Now that our season is over...

[mnagowski]

I don't see how property rights are relevant to the health care talk at all. People are decrying the mandate and the tax, but mandatory taxation to provide public goods has been a part of this country for a long time. This was an issue settled 200 years ago.

How is individual health a public good?

Because when everybody around you has tuberculosis you have a problem? Because when the majority of the country's teenagers are too fat to qualify for military service you have a problem? Because when a country's labor force becomes increasingly too sick or diseased to be productive suddenly you find it hard to obtain all of the great products and services that used to be available to you it kind of sucks?

[Rosey]

I don't see how property rights are relevant to the health care talk at all. People are decrying the mandate and the tax, but mandatory taxation to provide public goods has been a part of this country for a long time. This was an issue settled 200 years ago.

How is individual health a public good?

Because when everybody around you has tuberculosis you have a problem?

Okay, so preventing contagious epidemics is a public good.  How is, for instance, preventing or healing an individual's heart disease or MS or correcting his or her vision a public good?

Because when the majority of the country's teenagers are too fat to qualify for military service you have a problem?

That sounds like a feature, not a bug.  And even a vast majority of fatties still leaves millions of limbs for IED's to blow off ideal-weight teenagers.

Because when a country's labor force becomes increasingly too sick or diseased to be productive suddenly you find it hard to obtain all of the great products and services that used to be available to you it kind of sucks?

By your logic, anything that affects productivity is a public good.  "I don't have a plasma TV set, so I'm unhappy, so I'm less productive.  Plasma TV's only cost $1200, and my lack of one is making me much more than $1200 less productive, so clearly I need a subsidy."  So where do you draw the line?  I draw the line at non-exclusionary goods and services, because there's a natural dividing line there.  If your philosophy is to attempt to maximize national productivity, then you have to admit policies like this if you admit individual health as a public good.  Otherwise, please tell me what your guiding philosophy is.

[mnagowski]

So where do you draw the line?

We can draw the line wherever we choose to as a society. That's the beauty of our system of government. We can decide what we can afford and can't afford, what we think is valuable for us to invest in, and budget for it.

In the 1930s we created a wildly successful and beloved anti-poverty program for the elderly, orphans, and the disabled that didn't happen to increase the nation's productivity but certainly improved the social and physical well-being for a lot of the country and probably increased aggregate demand because most elderly people live hand to mouth. In the 1860s we provided lots of funds to create institutions of higher education that helped to foster a lot of important research/discovery/education in this country. In the 1800s we purchased enough land to double the country's size, allowing hundreds of thousands of settlers to prosper as a result of this investment.

I haven't seen any research backing the notion that lack of plasma televisions has resulted in worse social or economic outcomes for the country. If you can find decent evidence to this fact, maybe we should consider it.

But the productivity losses due to the current structure of health care payment are quite high. Millions of people are currently suffering from "job-lock" because they can't afford to lose their employer's health care coverage. They have a great business idea that they can't invest in, or they can't go back to school to get the advanced degree in engineering. That's why the rates of entrepreneurship suddenly jump at the age of 65.

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1305280

And countless others are too sick to work today because they didn't get the relatively cheap care they needed when it would have mattered. Like a lot of the 6,000 people who die of asthma every year.

[Robb]

Don't forget that now that you're forcing perfectly healthy people to buy insurance, they'll start using health care services at a much greater rate themselves

This doesn't make much sense to me. Perfectly healthy people choose to go to the doctor just to chat? Or are they going to start demanding open heart surgery just because they have insurance? Perhaps they are going to start getting tested for their cholesterol levels every other year, but that is not what is causing health care costs to skyrocket. It's end of life care.

"Perfectly healthy" was a poor choice of words on my part.  I'm thinking of people who don't currently have health care, but once they do will begin to make appointments with their PCF for every sniffle and muscle ache.  At the very least, these people will affect the access to care, if not the overall cost.

I completely agree that end-of-life care is the biggest issue.  You don't think it's a fixed cost.  What specifically, in this bill, reduces the cost of end of life care?  Increased preventive care delays it at best, and at worst extends lives into the regime where multiple systems begin failing simultaneously which will actually increase the end-of-life costs.  Or is it merely a hope that 85 year olds will demand less end-of-life care and just go into the night more quietly than their 75 year old counterparts would have?

[Jeff Hopkins '82]

This isn't an argument, it's just contradiction.

[Greenberg '97]

This isn't an argument, it's just contradiction.

No it isn't.

[ugarte]

This isn't an argument, it's just contradiction.

No it isn't.

Yes it is.

[Trotsky]

This isn't an argument, it's just contradiction.

No it isn't.

Yes it is.

Oh I'm sorry.  This is abuse.

[Jeff Hopkins '82]

This isn't an argument, it's just contradiction.

No it isn't.

Yes it is.

Oh I'm sorry.  This is abuse.

Stupid git.

[Rosey]

We can draw the line wherever we choose to as a society.

This is a misconception.  "Society" doesn't choose anything because society is not sentient.  Individuals can choose for themselves, and the resulting aggregate of those choices is what produces society as we experience it.

You are talking about substituting democracy for individual choice.  Democracy is just one way among many (monarchy, oligarchy, etc.) to legitimize the act of one group of individuals forcing their preferences on others.  You can use all the high-minded rhetoric you want to describe this, but this is in fact exactly what democracy is: the elimination of individual freedom in favor of majority preference.

[Greenberg '97]

Damn, I thought we had successfully derailed this conversation.  I'll try again.

Democracy is just one way among many (monarchy, oligarchy, etc.) to legitimize the act of one group of individuals forcing their preferences on others.

"Help, help, I'm being repressed!  Come see the violence inherent in the system!"

[Rosey]

Damn, I thought we had successfully derailed this conversation.  I'll try again.

Democracy is just one way among many (monarchy, oligarchy, etc.) to legitimize the act of one group of individuals forcing their preferences on others.

"Help, help, I'm being repressed!  Come see the violence inherent in the system!"

Bloody peasant!

[mnagowski]

Don't forget that now that you're forcing perfectly healthy people to buy insurance, they'll start using health care services at a much greater rate themselves

This doesn't make much sense to me. Perfectly healthy people choose to go to the doctor just to chat? Or are they going to start demanding open heart surgery just because they have insurance? Perhaps they are going to start getting tested for their cholesterol levels every other year, but that is not what is causing health care costs to skyrocket. It's end of life care.

"Perfectly healthy" was a poor choice of words on my part.  I'm thinking of people who don't currently have health care, but once they do will begin to make appointments with their PCF for every sniffle and muscle ache.  At the very least, these people will affect the access to care, if not the overall cost.

Sure. And there are provisions in the bill to produce more primary care physicians and increase funding for community health centers.

But let me ask you this: Do you currently have health insurance in Switzerland? And do you go see a primary care physician for every little sniffle or muscle-ache? Do all the people who live in Switzerland go see their doctor every week because they scratched their hand? If not, what makes you think that all those who are currently uninsured in America will take time out of their incredibly busy days, leave work, and pay money to see a doctor for a trivial issue?

When I lived in England for a year, I never had to go to the NHS because I thankfully didn't get sick. Even though it was free! (My friends did, and they had pretty glowing reports, much like my friends in Canada. And the UK and Canada have two of the "draconian" systems.) My father at the age of 60 has good insurance but he has only been to the doctor twice in the past two years because he hasn't been sick! People don't go to the doctor a) if they're not really sick, or b) they can't afford it.

I have a friend who just came back from the Peace Corps who is 25 and uninsured. She's afraid to take a cross-country road trip because if something happens, she has no insurance. And I can guarantee you that when does get insurance, she's probably not going to be running off to the doctor right away if nothing is wrong (except for perhaps, her annual gynecological exam).

I completely agree that end-of-life care is the biggest issue.  You don't think it's a fixed cost.  What specifically, in this bill, reduces the cost of end of life care?  Increased preventive care delays it at best, and at worst extends lives into the regime where multiple systems begin failing simultaneously which will actually increase the end-of-life costs.  Or is it merely a hope that 85 year olds will demand less end-of-life care and just go into the night more quietly than their 75 year old counterparts would have?

I don't think people with chronic conditions are a fixed cost. Give a man with high blood pressure some meds and get him on an exercise regime and the likelihood of him needing $250,000 bypass surgery goes way down. Make certain I can stay on my medications and that I do my physical therapy and the likelihood that I will ever receive very expensive joint replacement surgery goes way down. Hell, treat people with Type II diabetes the right way and their condition will likely reverse itself.

End of life care is a different story. But first, it should be noted that we're turning the conversation away from how we can insure everybody under the age of 65 to how we curb skyrocketing end-of-life costs. They're completely separate issues, and I think a lot of that has less to do with questions of insurance and more with the practices of physicians and hospitals

A lot of end-of-life care costs don't come in the final years of your life, they come in the final weeks. What's amazing is that even though everybody thinks that Medicaid is a program from the poor underclass, 80% of its spending actually goes to individuals over the age 80! So it's really a program for the old (who by being old, tend to be poor, and sick).

There is a wide level of variation in the type of end-of-life care that you will receive, mostly based on which hospital and which region of the country you end up in. If you're 85 and show up with metasized lymphoma, some hospitals will actually try to do chemo on you because there is money in it. Others will just give you same pain kills and tell you to try to enjoy life because they don't want you to suffer and they know that your life expectancy is the same anyway.

What the Affordable Care Act does is implement some programs that try to start working through this issue. It includes taxes for hospitals that have high re-admission rates and additional penalties for hospitals that see high rates of hospital-acquired infections. On top of that, there will be incentive payments for hospitals that demonstrate the lowest cost of care by age, sex and race adjusted per enrollee spending for Medicare. So the hospitals are finally being incentivized to start looking at their own practices and ask themeselves "why does it cost that county so much less to treat their patients than we do"?

None of these programs will be a magic bullet, but it's a start. And it's more than we have done in the last fifty years. It would have been nice if we could have done more. I know that there were at least 51 or 52 senators who wanted to go much further, but unfortunately the fillibuster prevailed.

[Trotsky]

"Help, help, I'm being repressed!  Come see the violence inherent in the system!"

Bloody peasant!

Oh, what a give away.  D'ja hear that, did you hear that, eh?  That's what I'm on about.

[mnagowski]

We can draw the line wherever we choose to as a society.

This is a misconception.  "Society" doesn't choose anything because society is not sentient.  Individuals can choose for themselves, and the resulting aggregate of those choices is what produces society as we experience it.

You are talking about substituting democracy for individual choice.  Democracy is just one way among many (monarchy, oligarchy, etc.) to legitimize the act of one group of individuals forcing their preferences on others.  You can use all the high-minded rhetoric you want to describe this, but this is in fact exactly what democracy is: the elimination of individual freedom in favor of majority preference.

I don't know what to tell you Kyle. We're social animals. Group behavior is what this species is all about. Just as groups of cells can be sentient, groups of people can be sentient as well. We've developed an imperfect system to encourage peaceful, cooperative group behavior to foster decision-making in terms of the allocation of our resources. While this system curbs certain individual actions (like the abillity to own nuclear weapons, earn an incoming without paying taxes, or building structures with asbestos in them) it also provides a lot of benefits to everybody in the group as well. Common defense. Research in basic science. Education for our youth. Public provisions to the young, old, and suffering. Greater prosperity and well-being.

If you really dislike democracy as a system of government, you can: 1) run for public office on a platform of getting rid of democracy, or 2) try to find another group of people somewhere else in this universe that will have you.