whole and those who don't agree with the decision are nonetheless expected to abide by it. If you are saying that even in such a situation, it is wrong for people to be forced to do what they don't want to do, then you would seem to have a problem with one of the basic assumptions of America's governmental system.
The point I was trying to make is that under America's governmental system, there are very narrow limits on what the government is allowed to do. Specifically, Congress may not legitimately pass any law at all having anything to do with health care, because the Constitution does not give it any power to do so. You don't have to take my word for it, either. If you want to learn about how our system of government works, I recommend the US Constitution and the Federalist papers. Both links are to government-run websites.
For that matter, are you sure you really believe the government works the way you suggest? Suppose Congress passed a law requiring that all Muslims in America report to concentration camps (it wouldn't be the first time something like that happened). Might you not consider that to be wrong?
As I said, getting it late is better than not getting it at all.
I've been trying to suggest that getting it too late is the same as not getting it at all. Also, under a government operated health-care system there are some things which you wouldn't get at all, late or otherwise.
If somebody stole your property, would you consider it theft for you to take it back?
Of course not. It might be hard to manage without committing some other crime in the process (assault with a deadly weapon, for instance). In fact this is not a theoretical question for me. Someone did steal a laptop from a friend's car a few years ago. The cops did recover it from the thief, and then stole it themselves (that is, assuming they weren't the ones who stole it from the car)--they sold it in a police auction instead of returning it to me. The guy who bought it from the cops figured out that it belonged to me, and offered to return it.
In this case the insurance had already replaced it, so I just recovered what I could from the hard drive. If I had taken it back, the innocent purchaser would have been out his money. That's the way our legal system works--we have this concept of "stolen property." A person who receives stolen property does not gain ownership of it, even if he has no idea of its status. Of course, the original owner can voluntarily surrender ownership, as in my example, but that's an unusual case.
Usually, we do consider it wrong for the victim to take it back directly, but we permit him to use the police and the courts to get it back and for these entities to use coercion in doing so.
Speak for yourself. :-) In fact, it's not wrong at all for the victim to recover his property directly. However, the victim may not break any laws in doing so. Note that it many states it's legal to use deadly force to apprehend a fleeing violent felon, in which case recovering the property might be an incidental benefit. For example, if I were walking down the street with my laptop when someone hit me from behind and grabbed it, I could legally shoot him in the back as he ran away--not to recover my laptop, but to apprehend someone who just committed a violent felony.
I don't know how familiar you are with geolibertarians or Georgists.
I've heard of them before, although not often. You might be interested to know that Murray Rothbard arrived at the same logical conclusion as you did in For a New Liberty.
A religious person (as I am) believes that these things happen by the will of God and that our wealth is a gift from God.
Doesn't your religion already account for this principle with zakat?
Subject: Re: Imagine the America you want to live in #6
I was the one who alluded to people seeking unnecessary treatment...I'd like to add to that as well because it's a major issue here. There's recently been a major overhaul of the prescription drug allotments, so that many of the prescription drugs that used to be covered by the national system are no longer covered. In one fell swoop they knocked out several commonly used drugs. The only coverage left for them is if you have complimentary private insurance (which we do), but then that made the complimentary insurance fees go up and I'm sure that pushed some people out of the market.Note as a point of interest, that there is a need for people to have complimentary insurance in many cases...there are things that the national system refuses to cover and they are not as unnecessary as you may think.
Anyway there's a situation here that may have given rise to this sweeping meds coverage reduction, which comes back to the excessive treatment point. When people seek excessive treatment, meds are part of it. Products as simple as acetominaphen, aspirin and vitamins, up to more expensive ones, could be hoarded cost-free by getting the doc to prescribe it. Why pay 3€ for a pack of pain reliever when you can convince the doc that you have chronic headaches and get a running prescription for it to be supplied free? Seems petty but people are cheap-minded here, the standard of living is lower here (France) than in the US.
So the government has been bleeding out through the pharmacies. Now they got strict with the prescription rules, not because the meds they distribute are so expensive, but because reducing the coverage ups the price and people won't be casually receiving their pick of meds anymore. Note that this puts some necessary meds, for which there is no "generic subsitute", out of reach for many...and to replace them, patients get a cheaper and ineffective covered medication that provides nothing but side effects, and the government spending meter ticks on uselessly. Then of course, since your meds aren't working, fancy that, you have to keep coming back to the doctor...tick, tick. This is a serious issue, I've experienced it firsthand.
Another thing...taxes are sky-high here, to pay for all the social services. So with a national system, you won't be paying for health care, but you won' t see half (give or take) your supposed income either. And if you have no income, the above described forces can often come into play and start costing you money you don't have.
Interestingly enough...agencies here had to start a charity group, operating in many of the pharmacies, for people to drop off extra unused meds that they received by prescription but never had the occasion to use! The stuff gets shipped off to Algeria so that they can remain dependent on French help for something (if you can't colonise them officially, do it culturally and medically...)
I'm not arguing against a national system in the US, in fact I'd like there to be one (and I'd like to someday come back to it!). But since I'm here experiencing these things I wanted to toss in my two centimes...
From the French desk,
Zafira
Subject: Re: Imagine the America you want to live in #6
Regarding healthcare, there are two developments in the near future which could drastically change health coverage. One is the aging of the population along with the political power of the elderly. As the senior population votes at a higher proportion than the younger one and as they increase in population, they will exert more pressure for better medical care for the elderly. That combined with the biological fact that we are close to the limits of the human body in terms of age already means that old people will require years of healthcare for a reasonable quality of life.The other issue is genetic testing etc. This would mean that we can predict reasonably well the probability of specific diseases. It might not be completely accurate but if I know that I am a very healthy guy with no chance of heart disease for example, then why should I get coverage for it? If enough healthier people opt out of the system, the insurance premiums for others skyrocket. It is possible for the system to fail in such circumstances.
Subject: Re: Imagine the America you want to live in #6
Well, for starters, I'd actually have health care. Which would be a first for me, at least since I turned 18 way back in 1997.And yes, I've worked full time pretty much since I turned 18. Problem is, I didn't finish college, so I really couldn't get a great job. See, I wasn't sure what I wanted to do, and it's not cheap to go to school...and I didn't think I could afford to go and not know what I wanted to do (turned out I was right). And it's hard to get health insurance working in retail or in food service. And there's no way that I could afford a private plan.
My employer would like to provide us with health insurance, but that just isn't possible because of expenses.
I firmly believe that it is both morally right and socially right that a community should provide for every member, no matter status, wealth, etc. The right to life is noted in the Declaration of Independence, and it is considered one of the basic rights all humanity shares.
It is hard to have anything one would consider a life if one is unable to be healed of injuries and illnesses.
Also, it should be noted that hospital and insurance costs would go down if universal care were made available. Currently, the uninsured use emergency rooms for any ailments determined bad enough to require a doctor. They occasionally don't pay, at least not all of it. They just can't afford to. Even when they can, most of the time they're there for things that could be done far cheaper with a primary care physician.
This cost is defrayed onto the insured patients. So you pay more. And because your costs are higher, your insurance costs are higher.
On top of that, with the larger customer base, individual costs go down because the risk is shared over a larger pool.
Basically, it breaks down like this. Right now, the average company is paying 8+% in health insurance costs, and as many as 40 million people are regularly without health insurance (or about 1 in 6). With a nationalized health plan, costs would, in fact, go down. The expected rate for a universal plan would be about 7.5%.
Subject: Re: Imagine the America you want to live in #6
I desire to live in a country that fulfills the moral priniciples of my Christian faith. The government should inspire moral clarity, preventing non-needed abortions, etc..I would like to see people should donate more to their religious or other social programs to help those in need. Government should have no role in social programs, it should be society at large that fulfills this moral obligation to help others.