Hawaii learns what happens when you start giving out universal health care

O2C, you asked why insurance was the best system, and somewhere in the past five pages I said I wasn't sure whether it was or not. Maybe you missed that.

I got that part, which is why I gave you a choice as to which question I should ask again. Otherwise I would have turned it into a

The problem is that you implied that a free market, without insurance, would result in a Dickensian tragedy. After your first set of evidence backing that claim proved irrelevant, your second set of evidence rested on the assumption that a free market without insurance... would have insurance, which you've already said you can't substantiate. Surely you can see why I would be frustrated by that?

Can we start over? I'm not being facetious - I really don't know what we're talking about here.

Lay out one premise at a time for me and let me see what I can do with it. Please?

Oh, she sees, alright. She thinks that transparent little game validates her high opinion of herself.

Albert, go back to rowing your canoe with a rifle, mmkay? Some of us are trying to have a serious conversation.

Maybe, but you ain't one of them.

See, I KNOW McCain is going to do shit all should he be elected President, and I KNOW that most of the 'promises' he makes on the campaign trail are just empty rhetoric designed to get the stupid morons who don't know any better to vote for him.

Why? Because he's just another politician, who is going to go to Washington and fuck up the system even more.

Is Obama the same way? Well, first of all he's running on a platform of 'hope and change'.....so one would think that he IS different from all the rest of them. But, according to what you're telling me, he won't do jack all when he's elected President.

Am I surprised? No. Why? Because I knew Obama supporters would begin saying that about a month before the election.

Its the only way you can justify voting for him. Because if he's running a campaign based on 'changing' Washington, but you personally don't believe he'll be able to change a thing, why are you voting for him?

Not even close.

Is health insurance a logical and optimal outcome of the free market, absent any government interference?

(You have answered: "I don't know")

What are the alternatives? (I didn't actually ask this, but you answered it)

(You have answered: "Medicare-for-all or a Dickensian tragedy")

Why does a free market in health care, absent government intervention and an insurance system necessarily create a Dickensian tragedy?

(Your first answer was irrelevant as the goods were not available to anyone, rich or poor*, and your second answer was about the failures of the insurance system and thus not an answer at all. This is what I'm waiting on.)

*well, they were towards the end of the 19th century, but it wasn't until the 1910's that any hospitals and nearly any doctors started charging for services; prior to that, medicine was very nearly completely charity-run.

Full of fail.

You said yourself that Obama 'probably' wouldn't be able to pass his health care bill through Congress, despite having a Democratic majority.

Why are you voting for him if he won't be able to implement any of the 'promises' he made on the campaign trail?

I thought he was going to change Washington?

Would you say that before there was health insurance, there was a free market in healthcare? Or has there never been a free market in healthcare in the United States?

Because if you say, yes, prior to the existence of health insurance in the United States, there was a free market, then you have only to look at the demographics to see that people died younger, often of opportunistic infections, and often because there was not a doctor or hospital or clinic in their area.

Then you factor in how expensive modern healthcare has become, and realize how few people could afford, say, a standard course of chemotherapy, or lifelong dialysis, if they didn't have health insurance. And you realize that far more people would die.

You factor in preventive healthcare. Screenings for expensive things like diabetes and cardiovascular disease, which in the long run can prevent or at least postpone these illnesses.

And so on.

Now, if you say, no, healthcare has never existed in a free market in the United States, then you can hypothesize just about anything.

Except that I'd argue that health is not a *commodity* in the same way that, say, a car or a Playstation is a commodity. Which raises a whole bunch of other questions.

I hope that answers at least some of it.

Can you foretell the future? I can't. Your repeated insistence that I do so is boring. Please try something else.

BTW, guys, I need to go offline for a while, but I'll revisit this later.

*cue the usual...

Your statement falsely implies you have the *ability* to make it into that upper 2%....

Well for fuck sakes I would hope you're at least going to vote for Obama because you THINK he is going to change some things in Washington.

There may have been a free-ish market for about 5-20 years, depending on the state. Prior to that it was all charity, and after that the government started subsidizing insurance. But this was basically the infancy of medicine as an industry beyond leeches, splints, and amputation.

Or it could have something to do with the fact that penicillin hadn't been discovered and commercialized - it was only a year between when penicillin was first widely available and when the federal government started interfering; the states started interfering to raise the cost of medical care by licensure 10-15 years prior. And that was lobbied for by the AMA, incidentally, not patients, who certainly preferred the low prices.

There's your logical fallacy. The standard of health care has not become inherently more expensive. The prices have been artificially raised by the government by all manner of machinations; from licensure to requiring approval for experiment beyond the consent of the patient, from inflation to subsidization, from the FDA to the DHHS.

All the more likely to be prevalent if insurance is not.

The difference is, I can back up mine with logic. So far, you've yet to, except by abandoning the a priori assumptions that were supposed to be the engine for this train of thought.

It is. It really is. In the same way that food, water, and shelter are commodities. Your dislike of that fact does not change it's truth value. Of course, if you have evidence that's not simply an emotional appeal (which I can shoot down by pointing to the myriad of homeless shelters and food banks), I'll listen.

Some.

Pretty much. And it's hard to say whether or not many of the advances that have occurred since would have occurred as quickly, or at all, if no one saw any profit in them. You might have had a niche market catering to rich people and their illnesses, but not much else.

And you certainly can't say that charities would foot the bills nowadays.

The absence of antibiotics was what I meant about "opportunistic infection." Guess I should have been clearer.

Also, if you look at the history of the development of penicillin, it might have been brought to market a decade sooner if there *had* been government intervention - in the form of funding - in England when Fleming was first cultivating it. He had to abandon his work because he didn't have the financing to preserve or promote it, and no wealthy entrepreneurs were stepping forward to help.

So, lousy marketing resulted in how many deaths? We'll never know. I do know Fleming had completed his research by 1928, and one of my grandmothers died in 1932 from an infected cut on her hand.

If private investment ain't there, and government don't care, people die. So does your economic theory have an underlying ethic that places some value on a human life, or only on *some* human lives?

And I'd argue that, first of all, some medical devices and screenings *are* inherently expensive. The rest is artificially inflated prices because the drug and device companies know they can get away with it under the rubric of "recouping development costs."

When you overhear some pharma rep bragging to a room full of MDs how it costs them two cents to make a pill that they're charging the patient $10 for, because they want to make as much as they can before the patent runs out - at which point they'll rename it, repackage it, and apply for a new patent for a new indication - you're inclined to become a bit cynical about the lofty claims on their websites.

Start from the premise that the majority of humans are born with good health. Then it becomes theirs to keep or to lose, depending on myriad circumstances. What other innate attribute would you consider a commodity?

Health *care* is not a commodity, it's a service - a service that some people need more than others. The rubric within the industry is that 20% of the population utilizes 80% of the service. Is that applicable to any other service industry?

Ready for more if you've got it.

a bit off topic but...one thing we hear so very much about is the EEEVils of lobbyists.

If it's true that, by definition, to have a big powerful lobbyist is to be a villain, then why is it the folks who most rail against lobbyist for the pharmas or big tobacco or big oul have so little to say about the the powerful lobbyist for the NEA, or big labor unions, or AARP?

Conversely, if there is such a thing as "good lobbyist" then why does the expression "they have big powerful lobbyist" so often offered as conclusive proof of bad intent?

And when the GOP loses so many seats they can do nothing to stop any Democrat inititive? whose fault will it be when they don't make it all better?

Bush.

Yes, I think he can. That doesn't mean I'm absolutely positively certain he can.

What's "it"? And who said anyone could make it "all better"?

Can I have this conversation with you again in about 2 years?

Absolutely.

I haven't read the whole thread yet, but there is plenty of expectancy for a National Healthcare scheme....it seems sure enough that in May, when Zel's employer's contract expired and a new one was negotiated, they put a clause in there that states they reserve the right to dump the current Medical plan if "a national healthcare option becomes available."

While I believe many people who want healthcare for all have the best interest of poor people and kids in mind, they either overlook or ignore the fact that companies are not gonna pay for benefits the Government is handing out for free. They won't and they will dump thousands of people leaving them no option but to get on the National tit, overburden the system even more and make the notion even more unworkable than it is.

Seems cynical....but I've seen the clause in black and white and have little illusion that others are not doing the same.

^Under the McCain plan, you can bet Zel's employer will exercise that option.

Obama's plan would require employers other than small businesses who don't offer health care to pay a tax to cover the cost of subsidizing private purchases of individual plans by employees. You won't lose coverage under that plan unless Zel's employer is retarded. Obama's plan is not, in any event, anything resembling a nationalized insurance or health care plan, but rather is a plan to subsidize private purchases of insurance. The government simply doesn't provide insurance or health care under Obama's plan.

On the other hand, McCain would seek to eliminate the tax deduction for employer sponsored health care, which makes it a sure bet that Zel's employer would drop coverage at the first opportunity given how much more insurance would cost. Given your preexisting condition, you'd be unable to purchase replacement insurance. You'd basically have to impoverish yourself to qualify for Medicaid if you wanted insurance. Lucky for you, McCain's plan has zero chance of passing even if he wins.

Whatever makes you, the generic voter, unhappy.

All politicians.

Of course. And by the time you're old enough to vote, you figure out that nobody can accomplish everything. So you vote for the person who's the best fit with what you think is important, and hope for the best.

^^
Would that such were true.

But too many people fall for "it's all Bush's fault" (or Clinton's, depending on source) for that to be true.

The last sentence does not follow from the second one. The government did not create the profit opportunity.

But you can't say that without government interference they couldn't. I can say that they'd be able to help much more however, and be extremely confident in that statement.

You've got some historical problems there. See below. And it wouldn't have mattered: because of government interference, it wasn't until 1945 that it was released for civilian use, and initially only in Australia.

Fleming stopped his research in 1931, convinced that it bioavailability of penicillin was too low and for too short a time. That's got nothing to do with the government. He didn't restart his work until 1934. There was enough penicillin to cure a whole 2 patients by 1942. 10 by 1943. And it was Merck, not the government, who finally figured out a way to mass produce the stuff.

Again with the unproven assumptions...[/quote] and government don't care, people die. So does your economic theory have an underlying ethic that places some value on a human life, or only on *some* human lives?[/quote]If it saves people's lives, private investment will be there; if nothing else, you can't sell prescriptions to dead people. Ethics has nothing to do with illness; no aggression or fraud is committed when someone becomes ill. Therefore it is aggression to rob other people to pay for research and treatment. There is no justification for that except emotional appeal, which works just as well to get charity, but without the force against innocents.

How many people would have died or never been born in a Malthusian tragedy if it wasn't for the free market figuring out how to increase crop yields? Medicine is no more special than food; the both keep you alive, they both prevent disease (whatever vs. malnutrition, beri beri, scurvy, rickets, anemia etc.), and when the government gets involved, bad things happen. Did you know that prior to FDR's Agricultural Adjustment Act, there was no malnutrition in America? It's true. Not even during the westward expansion. Just after the passage of farm controls and subsidies was the first time it had ever been seen here. Capitalism saves lives, more than any other system ever has. Government destroys them. Imagine if your grandmother had cut her hand in 1945 instead of 1932. Penicillin was commercialized, but still only legal for the military. You would be singing a very different tune.

And your evidence their costs are not being propped up by the government is...?

Which would be a lot less plausible were it not for the FDA. And if people were not being overdiagnosed and overmedicated. Which they wouldn't be if they were paying for their own care. And if doctors were not essentially giving kickbacks to their friends in the pharmaceutical industry. Doctors are not oracles, despite the popular notion to the contrary. They possess no magic powers. They do, however, have a nice little monopoly going, which is why they can get away with the above, with barriers to entry erected by... the government!

Believe me, I am much, much more cynical than you can possibly imagine about everything to do with the medical industry; I've been on 5 of the 7 sides of it. And I should point out that the patent office is yet another government function. If we are to have a patent system, it is in need of some drastic reform. The only justification for allowing a 2nd patent for a different indication is... guess. That's right, because the FDA requires the same onerous testing for the new indication as for the first. I should also point out that without insurance, it would not be viable for the pharma companies to charge $10/pill.

I misread that to say "health care is not a commodity." No, health is a state of being. But you can't buy states of being with any amount of money so that part of the argument is pointless.

A meaningless distinction, economically, and yes it is.

I imagine the top 20% of wage earners in the population buy 80% of the HDTV's produced, but that's neither here nor there. Haircuts are probably similar, if you want services for whatever reason. There are plenty of other examples in goods, and I'm sure there are others in services as well.

But your point is well taken. Clearly we need to increase the supply of medical services. But that's not going to happen with the barriers to entry the government has erected.

One additional question for now:

The medical insurance system, as Pardot has told us, started as a few non-profit organizations. Later, the for-profit insurers came in and started screwing everyone over.

Why were the for-profit companies able to steal customers from the non-profits if rates and services were better with the non-profits?