The Opposition is Heard

[Selene]

Darrell:

Absolutely.

Our argumentation has to be emotionally scrubbed, supported by neutral or negative evidence. That is why I am going to the pro Obiwan Townhall Meetings and I am participating in the conference call tomorrow night at 8 PM with Axelrod's guru.

Only by understanding their arguments can they be effectively defeated.

The way I taught debate was to research and prove the oppositions case first and then develop my arguments and case.

Adam

Edited August 10, 2009 by Selene

[Jonathan]

Jonathan, this is pie in the sky. it's not what happens, it's not what can possibly happen. Doctors today are shamefully underpaid by Medicare and Medicaid, and young people, as a result, are not entering medical schools in nearly the numbers they once did. They are not willing to face 12 years of difficult and expensive study and then a lifetime of being underpaid and under-appreciated -- a situation which will only become worse with nationalized health care. In Canada, ny sister-in-law had a 9-hour operation for a brain aneureism that had burst; the surgeon, who saved her life, was world-famous in his field. He was paid $400.

Sure, some doctors are dishonest, as are some in any profession or trade., But as I pointed out, it is the million dollar judgments awarded in malpractice suits and the prohibitive resulting cost of malpractice insurance that has driven many doctors out of their profession and has been a major cause of questionable tests and drawn-out treatment.

I agree. The interesting thing to me is that doctors are motivated by government policies to inappropriately draw out treatment of some patients in order to pay for the treatment of other patients, and then they're vilified for doing so. In effect, when they find a way to do what the public wants them to do -- rob Peter in order to treat Paul -- they are seen as something akin to vampires by both the public and the government. I think it's one of the main reasons that you see some insurance companies and doctors supporting government health care proposals. They're sick of being in a no-win situation. I think a lot of them are basically thinking that if the public wants certain people to have free health care, then the public can put its money where its mouth is and pay for it rather than expecting doctors and insurance companies to absorb the costs while being vilified for finding realistic ways to absorb the costs.

As for the "everybody" who seem to agree that illnesses such as congestive heart disease, coronary artery disease, depression, etc., are poorly handled -- these are among the areas in which medical miracles have been performed in the last few decades, extending our lives to an extent heretofore undreamed of. But not in countries where the government controls heath care. On his show today, Greg Beck announced the prognosis for prostate cancer in the US, Canada, and England. In America, the relative 5-year survival rate is 100%; in Canada it is 95%; in England it is 77%.

I think you've misunderstood my comment, which was that almost everyone seems to agree that our current system does a poor job of handling comorbidities involving the five costliest chronic diseases, and that there is a lot of room for savings and improved care in that area. Personally, I don't believe that the government would do a better job unless it did so at the expense of doing much greater damage elsewhere in the system.

What is astonishing is not the anger and the sin of shouting at Town Hall meetings on the part of people who have some understanding of their future under governmental health care -- what is astonishing is that they have not dumped their supposed representatives into Boston Harbor.

I don't think it's the representatives who need to be dumped into a harbor so much as the people who elected them. The idiots who feel good about themselves because they believe that they're helping the poor, by forcing "the rich" to pay for them, need to feel the effects of what they're asking for. I think it's a good thing that many of them appear to be realizing that the burdens they had hoped to impose on others will be imposed on them.

J

[Selene]

This is the Fox interview with the tax paying citizen in Michigan with his son in the wheelchair loudly and assertively/aggressively confronting the 83 year old Dingle.

http://www.foxnews.c...listId=playlist

Interesting man.

Adam

Edited August 10, 2009 by Selene

[Darrell Hougen]

I just had to insert this smoking gun video, just in case anyone doubted the true intentions of the Democrats:

Darrell

[Barbara Branden]

Gulch: "Do you suppose that Obama is oblivious to the consequences or that he has deluded himself into thinking that somehow it will work here despite its failure everywhere in the world it has been implemented?"

Neither. I think he is perfectly well aware of the consequences. And he knows it will work here no better than it has anywhere else, I'll make my point by a different example for a moment. People who want to "redistribute the wealth" know very well that to do so means that everyone in society will have less, including the poor. But that's not what's important to them. What matters is that the rich and successful, whom they hate and fear and envy and feel inferior to, will be brought down to the level of everyone else. There will no more mansions for them, no more private jets, no more extravagant vacations. They will no longer cast their shadow across the lives of those who can never hope to equal them.

What does this mean about the issue of nationalized health care? Obama and those who advocate his position know that no one one will get decent medical treatment. But that's not what's important. What matters is that everyone will be the same. The rich will have to scrounge and beg for medical treatment just like everyone else, just like the lowest in society. There will no longer be anyone to envy or fear or feel inferior to.

Do you remember the scene in The Fountainhead, when Peter Keatiing asks Toohey why he wants to kill Roark? Toohey answers:

I don''t want to kill him. I want him in jail. You understand? In jail.

In a cell. Behind bars. Locked, stopped, strapped -- and alive. He'll

get up when they tell him to. He'll eat what they give him. He'll

move when he's told to move and stop when he's told. .. . And

he'll obey. He'll take orders. He'll take orders.

Did you see Obama shake his finger in the faces of the group of businesmen he summoned to the White House, as he told them what he would allow them to do and what he would not allow them to do? They took orders. His orders.

Barbara

[Selene]

Gulch: "Do you suppose that Obama is oblivious to the consequences or that he has deluded himself into thinking that somehow it will work here despite its failure everywhere in the world it has been implemented?"

Neither. I think he is perfectly well aware of the consequences. And he knows it will work here no better than it has anywhere else, I'll make my point by a different example for a moment. People who want to "redistribute the wealth" know very well that to do so means that everyone in society will have less, including the poor. But that's not what's important to them. What matters is that the rich and successful, whom they hate and fear and envy and feel inferior to, will be brought down to the level of everyone else. There will no more mansions for them, no more private jets, no more extravagant vacations. They will no longer cast their shadow across the lives of those who can never hope to equal them.

What does this mean about the issue of nationalized health care? Obama and those who advocate his position know that no one one will get decent medical treatment. But that's not what's important. What matters is that everyone will be the same. The rich will have to scrounge and beg for medical treatment just like everyone else, just like the lowest in society. There will no longer be anyone to envy or fear or feel inferior to.

Do you remember the scene in The Fountainhead, when Peter Keatiing asks Toohey why he wants to kill Roark? Toohey answers:

I don''t want to kill him. I want him in jail. You understand? In jail.

In a cell. Behind bars. Locked, stopped, strapped -- and alive. He'll

get up when they tell him to. He'll eat what they give him. He'll

move when he's told to move and stop when he's told. .. . And

he'll obey. He'll take orders. He'll take orders.

Did you see Obama shake his finger in the faces of the group of businesmen he summoned to the White House, as he told them what he would allow them to do and what he would not allow them to do? They took orders. His orders.

Barbara

Precisely Barbara.

Most people are basically decent folks who are fair and believe in giving others the benefit of the doubt. Most folks try to see the other person as non-malignant.

However, evil, conscious or unconscious, is subconsciously avoided by people of good will. It is a fatal flaw in most folks because it leads to their tolerance of individuals

that should be shot on sight like the psychologically rabid animals that they are. No one wants to accept that there are people in existence who are purely evil.

Seriously, does anyone believe or accept the fact that Ezekiel Emanuel can actually exist, be a key adviser to the President of the United States and hold the concept that

a human being does not exist until the human is five years old and that evaluation is dependent upon communitarian values is breathtaking in its audacity.

These people are evil, objectively evil.

Adam

[Philip Coates]

Subject: Envy and Hate vs. Error - Part 1.

> People who want to "redistribute the wealth" know very well that to do so means that everyone in society will have less, including the poor. But that's not what's important to them. What matters is that the rich and successful, whom they hate and fear and envy and feel inferior to, will be brought down to the level of everyone else. There will no more mansions for them, no more private jets, no more extravagant vacations. They will no longer cast their shadow across the lives of those who can never hope to equal them...Peter Keating asks Toohey why he wants to kill Roark..."He'll obey. He'll take orders." [barbara]

My view is that the overwhelming majority of people in every country, even staunch Democrats or people who agitate for bigger government, even academics or intellectuals are not motivated by envy, fear, or hate. They are often motivated by a misguided idea that they will be making a better world. [still other possibilities exist: In some cases, they may be non-cognitive parrots paying lip service with no real awareness of what they are advocating; some hope to profiteer or get elected or hold onto their jobs.]

I didn't want to address this to Barbara only because on this issue **I seem to be in disagreement with the preponderance of the Objectivist movement, from Rand on down**. And it affects how people live, how they judge others. And their persuasiveness skills. And their overall benevolence and view of what kind of social and political environment they are surrounded by. On the other hand, this is not a philosophical topic but a psychological one. The topic is one of -assessing motivation, judging people- and believing one has insight into a certain bad motivation of huge groups of people, presumably in the millions.

This motivation-assessment, first-handed, would need to rest on observing the people around you, the ones you grew up with. Across a lifetime. So I can't -prove- my view on this series of posts or an endless series of arguments. Only ask people to introsopect and reflect back on what they've seen in their personal observations of their own encounters and experiences(maybe extended to their own television screens).

A preliminary set of scientific or empirical issues first. How do you define the group? *How many* of the people who want to redistribute wealth are motivated by hate and fear and envy? Is it the voters, everyone who is a staunch, fervent Democrat in the U.S. or a social democrat abroad? On the other extreme is it only a microscopic handful of clever leaders and manipulators in politics, law, the media, etc.? Who are they? Can you name names? Have you met them? And can you recognize them? Envy is clearly something people would try to hide.

And how do you know this is true? --> "[they] know very well that to [redistribute the wealth] means that everyone in society will have less, including the poor." Do you know this strong a claim is widely true, rather than widespread honest error or brainwashing and indoctrination as these people grew up?

[Jonathan]

I think that Barbara was generalizing, but she's basically right. I think that liberals usually initially say that they're motivated by an interest in helping others, but when you take the time to discuss their views with them in more detail, you see other motives.

I've had a lot of friends and relatives who are liberals, I've had many frank conversations with them, and my overall impression is that they want to make other people help the "less fortunate," they usually count themselves as either qualifying as recipients of the services that they advocate or as paid distributors of them, or both, and their general approach to their ideology is that it's a set of rules by which others should live, but from which they should be largely exempt. Not all express hatred for the rich, but many do. Most seem to be motivated primarily by fear more than hatred, envy or of wanting to help others. They seem to feel that they can't make it in life on merit.

I've known only a couple of liberals who were generally not hypocrites. They were strong, they took matters into their own hands, and they put their time and money where their mouths were. Unlike most of the other liberals I've known, their actions were usually consistent with their words.

J

[Darrell Hougen]

In my view, there are a wide range of factors that motivate people and some people are more motivated by some factors while others are more motivated by others.

Jealousy (or envy) is certainly a powerful motivating factor for a lot of Democrats. I've had arguments with people in which they've all but admitted that they would prefer everyone to be poor and equal than to have a situation in which almost everyone is relatively well off -- not starving -- but some people are much better off than others. This is especially true of the debate over health care. People can tolerate the fact that other people eat at better restaurants or drive better cars than other people, but when it comes to the notion that some people might actually receive better medical care and consequently live longer, healthier lives than others, and that those other might be more likely to suffer and die, watch out! It makes no difference that everyone is more likely to live longer under a free system. The notion that some people might actually receive better care and live longer engenders incredible jealousy and some amount of fear.

There are many people -- perhaps most ordinary people -- that have a genuine (if misguided) concern for the plight of the poor. Some people tend to be very empathetic. When they look around them and see other people suffering, they suffer too. And, they honestly want to do something about that suffering. Unfortunately, that empathy makes them easy targets for manipulators.

That brings us to the third group, the politicians. In my view, most Democratic and many Republican politicians are dishonest manipulators. They may be motivated partly by fear and jealousy, but by the time they obtain office, that feeling has turned into a lust for power. Some are petty bureaucrats that have their own little fiefdoms and just like to tell ordinary people what they can or cannot do. Others, like Obama, are master manipulators. You can tell by looking at him the scornful disdain that he feels for ordinary citizens -- his subjects. He even knows how to manipulate other big name politicians. He knows how to push their buttons and he knows it. He's enjoying his power trip. Of course, despite their age, ambition, and credentials, they are really nothing more than obsequious lackeys at heart. A few may be secretly harboring hopes of taking his place some day. Others are satisfied with their retinue of aides and subordinates.

This is an image, not a video, of Obama in Mexico.

Darrell

Edit: Let me also echo what Barbara was saying. A lust for power comes from feelings of inferiority. A person that is strong and self-confident has no psychological need to control or manipulate other people.

Edited August 11, 2009 by Darrell Hougen

[Selene]

I think that Barbara was generalizing, but she's basically right. I think that liberals usually initially say that they're motivated by an interest in helping others, but when you take the time to discuss their views with them in more detail, you see other motives.

I've had a lot of friends and relatives who are liberals, I've had many frank conversations with them, and my overall impression is that they want to make other people help the "less fortunate," they usually count themselves as either qualifying as recipients of the services that they advocate or as paid distributors of them, or both, and their general approach to their ideology is that it's a set of rules by which others should live, but from which they should be largely exempt. Not all express hatred for the rich, but many do. Most seem to be motivated primarily by fear more than hatred, envy or of wanting to help others. They seem to feel that they can't make it in life on merit.

I've known only a couple of liberals who were generally not hypocrites. They were strong, they took matters into their own hands, and they put their time and money where their mouths were. Unlike most of the other liberals I've known, their actions were usually consistent with their words.

J

Yes Jonathan:

I have worked with strong committed liberals and I have no problem with them at all. You are accurate in that they put themselves, their money/assets and their time into achieving the goal they seek to effect. We established an environmental preserve with about 95% private money that works.

I used to make what I thought was an excellent argument with the anarcho communalists in the 60's. My point was that they could exist in our anarcho capitalist utopia, but we would not be permitted in their utopia because of the property issue.

However, in our utopia, they could pool their lands and establish their commune and abolish private property within their commune. No problem. The obverse would not be allowed.

Adam

[BaalChatzaf]

Darrell

Edit: Let me also echo what Barbara was saying. A lust for power comes from feelings of inferiority. A person that is strong and self-confident has no psychological need to control or manipulate other people.

Why should Obama feel inferior? He has a first rate mind and he was one of the brightest law students at Harvard. A man of his innate ability should be able to succeed at rightful productive enterprises.

Ba'al Chatzaf

[Christopher]

I doubt Obama feels inferior. We have to be honest and admit - those who haven't studied economics and philosophy geared towards individualism often do not comprehend things the way you and I comprehend things. In other words, I think there are many people out there with good intentions and terrible ideas. Government is driven by emotional intentions far more than ethical idealisms. I don't doubt that we might be on the road to hell, but I doubt many leaders are fully aware of their unintended destination.

The health care system in the U.S. does suck. It has MAJOR problems. It needs political intervention to destroy some of the crazy legislation that currently exists and to stop some of the practices by private industries that are downright unethical and deceptive. Unfortunately, those with the power to make the necessary changes are focused on correcting the problem in the wrong way -- by implementing massive controls.

The education (and club-joining) required to become a physician...

The requirements by government to provide health insurance...

The laws that govern doctor's interactions with insurance companies...

The massive rate differences given to those with insurance versus without insurance (and supported by the government-backed insurance-monopoly)...

The truth that health insurance does try to weasel out of contracts with those insured in order to save a buck...

This is today's climate. Anyone who reads the news knows that the health system is seriously in trouble. We need it fixed. The White House's arguments about the state of the current system are correct. Unfortunately the proposed solution is so much worse, and until the U.S. health system is fixed, the horrors that such a system can create will fuel the potential for an even worse creation.

When there is a fear-inducing event/climate, government always seems to use that event to expand powers (and not correct the issue). It is a matter of good intentions, strong emotions, and a road to hell.

Edited August 11, 2009 by Christopher

[Darrell Hougen]

Darrell

Edit: Let me also echo what Barbara was saying. A lust for power comes from feelings of inferiority. A person that is strong and self-confident has no psychological need to control or manipulate other people.

Why should Obama feel inferior? He has a first rate mind and he was one of the brightest law students at Harvard. A man of his innate ability should be able to succeed at rightful productive enterprises.

Ba'al Chatzaf

Maybe I should have said that the two things go together.

I think certain people look around, see that other people have a lot more money than they do, don't see how they can possibly earn that much money by legitimate means, and come to believe that the rich people around them didn't earn their wealth by legitimate means either. They convince themselves that wealth is the result of power. That rich men became rich by manipulating and controlling other people and they start trying to figure out how they can control other people too, so that they can become rich.

Of course, in our society of mixed premises, of mixed and often irrational systems of morality and ethics, it is true that some people really do gain wealth through power. So, it is not incorrect to believe that people can become rich through power. The fault lies in believing that the only means or the primary means or the best means to wealth is through power.

Look at what Obama says and the way he behaves -- scolding businessmen as if they were evil tyrants while he vacations here and there, takes his wife via helicopter to a play in New York, and otherwise indulges himself without concern about the cost to the taxpayer or the inconvenience it might cause ordinary citizens. He's the king of the hill!

It's also instructive to look at his life before he got elected. Why did he attend the church of the hateful Reverend Wright? I don't know what he was thinking, but what kind of person enjoys listening to someone deride another race of people? Answer: A person who is jealous of that race -- a person who thinks that it's unfair that so many members of that race have so much wealth and power that he is unlikely to obtain himself. Why do some people hate the Jews? Jealousy. And what better way to demonstrate one's own superiority than to become their leader?

Obama is potentially, in my view, a very dangerous man.

Darrell

[BaalChatzaf]

Obama is potentially, in my view, a very dangerous man.

Darrell

Not potential. Actual.

Ba'al Chatzaf

[Darrell Hougen]

I doubt Obama feels inferior. We have to be honest and admit - those who haven't studied economics and philosophy geared towards individualism often do not comprehend things the way you and I comprehend things. In other words, I think there are many people out there with good intentions and terrible ideas. Government is driven by emotional intentions far more than ethical idealisms. I don't doubt that we might be on the road to hell, but I doubt many leaders are fully aware of their unintended destination.

The health care system in the U.S. does suck. It has MAJOR problems. It needs political intervention to destroy some of the crazy legislation that currently exists and to stop some of the practices by private industries that are downright unethical and deceptive. Unfortunately, those with the power to make the necessary changes are focused on correcting the problem in the wrong way -- by implementing massive controls.

The education (and club-joining) required to become a physician...

The requirements by government to provide health insurance...

The laws that govern doctor's interactions with insurance companies...

The massive rate differences given to those with insurance versus without insurance (and supported by the government-backed insurance-monopoly)...

The truth that health insurance does try to weasel out of contracts with those insured in order to save a buck...

This is today's climate. Anyone who reads the news knows that the health system is seriously in trouble. We need it fixed. The White House's arguments about the state of the current system are correct. Unfortunately the proposed solution is so much worse, and until the U.S. health system is fixed, the horrors that such a system can create will fuel the potential for an even worse creation.

When there is a fear-inducing event/climate, government always seems to use that event to expand powers (and not correct the issue). It is a matter of good intentions, strong emotions, and a road to hell.

Chris,

You're being naive. And, you pay too much attention to the news.

Just a couple statistics (from Gratzer's book): Death by cardiac disease has dropped from 307 per 100,000 in 1950 to 126 per 100,000 today. That sounds like a huge success to me. "Today, the average 45 year-old will have to shell out $30,000 on cardiac care in his life. But he will also live longer, by about 4.5 years." If he can extend his working career by 4.5 years (like Dick Cheney) it may well be worth the cost monetarily as well.

I agree that we should implement major reforms and I've mentioned some of them above and in other threads. But, if you think it's ever going to be possible to completely eliminate corruption from the system, you have another think coming. There will always be fraudulent insurance schemes, just as their will always be murders, rapes, robberies and every other crime imaginable. That's just human nature. But, we have a system for dealing with it. We have police to arrest criminals, courts in which to try and convict them, and jails in which to put them. We also have a civil court system for pursuing compensation. What more could you ask for?

I agree with your other comments, but let's stay focused. The problem is not with the insurance companies, per se. The problem is with the tax code and the irrational regulations under which the system operates.

Darrell

[Selene]

This is not about health reform, or health care, or survival rates.

However, if it was, decentralizing the medical field and opening up all competition should be our goal.

"Eastern" medicine businesses should be de-criminalized which can be done by edict or executive order. Voluntary experimental treatments should be available.

Hell they are vaccinating volunteers with your tax dollar as we type with the "swine flu" which, of course, has nothing to do with swine.

Then, if a problem arises, we target that problem, and that problem only. Shit, even government might get one of the problems solved just by chance. At least when they

fail, it will be minimized rather maximized.

A baseline catastrophic policy should be available for assigned risk business. For example, have open competition for the assigned risk pool with a 5,000.00 deductible.

Then the government could establish a program along the lines of the existing social service model with computer cash cards. Whatever the person does not use, they keep 50%

of and 50% goes to reducing costs.

The creative plans that could exist would be almost infinite.

Oh and all government employees could not have a better plan than offered to the entire population.

Elected officials would have to pay for their own coverage out of their non-public monies. If they had insufficient personal monies, then they would also go into the assigned risk pool.

And these are just some quick ideas.

Adam

[Barbara Branden]

Phil: "My view is that the overwhelming majority of people in every country, even staunch Democrats or people who agitate for bigger government, even academics or intellectuals are not motivated by envy, fear, or hate. They are often motivated by a misguided idea that they will be making a better world."

Phil, Christopher: I do not believe it possible to live in this world, to have seen what the rule of big government leads to -- to have seen Nazi Germany and Communist Russia and East Germany and Red China and Cambodia, to see North Korea today, and Iran, and the countries ruled by Muslim fundamentalists, to see even England teetering on the edge of bankruptcy and socialized medicine destroying lives wherever it is tried -- to see all this endless nightmare and, short of having a defective brain, to believe that ever-increasing government power is the path to a better world.

It's not often that history obliges us with a morality play in the form of events that scream out their meaning, but the blood-soaked 20th Century was just such a morality play. The 2ist century is well on its way to being another one.

I am well aware that human beings make innocent mistakes, even enormous innocent mistakes. But human intelllgence is not infinitely malleable. To demand that we take more of the poison that has made us deathly ill, is not innocent.

Barbara

[Barbara Branden]

Ba'al: "Why should Obama feel inferior? He has a first rate mind and he was one of the brightest law students at Harvard. A man of his innate ability should be able to succeed at rightful productive enterprises."

Ba'al, feelings of inferiority rarely have anything to do with intelligence or its lack.

Barbara

[jeffrey smith]

I doubt Obama feels inferior. We have to be honest and admit - those who haven't studied economics and philosophy geared towards individualism often do not comprehend things the way you and I comprehend things. In other words, I think there are many people out there with good intentions and terrible ideas. Government is driven by emotional intentions far more than ethical idealisms. I don't doubt that we might be on the road to hell, but I doubt many leaders are fully aware of their unintended destination.

The health care system in the U.S. does suck. It has MAJOR problems. It needs political intervention to destroy some of the crazy legislation that currently exists and to stop some of the practices by private industries that are downright unethical and deceptive. Unfortunately, those with the power to make the necessary changes are focused on correcting the problem in the wrong way -- by implementing massive controls.

The education (and club-joining) required to become a physician...

The requirements by government to provide health insurance...

The laws that govern doctor's interactions with insurance companies...

The massive rate differences given to those with insurance versus without insurance (and supported by the government-backed insurance-monopoly)...

The truth that health insurance does try to weasel out of contracts with those insured in order to save a buck...

This is today's climate. Anyone who reads the news knows that the health system is seriously in trouble. We need it fixed. The White House's arguments about the state of the current system are correct. Unfortunately the proposed solution is so much worse, and until the U.S. health system is fixed, the horrors that such a system can create will fuel the potential for an even worse creation.

When there is a fear-inducing event/climate, government always seems to use that event to expand powers (and not correct the issue). It is a matter of good intentions, strong emotions, and a road to hell.

Chris,

You're being naive. And, you pay too much attention to the news.

Just a couple statistics (from Gratzer's book): Death by cardiac disease has dropped from 307 per 100,000 in 1950 to 126 per 100,000 today. That sounds like a huge success to me. "Today, the average 45 year-old will have to shell out $30,000 on cardiac care in his life. But he will also live longer, by about 4.5 years." If he can extend his working career by 4.5 years (like Dick Cheney) it may well be worth the cost monetarily as well.

I agree that we should implement major reforms and I've mentioned some of them above and in other threads. But, if you think it's ever going to be possible to completely eliminate corruption from the system, you have another think coming. There will always be fraudulent insurance schemes, just as their will always be murders, rapes, robberies and every other crime imaginable. That's just human nature. But, we have a system for dealing with it. We have police to arrest criminals, courts in which to try and convict them, and jails in which to put them. We also have a civil court system for pursuing compensation. What more could you ask for?

I agree with your other comments, but let's stay focused. The problem is not with the insurance companies, per se. The problem is with the tax code and the irrational regulations under which the system operates.

Darrell

I think some things tend to run unnoticed in this type of discussion:

1) most people find the idea that quality of medical care, and ultimately survival, is linked to one's access to financial resources (meaning one's own assets and the available insurance) to offend their ideas of morality. They think it's Wrong (with a capital W) that Betty Boop will die because she can't afford to pay the hundred thousand dollars the hospital and surgeons will charge to perform the latest procedure that's been shown to be effective in her type of case.

2) possible innovation and rationing are actually the weakest points with which to attack Obamacare.

a ) if you can't access the innovative technology, procedure, or medicine because you don't have the money to pay for it (and lots of these innovations are expensive), then you are not inclined to be impressed by the idea that medical innovation will go into a serious decline

b ) most people, especially those of us with chronic illnesses or serious medical episodes, are already subject to bureaucrats making decisions about our medical care. The fact that they work for insurance companies is not, for them, a serious distinction. Especially for those people who have to deal with serious medical issues, it's not easy to switch insurance companies (if they can even get it outside their employer's medical benefits), especially since they will probably face the same problems with their new plans. The possibility that the bureaucrats will be government personnel may seem a plus to them--no suspicion of a profit motive, and there is always the possibility that an appeal to one' local Congresscritter will make the bureaucracy respond more favorably.

3) There are three major problems with the health care system:

a) the current insurance setup, keyed as it is to employer benefit plans, is a huge drain on corporate profits and on company resources. It also, in many cases, ties employees to their current job because they can't afford insurance (or afford to self insure) on their own. Most companies would in fact love to unload the problem of health insurance on someone else.

b ) there is almost no way to "comparison shop" when choosing facilities for medical procedures, and often enough in an emergency the patient has no choice in the facility--it's whichever hospital the ambulance crew decides is closest or best in the particular situation.

c ) the people who are usually in most need of medical insurance are usually the people who have the most trouble getting it--insurance companies being rational are loath to sign on customers whom they know will cost them several thousand dollars a year (at least). (I'm in that case myself, because I have Crohn's Disease (albeit relatively mild) with arthritis and osteoporosis that followed on because of the medicines and restricted diet. No way could I afford insurance as an individual; nor could I to spend in the neighborhood of ten thousand dollars a year for medicines and frequent colonoscopies.)

Edited August 12, 2009 by jeffrey smith

[Darrell Hougen]

I think some things tend to run unnoticed in this type of discussion:

1) most people find the idea that quality of medical care, and ultimately survival, is linked to one's access to financial resources (meaning one's own assets and the available insurance) to offend their ideas of morality. They think it's Wrong (with a capital W) that Betty Boop will die because she can't afford to pay the hundred thousand dollars the hospital and surgeons will charge to perform the latest procedure that's been shown to be effective in her type of case.

The answer to that is that it is Wrong (with a capital "W") to steal from other people. One person's problem does not give her a claim on someone else's life.

2) possible innovation and rationing are actually the weakest points with which to attack Obamacare.

a ) if you can't access the innovative technology, procedure, or medicine because you don't have the money to pay for it (and lots of these innovations are expensive), then you are not inclined to be impressed by the idea that medical innovation will go into a serious decline

Innovation ultimately drives down cost, making medical care more affordable and, therefore, more accessible to Betty Boop.

As far as rationing goes, I'm just looking at what has been working. People at town hall meetings have been yelling about rationing. No body wants it. People hated it when HMO's did it and they don't want the government to do it either.

b ) most people, especially those of us with chronic illnesses or serious medical episodes, are already subject to bureaucrats making decisions about our medical care. The fact that they work for insurance companies is not, for them, a serious distinction. Especially for those people who have to deal with serious medical issues, it's not easy to switch insurance companies (if they can even get it outside their employer's medical benefits), especially since they will probably face the same problems with their new plans. The possibility that the bureaucrats will be government personnel may seem a plus to them--no suspicion of a profit motive, and there is always the possibility that an appeal to one' local Congresscritter will make the bureaucracy respond more favorably.

Congress critters love this type of arrangement because it allows them to be seen solving their constituents problems, thereby making them more popular. They're handing out goodies that should have been available for purchase on the open market in the first place. However, this one might come back to bite them. When a large number of people in a district are dissatisfied with something like medical care, there's no way that a Congress critter could help them all, leaving people frustrated and upset.

3) There are three major problems with the health care system:

a) the current insurance setup, keyed as it is to employer benefit plans, is a huge drain on corporate profits and on company resources. It also, in many cases, ties employees to their current job because they can't afford insurance (or afford to self insure) on their own. Most companies would in fact love to unload the problem of health insurance on someone else.

Some companies would like to dump this problem on someone else, but the real problem is that insurance is being over used as it is. Insurance should not cover minor, routine procedures. It should be reserved for major, financial hardships.

b ) there is almost no way to "comparison shop" when choosing facilities for medical procedures, and often enough in an emergency the patient has no choice in the facility--it's whichever hospital the ambulance crew decides is closest or best in the particular situation.

No one is talking about comparison shopping in an emergency. What I'm talking about is comparison shopping for routine problems. If I have a cold that can't be handled by an over-the-counter drug, I'm going to look for the cheapest way to handle my problem. If I can visit a nurse to obtain a prescription for an antibiotic, then why should I pay a doctor?

c ) the people who are usually in most need of medical insurance are usually the people who have the most trouble getting it--insurance companies being rational are loath to sign on customers whom they know will cost them several thousand dollars a year (at least). (I'm in that case myself, because I have Crohn's Disease (albeit relatively mild) with arthritis and osteoporosis that followed on because of the medicines and restricted diet. No way could I afford insurance as an individual; nor could I to spend in the neighborhood of ten thousand dollars a year for medicines and frequent colonoscopies.)

Some reform of insurance law is probably in order. But, insurance would be impossible if insurance companies were denied the right to refuse to insure people with pre-existing conditions -- one of the primary features of Obamacare. People would simply wait until they were sick to buy insurance. So, people that were healthy would never pay in and sick people wouldn't pay in until they were sick. At that point, the insurance companies wouldn't have any money to pay the sick people's medical bills.

Obama's "solution" is to force everyone to buy insurance, whether they want it or not. This will simply compound the problem alluded to above. Insurance shouldn't be used to for minor or relatively inexpensive, routine procedures. It is the very existence of this all pervasive third-party payer system that is making the medical marketplace so inefficient. In fact, it doesn't behave like a market at all.

There are possible solutions, however. For example, insurance companies could be allowed to deny coverage to sick people for a certain number of years before they started to pay for their pre-existing conditions. Then, at least people would have to think twice about going uninsured. Generally, I don't like interfering in the market, but this might be a compromise solution.

Another thing to do might be to allow insurance companies to limit the amount of money they would pay out in a single year. Then, for example, I could buy a catastrophic insurance policy with a $5000 deductible, a $200,000 yearly maximum and a $2,000,000 lifetime maximum. Allowing insurance companies to put boundaries on the amount of money that they might have to pay out, allows them to make their expenditures more predictable and should help to reduce cost.

Darrell

Edited August 12, 2009 by Darrell Hougen

[Selene]

I happen to really like Camille Paglia, here is just another reason why:

Obama's healthcare horror

Heads should roll -- beginning with Nancy Pelosi's! By Camille Paglia

Aug. 12, 2009 |

Buyer's remorse? Not me. At the North American summit in Guadalajara this week, President Obama resumed the role he is best at -- representing the U.S. with dignity and authority abroad. This is why I, for one, voted for Obama and continue to support him. The damage done to U.S. prestige by the feckless, buffoonish George W. Bush will take years to repair. Obama has barely begun the crucial mission that he was elected to do.

Having said that, I must confess my dismay bordering on horror at the amateurism of the White House apparatus for domestic policy. When will heads start to roll? I was glad to see the White House counsel booted, as well as Michelle Obama's chief of staff, and hope it's a harbinger of things to come. Except for that wily fox, David Axelrod, who could charm gold threads out of moonbeams, Obama seems to be surrounded by juvenile tinhorns, bumbling mediocrities and crass bully boys.

Case in point: the administration's grotesque mishandling of healthcare reform, one of the most vital issues facing the nation. Ever since Hillary Clinton's megalomaniacal annihilation of our last best chance at reform in 1993 (all of which was suppressed by the mainstream media when she was running for president), Democrats have been longing for that happy day when this issue would once again be front and center.

But who would have thought that the sober, deliberative Barack Obama would have nothing to propose but vague and slippery promises -- or that he would so easily cede the leadership clout of the executive branch to a chaotic, rapacious, solipsistic Congress? House Speaker Nancy Pelosi, whom I used to admire for her smooth aplomb under pressure, has clearly gone off the deep end with her bizarre rants about legitimate town-hall protests by American citizens. She is doing grievous damage to the party and should immediately step down.

There is plenty of blame to go around. Obama's aggressive endorsement of a healthcare plan that does not even exist yet, except in five competing, fluctuating drafts, makes Washington seem like Cloud Cuckoo Land. The president is promoting the most colossal, brazen bait-and-switch operation since the Bush administration snookered the country into invading Iraq with apocalyptic visions of mushroom clouds over American cities.

You can keep your doctor; you can keep your insurance, if you're happy with it, Obama keeps assuring us in soothing, lullaby tones. Oh, really? And what if my doctor is not the one appointed by the new government medical boards for ruling on my access to tests and specialists? And what if my insurance company goes belly up because of undercutting by its government-bankrolled competitor? Face it: Virtually all nationalized health systems, neither nourished nor updated by profit-driven private investment, eventually lead to rationing.

I just don't get it. Why the insane rush to pass a bill, any bill, in three weeks? And why such an abject failure by the Obama administration to present the issues to the public in a rational, detailed, informational way? The U.S. is gigantic; many of our states are bigger than whole European nations. The bureaucracy required to institute and manage a nationalized health system here would be Byzantine beyond belief and would vampirically absorb whatever savings Obama thinks could be made. And the transition period would be a nightmare of red tape and mammoth screw-ups, which we can ill afford with a faltering economy.

As with the massive boondoggle of the stimulus package, which Obama foolishly let Congress turn into a pork rut, too much has been attempted all at once; focused, targeted initiatives would, instead, have won wide public support. How is it possible that Democrats, through their own clumsiness and arrogance, have sabotaged healthcare reform yet again? Blaming obstructionist Republicans is nonsensical because Democrats control all three branches of government. It isn't conservative rumors or lies that are stopping healthcare legislation; it's the justifiable alarm of an electorate that has been cut out of the loop and is watching its representatives construct a tangled labyrinth for others but not for themselves. No, the airheads of Congress will keep their own plush healthcare plan -- it's the rest of us guinea pigs who will be thrown to the wolves.

With the Republican party leaderless and in backbiting disarray following its destruction by the ideologically incoherent George W. Bush, Democrats are apparently eager to join the hara-kiri brigade. What looked like smooth coasting to the 2010 election has now become a nail-biter. Both major parties have become a rats' nest of hypocrisy and incompetence. That, combined with our stratospheric, near-criminal indebtedness to China (which could destroy the dollar overnight), should raise signal flags. Are we like late Rome, infatuated with past glories, ruled by a complacent, greedy elite, and hopelessly powerless to respond to changing conditions?

What does either party stand for these days? Republican politicians, with their endless scandals, are hardly exemplars of traditional moral values. Nor have they generated new ideas for healthcare, except for medical savings accounts, which would be pathetically inadequate in a major crisis for anyone earning at or below a median income.

And what do Democrats stand for, if they are so ready to defame concerned citizens as the "mob" -- a word betraying a Marie Antoinette delusion of superiority to ordinary mortals. I thought my party was populist, attentive to the needs and wishes of those outside the power structure. And as a product of the 1960s, I thought the Democratic party was passionately committed to freedom of thought and speech.

But somehow liberals have drifted into a strange servility toward big government, which they revere as a godlike foster father-mother who can dispense all bounty and magically heal all ills. The ethical collapse of the left was nowhere more evident than in the near total silence of liberal media and Web sites at the Obama administration's outrageous solicitation to private citizens to report unacceptable "casual conversations" to the White House. If Republicans had done this, there would have been an angry explosion by Democrats from coast to coast. I was stunned at the failure of liberals to see the blatant totalitarianism in this incident, which the president should have immediately denounced. His failure to do so implicates him in it.

As a libertarian and refugee from the authoritarian Roman Catholic church of my youth, I simply do not understand the drift of my party toward a soulless collectivism. This is in fact what Sarah Palin hit on in her shocking image of a "death panel" under Obamacare that would make irrevocable decisions about the disabled and elderly. When I first saw that phrase, headlined on the Drudge Report, I burst out laughing. It seemed so over the top! But on reflection, I realized that Palin's shrewdly timed metaphor spoke directly to the electorate's unease with the prospect of shadowy, unelected government figures controlling our lives. A death panel not only has the power of life and death but is itself a symptom of a Kafkaesque brave new world where authority has become remote, arbitrary and spectral. And as in the Spanish Inquisition, dissidence is heresy, persecuted and punished.

Surely, the basic rule in comprehensive legislation should be: First, do no harm. The present proposals are full of noble aims, but the biggest danger always comes from unforeseen and unintended consequences. Example: the American incursion into Iraq, which destabilized the region by neutralizing Iran's rival and thus enormously enhancing Iran's power and nuclear ambitions.

What was needed for reform was an in-depth analysis, buttressed by documentary evidence, of waste, fraud and profiteering in the healthcare, pharmaceutical and insurance industries. Instead what we've gotten is a series of facile, vulgar innuendos about how doctors conduct their practice, as if their primary motive is money. Quite frankly, the president gives little sense of direct knowledge of medical protocols; it's as if his views are a tissue of hearsay and scattershot worst-case scenarios.

Of course, it didn't help matters that, just when he needed maximum momentum on healthcare, Obama made the terrible gaffe of declaring that, even without his knowing the full facts, Cambridge, Mass., police had acted "stupidly" in arresting a friend of his, Harvard professor Henry Louis Gates Jr. Obama's automatic identification with the pampered Harvard elite (wildly unpopular with most sensible people), as well as his insulting condescension toward an officer doing his often dangerous duty, did serious and perhaps irreparable damage to the president's standing. The strained, prissy beer summit in the White House garden afterward didn't help. Is that the Obama notion of hospitality? Another staff breakdown.

Both Gates and Obama mistakenly assumed that the original incident at Gates' house was about race, when it was about class. It was the wealthy, lordly Gates who committed the first offense by instantly and evidently hysterically defaming the character of the officer who arrived at his door to investigate the report of a break-in. There was no excuse for Gates' loud and cheap charges of racism, which he should have immediately apologized for the next day, instead of threatening lawsuits and self-aggrandizing television exposés. On the other hand, given that Cambridge is virtually a company town, perhaps police headquarters should have dispatched a moderator to the tumultuous scene before a small, disabled Harvard professor was clapped in handcuffs and marched off to jail. But why should an Ivy League panjandrum be treated any differently from the rest of us hoi polloi?

Class rarely receives honest attention in the American media, as demonstrated by the reporting on a June incident at a swimming pool in the Philadelphia suburbs. When the director of the Valley Swim Club in Montgomery County cancelled its agreement with several urban day camps to use its private pool, the controversy was portrayed entirely in racial terms. There were uninvestigated allegations of remarks about "black kids" made by white mothers who ordered their children out of the pool, and the racial theme was intensified by the director's inept description of the "complexion" of the pool having been changed -- which may simply have been a whopper of a Freudian slip.

Having followed the coverage in the Philadelphia media, I have lingering questions about how much of that incident was race and how much was social class. Urban working-class and suburban middle-class children often have quite different styles of play -- as I know from present observation as well as from my Syracuse youth, when I regularly biked to the public pool in Thornden Park. Kids of all races from downtown Syracuse neighborhoods were much rougher and tougher, and for self-preservation you had to stay out of their way! Otherwise, you'd get knocked to the concrete or dunked when they heedlessly jumped off the diving board onto our heads in the crowded pool.

In general, middle-class children today are more closely supervised at pools because the family can afford to have a non-working parent at home -- a luxury that working-class kids rarely have. What happened at the Valley Swim Club, whose safety infrastructure was evidently also overwhelmed by too many visiting kids who were non-swimmers, may have been a clash of classes rather than races. Were the mothers who pulled their kids out of the pool that day really reacting to skin color or what they, accurately or not, perceived to be an overcrowded, dangerous disorder? The incontrovertible offense in all this, which went unmentioned in the national media, was the closure for budgetary reasons by the city of Philadelphia this summer of 27 of its 73 public pools. There is no excuse for that kind of draconian curtailment of basic recreational facilities for working-class families, sweltering in the urban summer heat.

Now on to art and pop. Highlight of the month for me was definitely a recent performance by Alo Brasil, a local Brazilian music and dance ensemble, at Philadelphia's World Cafe Live. I positioned myself smack in front of the stage to bathe in the magnificent, hypnotic drumming, a Bahian style with West African roots that takes one into another reality -- sublime and trans-historical. Of course, then there was the sensory overload of the beautiful, nimble, long-legged samba dancers in their jeweled bikinis and high heels! But all the dancers of Alo Brasil, male and female, are absolutely brilliant -- it was mind-blowing. Anyone born and raised in Bahia (such as Daniela Mercury) has obviously been immersed in these rhythms from earliest childhood. They are surely profoundly transformative, reshaping the neural synapses and opening the mind toward ecstatic group communication. To be continued!

Our pop medley for this column begins with the Algeria-born Etienne Daho, whose three-disc set, "Dans la Peau de Daho" (2002), I have been working my way through. Last year, I posted two other videos featuring Daho -- his quietly compelling

with Charlotte Gainsbourg and his moving tribute to Warhol superstar Edie Sedgwick. This song,

is a hauntingly atmospheric ode to random encounters in the streets and cafés of Paris. In the narrative superimposed by the video, two notable French performers do their thing -- Virginie Ledoyen (who appeared with Catherine Deneuve in "8 Women" and with Leonardo DiCaprio in "The Beach") and singer/actor Benjamin Biolay, ex-husband of Chiara Mastroianni, the daughter of Deneuve and Marcello Mastroianni. I love the way Daho's shimmery song re-creates the meditative mystique of French eroticism, shown in a thousand films. And that liquid, stuttering bass line -- divine! (Hey, Salon readers, if you don't have good speakers on your computer, you're missing the cultural riches of the Web.)

Next on the docket is Sharon Stone, exploding in all her topless glory on the cover of Paris Match. Now there's a gal who knows how to work the gym while still keeping the sacred flame of sexiness alive! Yes, you know who the Big Bad Example is of obsessive gym culture gone to seed -- that increasingly artificial construction of paraffin and chicken wire, our Madonna of the Shallows. Jesus Luz must be blessedly myopic. (Cue the Contours' 1965 R&B hit, "First I Look at the Purse.")

Caught HBO's 1998 movie "Gia" for the umpteenth time on cable the other day. My admiration remains boundless for the 22-year-old Angelina Jolie's bravura performance as the Philadelphia-born fashion model Gia Carangi, a heroin addict who died of AIDS in 1986. I've often recommended Stephen Fried's excellent 1993 biography, "Thing of Beauty: The Tragedy of Supermodel Gia," but this time I hit the Web to see what else I could dig up.

Mother lode! I found Gia's original nude fence photos, shown in the movie being shot by the perverse fashionista Chris von Wangenheim. I was startled to learn that Wangenheim was killed in a car accident in 1981, another blow for Gia. In trying to find his obit, I discovered that New York Times files of the World War One era are filled with references to his noble German ancestors, many of whom were barons killed in battle. Another German decadent artiste, like the incomparable Helmut Newton.

Here are some wonderful photos of Wilhelmina (stylishly played in the movie by Faye Dunaway), the Dutch fashion model veteran of 300 covers who founded an agency that hired the scrappy Gia but who then tragically died of cancer at age 40 in 1980, leaving Gia bereft. And here's Gia's ever-patient, real-life girlfriend, Sandy Linter, who turns out to be a more in-your-face urban type of the Deborah Harry school than she was portrayed in the movie.

Interested parties should check out this

, with a great song, which ingeniously conflate Gia with Patricia Charbonneau in that lesbo classic "Desert Hearts" (1985). This is a good chance to appreciate anew the charming eroticism of the car-in-the-rain first kiss between Charbonneau and Helen Shaver, which proves the point I made in my last column about the best lesbian scenes on film having ironically been performed by straight women. Finally, here is Gia herself --

showing her in surly, rambling butch mode, with druggy speech and tics, and then a dazzling collection of her

, which whiz by too fast but still reveal what an astonishing, almost supernormal presence she was.

Oh, one last note. Gay trivia: The 17-year-old hustler who in 1975 murdered the gay film director Pier Paolo Pasolini by repeatedly running him over with his own car on an Italian beach was named Giuseppe Pelosi. Hmm ... Hustling must run in the family.

Adam

[jeffrey smith]

I think some things tend to run unnoticed in this type of discussion:

1) most people find the idea that quality of medical care, and ultimately survival, is linked to one's access to financial resources (meaning one's own assets and the available insurance) to offend their ideas of morality. They think it's Wrong (with a capital W) that Betty Boop will die because she can't afford to pay the hundred thousand dollars the hospital and surgeons will charge to perform the latest procedure that's been shown to be effective in her type of case.

The answer to that is that it is Wrong (with a capital "W") to steal from other people. One person's problem does not give her a claim on someone else's life.

Just to be clear, I agree with you. But I'm talking here about the way most people perceive things, and the political impact that has.

2) possible innovation and rationing are actually the weakest points with which to attack Obamacare.

a ) if you can't access the innovative technology, procedure, or medicine because you don't have the money to pay for it (and lots of these innovations are expensive), then you are not inclined to be impressed by the idea that medical innovation will go into a serious decline

Innovation ultimately drives down cost, making medical care more affordable and, therefore, more accessible to Betty Boop.

Again, public perception is what I'm talking about here. People don't usually think of medicine as an economic good, and that perception has results in politics and other places.

As far as rationing goes, I'm just looking at what has been working. People at town hall meetings have been yelling about rationing. No body wants it. People hated it when HMO's did it and they don't want the government to do it either.

Agreed. But for many people it boils down to rationing by an insurance company or rationing by the US government.

b ) most people, especially those of us with chronic illnesses or serious medical episodes, are already subject to bureaucrats making decisions about our medical care. The fact that they work for insurance companies is not, for them, a serious distinction. Especially for those people who have to deal with serious medical issues, it's not easy to switch insurance companies (if they can even get it outside their employer's medical benefits), especially since they will probably face the same problems with their new plans. The possibility that the bureaucrats will be government personnel may seem a plus to them--no suspicion of a profit motive, and there is always the possibility that an appeal to one' local Congresscritter will make the bureaucracy respond more favorably.

Congress critters love this type of arrangement because it allows them to be seen solving their constituents problems, thereby making them more popular. They're handing out goodies that should have been available for purchase on the open market in the first place. However, this one might come back to bite them. When a large number of people in a district are dissatisfied with something like medical care, there's no way that a Congress critter could help them all, leaving people frustrated and upset.

3) There are three major problems with the health care system:

a) the current insurance setup, keyed as it is to employer benefit plans, is a huge drain on corporate profits and on company resources. It also, in many cases, ties employees to their current job because they can't afford insurance (or afford to self insure) on their own. Most companies would in fact love to unload the problem of health insurance on someone else.

Some companies would like to dump this problem on someone else, but the real problem is that insurance is being over used as it is. Insurance should not cover minor, routine procedures. It should be reserved for major, financial hardships.

b ) there is almost no way to "comparison shop" when choosing facilities for medical procedures, and often enough in an emergency the patient has no choice in the facility--it's whichever hospital the ambulance crew decides is closest or best in the particular situation.

No one is talking about comparison shopping in an emergency. What I'm talking about is comparison shopping for routine problems. If I have a cold that can't be handled by an over-the-counter drug, I'm going to look for the cheapest way to handle my problem. If I can visit a nurse to obtain a prescription for an antibiotic, then why should I pay a doctor?

Because the nurse may be almost as expensive as the doctor.

But what I had in mind was not nurse vs doctor but doctor X v doctor Y. If Dr. X charges more, than I'll probably choose Dr. Y if they seem to have equal backgrounds, etc. But very often I don't have that option. Nor do I have any feasible way of finding out which hospital charges less for a colonoscopy when my GI doctor says he needs to do one. I don't even have a way of finding out even what the hospital I use charges.

c ) the people who are usually in most need of medical insurance are usually the people who have the most trouble getting it--insurance companies being rational are loath to sign on customers whom they know will cost them several thousand dollars a year (at least). (I'm in that case myself, because I have Crohn's Disease (albeit relatively mild) with arthritis and osteoporosis that followed on because of the medicines and restricted diet. No way could I afford insurance as an individual; nor could I to spend in the neighborhood of ten thousand dollars a year for medicines and frequent colonoscopies.)

Some reform of insurance law is probably in order. But, insurance would be impossible if insurance companies were denied the right to refuse to insure people with pre-existing conditions -- one of the primary features of Obamacare. People would simply wait until they were sick to buy insurance. So, people that were healthy would never pay in and sick people wouldn't pay in until they were sick. At that point, the insurance companies wouldn't have any money to pay the sick people's medical bills.

Obama's "solution" is to force everyone to buy insurance, whether they want it or not. This will simply compound the problem alluded to above. Insurance shouldn't be used to for minor or relatively inexpensive, routine procedures. It is the very existence of this all pervasive third-party payer system that is making the medical marketplace so inefficient. In fact, it doesn't behave like a market at all.

There are possible solutions, however. For example, insurance companies could be allowed to deny coverage to sick people for a certain number of years before they started to pay for their pre-existing conditions. Then, at least people would have to think twice about going uninsured. Generally, I don't like interfering in the market, but this might be a compromise solution.

Another thing to do might be to allow insurance companies to limit the amount of money they would pay out in a single year. Then, for example, I could buy a catastrophic insurance policy with a $5000 deductible, a $200,000 yearly maximum and a $2,000,000 lifetime maximum. Allowing insurance companies to put boundaries on the amount of money that they might have to pay out, allows them to make their expenditures more predictable and should help to reduce cost.

Darrell

Non coverage of pre-existing conditions for (usually) a year, and yearly/ lifetime maximums have been part of every insurance plan I've had

Jeffrey

[Selene]

This is from my daily Rasmussen e-mail:

"Support for the health care reform plan proposed by President Obama and congressional Democrats has fallen to a new low. Just 42% favor the plan while 53% are opposed. Other data shows that 51% fear the federal government more than private insurance companies. Forty-one percent (41%) fear the insurance companies more. Overall, 32% favor a single-payer health care system for the U.S. while 57% are opposed."

Note: This is the tipping point if it is maintained and expanded. 51% FEAR the federal government more than private insurance companies.

This is stunning. Now is the time to push really hard, of course, the self destructive libertarian party, for lack of a better phrase, is no where to be found. No ad buys, no radio spots pitiful.

Remember, Rasmussen selects from voters unlike Gallop and some other major polling firms.

Adam

Edited August 12, 2009 by Selene

[Darrell Hougen]

Because the nurse may be almost as expensive as the doctor.

But what I had in mind was not nurse vs doctor but doctor X v doctor Y. If Dr. X charges more, than I'll probably choose Dr. Y if they seem to have equal backgrounds, etc. But very often I don't have that option. Nor do I have any feasible way of finding out which hospital charges less for a colonoscopy when my GI doctor says he needs to do one. I don't even have a way of finding out even what the hospital I use charges.

Nurse versus doctor is just one example. It could be doctor X versus doctor Y. But, I think that if there were more of a market in medicine, medicine would be more like getting your car fixed or going to a dentist. They probably wouldn't tell you the cost over the phone, but if you came in, they might do a free consultation to get your business. Or, they might charge for the initial diagnosis, meaning it would cost you something to shop around. But it still might be worth it if the problem was expensive to treat.

In a free market, there is an incentive for service providers to tell you how much it is going to cost. One of the ways that a person offering identical services to another can drum up business is to offer his services at a lower price. And, supply is usually plentiful in a truly free market, meaning price competition will exist.

I think a market place would also help to change people's perception of medicine. People routinely plunk down $20,000 for a new car, so what is so horrible about plunking down $20,000 for a new hip joint? The one difference that might be hard to overcome is that a new hip joint is seen as a repair while a new car is seen as something that will enhance a person's life. So, people tend to curse about the cost just as they curse about the cost of getting their car fixed.

I need to modify something that I said above. The marketplace should operate for major, expensive procedures as well as minor, inexpensive ones. Through co-insurance, people would have a motivation to choose less expensive care. I realize that many people already have to pay co-insurance, but there are still a lot that don't and I think that is one of the factors that makes doctors reluctant to discuss costs.

Of course, there are other problems with the market beyond the perverse tax incentives for insurance. The limits on the numbers of doctors and nurses, over regulation of medications and regulations of hospitals and clinics also hamper the marketplace.

Nevertheless, if I were paying the bill, I'd want to know how much my treatment were going to cost, and I don't think it inappropriate to ask a doctor or office personnel what the total charges are going to be. People are just much less likely to do that if insurance is footing the bill.

Non coverage of pre-existing conditions for (usually) a year, and yearly/ lifetime maximums have been part of every insurance plan I've had

Well, I guess that goes to show what I (don't) know about insurance. I guess if my insurance has had a yearly cap, I've never noticed it, though I have seen lifetime caps before.

Part of the complexity is that different states have different regulations. When I was in Illinois, I looked into buying insurance and it was very expensive -- something like $6000 / year. Modifying the deductible didn't help that much. There was no way to choose a different lifetime maximum and she never said anything about a yearly maximum. At the time, I thought that the problem was probably with the insurance company, but now I suspect it was with the law in Illinois. Illinois might have required the insurance to be comprehensive, covering psychiatric care, chiropractic care, etc.

Later, when I was unemployed for a while in Colorado, I bought a catastrophic health care policy. I don't remember what the deductible was, but it was probably between $5,000 and $10,000. The premiums were fairly low. Again, I don't remember the exact figure, but I think it was between $99 and $200 per month for myself, only. (My wife and kids were covered under her employer's policy, but it was actually cheaper for me to buy a catastrophic policy for myself than to be added to her comprehensive policy.)

Darrell

[Darrell Hougen]

Just to add to the stats Adam posted earlier, here are some stats from an article at Townhall.com.

Rasmussen now reports that elderly folks over 65 are against Obamacare by 56 to 39. That’s a bad number for Democrats who rely on seniors to maintain their governing coalition. Incidentally, polls also show that about 75 percent of Americans are satisfied with their health-care services, while 80 to 90 percent are happy with the whole U.S. health-care system.

It’s still tough to know whether this behemoth government takeover of heath care will actually pass. But two key markets are betting against it. First, over at the Intrade pay-to play online-betting parlor, the bid for the U.S. government health-plan contract is only 38 cents. That’s down from 50 cents in late July. Second, the share prices of big private health insurers have rallied in recent weeks. UnitedHealthcare is up 13 percent; Humana is up 12.4 percent; and Aetna is up almost 10 percent. These firms will be decimated if the government insurance plan passes. But investors are now predicting it won’t.

I'm cautiously optimistic.

Darrell