The Healthcare debate

[Koss]

[FONT=Verdana,Arial,Helvetica][SIZE=+1]Thomas Jefferson to James Madison[/SIZE][/FONT]
[FONT=Verdana,Arial,Helvetica][SIZE=-1]15 Mar. 1789[/SIZE][/FONT]

[FONT=Verdana,Arial,Helvetica][SIZE=-1]Papers 14:659--61 [/SIZE][/FONT] Your thoughts on the subject of the

Declaration of rights in the letter of Oct. 17. I have weighed with great

satisfaction. Some of them had not occurred to me before, but were

acknowledged just in the moment they were presented to my mind. In the

arguments in favor of a declaration of rights, you omit one which has great

weight with me, the legal check which it puts into the hands of the judiciary.

This is a body, which if rendered independent, and kept strictly to their own

department merits great confidence for their learning and integrity. In fact

what degree of confidence would be too much for a body composed of such

men as Wythe, Blair, and Pendleton? On characters like these the "civium

ardor prava jubentium" would make no impression. I am happy to find that

on the whole you are a friend to this amendment. The Declaration of rights is

like all other human blessings alloyed with some inconveniences, and not

accomplishing fully it's object. But the good in this instance vastly

overweighs the evil. I cannot refrain from making short answers to the

objections which your letter states to have been raised. 1. That the rights in

question are reserved by the manner in which the federal powers are

granted. Answer. A constitutive act may certainly be so formed as to need no

declaration of rights. The act itself has the force of a declaration as far as it

goes: and if it goes to all material points nothing more is wanting. In the

draught of a constitution which I had once a thought of proposing in Virginia,

and printed afterwards, I endeavored to reach all the great objects of public

liberty, and did not mean to add a declaration of rights. Probably the object

was imperfectly executed: but the deficiencies would have been supplied by

others in the course of discussion. But in a constitutive act which leaves

some precious articles unnoticed, and raises implications against others, a

declaration of rights becomes necessary by way of supplement. This is the

case of our new federal constitution. This instrument forms us into one state

as to certain objects, and gives us a legislative and executive body for these

objects. It should therefore guard us against their abuses of power within

the feild submitted to them. 2. A positive declaration of some essential

rights could not be obtained in the requisite latitude. Answer. Half a loaf is

better than no bread. If we cannot secure all our rights, let us secure what

we can. 3. The limited powers of the federal government and jealousy of the

subordinate governments afford a security which exists in no other instance.

Answer. The first member of this seems resolvable into the 1st. objection

before stated. The jealousy of the subordinate governments is a precious

reliance. But observe that those governments are only agents. They must

have principles furnished them whereon to found their opposition. The

declaration of rights will be the text whereby they will try all the acts of the

federal government. In this view it is necessary to the federal government

also: as by the same text they may try the opposition of the subordinate

governments. 4. Experience proves the inefficacy of a bill of rights. True. But

tho it is not absolutely efficacious under all circumstances, it is of great

potency always, and rarely inefficacious. A brace the more will often keep up

the building which would have fallen with that brace the less. There is a

remarkeable difference between the characters of the Inconveniencies which

attend a Declaration of rights, and those which attend the want of it. The

inconveniences of the Declaration are that it may cramp government in it's

useful exertions . But the evil of this is shortlived, moderate, and reparable.

The inconveniencies of the want of a Declaration are permanent, afflicting

and irreparable: they are in constant progression from bad to worse. The

executive in our governments is not the sole, it is scarcely the principal

object of my jealousy. The tyranny of the legislatures is the most formidable

dread at present, and will be for long years. That of the executive will come

in it's turn, but it will be at a remote period. I know there are some among

us who would now establish a monarchy. But they are inconsiderable in

number and weight of character. The rising race are all republicans. We were

educated in royalism: no wonder if some of us retain that idolatry still. Our

young people are educated in republicanism. An apostacy from that to

royalism is unprecedented and impossible. I am much pleased with the

prospect that a declaration of rights will be added: and hope it will be done in

that way which will not endanger the whole frame of the government, or any

essential part of it.










Koss:
Could we not start to pave the way for health care of all citizens of the shining beacon of hope that is the United States of America? Have we lost our way? Have we traded some humane quality for that of profit margins and productivity? Does the squeaky wheel get the oil?

Or can we find it within our hearts for those of us who live within our borders... born free, or put in the effort to follow the rules to live free within Liberties Grasp and become citizens of such a Country and Ideal; to set aside our differences and put forth the effort to pave the way for humane care of the sick and needy for all. Those of us, who can be proud that we are so successful as to feel the warmth of charity to help those who are below our social standing, and also those of us who are reaching out our hands in need, struggling to find the next breath of life; but continue to work to support our families, goals, and dreams in life. Life that brings warmth to every crevice of our nation. (EDIT) From the bottom up.


Sorry for the long post, and thank you for reading if you managed to set aside enough time from your lives to read one of the greatest minds that shaped and molded the country that is the United States of America. And inspired, influenced, or befriended those which we have both learned and mentored the ideals of humanity; (EDIT) ideals borne within our own country and the ones from abroad. May the world one day find peace and happiness when there is still happiness to be had.

From the heart,
-Adel
(I may have been laid off twice, and see my career in the automotive industry sink into shark infested waters... but I shall never give up hope for the human race. I have returned to finish my bachelors degree, my third degree so far in my 26 years on this earth. And I am thankful for the oppuntunity... even given the circumstances of brining me here.)

 

[tsmba]

It always seems that when the discussion turns to "fundamental rights" or "the way things ought to be" that those phrases are code for ideas that aren't in the Constitution. That opens the door for politicians to try to convert their beliefs and values into law. Thankfully, the Framers knew of this tendency and created mechanisms for handling those actions. Once the door was opened to Congress posing as a charitable organization, trouble began. I like the little saying that supports this:

"When you dip into your own pocket to help a brother, you are doing good works. When you dip into someone else's pocket for the same reason, you are stealing."

 

[arcman]

I honestly don't see the point in arguing whether or not you can point out constitutional support for unversal health care. It isn't as if it's out of line with the things we have in place already. We believe we have a fundamental right to education, to legal representation, to quick-responding emergency services at the dial of 911. If these services were denied it would cause scandals, so why should it be different when talking about ensuring access to health care?

Let's also not forget that assuming people do not have a basic human right to health care carries with it morbid consequences. We average 20 thousand people a year die because they don't have any access to medical treatment. If one insists that health insurance coverage is a privilege and the under privileged must do without, the thought followed to its logical conclusion is that a growing portion of the population do not have the right to live. Remember that the costs of health insurance are rising exponentially, far higher than wage growth, and far out of line with the cost inflation of the rest of the economy--more than double in most cases. The system as it is, is unsustainable. Without reform, it is literally a matter of years before the entire middle class will be unable to afford health insurance. Before long the question will not be "Do you believe you have a right to health care?", it will be "Should only the rich have access to health care?"

If you prefer charities to governments that's fine, charities can do wonderful things to those that find themselves in dire straits, they can provide food, clothing, and shelter to those in need. What charities cannot do however is save your life if your appendix bursts. If you don't want to die in this case you need a doctor, you will eventually need to pay said doctor, and as good as charities are, none of them are great enough to take on the cost of the uninsured. Universal care systems do this not only under the premise that people have the right not to die and not to be perpetually sick, but as previously mentioned, it is in the best financial interest of the entire network of health care providers to ensure everyone has access to basic preventative care. The costs of basic preventative care trump the costs of emergency care every time, and you can't opt out of paying one without paying for the other.

 

[arcman]

Moved reply to the appropriate thread:

At the risk of going off topic, it is a bit humorous you became a customer out of that article seeing as how the Whole Foods stores themselves had to do some massive damage control distancing themselves from Mackey's statements since he'd basically flipped the bird to his entire customer base.

I frankly don't have time to list all of the things that are factually incorrect with that op-ed, except to say that the man has no earthly clue how health care actually works in the developed world.
(Hint: everyone else spends less money than we do, they're healthier than we are, and happier with their providers than we are.)

So I can presume you provide health care for MORE than 52000 people? People who seem to be quite satisfied?

Also, Mackey isn't saying our current situation is ideal. Thats why he lists about eight ways to fix it. This includes several that address costs.

No one one is saying his customer base has any common sense either. His health plans are designed to work (and apparently do work to the satisfaction of everyone involved), not to impress soocialsits. (deliberate misspelling to fool the anti-spam system)

It's commendable for a retail-level employer to provide health care benefits--especially given in this country that's really the only way to get coverage that's anywhere near worth paying for. I'm not fond of the Wal-Mart corporation for spearheading our tremendous trade deficit with China, but I credit them for offering their hourly workers with medical coverage.

That doesn't mean either company is above reproach however, and many of Mackey's proposed solutions would be of little benefit in terms of cost-saving and ensuring access to care.

Mackey calls the heatlh care reform a "massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system." This, despite the fact that the bill is 100% deficit neutral and will actually decrease the deficit by over $100 billion in its first decade. Trotting out the government takeover of health care is a flat out lie. The only proposed government involvement beyond what is currently offered is the public option which may or may not make it in the final senate bill, and it accounts for a minute portion of the insurance market. People who have insurance already through their employers, which accounts for the overwhelming majority, would not be permitted to even participate in the new insurance exchanges, in which the public option resides. And the public option is only one insurer of many private insurers within the exchanges available to individuals and small businesses, the only conceivable way the public option will even survive is if the consumer chooses it and prefers it to private insurance plans. Calling that a "government takeover" is a misrepresentation at best.

Opening state lines for insurers to compete is a red herring. Doing this means the insurance companies will do exactly what the credit card companies have done, move their business to states with the least amount of regulation so they can make the cheapest plans that provide little to no protection when their members develop any sort of severe illness. Moreover, there is absolutely nothing preventing insurers from operating in whatever state they would like.

Tort reform is likewise a red herring. Malpractice suits account for <1% of healthcare spending. The Congressional Budget Office has already determined tort reform would result in a paltry 0.5 percent savings in spending. Plus there are lots of studies to show that tort reform has done nothing significant in terms of health insurance savings.

And as far as his rantings on the right of health care, see my previous post. From a purely pragmatic, financial standpoint, ensuring equal access to health care, including affordable premiums and subsidies for the underclass, are the only ways to keep medical costs from spiraling out of control. They ensure fairness in ways that we already agree with, that people shouldn't be permitted to die just because they find themselves unable to pay a medical bill, or lose their job.

This is how every other country in the developed world works. No one else runs on a pure market health care system with insurance plans containing massive deductibles which may or may not cover you when you develop an expensive illness. No other developed country in the world allows 20k people to die directly because they cannot afford health insurance.

Not all of Mackey's ideas are bad ones, although it won't result in any significant savings, tort reform isn't a bad thing, and to be sure there are reforms to be made in medicare. But to argue against the reforms as they are currently proposed with accusations of social-ism, rationing, and death panels is to argue on the wrong side of history. The exact same arguments were made by the right in the past when social security and medicare were proposed. Nearly word for word, medicare was decried as a social-ist government takeover of health care, that it would result in the downfall of our capitalist economy. Decades later, medicare remains as one of the most popular government programs in existence, one even the most die hard republican representatives will defend.

The current reforms are no different, and those that argue against them will find themselves once again on the wrong side of history. Afraid of rationing? Guess what, your insurers already ration your health care. Which of your medical bills will be paid for is decided by your for-profit insurers--by a board you didn't vote for, who have financial motivation to deny a claim as often as legally (or illegally!) possible. Death panels? How about the scores of cancer patients who have run out on their private insurance annual life cap, or those whose policies were rescinded altogether because they committed "fraud" by not reporting a case of acne?

 

[Bertilak]

<lots of stuff>

All I can say is I think he is more qualified to discuss this than you are and I hope you are wrong about the "side of history" remark because it would be a shame to have our country slip any further into so......m.

 

[bonusmarple]

A market solution to health care is not feasible. In the end it is a matter of choice. The majority of individuals do not choose which disease will afflict them and when. When that disease strikes, the options are usually limited, get treatment or die. Even death is usually managed by health care providers so that option can be expensive. As far as routine medical procedures like pregnancy, delivery, and physicals, these items save more money than they cost. A botched pregnancy or delivery creates another person who is handicapped and will require more care throughout their lives. Physicals are an opportunity to catch most issues before they require expensive treatment. Lastly, consumers can't "shop around" for treatment. Effective bargaining requires people to not be emotionally vested in the outcome. Clearly this is laughable for serious issues.

In the end, choice is very limited due to the nature of why people need medical treatment, the inability to bargain or rationally refuse treatment, and the inability to bargain for a better price. Health care providers literally hold the power of life and death so the price is essentially non-negotiable.

Choice is at the heart of a free-market solution and since choice is limited, the ability for the market to solve the problem is equally limited. The free market can only effect price to the degree that consumers can exercise choice.

So, since free market does not work, the only other solution we have is public policy. Time will tell if the citizens of the US will allow a greater role for public policy in health care and what that role will look like.

What do we do? Simply throwing funds at the system will not fix anything in the long term. Trying to control prices or enforce limits will only reduce quality. In the end, the government will need to subsidize insurance and reduce the costs to practice medicine. The most obvious method to reduce costs will be to subsidize or cover malpractice insurance, subsidize education expenses for medical personnel, and to enlarge the pool of insured citizens to better cover costs. Fraud and consumer protections will also reduce costs by effectively eliminating waste.

 

[Bertilak]

A market solution to health care is not feasible. In the end it is a matter of choice.

That should be nominated for the biggest non sequitur of the day.

"Choice" and "Market" are pretty much synonymous.

 

[arcman]

You might want another try on that if you're trying to disagree with him; You just proved his point.

 

[tsmba]

I'd like to see the proponents of the "health care reform" farce can actually work. The notion of extending coverage to every American sounds good in theory, but expecting a 2000pg bill created by politicians to accomplish this is ludicrous. Several states have tried this, they're broke. The legislature has interfered with health insurance for years, all in an effort to make coverage "more affordable and accessible" and their efforts have made things worse. Every one of the existing programs was supposed to be a "solution" and they are all so mired in unfunded liabilities they are driving the country towards financial ruin.

Yet, here we are again, faced with rogue politicians claiming to have "answers". Now, they are making pathetic comments about their "concern" for the deficit. They would have us believe that we can somehow spend and legislate our way out of the mess they have created. "Solutions" do not come from the government!

 

[riooso]

I am a bit anxious. I live in California and we are broke! BROKE! I really can't wait for all the packages on the Federal Level to pass and the federal government goes broke also! It is only through pain and misery that the American people will do something about the amount of money that the politicians spend. I will probably lose everything that I have work for in 40 years but I will go through that and more to make sure that my children and my grandchildren are not put into a life of slavery that will come if this attitude of the politicians and the people continue. The cost of this one health care package of $1.6 TRILLION, projected mind you and that is seldom 1/5 the real cost, will be added to the cost of bailing out Medicare and the Social Security systems which is around the corner.

Say it can't happen? The dollar is falling daily and has lost 25% of it's value since the beginning of the year when you look at the standard, GOLD. We will make up the difference through inflation which is nothing more than the government stealing our paychecks by printing money they can not back. My mother came from Brazil which is a county that is used to 1000% a year inflation that went on for decades. I hope that we don't get there but I am not hopeful. Dark days are ahead if we do not pull it together, but then we are at the mercy of people that have lost their way and don't know the value of what we once had!

Richard

 

[sandmountainslim]

I think the real debate for Americans is how long we will sit idol while the Federal Government tramples the US Constitution. It's been going on for a long time.

Amen to that!
I remain a Jeffersonian to the end.
Wp

 

[Protocol]

I'm not entirely comfortable with a political discussion on B&B myself, but just wanted to say that, as a lifelong registered Republican, I am disturbed that the opposition to a healthcare overhaul has become so vitriolic. It is absolutely the case that our system needs fundamental change. It is clear as day that futzing around on the margins (changing health insurance, eliminating exclusions, mandating universal coverage, tort reform, et al) isn't going to do it. And it is vital to our competitiveness as a nation that we solve these issues quickly and with a shared spirit of sacrifice and collective interest. It won't be solved by misinformation of "death panels" or "greedy insurance companies".

Here is my rather draconian solution:

1) eliminate fee-for-service. Though I am sure that some doctors and health care providers are capable of providing quality care without sticking it to the patient or insurance company, the ffs system invites abuse. Too much overtreatment, unnecessary procedures, and straight up crazy crap happens because there is too much money in it.

2) institute evidence based medicine. Folks will scream about the latest experimental technique being absolutely necessary to save someone's life, but the lot of us shouldn't have to pay a nickel for snake oil. If it isn't statistically proven to be safe and effective, NO PAYMENT.

3) baseline insurance. Individual states or providers will scream that "everyone is a unique snowflake", but the fact of the matter is that policies need to be understandable for the consumer. Otherwise there IS NO MARKET.

4) real licensing reform. Medical boards should not be run by current doctors. This has led to a sort of labcoat wall that protects bad doctors from real consequences. If you screw up too much, you should not be able to just skip to another state and practice. This would do wonders to reduce malpractice suits.

5) eliminate state monopoly exemptions. Open competition for insurance companies across jurisdictions. Currently 85% of the market share for insurance in East Tennessee is BC/BS. That has to end. But first there has to be a federal regulation of the insurance industry rather than having it regulated at the state level. Otherwise, we'll end up with the same crap we have with credit card companies (where they all set up shop in Delaware so they can screw the consumer).

If we do all of this, we won't need the coveted "public option".

 

[Bertilak]

I'm not entirely comfortable with a political discussion on B&B myself, but just wanted to say that, as a lifelong registered Republican, I am disturbed that the opposition to a healthcare overhaul has become so vitriolic.

I think most of the "vitriol" has been against the general drift (socialized medicine) of the so-called solution now slithering its way through congress. (That was fun!)

I believe nearly everyone believes something needs to be done -- an overhaul if you wish. It's just that further socializing the health-care industry is moving in exactly the wrong direction. Democrats are selling the health of the country down the river to gain another built-in voting block -- the give-me-something-for-nothing-and-make-someone-else-pay-for-it crowd.

I don't agree with all the points you made but they are reasonable discussion points and *could* help move us towards a real solution. At the risk of being redundant, I think John Mackey of Whole Foods has made the best high-level summary of workable and effective reforms. I posted a link in another thread so will repeat it here: http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html.

 

[TimmyBoston]

This thread has managed to stay open longer than it should have. Please don't make us regret that.

Thank you and Happy Thanksgiving.

 

[Austin]

Gents, I think we have plenty to be thankful on this blessed day. Let's give this thread a rest. Thank you.

 

[Protocol]

I think most of the "vitriol" has been against the general drift (socialized medicine) of the so-called solution now slithering its way through congress. (That was fun!)

I believe nearly everyone believes something needs to be done -- an overhaul if you wish. It's just that further socializing the health-care industry is moving in exactly the wrong direction. Democrats are selling the health of the country down the river to gain another built-in voting block -- the give-me-something-for-nothing-and-make-someone-else-pay-for-it crowd.

I don't agree with all the points you made but they are reasonable discussion points and *could* help move us towards a real solution. At the risk of being redundant, I think John Mackey of Whole Foods has made the best high-level summary of workable and effective reforms. I posted a link in another thread so will repeat it here: http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html.

I don't think a federal takeover is necessary. There clear examples of countries that have successfully arrived at functional universal coverage without it (e.g.: Holland actually had a public option that was competed out of existence by private insurance carriers). That said, I think the tone of the objection to reform in general seems, at least to me, objection for objection's sake. And I have to agree with David Frum that if we (Republicans) stand only for opposition, that will be the only job the American people will hire us for. At some point, we have to propose solutions that actually add up.

 

[Bertilak]

I don't think a federal takeover is necessary. There clear examples of countries that have successfully arrived at functional universal coverage without it (e.g.: Holland actually had a public option that was competed out of existence by private insurance carriers). That said, I think the tone of the objection to reform in general seems, at least to me, objection for objection's sake. And I have to agree with David Frum that if we (Republicans) stand only for opposition, that will be the only job the American people will hire us for. At some point, we have to propose solutions that actually add up.

Agreed -- all but that "objection for objection's sake". There is a lot to object to.

 

[bonusmarple]

Agreed, lets give it a rest for Thanksgiving!

 

[ironbrewer]

I'm not entirely comfortable with a political discussion on B&B myself, but just wanted to say that, as a lifelong registered Republican, I am disturbed that the opposition to a healthcare overhaul has become so vitriolic. It is absolutely the case that our system needs fundamental change. It is clear as day that futzing around on the margins (changing health insurance, eliminating exclusions, mandating universal coverage, tort reform, et al) isn't going to do it. And it is vital to our competitiveness as a nation that we solve these issues quickly and with a shared spirit of sacrifice and collective interest. It won't be solved by misinformation of "death panels" or "greedy insurance companies".

Here is my rather draconian solution:

1) eliminate fee-for-service. Though I am sure that some doctors and health care providers are capable of providing quality care without sticking it to the patient or insurance company, the ffs system invites abuse. Too much overtreatment, unnecessary procedures, and straight up crazy crap happens because there is too much money in it.

2) institute evidence based medicine. Folks will scream about the latest experimental technique being absolutely necessary to save someone's life, but the lot of us shouldn't have to pay a nickel for snake oil. If it isn't statistically proven to be safe and effective, NO PAYMENT.

3) baseline insurance. Individual states or providers will scream that "everyone is a unique snowflake", but the fact of the matter is that policies need to be understandable for the consumer. Otherwise there IS NO MARKET.

4) real licensing reform. Medical boards should not be run by current doctors. This has led to a sort of labcoat wall that protects bad doctors from real consequences. If you screw up too much, you should not be able to just skip to another state and practice. This would do wonders to reduce malpractice suits.

5) eliminate state monopoly exemptions. Open competition for insurance companies across jurisdictions. Currently 85% of the market share for insurance in East Tennessee is BC/BS. That has to end. But first there has to be a federal regulation of the insurance industry rather than having it regulated at the state level. Otherwise, we'll end up with the same crap we have with credit card companies (where they all set up shop in Delaware so they can screw the consumer).

If we do all of this, we won't need the coveted "public option".

I'm also leary of getting into a public debate here on B&B.

I really liked this post though.

I think you left one thing out. We need major campaign finance reform before any real change will happen. Big corporations are not people and should not be able to pump millions into campaigns. They don't get free speech. Individuals do. All people who get the required signatures to run for office should get the same air coverage and money to run. The lobbiests need to be cut off at the knees.