Tea Party march on Washington / Single Payer healthcare

[Belthus]

As far as my understanding of the plan runs, it is the government actually getting involved in the free market by purchasing insurance on the free market and selling it to people.

Do you have a source? Your description does not fit my understanding of the public option.

I was looking through a couple of pages on the various different bills and I think that might have been deprecated. I'm not sure. I believe that in the America's Affordable Health Choices Act they talk about the Health Insurance Exchange, which doesn't quite do the same thing but in fact allows private firms to sell qualifying plans (those that don't restrict on pre-existing conditions, have coverage offered on a guaranteed issue and guaranteed renewal basis, and so on) alongside each other in order to promote transparency and reduce the effects of imperfect information.

America's Affordable Health Choices Act (http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf), p. 120:

In order to provide for
the establishment of the public health insurance
option there is hereby appropriated to the Sec-
retary, out of any funds in the Treasury not
otherwise appropriated, $2,000,000,000. In
order to provide for initial claims reserves be-
fore the collection of premiums, there is hereby
appropriated to the Secretary, out of any funds
in the Treasury not otherwise appropriated,
such sums as necessary to cover 90 days worth
of claims reserves based on projected enroll-
ment.

That quote and following sections make it clear that the public option would not just be an insurance broker matching people with private insurance companies. It would collect premiums and pay claims. It would establish a preferred health provider list, i.e., those doctors and hospitals that agree to accept the government's rates as full payment (see p. 127). And so on, for all the details of starting a new health insurance plan.

[Belthus]

That makes sense. That would all be run through the HIE alongside qualifying programs, right?

Yes, as far as I can tell.

By the way, it's useless to ask for quality debate from EH. He is repeating Michael Savage and a couple of other demagogues. He takes their utterances as received truth and won't take the time to cast a wider net. The only people who would take such propaganda seriously already believe it.

[Daxx]

I've long believed that debating someone on the internet is not about convincing them, at least not in the end. Most ideologues never change their ideas over the course of a single argument, because cognitive dissonance is extremely powerful. The best you can usually hope for is to convince and influence people who are reading along.

[Daxx]

As far as my understanding of the plan runs, it is the government actually getting involved in the free market by purchasing insurance on the free market and selling it to people.

Do you have a source? Your description does not fit my understanding of the public option.

I was looking through a couple of pages on the various different bills and I think that might have been deprecated. I'm not sure. I believe that in the America's Affordable Health Choices Act they talk about the Health Insurance Exchange, which doesn't quite do the same thing but in fact allows private firms to sell qualifying plans (those that don't restrict on pre-existing conditions, have coverage offered on a guaranteed issue and guaranteed renewal basis, and so on) alongside each other in order to promote transparency and reduce the effects of imperfect information.

Don't conflate the profiteering of Glenn Beck with a corruption of the motives of the march as a whole.

I don't know. My personal impression of the majority of people on those marches is that they don't actually understand what's going on. That's true in many political movements, but it's striking in this one because they are vocal in their ignorance. Whether your parents are amongst those, I wouldn't know or care to comment, but one person rarely represents a mob. The fact that the movement is promoted by and fed disinformation from entrenched interests completely removes any moral authority from "grassroots" claims.

In what sense is this deviating from a free-market solution?

In the sense that the government will fine your a$$ thousands of dollars for not purchasing the health care that they demand you have.  That may be a market, but it sure ain't free.

The requirement part is true, yes, and that isn't "free market" in the absolute definition of the word. Perhaps you are right, a better phrase to use would have been simply a "market solution". Of course, this is the point of the matter - if one is going to insist that government mandate in terms of provision is bad, then why complain when the bill is designed to use virtually the entire mechanism of the free market (with the quite reasonable exception of non-participation)?

Now, I can see STATE governments doing this.  State governments already do something similar by forcing drivers to have car insurance before allowing them to drive.  But allowing this to happen on a Federal level is utterly unconstitutional.

Here's the link to a relevant part of the HR 3200 bill:
http://en.wikisource.org/wiki/H.R._3200/Division_A/Title_II/Subtitle_A#Sec._208._Optional_Operation_of_State-Based_Health_Insurance_Exchanges.

But about half of bankruptcies in the US are caused by medical bills.

See the above article.  If health care expenses were treated like any other rational kind of expense -- paid for out of pocket, or with credit or savings for significant expenses, and with health 'insurance' only used for what every other kind of insurance -- extreme emergencies -- medical costs would drop to the reasonable levels that traditional supply-and-demand would force them to.  Only because of the occult nature of pricing and payment - created by the health insurance system - is health care noticably more expensive here than elsewhere.

That, and our national diet sucks, which makes us much, much more prone to heart attacks, cancer, diabetes, and a host of other diseases that no one will ever tell you are diet-related. 

Well, also, our doctors are taught and our medicines are made to treat symptoms rather than actualyl solving the underlying problems that cause them.  But that's just good business sense, from a strictly capitalist perspective.

But mostly it's the health insurance thing.

Oddly, I read that Atlantic article in the print copy some while ago (how quaint!). It has some interesting points to make. I disagree with the author's conclusions, however, because I think he is being far too dismissive of single payer systems which he admits perform better in other countries. Whether the idiosyncrasies of US politics combined with the intransigence of special interests and the mindless opposition would allow that to be effective in practice is a different debate.

[Daxx]

That quote and following sections make it clear that the public option would not just be an insurance broker matching people with private insurance companies. It would collect premiums and pay claims. It would establish a preferred health provider list, i.e., those doctors and hospitals that agree to accept the government's rates as full payment (see p. 127). And so on, for all the details of starting a new health insurance plan.

That makes sense. That would all be run through the HIE alongside qualifying programs, right?

[Daxx]

This is going to be a mess of a response. I'm going to try to group quotes as best I can, but the problem with this discussion is that at its heart it is entirely schizophrenic. It is not at all clear what the focus is, since you continually mix your arguments between partisan politics, the actual bill, and some hypothetical system you are afraid is going to be implemented (though these three are only barely interrelated). It would be far more helpful if the discussion could focus on one thread of argument at a time (or alternatively be split into different threads so the discussions won't overlap).

First- name calling does not contribute anything at all to this discussion. I fail to see how wanting the government to follow the limits specifically imposed by the Constitution is "partisan politics". That's a favorite tactic of the Democrat party- if you use facts and logic instead of soundbites and emotional appeal its "partisan politics".

Who's calling names? In fact, I'm trying very hard to make sure I'm not, because frankly this is frustrating. You aren't actually making any effort at all to engage with the debate in any meaningful way. Rather than ask when you are confused, you make assumptions. You try to snipe points off the Democrats and then say you're not engaging in partisan politics (even though I'm not even from the US, let alone a Democrat, so the points are pretty irrelevant). I could clarify individual instances where you are talking about the bill, where you are talking about a hypothetical system, and where you are talking about politics, but that's ridiculous. The point I'm trying to make is that you seem to me to be either deliberately obfuscating issues in an attempt to avoid being pinned down, or incapable of following a thread. I'm not calling names, I'm pointing out why this discussion is difficult to follow and where I perceive you to be engaging in sophistry. Do you understand what I mean? I apologise if you feel offended that I am being direct with you in my assessment, but it is because I am trying to be honest. If we can agree to not attempt to confuse the discussion with irrelevancies any further, then I think that will solve the problem.

Second- there is no "actual bill" at the moment- just a lot of hype.

There are two major alternative bills currently introduced in congress. They can be found here (http://en.wikipedia.org/wiki/America%27s_Affordable_Health_Choices_Act_of_2009) and here (http://en.wikipedia.org/wiki/H.R._676). Congress will probably at some point work on a merged bill. If you want to talk about the actual legislation that may be passed, you should be looking at them first, which is why I'm focusing on them.

the Democrats have lyed about what's in the bill, worked to scare people into supporting it and the whole thing was written by special interests and lobbiests. ... They are already saying they will not keep that promise with whatever healthcare bill they come up with. They have even suggested they will have entire sections that will be left blank until after the vote and then fill in with whatever they want to put in after it is approved.

Do you have any proof at all for any of these rather outlandish statements? I think it's safe to ignore them unless supported.

I'm going to split the economic discussion about stimulus spending off into another thread.

The high unemployment right now is a significant factor in the number of people who the government is calling "uninsured". How significant might be debatable- and depend on where you get your information from- but it is significant nonetheless.

This would be relevant if the statistics we were using covered the period where unemployment has risen. Statistics from 2007 and 2008 still show about the same numbers (15.3% in 2007 rather than 15.4% in 2008). What this means is that as unemployment is rising due to the recession, the figures for uninsured will increase even further. This isn't some figure which is artificially inflated due to a temporary rate of increased unemployment.

Using your example- the government should tax everybody to pay for oil changes in my car because it saves money. If my car breaks down, I can't get to work and will likely lose my job and end up on unemployment/welfare. That has a negative impact on society as a whole- and it could all be avoided if you just payed the $25 for my oil change. ... We could save money if we let the government just deliver food to us every week. It would create jobs. We wouldn't have to worry about eating if we lost our jobs. The government could buy in bulk and therefore squeeze the providers to take lower prices.

Except "conservatives" would pitch a fit, and scream SOCIALISM and COMMUNISM until their faces were blue.

Facetiousness aside, you should stop offering up false equivalences. A typical mixed economy like the USA runs on a balancing act between the efficiency of the free market and the reduced impact of market failure in an interventionist case. This means that in individual industries the government must choose when and where to intervene in a market to correct failure. Sometimes it is very simple and relatively costless to do so compared to the benefits you get in return - and sometimes it is much more costly to do so. For example, providing individual citizens with food would require teams of experts going from house to house and refrigerator to refrigerator in order to analyse food consumption. Then, you would need to institute an administrative team to decide what people get to eat, and transport to distribute it, and administration to oversee the distribution, and so forth.

Providing health insurance through a government program is, comparatively, extremely cheap from an administrative perspective - indeed, the costs can (and will, according to the AAHC bill) be financed by the operation of the program itself. It will likely only take about $2bn as an investment before the first premiums start coming in. This is not so from the food or oil perspective without raising prices, because that is massively costly from an administrative perspective. This means that the third part of the substitution in the first part does not hold. Does that illustrate the false equivalence?

Here's an example of where the government would want to intervene on an ongoing basis, rather than just for emergencies. The government essentially runs large organised gangs of highly armed people on a grand scale - they call it the police force. But the police don't just run out to try to catch criminals once a crime is committed - they engage in crime prevention strategies like increasing police visibility in terms of patrolling, education about crime, investigation of suspects, crime prevention advice and warnings, and so on. By the methods you appear to be advocating, the police should simply respond to crimes as and when they happen and everything else should be dealt with by private security paid for out of someone's pocket.

Claiming healthcare is some kind of right or moral imperative is ridiculous. People lived 10s of thousands of years before there were such things as doctors or hospitals.

They also had life expectancies of thirty. But, see, I can do the substitution thing as well: Claiming that maintaining a highly-funded organised military is some kind of right or moral imperative is ridiculous. People lived tens of thousands of years before there were such things as guns and tanks. Except... wait! Society progresses! I am not personally claiming that healthcare is a right or a moral imperative because I do not believe that "rights" as a concept have any intrinsic worth, and I subscribe to a highly subjective moral framework. Nevertheless the economic benefits that I have outlined earlier in the thread are undeniably strong, and as you haven't yet even partly responded to my analysis other than to pick at concepts you don't understand, I'll take it that you agree.

You have NEVER explained how police/military/road building constitute redistribution of wealth other than to claim it is and never offer any explanation other than to attack the arguments I have made explaining how they aren't.

I'll explain it step by step in a lot of detail, using roads as an example, so it is easier to follow. I will include many of the obvious steps I would otherwise gloss over, since they might be causing the problem.

• Roadbuilding is a good that is provided by the government because it is underprovided by the free market.
• Consumption of the good "roadbuilding" follows an uneven distribution across consumers. This means that not everyone uses roadbuilding services the same amount. Some use them more, others use them less, for a variety of reasons (some travel on the roads more, others live in areas where roads are more expensive, etc).
• Roadbuilding is not cost free. The government must recoup its expenses somehow.
• The government determines that it is cheaper to do away with the complicated surveying it would take to determine how much each person consumes the roadbuilding good, and simply finances the projects from a central fund.
• The central fund is not related to the consumption of the roadbuilding good, because it is based on a rate based on some other factor (for example, progressive taxation on income).
• Some people's wealth is therefore disproportionately used in the payment, and the returns are disproportionately distributed. Some people consume the roadbuilding good more than they have otherwise paid for. This generates inequity.
• The inequity is justified by the massive social returns granted by the roadbuilding good.

This is the same method used to finance and justify virtually every government service in a standard mixed economy. So, as many people have pointed out, this means that you cannot simply call the government interacting with the insurance markets "SOCIALIST" based on a loose definition which apparently marks any government intervention as socialism, without considering the sliding scale of government provision. There is no black and white answer to this - healthcare provision works in the exact same way as military or education provision so condemning things as intrinsically wrong because they are "SOCIALIST" is fundamentally ignorant of how governments work.

[Evil Hamster]

I've only made it partway through this. I'll try and get back to the rest of it later.

This is going to be a mess of a response. I'm going to try to group quotes as best I can, but the problem with this discussion is that at its heart it is entirely schizophrenic. It is not at all clear what the focus is, since you continually mix your arguments between partisan politics, the actual bill, and some hypothetical system you are afraid is going to be implemented (though these three are only barely interrelated). It would be far more helpful if the discussion could focus on one thread of argument at a time (or alternatively be split into different threads so the discussions won't overlap).

First- name calling does not contribute anything at all to this discussion. I fail to see how wanting the government to follow the limits specifically imposed by the Constitution is "partisan politics". That's a favorite tactic of the Democrat party- if you use facts and logic instead of soundbites and emotional appeal its "partisan politics".

Second- there is no "actual bill" at the moment- just a lot of hype. There were a few versions posted online but any critique of them was countered with accusations of lying, fear-mongering, or "special interest" attacks. This all ignored the fact the Democrats have lyed about what's in the bill, worked to scare people into supporting it and the whole thing was written by special interests and lobbiests.

Third- yes, it is all hypothetical at this point. The people in power are going to break their promises again, Obama and the democrats promised to post any bill online for at least 48 hours so the public will have a chance to read and comment back to their leaders (can't really call them representatives anymore). So far they have purposely failed to keep that promise. Think back to the "stimulus" package- they dumped a 1000 page bill that was nothing but pork and demanded a vote on it 12 hours later- it is impossible even for speed readers to read that fast. They are already saying they will not keep that promise with whatever healthcare bill they come up with. They have even suggested they will have entire sections that will be left blank until after the vote and then fill in with whatever they want to put in after it is approved.

As for the "one argument" thing- this is a complex topic that has dozens of inter-related issues from taxes to the economy. Nothing is preventing anybody from starting a seperate thread if they want to discuss another issue in detail seperate from healthcare if they want.

This is an extreme tangent. I think this should be split off into a new thread if it needs further discussion.

Increased government spending decreases unemployment because government spending is a component of aggregate demand. Provided we're not in the extreme monetarist case where any expansion of demand is purely inflationary (which is probably not the case, even in the long term), expansions of aggregate demand have the effect of increasing employment. Furthermore, due to the circular flow of income, that spending increases through the multiplier effect and causes even bigger growth. Government stimulus programs are therefore one method which can be used to stimulate the economy.
Where the government gets that money is another question. Some can be raised by internal methods such as decreasing spending in other areas, but let's assume for the moment that they are implementing the programs ex nihilo. If they borrow the money, then it is likely to be in part inflationary because the money supply is being increased, and it might potentially have a depressive effect on future government spending due to increased government debt. If the government increases tax revenue, this has an ambiguous effect. Since the government does not save the money, the multiplier effect is more increasing in demand than the taxation decreases demand. On the other hand, one would presume the government would already be at the optimal point on the laffer curve, and so therefore tax increases would be suboptimal. The effect also depends on who is being taxed.

Relating this theory back to the real world, the stimulus programs instituted by the Bush administration and the Obama administration (I assume you're referring to these, because this discussion actually has nothing to do with the healthcare bill) have lessened the impact of the recession at the cost of running a larger budget deficit. The problem faced by governments whose economies are running into recession is that it is more acceptable to lessen the impact rather than take into account future problems that may cause. Of course, it is also more reasonable from an economic perspective to mitigate the excesses of the business cycle, because it is more efficient to run at a modest rate of growth than it is to go through constant cycles of boom/bust.

Government spending does not create demand or provide jobs (other than more bureaucrats). I don't even know where you get that. You're right to look at the money, but wrong about the effect. The stimulus plans are little more than a temporary crutch to delay the crash that is going to happen regardless and will be even worse once the crutch is removed. Right now the government is borrowing money (mostly from China)- which will have to be paid back with interest through higher taxes by our children and grandchildren. They have also printed and electronically created trillions- which WILL lead to inflation in the near future further exasperating the bad economy. The only reason inflation has not kicked in yet is all that money has so far been given to the ultra-rich in this country. Once it filters down to the middle and poor- then we will see the double-digit inflation we haven't seen since Carter. Another small point- the "boom/bust" cycle you mentioned is another creation of government. When they de-coupled the dollar from the gold standard and created the federal reserve- it allowed for a massive growth cycle (the roaring 20s) followed by the great depression. I agree this should be split off into a seperate thread if you want to talk about it more.

None of this (even if it was correct, which it's not) relates to my point about unemployment. The point I was making was that the high unemployment right now is a significant factor in the number of people who the government is calling "uninsured". How significant might be debatable- and depend on where you get your information from- but it is significant nonetheless. The problem is the government is using the current economic crisis (which they created) to claim they need to now take direct control of 1/6 of the economy. "You never want a serious crisis to go to waste"- Rahm Emanuel

But to your point- if you have a medical emergency you can go to any hospital and they are required by law to treat you regardless of your ability to pay. The same can't be said for routine doctor visits. If I sit on my but all day not working even if I am able and you go work hard every day- is it right for me to go see the doctor and make you pay for it just because you have the money?

There are two distinct issues here. The first is the effectiveness of emergency vs preventative care. The second is the moral issue surrounding healthcare.

Let's deal quickly with the first because it is simple. Preventative care reduces medical costs in the long run, in the same way that performing maintenance on a car on a regular basis reduces repair costs. A significant number of people are admitted to emergency rooms in the US for conditions which are easily treatable and preventable if caught at an earlier stage. This might be because they do not have insurance, or it might be because they cannot afford even with their insurance plans to get treatment. In this case, it is more efficient for people to have preventative care. Emergency care alone is not enough to actually improve someone's quality of life, so the provision for emergency care is not a mitigating factor when we're talking about actual solutions in healthcare reform.

The second is far more tricky. You're presumably claiming that it is not morally right for someone's medical bills to be subsidised by other people. There are a number of arguments, both philosophical and practical as to why healthcare should be subsidized or publicly funded. I'll list them briefly, otherwise we could be here all day.

• Negative externalities resulting from lack of healthcare provision impact everyone, not just the sick person. Positive externalities from healthcare provision impact everyone, not just the sick person. Together, these more than justify some redistribution of wealth on a private cost/benefit level even without getting into moral arguments.
• Increased social welfare could be considered a moral imperative. As I've demonstrated, that would naturally lead to a moral imperative for increased healthcare provision.
• The same argument, that redistribution of wealth is theft and inherently immoral, can be exactly applied to other redistributive programs like roadbuilding, policing and other emergency services, the military and so forth because they operate on exactly the same principle of redistribution of wealth in order to provide products/services on a public basis.

[/quote]
I agree with you- preventative care is cheaper than emergency care. That does not make it a moral imperative. Using your example- the government should tax everybody to pay for oil changes in my car because it saves money. If my car breaks down, I can't get to work and will likely lose my job and end up on unemployment/welfare. That has a negative impact on society as a whole- and it could all be avoided if you just payed the $25 for my oil change.

Claiming healthcare is some kind of right or moral imperative is ridiculous. People lived 10s of thousands of years before there were such things as doctors or hospitals. A moral imperative would be food- we all need to eat to survive. We could save money if we let the government just deliver food to us every week. It would create jobs. We wouldn't have to worry about eating if we lost our jobs. The government could buy in bulk and therefore squeeze the providers to take lower prices. Let me fix your list for you:

• Negative externalities resulting from lack of FOOD impact everyone, not just the HUNGRY person. Positive externalities from FREE FOOD impact everyone, not just the HUNGRY person. Together, these more than justify some redistribution of wealth on a private cost/benefit level even without getting into moral arguments.
• Increased social welfare could be considered a moral imperative. As I've demonstrated, that would naturally lead to a moral imperative for FREE FOOD.
• The same argument, that redistribution of wealth is theft and inherently immoral, can be exactly applied to other redistributive programs like roadbuilding, policing and other emergency services, the military and so forth because they operate on exactly the same principle of redistribution of wealth in order to provide products/services on a public basis.

You have NEVER explained how police/military/road building constitute redistribution of wealth other than to claim it is and never offer any explanation other than to attack the arguments I have made explaining how they aren't.

This country is founded on the principles of freedom and individual responsibility. Unfortunately that has been corrupted by the central planners who constantly beat the drum of: life will be easy if you just let us run it for you.

[captain haddock]

Just had another thought to do with the libertarian argument against redistribution of wealth. The implementation of law in the administering of justice is yet another example of this redistribution of wealth. The salaries of the judiciary are payed with taxpayer money to provide a good/service; to carry out the process of justice decreed by the laws of the country. Police, judges, prisons and state prosecutors all cost the taxpayer (although there may be some private jails in the US, I'm not sure about that), and individual taxpayers benefit from the service provided by having fewer dangerous people on the streets and the security of a well-oiled system to redress attacks (of whatever kind) on individuals. Obviously not everyone will be attacked in their life, so they don't benefit as much as those who do get attacked and provided with redress from this tax-funded system.

EvilHamster, let me ask you this. If you walked past a pond and a baby was drowning, would you jump in the pond to save it? I'll assume yes (provided it wasn't that lovecraftian dancing baby from the internet circa 2001). Would you still jump in if it would ruin the shoes you'd worked for a year to be able to afford? Again, yes. So why is it ok to sit on excess income which you don't need when others do?

I'll leave it at that because I'm getting slightly tangential, I just want to see how a libertarian approaches the drowning baby problem.

[captain haddock]

I've long believed that debating someone on the internet is not about convincing them, at least not in the end. Most ideologues never change their ideas over the course of a single argument, because cognitive dissonance is extremely powerful. The best you can usually hope for is to convince and influence people who are reading along.

Colour me convinced Daxx. Well, thats not really true, because I agreed with you to begin with, but man, you make some powerful points! I'm eager to see if EH is going to ignore your 'roadbuilding' example or attempt to argue the point.

I've followed this debate since I stopped posting, because frankly you were doing a far better job than I could, and I have a tendency to lose my temper over this issue. I just wanted to say that your posts have always been logical, generally well-researched, calm, to the point, non-partisan and not aggressive. It has been very enjoyable watching someone deconstruct baseless attacks on their argument while engaging with the real issues. A higher standard of internet debate than I am accustomed to lol.

So yeah, Keep up the good work!


P.S. Here in Australia a number of large stimulus packages have pushed our economy through the roof - we're almost level with the US dollar now. Look out Daxx, we're coming for the pound!

[Daxx]

Thank you.

I'm not perfect - I'll be the first to admit that, but I do try to be honest in my arguments, and support them as best as I can.

[captain haddock]

Don't confuse libertarians with anarchists.  Libertarians acknowledge a role for a taxpayer-funded government, such as the existance of a judicial system.

Well I think that varies from libertarian to libertarian. The point I'm trying to make is that it simply isn't enough to say that redistribution of wealth is wrong because it disadvantages some people. The onus is on the libertarians to define what is acceptable and non-acceptable redistribution of wealth, and more importantly, why.

You have NEVER explained how police/military/road building constitute redistribution of wealth other than to claim it is and never offer any explanation other than to attack the arguments I have made explaining how they aren't.

Libertarians need to accept that the principle of redistribution of wealth which seems so central to their philosophy frequently benefits them (unless they live completely outside of society).

[Fortis]

Don't confuse libertarians with anarchists.  Libertarians acknowledge a role for a taxpayer-funded government, such as the existance of a judicial system.