It seemed appropriate that Rudy Giuliani would introduce his health care plan yesterday on what would have been Milton Friedman?s 95th birthday. Friedman would have been pleased. If you like tax increases, government mandates, uniformity, and regulation there is not much you will like in the RudyCare plan. But, if you like the free market, competition, individual ownership and personal responsibility there is much to interest you.
The Plan is most striking for what it does NOT do. It eschews a single payer system. There is no mandate requiring individuals to purchase insurance, which was the central feature of Mitt Romney?s Massachusetts plan. There is no requirement for businesses to cover their employees.
Sally C. Pipes, President and Chief Executive Officer of the Pacific Research Institute, a San Francisco-based think tank, and health care advisor to Giuliani has been a frequent critic of the Massachusetts plan. She explains that government mandates simply don?t work to increase coverage and lower costs as evidenced by the Massachusetts plan. According to Pipes, costs in Massachusetts have exceed projections, individuals are opting to pay a yearly fine rather than purchase insurance, and the state has been forced to exempt 20% of the population from the individual mandate.
Why not require businesses to cover their employees? Dr. Mark McClellan, former head of the FDA who advised Giuliani on his plan, explains that without fundamental reforms insurance is simply not affordable for many small and medium sized businesses.
So what does Giuliani?s plan do? Pipes says the concept is simple: ?It is about giving Americans control and ownership over their health care which will allow affordable, accessible and quality health care.?
Some key components of the plan include: 1) an income exclusion of up to $15,000 for a family for those without employer coverage; 2) a Health Insurance Credit to low-income Americans that can be coupled with Medicaid and employer contributions; 3) expanded access to health savings accounts by simplifying the rules and regulations; 4) a reduction in unnecessary medical costs by limiting non-economic damages in medical malpractice lawsuits; 5) block grants provided to states to encourage innovation; 6) reduce or eliminate some of the 1,900 state mandates which limit coverage options, increase costs and prevent individuals from purchasing insurance across state lines; and 7) increase accountability and efficiency for government approval of new drugs(which sometimes takes up to 15 years).
Dr. McClellan says in the current system we are spending billions of dollars, half of it paid for by the government, but we are ?not getting our money?s worth.? He emphasizes that preventive medicine is an essential part of any reform. The plan, he says, will help us move toward ?more emphasis on catching diseases early and allowing individuals to find effective treatment options before complications set in.?
Clearly, if individuals are purchasing insurance they have every incentive to spend small amounts on ?maintenance? — just like they do for their cars — rather than incur huge costs down the road.
What about uninsured Americans? Pipes says that by putting money in the hands of individuals we will ?increase the number of entrants into the health care market.? If we simultaneously reduce costs by measures such as eliminating the maze of state mandates and limiting frivolous lawsuits which drive costs up, insurance will be more affordable both for individuals who purchase insurance themselves and for employers who provide insurance to their employees. In this way Giuliani hopes that every individual who wants insurance can afford it. Pipes explains that Giuliani is offering ?universal choice, not universal coverage.?
Who is going to like this plan? Pipes says the uninsured, those who would like to reduce their costs of insurance, and doctors stand to benefit. The losers? Pipes says bluntly,
?Plaintiffs lawyers and Democrats who advocate government control of health care.? Not a bad political outcome for someone running for the Republican nomination under the banner of free market capitalism. And not a bad tribute to Milton Friedman.
August 1st, 2007 at 10:25 am
I have to say, as a current Romney guy, former Giuliani guy, that I am very, very impressed by this. Romney’s plan was very practical, but once I found out about the inner-workings, it struck me as a little anti-liberty. I understand that if hospitals have to give you care, that you should have to have insurance, but still.
Home run, Rudy. Home run. I’d love to see him tear apart Hillary Care in a debate.
August 1st, 2007 at 10:28 am
It’s absolutely amazing that all these Ron Paulist so-called
“Libertarians” are completely
ignoring the fact that an outspoken libertarian like Sally Pipes
has been appointed
to the Giuliani Campaign.
August 1st, 2007 at 10:45 am
Just a comment about #5 and #6.
#5 Edwards and company will hate this plan because there will be tort reform. Illinois has a huge physician bleed because Wisconsin has tort reform and we don’t. Malpractice insurance premiums force doctors to leave the state. Don’t get into a car accident in Southern Illinois since there are no neurosurgeons for hundreds of miles. People in high risk pregnancies are being told to sue if anything is wrong with the baby. There is no such thing as act of nature. Now, it’s always the doctor’s fault.
#6 state mandates Medicare in Illinois is forced by law to pay for fertility treatments of anyone receiving Medicare. There are expensive claims being made and they have to be paid.
Since Illinois is run mainly by Democrats, there is never any hope for health care reforms since trial lawyers are the main contributors to their campaigns.
August 1st, 2007 at 10:47 am
What are important are Rudy’s ideas, not Rudy’s endorsements, Eric. Where is your logical consistency?
The fact is that Rudy is not at all a fan of individual freedoms. One look at his record and rhetoric can show that.
August 1st, 2007 at 10:55 am
Several problems with this article. First, Romney’s plan in Mass. is NOT the plan he will endorse as president. The facts are a little misleading in your article. Second, Romney’s plan in Mass HAS IN FACT increased coverage of uninsured citizens in Mass by over 100,000 in the short time that it has been around. Romney’s plan has worked well though there have been some unanticipated hang-ups, but it is worth mentioning that none of the hang-ups have “broken the system” or been too major of a problem. The system is working.
August 1st, 2007 at 10:58 am
It is also worth mentioning that Romney is the only candidate to have actually ACCOMPLISHED anything in this area, including GOP or Dem candidates. Anybody can put forward a plan, but getting it to work is totally different.
August 1st, 2007 at 11:04 am
I think the ideal health care plan is conservative / libertarian. Hospitals don’t have to take care of you if you don’t have insurance combined with some subsidies to the poor to help them purchase health care if they so choose. However, that will NEVER happen. People will always find it totally inhumane for a hospital not to take care of an uninsured person – even though in the long-run I at least believe it is the more cost-effective and thus humane solution.
Given that, I think Rudy’s plan is worth a shot b/c it appears through deregulation that the number of uninsured will decrease from the current 45 million. However, if there are still some significant portion who are uninsured, let’s 20-25 million, then I think it makes economic sense to mandate health insurance for everyone. Otherwise, you allow the uninsured to basically steal money from the insured and that doesn’t strike me as particularly fair or conservative.
August 1st, 2007 at 11:04 am
This is a fine start to a plan but clearly is only a start.
The problem is that Rudy never did anything about healthcare reform when he had the chance. It reduces his credibility on this issue.
August 1st, 2007 at 11:08 am
econ grad stud… ok, I refrain from comment
August 1st, 2007 at 11:34 am
Well… There is a significant difference of opinion as to whether Mitt’s plan “worked” or is simply a ticking time bomb.
I have to admit that after the 2004 election when I was taking a close look at all of the candidate’s records, Mitt’s record of accomplishment was very, very, appealing to me.
But when I discovered that Romneycare specifically excludes HSA plans from satisfying state requirements for a qualifying health plan, I knew that Mitt could never be my first choice for the Republican nomination.
HSA plans are the conservative solution to our nation’s health care crisis. They are the way out of the mess that we are in. HSA’s are a beacon of hope that we can solve our health care crisis without a massive expansion of government.
For those who do not know what HSA are, here’s a really quick primer:
-An HSA (Health Savings Account)is a high deductible individual health plan that is attached to a savings account (as the name implies!)
-Because the deductible is high on these plans, the premium you pay is quite low (we’re talking under $90 a month in many cases)
-You can then divert money from your paycheck on a pre-tax basis into the health saving account. This lowers your tax burden (like a 401K)
-The money that you deposit in your HSA can now be invested and grow over time (just like a mutual fund/401K)
-The money in your HSA account can be used to satisfy your deductible and pay co-pays and the like if you choose that option on your plan.
So imagine this hypothetical scenario (now I am just coming up with this on the spot to give you the gist)…
You have a child (congrats!), you take out a HSA plan for your family, and immediately begin depositing a certain amount each month into the HSA. Since the deductible is high, your premium each month is very low. The money that you deposit comes out pre-tax, so you get to pay less money in taxes to the government (Yeah!)
Over time that money grows and grows, with a little bit coming out here and there for the occasional ear infection, broken arm, etc… Eventually there is multiple thousands of dollars in reserve to cover costs when needed.
When folks start having the usual problems like high cholesterol, high blood pressure, etc… They have enough money to cover their deductible to pay for these costs.
So let’s say Johnny has a $3200 a year deductible, after which the insurance company pays 100% of the cost. He suffers a heart attack and needs major work. Since he has tens of thousands of dollars in his HSA, he will be able to pay that $3200 deductible for years on end! It’s essentially already been paid for!
This is the way for people to assume control and responsibility for their own health care. And it keeps the government out of it! No government controls on what health care you can or cannot have. No massive expansion of government.
This is the future that Rudy envisions for America folks… A vision of market solutions empowering people to have control over their own lives!
August 1st, 2007 at 11:37 am
EGS #9,
Doing nothing is preferable to doing what Mitt did in MA. See my above post for why.
August 1st, 2007 at 11:39 am
If anyone calls Rudy a “RINO” after the annoucement of this plan I will just scream….this makes him 50 times more conservative than than GW, the biggest RINO of all
August 1st, 2007 at 11:50 am
AU,
Rudy=RINO
Just Kidding.
August 1st, 2007 at 12:01 pm
Well, on social issues, Rudy is the deffinition of a RINO, though, in terms of economic issues, Rudy seems to be reasonably Conservative – though his record of expanding the NYC debt is not exactly encouraging.
I think Romney’s plan has high points and low points, as I’m sure does Rudy’s.
August 1st, 2007 at 12:17 pm
ACT Blog, can’t you understand that there is more to being a Republican than social issues? There’s a reason that I’m a Republican and not a member of the Libertarian Party. (Well, when I turn 18 in March, anyway.) As many are prone to repeat around here: parties are coalitions of interests. Rudy is not a “RINO on social issues.” He’s a moderate on social issues. He’s a conservative on economic and defense issues. It goes back to what Kavon was saying yesterday — if abortion is what defines one’s conservatism, then fine, Rudy’s a RINO. Have it your way. But if, as David B said last month, that it’s about one’s overall stances on the issues and what priority is placed on each of them and not about just throwing everything into a blender to get a political label, then Rudy is a thorough conservative. But his conservatism is primarily focused on economic growth and protecting the country. This is different than, say, Brownback’s conservatism — purely social.
But it’s all about priorities — what is this man going to try to *do* as President? He can only focus on so many issues at once. Brownback, for example, may be a lovely fiscal conservative, but that’s *not going to be his focus.* Likewise, gun control is not going to be a top priority for Rudy, so I’m not concerned about it. Do I wish he weren’t in favor of it? Yes. Are any of us really suffering under the delusion that President Giuliani’s top initiative will be taking away our guns? Of course not. Rudy will govern as a conservative. But his priorities will not be social.
It should speak volumes about this health care plan that the only thing that the Romneybots can come up with to criticize it is that it wasn’t implemented sooner. (#9) And I think it should reassure all of us who place utmost importance on economic issues that Rudy should indeed be our guy.
August 1st, 2007 at 12:21 pm
Kavon, I’m sure you think HSA are a magic bullet. They aren’t.
HSA will work for upper middle class folks (upper 25% of wage earners) because their health costs don’t rise above 20% of their total income until old age. For this group HSAs are indeed a solution.
For the bottom 75% of wage earners healthcare costs are at least 20% of their yearly expense. One emergency room visit can be 5-10% of their yearly income if they don’t have insurance.
Healthcare is too complex for a one-size fits all solution like HSAs.
A real solution to healthcare will have to focus on the need for healthcare not just the cost of it. Worse than an inefficient healthcare system, Americans are becoming more unhealthy.
August 1st, 2007 at 12:33 pm
Econ,
Although I would like to be, I’m not in the upper 25% of wage earners. I have 3 kids and have had an HSA for the last 3 years. It is a great, market driven idea. I don’t think that Kavon put it forward as a “magic bullet” but it should be part of the puzzle.
TLG,
“Romneybots” are not bashing Rudy’s plan but pointing out that he had to get what he could from a Mass. legislature and it was pretty good considering the circumstances. You can float an idea that you like (like Rudy’s) without the hassle of getting it through the Legislature. It can be a great idea. Romney did the best he could in Mass. and has said that it is not the plan that will work all around the US.
August 1st, 2007 at 12:39 pm
“There is no mandate requiring individuals to purchase insurance, which was the central feature of Mitt Romney’s Massachusetts plan. ”
So when someone elects *not* to purchase insurance, I (the tax payer) am still compelled to underwrite their lack of insurance by my tax dollars when they are in the hospital for weeks? I not saying that the government ought to compel a person to a particular plan, I’m saying the government should compel someone to get *a plan* that meet the basics so I don’t have to bail them out as often. I have to buy a limited amount of car insurance for the same reasons, why not health insurance?
Rudy’s plan has some good things on paper but I’d doubt that it would ever pass. Something as monumental has health care is going to require both parties signing onto it. There is just too much here that the Democrats would never go for. Before you knock Mitt’s Health care plan, remember that Mitt himself has said that the Massachusetts Plan would not work nationally. However, he did say that a different version of his plan could work nationally.
Bottom line, it is going to take serious innovation and cooperation for anything like this to be accomplished. Romney is the only candidate running who has achieved such a thing. Nearly all candidates have come up with health plans and failed. How many have actually succeeded? Just Romney.
August 1st, 2007 at 12:52 pm
Troy I assume you’ve got a co-operative employer, no?
I certainly agree that for families with a lot of disposable income and good health or chronically bad health HSAs are a good plan.
They don’t address the main problem though which is that preventative care remains less costly in the short-run than healthcare. Since most people have small time horizons (explain the dearth of retirement otherwise) changing the method of payment doesn’t actually improve health outcomes.
HSA are fine but I’d appreciate it if our candidates would get down to the real problem which is Americans worsening health.
August 1st, 2007 at 12:54 pm
that should be “preventative care remains _more_ costly in the short-run than healthcare”
August 1st, 2007 at 12:59 pm
The bottom line is what he said above. This plan will never pass, especially with the current Congress, so it’s really just rhetoric right now. Meaningless. It’s like Bush’s ideas on Social Security. They may have been great, but they were never going to pass. That said, for Rudy to get this out there and have a conservative plan with conservative principles and Friedman inspired qualities can only help him in the primaries.
Anyone who thinks however that a Rudy WH would really be concerned with health care all that much is kidding themselves. Foriegn policy, terrorism, taxes, the economy and good judges will be his main priorities.
We all know that this plan has 0% chance of passage so it’s really much ado about nothing.
August 1st, 2007 at 1:37 pm
Actually, it’s highly presumptuous and simplistic to state that “this plan has 0% chance of passage.” In the sense of being swallowed whole without alteration, amendment, or addition, then that’s obviously true – and is true of every other plan advanced by every other candidate and non-candidate.
One thing that actually gives Rudy’s approach more of a chance of being adopted is that its ideas and provisions are not mutually dependent, and can be adapted and adjusted. The more that a plan is dependent on being adopted in full, the more likely it is to suffer the fate of Clintoncare or, for that matter, Immigration Reform. The era of big government may not be over, but the era of thinking in terms of big fixes, and of total re-structuring of massive segments of the economy, may be.
August 1st, 2007 at 1:55 pm
I like how this article sets up Romney’s Massachusetts plan as the straw man to knock down when presenting Giuliani’s “planâ€, since everybody knows the Massachusetts plan isn’t Romney’s national plan. I also like how it states that “individuals are opting to pay a yearly fine rather than purchase insurance†as if it shows a failure in the system. How is this really different from insurance? They pay the government, and later the government winds up paying for their healthcare. If they paid nothing, that would be a problem. Eventually I would expect insurance companies to figure out a way to reach this group and make money from them, but some things take time.
Calling Rudy’s “plan†free market capitalism seems a little crazy to me. I’ll give it, that it seems to increase choice ever so slightly, but it doesn’t seem to get people off of free government healthcare which is the definition of socialized medicine if you ask me.
There is one part I have to agree with though; “The Plan is most striking for what it does NOT do.†Which is much of anything.
August 1st, 2007 at 2:09 pm
“The Plan is most striking for what it does NOT do.”
Ya got that part right, at least.
EGS is correct about how HSAs are no real solution at all. They may be an attractive option for people who are not really experiencing any problem with health care to begin with, or who have well paying jobs for employers who are looking to shed their healthcare costs. But not for most people.
He goes on to write: “HSA are fine but I’d appreciate it if our candidates would get down to the real problem which is Americans worsening health.”
Aint gonna happnen. Sorry to be blunt here, but Republicans DO NOT CARE about the health of Americans. They care about avoiding anything that would get in the way of a tax cut, and they care about trying to force an economic ideology onto situations irrespective of whether that makes the situation any better. Republicans will offer “healthcare plans” to the extent that they read the polls and see that it is something that voters care about. But none of them will be serious attempts to solve any problem beyond the problem of November 2008.
August 1st, 2007 at 2:29 pm
just a little heads up…
Rudy will be on the Charlie Rose Show tonight, for an hour-long interview.
For those of you who dont know the show, it is probably the best TV interview show out there, and usually yields very insightful discussion.
On PBS, probably at 11:00 – check your local listings….
August 1st, 2007 at 2:30 pm
– “Republicans DO NOT CARE about the health of Americans.”
I just got an image of Kanye West: “George Bush doesn’t care about black people.” Thanks Tano, I spit my drink all over the keyboard. That should go down as one of the all time stupid statements of the year.
August 1st, 2007 at 2:42 pm
Tano:
Would you hold a gun to a doctor’s head forcing him to give you healthcare?
August 1st, 2007 at 2:45 pm
Troy,
Very insightful response.
Your lack of any substance makes it hard for me to find anything to even consider, let alone learn from in your response.
If there is any sincerity in your response, as opposed to just knee-jerk name calling, let me point out that I am not saying that Republicans wish anything bad for Americans, nor am I saying that, in some cosmic sense, they are indifferent to pain and suffering that ill people endure.
I am simply saying that as political actors, considering their political agenda, and what they feel the governmennt should be doing, they do not take healthcare issues seriously. In that sense, they do not care about the health of Americans – as a political concern, as a reason for the government to do something.
I dont see why you find this offensive, or stupid. If pressed, I bet you can find most Republicans saying almost the exact same thing – although obviously they would put it in a less-blunt, more indired manner.
Government should provide for the national defense, and do little more. What does that mean, except that “we dont care about health issues when we consider the proper agenda for government”?
Just look at the Republcian healthcare “plans”. They seem obviously to be absolutely minimal efforts to say that they have done something (because the voters are concerned), but basically saying “your health is your own concern, not ours”.
Thats Rudy’s plan, right? Catastrophic insurance, and tax breaks to allow you to save up to take care of your own problems. With a little welfare thrown in for the very poor who obviously cant play.
No consideration of whether this would ACTUALLY work to make things better (it clearly wont). No attempt to do the slightest thing to actually reduce the number of uninsured. No overall vision of how to make the system more efficient, or available to all. He just doesnt care about those concerns, because caring about them is alien to his ideology.
Mitt gets a partial exemption from this critique, because his plan at least is an attempt to see and deal with the fundamental problem.
August 1st, 2007 at 2:56 pm
It is just absolutely astounding to me that the problem of rising healthcare costs, which was caused by the government’s involvement in healthcare in the first place, is being solved by what, by both Republicans and Democrats? The Government!
Imagine you’re sick. The doctor gives you Cure X. Cure X makes you sick. Do you demand more of Cure X? Of course not!! You get the doctor the heck out of your life. When will people realize this?
We don’t need more governmental involvement in healthcare, whether it be fuddling around with the tax code or mandatory health insurance or a single payer insurance program. We just need to stop diagnosing the wrong cure.
August 1st, 2007 at 3:04 pm
Nusrat,
Your assumption is wrong.
Rising health care costs are 1) not the only problem with the health care system, and 2) not primarily caused by government involvment.
Health care costs are rising because people are living longer (a very large amount of money is spent on the elderly trying to maintain life in cases where, in the past, people would simply have died earlier), and because medicine is becoming a very high-tech operation. Instead of a GP spending a few minutes poking a prodding your painful shoulder, we now send you to get a (very expensive) MRI. One of a million examples of the types of advances that happen to be infinitly more expensive then what used to be the standard.
You seem completely uninterested in actually looking at the real world of health care, but just spout off on ideologically -driven assumptions about the big bad guvmint.
Makes me think you really dont CARE about the health of Americans.
August 1st, 2007 at 3:57 pm
Just curious, do liberals also support universal, single payer food, clothing, shelter, employment, etc…
All those things are just as important as health care. If you don’t have food to eat, you die. If you’re homeless or don’t have a job, you’re in bad shape. If you don’t have clothing you, won’t get a job.
If the govt has a responsibility to give health care to its citizens and pay for it, why doesn’t it have a responsiblity to feed them or clothe them or employ them?
How do liberals draw the line as to why it’s important to have universal health care but it’s not to have the govt pay for our food and shelter and give us all jobs?
Or are they just later steps in the plan?
August 1st, 2007 at 4:08 pm
The importance of Rudy’s proposal lies elsewhere, and will help to explain the inevitable, venomous socialist attacks against it…the denial of future political power. If we move towards socialized medicine (to whatever degree,not debating the specific plan here), the future US political landscape changes dramatically… against liberty and free market advocates. The creation of a Rudy like plan does more than just give a victory for more market oriented politics but potentially removes the issue (the socialist sense of it)from political debate going forward. This would be a huge blow to the american Left. And perhaps most disturbing for the left would be the creation ,thru HSAs, of a vested interest against future socialization….of course this cannot be allowed to happen for the Left…so they will kick and scream like children, all in the name of ideology and politcal power, to deny americans liberty. Liberty is a constant battle, these people never, ever stop trying to destroy it be it in the form of Bismarkian nationalists, New Dealers, or Rawlsians.
August 1st, 2007 at 4:16 pm
jim, the govt does feed and shelter the indigent (although clothe I’m unsure of).
Providing help to some (subsidized housing, food stamps) and taking over a whole industry are different things.
August 1st, 2007 at 4:28 pm
jim,
I dont quite know what to make of your question. Is there any sincerity to it, or is it just an excuse for mindless snark?
I’ll try to answer it on the assumption that it is sincere.
Universal, single payer health care is not some alien idea, it is simply a big insurance pool, the most rational, and efficient of insurance pools.
There is nothing wrong with the government providing insurance to people to meet the uncertain costs of health care.
The analogy to food or clothing falls down, because, though they are equally important to the maintenance of life, they are not relatively scarce and expensive resources that need be accessed in an unpredicatable manner, and with costs that could be catastrophic. In other words, they are not the things that anyone buys insurance for.
Insurance, by its nature, is a means to distribute risk – the risk of catastrophic costs that can destroy the stability of an individual or family, in an unpredictable manner. Like with car accidents. We require all drivers to have auto insurance, not only to protect them, but to rationalize the costs to society, since uninsured people who have accidents end up draining societal resources in any case.
Beyond mere catasrophic insurance, it is also rational and efficient to facilitate and encourage all people to have constant healthcare, to forestall the large expenses that come with uncared-for illnesses, and to generally promote a healthier population. And, of course, to the extent that health insurance is a necessary part of a stable family economy, the disentanglement of health insurance from employment frees up labor mobility to create a more efficient and well-functioning market place.
August 1st, 2007 at 4:32 pm
jim,
Universal, single payer health care is not some alien idea, it is simply a big insurance pool, the most rational, and efficient of insurance pools.
There is nothing wrong with the government providing insurance to people to meet the uncertain costs of health care.
The analogy to food or clothing falls down, because, though they are equally important to the maintenance of life, they are not relatively scarce and expensive resources that need be accessed in an unpredicatable manner, and with costs that could be catastrophic. In other words, they are not the things that anyone buys insurance for.
Insurance, by its nature, is a means to distribute risk – the risk of catastrophic costs that can destroy the stability of an individual or family, in an unpredictable manner. Like with car accidents. We require all drivers to have auto insurance, not only to protect them, but to rationalize the costs to society, since uninsured people who have accidents end up draining societal resources in any case.
Beyond mere catasrophic insurance, it is also rational and efficient to facilitate and encourage all people to have constant healthcare, to forestall the large expenses that come with uncared-for illnesses, and to generally promote a healthier population. And, of course, to the extent that health insurance is a necessary part of a stable family economy, the disentanglement of health insurance from employment frees up labor mobility to create a more efficient and well-functioning market place.
August 1st, 2007 at 4:43 pm
Tano:
You have false premises. I absolutely would love it if everyone had healthcare. However, I don’t think that we should point guns at people and force them to pay for others.
August 1st, 2007 at 4:43 pm
The govt doesn’t pay for your auto insurance. Should it?
Clothing isn’t important? When was the last time you saw someone walking around the streets and functioning naked? If you want a good job, you need nice clothes. Should the govt pay for everyone to have some nice suits and nice shoes?
egs, the govt does provide subsidize healthcare under medicare and medicaid and emergency rooms and the like. for a small amount, it’s ok. What the dems want is the govt to pay for everyone, to control health care. Will govt run hopsitals be open on Sunday or will they closed like the post office is? You think people are concerned about the govt and its civil liberties. Imagine if they were in total control of your health.
Tano, I notice you ignored food and employment. Those are pretty important. Should the govt feed everyone? employ everyone? If not, why not?
It’s one thing to have it in small countries like Canda with 25M or England or France with 60M or Curba with 12M that are fairly homogeneous and have been having it for years. To all of a sudden switch in a country of 300+M that has no experience with it and is heterogeneous and has strong provate doctors and insurance groups and interests is a whole different thing all together.
Unless and until there’s 60+ dems in the Senate with a dem president, it’s highly unlikely to happen.
August 1st, 2007 at 5:06 pm
I write:
“The analogy to food or clothing falls down, because, though they are equally important to the maintenance of life,
And jim reponds; “Clothing isn’t important?” and “I notice you ignored food and employment. ”
and “Should the govt feed everyone? employ everyone? If not, why not?”
Which I explained explicitly – while explaining the concept of insurance to him.
What more can I say except….start over Jim.
August 1st, 2007 at 5:14 pm
I’m glad I’m not the only one who thinks it’s hilarious that Kanye West said, “George Bush doesn’t care about black people.â€
August 1st, 2007 at 5:24 pm
Jim,
Good point. You made a point about the funtional role of government in providing health care, and you get a definition of insurance back…a defintion which does not answer why there should be socialized insurance in that arena anyway…wow…
if a mere definition of insurnace is used as justification then any insurance market qualifies for government takeover, there is no logical arugment against it …..homeowners insurance, life insurance, mortgage insurance, or options markets…..of course there are economic reasons of efficiency against single pools but to Bismarkian nationalists these do not matter.
August 1st, 2007 at 5:42 pm
It’s more than a little frightening to me that people think it’s okay to impose force upon others.
But even if socialized medicine did work — which is the presumption: that no one would ever suffer health woes ever again if only the state came in and took over — it still wouldn’t be right unless it were consensual and voluntary. All this blathering about me not “caring” is really just code word for me being in favor of individual rights.
Whenever socialists find that their plans don’t work or aren’t popular, they trot out some dying child and say “oh, if only the state were involved!”
So Tano — if you care so much, what have you been doing in the private sector to help other people with their health care costs..? Have you donated to any charities? Volunteered at any hospitals?
As our friend Ron Paul likes to say: it’s so much easier to be generous with other peoples’ money, isn’t it, Tano?
August 1st, 2007 at 6:13 pm
Tano,
You made my point for me in citing auto insurance. Does the govt pay for everyone’s auto insurance? homeowners? etc… No Should they?
And yes health insurance has high costs but for most of the people with low incomes who don’t have it, food and clothing have equally high costs. And yes there’s programs like food stamps but there’s like programs in medicare and medicaid. To massively change the economy with socialized medicine is a big step. It’s funny how the dems and media keep bringing up the 45M uninsured. I don’t ever recall hearing about the # of uninsured from 1993-2000. All I heard was how great the economy was and how many jobs there were and how everyone was living high.
August 1st, 2007 at 6:16 pm
No, i mentioned auto and homeowners…in support of your argument…
August 1st, 2007 at 6:19 pm
my mistake… I only mentioned homeowners
August 1st, 2007 at 6:46 pm
TLG, individual rights are an imaginary concept. We support these concepts because they’re good guidelines. However we don’t take them to logical extremes as if they were real. When you shout FIRE in a crowded theater we lock you away. When you assert your right to stand naked beside the highway we also lock you away.
Any resort to individual rights is just an admission you have no good relevant arguments.
I oppose universal healthcare because the govt is inefficient and ineffectual in providing services. It’s cheaper and more effective to find some other way to ensure everyone gets healthcare (a laudable goal). I could care less about anti-social libertarians griping about their “rights”.
August 1st, 2007 at 7:02 pm
Yes, econ grad stud, because shouting fire in a crowded theater would be a lie. Thanks for playing, let’s try again.
“Imaginary concepts” — that would be a not-so-nice word for “abstractions,” kind of like, you know, things you’re prone to like: family values, spirituality, traditional morals.
We both love abstractions — “imaginary concepts” — but we just love different ones. Don’t bash me for loving them when you do, too. Unless we aren’t supposed to pretend spirituality and family values that you hold so dear are real?
THE POINT IS THAT WE PUT ABSTRACTIONS INTO ACTION. We’re supposed to apply the hypotheticals to real-life scenarios. Everyone in politics knows this.
August 1st, 2007 at 7:11 pm
Jim,
“To massively change the economy with socialized medicine is a big step.”
First off, it is not “socialized medicine”. You Republicans can play these games amongst yourselves, but you cant really expect any rational person to go along with your propaganda. Socialism is government ownership. Socialized medicine would be like what the UK has – a government owned and run health care system. NO ONE is raising any such proposals, at least no one serious or who has a serious chance of being elected to anything.
Creating a national health insurance pool does NOTHING to the private nature of health care provision. You need not even eliminate the private health insurance field. Some provisions may, but that is not a necessary step. Even if it becomes gov’t insurance, that doesnt change the private nature of the hospitals, doctors and all other providers.
“I don’t ever recall hearing about the # of uninsured from 1993-2000. ”
Well you were obviously not paying attention. That was one of the loudest, and most frequently made arguments underlying the HillaryCare effort. And when that failed, the focus turned to incremental advances, like S-Chip, that were explicitly addressed to the problem of the uninsured (children, in this case).
To EGS, who says,
“I oppose universal healthcare because the govt is inefficient and ineffectual in providing services. ”
But the fact is that the private insurance bureaucracies are many times LESS efficient than Medicare. Their overhead costs are above 15%, whereas Medicare is under 5%.
It’s funny how the dems and media keep bringing up the 45M uninsured. I don’t ever recall hearing about the # of uninsured from 1993-2000.
August 1st, 2007 at 7:13 pm
oops that last line in my last post was not mine, but a pasted quote that I addressed above….
August 1st, 2007 at 7:29 pm
Tano, how much would it cost to extend Medicare coverage to everyone?
This is of course ignoring the negative externalities of demand for medical services skyrocketing and willingness to pay reaching the inverse of the co-pay percentage.
Essentially we’d be creating a system where cost inflation would be made worse.
Divorcing consumers from healthcare costs would likely lead to a bankrupt treasury. It would also remove the already weak price incentive for illness avoidance.
I agree with the goal of making sure everyone can have medical care but bankrupting the nation isn’t the answer.
Preventative care and illness avoidance are where real progress can be made. Insurance is simply too expensive for our nation as long as our health (uninsured and insured) is so bad.
August 1st, 2007 at 7:34 pm
TLG, the family and religion are biological imperative (all societies have them). Individual rights are a modern invention. They’re not any more important than the attempt to improve governance.
BTW government predates the invention of individual rights. One is historically dispensable (see China), one is not (see Somalia).
I’m begining to think libertarianism is a brain-eating disease. It removes the capacity for seeing reality or history regardless of intellect.
August 1st, 2007 at 7:43 pm
“Tano, how much would it cost to extend Medicare coverage to everyone?”
Probably less than is being spent now. Take out all the extra overhead that now exists in private insurance, plus the great redundancy of administration that all those companies support.
Plus there are large savings to be had in spending smaller amounts for preventive care rather than expensive emergency care for illnesses that are left to fester. Even minor care, which is not given to the uninsured in emergency rooms would be much cheaper if done routinely under a system that insures preventive care.
Probably a net savings. Dont have the numbers at hand though.
And I am not sure I track your problem with “skyrocketing” demand. The only increase in demand is from people who dont get adequate health care now. Thats a good thing.
The potential problem of people actually overusing the system is no greater in Medicare than in private insurance.
“Insurance is simply too expensive for our nation as long as our health (uninsured and insured) is so bad.”
I dont understand that argument at all. How can insurance be too expensive? Insurance just allocates risk and cost, it doesnt add to it.
Unless you are arguing that some millions of people now are not getting adequate care, and we should leave it like that. Let the poor bear the health burden of the fact that we “cant afford” their coverage. Is that it?
August 1st, 2007 at 10:00 pm
econ grad stud — Um. So, what? I’m not getting the point. “Individual rights are a modern invention,” while religion and the family seem to arise naturally.
Um, that’s nice..? What on Earth does that have to do with their justifying them?
So simply because something is traditional or biological means that we should accept it..? The answer would be: no, that’s why we banned rape. You first have to show WHY WE SHOULD KEEP IT. Tradition on its own isn’t even an argument. WHY is tradition more valid? That’s why I’m always weary of people saying: “Well, what would the Founders do!?” Who knows and who cares, idiots? That’s why they gave us a 10th Amendment: because they weren’t infallible.
Sometimes things set up biologically or centuries ago as a social institution becomes obsolete. This is what normal people call “progress.” Clinging onto the past and pretending it works or is real (religion…) doesn’t do anything to progress society.
Talk about brain-eating diseases…
August 1st, 2007 at 10:02 pm
Still waiting for Tano to answer this.
Tano, paging Tano…
Tano?
“So Tano — if you care so much, what have you been doing in the private sector to help other people with their health care costs..? Have you donated to any charities? Volunteered at any hospitals?
As our friend Ron Paul likes to say: it’s so much easier to be generous with other peoples’ money, isn’t it, Tano?”
You said that conservatives (and libertarians, I presume!) don’t “care” about the health of Americans, because they aren’t willing to surrender a fifth of their income.
So, since you care so much, what have you been doing?
August 1st, 2007 at 10:31 pm
wow…”rights are a modern invention”….this is sad to hear coming from someone who seems to value religion,… because so much of our western conception of classical rights comes from natural rights theory and its evolution/ties to Christian thought…starting, heck, in the medieval period!!!
August 2nd, 2007 at 12:07 am
Heh, interesting to point out, Au standard. I’m so used to arguing in secular terms that I sometimes will forget about the sort of things I can use to catch the religionists in their double-”logic.”
August 2nd, 2007 at 12:43 am
so much wrong and to be corrected, so little time..and way too tired…but here’a start..
“Socialism is government ownership”
what is this?…a high school poli sci class? anyway….
whew…thats a BIG WRONG….direct government ownership is just one strain of socialist thought….socialist thought esp. starting after (hell, during!) the nutty French Revolution and on thru the rest of the 19th and into the 20th centures is quite a rich tapestry of arguments…that of direct state ownership being just one…but others concerned themselves with coersion of private actors while retaining “private ownership”…this under the realization that if you are conrolled in what you do, private property neccessarily loses its punch…if you can’t do want you want to do, then the “private property” ain’t really private property after all…
August 2nd, 2007 at 2:14 am
The notion of private property entails privately made choices among privately selected options. If there is government coercion for the private sector to act in a certain manner, then meaningless semantics really make no difference: it’s forceful and socialist by nature. The point of private ownership is for individuals to make mutually voluntary beneficial exchanges. That’s not how it works under any system where the government is setting mandates for those companies to follow. At the very best, it’s a mixed economic system. That’s what we’re at right now, and it’ll slip even more — leaning socialist — if we go to socialized medicine. The government will indeed more or less run things.
Tano knows nothing about economics:
Tano’s dream system — where everyone pays into a big bucket of cash people can pull from to pay for health care — is simply not going to happen. There will, of course, be certain limitations and guidelines — which is not capitalist in nature! Isn’t it the *cost* of health care that people are complaining about? And what would a big pool of money to pull from do? Make it more affordable? Haha…yeah, sure. It’s only as low as it is now due to demand. If there’s nothing but a big pool of money to take from, the prices will just increase again due to increased demand…this is Economics 101 right here.
See now? The government would *have* to handle things for “universal health care” to “work.” Therefore, it WILL be socialized medicine. If you leave it to the private sector, it’s subject to rules of supply and demand. If you put it with the government, it’ll distort the laws of supply and demand, which is why it doesn’t work…
August 2nd, 2007 at 2:50 am
Kavon W. Nikrad, #11: “Mitt’s record of accomplishment was very, very, appealing to me.
But when I discovered that Romneycare specifically excludes HSA plans from satisfying state requirements for a qualifying health plan, I knew that Mitt could never be my first choice for the Republican nomination.”
If you aren’t supporting Romney just because of the way the healthcare thing played out in Massachusetts, that’s not a very good reason. You have to keep in perspective that Romney was working with a hostile state house and senate on the other side of the aisle. Imagine George Bush right now trying to pass his the perfect conservative health care bill with the Dems in control. Exactly.
Romney did a really good thing by preventing Massachusetts from getting something much worse, a completely government takeover. That’s what would have happened had there been a Democrat as governor, and in fact, the new governor of Massachusetts is working hard already to undermine the market-driven, conservative pieces of the healthcare plan as it stood with Romney.
The most important thing Romney did is not so much pass a health care initiative, but prevent a much more liberal and worse one from becoming a reality. As conservatives, there’s a lot we can point to that we don’t like about the plan, but even Romney says that this is a plan that he doesn’t think would work for the nation. Don’t judge Romney negatively on healthcare because it’s not the most ideal thing. I’m sure much of what he did in that state was not his first plan.
In fact, as some news stories have pointed out, Mitt isn’t talking about his progress on healthcare in this country as much at this stage in the race. I think the reason for that is simple, Mitt right knows that what passed in Massachusetts isn’t the ideal conservative plan, he’s still proud of it I’m sure, but it’s not what he wants to show the conservatives he is trying to appeal to right now. But if he wins the nomination, he will probably go onto the general election touting the plan and showing that he, unlike the Democratic nominee, has made real progress on this issue and I think he could quite possibly own the issue, stealing the Democratic thunder and taking independent and maybe some Dem votes with it.
Personally, I like the idea of states coming up with their own plans. It kind of lets other states look at each other, see what works and what doesn’t, and experiment themselves. I think when this happens, the cream tends to rise to the top, a sort of (dare I say it) Darwinism of the best idea that works. It encourages competition among the states. If one state happens to nail it and come up with an awesome healthcare plan, for example, then that state might be more appealing for businesses or people to live in, and other states will look at that appeal and they’ll want to copy it. This is tons better than imposing a healthcare plan “from on high” from the federal government.
August 2nd, 2007 at 4:17 am
So, like, explain Romney’s saying that his plan was “fabulous” during the first debate..?
August 2nd, 2007 at 8:04 am
TLG,
Cherry pickin’ an out of context quote? Pretty sad.
April 29th, 2008 at 12:18 pm
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