Jason, your demonizing of “the left”, which from your blog, appears to be your style, is ironic, especially as you seem fond of demonizing lefties for demonizing righties. We actually could have a rational discussion, but we're so polarized that it always seems to degenerate into something like this. Too bad.

GreenDreams, I do criticize lefties but I don't think I demonize them. And I would love to have a rational debate among alternatives and moving towards a compromise on health care. But as long as people like Kathy keep inserting into the debate their presumption that anyone who disagrees with them or even doubts their purist demands for a second is not only wrong but a bad person, I don't think that is likely.

Unfortunately, people like Kathy have no reason to alter their openly vicious rhetoric as long as their fellow liberals and leftists remain silent about it while at the same time criticizing the other side any time it puts so much as a rhetorical toe out of line.

As for prevention, through lifestyle or other incentives, we could do much there. I think most are not aware of how poorly we do in this area. In the US, we have only 4 preventive medicines available over the counter: fluoride toothpaste, sunscreen, seasickness prevention and aspirin. There is actually a 5th, formerly ulcer medicines, now approved for “indigestion prevention.” When we talk about “preventive medicine” we usually mean early disease detection (mammograms, prostate check, cholesterol testing). The realm of preventive medicines is relatively unexplored, except in the dietary supplement world.

But then you run into a serious problem. What you say (and other examples I can think of) appeal wonderful in theory, but you'll find that in many cases, the tests, for example, have been considered by people already in the government(s) and rejected as not cost-effective.

This is something to keep in mind as the scope of public health care grows (as it is likely to do).

Well to the left (far left of the public, like a left-wing Dem or even playing with Green-dom). Part of where he appears at any time (what words he chooses) depends on the lib Dem point of view on the issue of the moment about which he wants to contribute.

Krugman is like other “economists” notably in the Northeast who are well left of the public and routinely mix their economics with politics.

Note the correct meaning of that word “care” here means specifically, “provide medical care,” not anything more general or broad and subject to being a rationale for all kinds of entitlements as well as a way of satisfying feelings or cravings some might have.

Absolutely. There is no “right” [sic] to this (nor to so many other things that in practice are claims on others' time, labor, and money). It is merely a decision to create an entitlement, that word being fully sound not only legally but conceptually.

A significant fraction strongly want public health care, and plenty among the many who are wary of too much government and loss of freedom (and privacy, etc.) would still look to it as a default alternative if everything else seems worse or intolerable eventually.

I've never said that. There are up-front savings and it's logical to assume that Medicare for All would be “streamlined” compared to what we have now. But there won't be a permanent cap or brake on the costs, because the demographics (aging of the population) and increasing expense of improvements in medical treatments will force costs upward. “Wellness” emphasis that goes beyond the well-known preventive care will not achieve miracles, and there are limits, anyway, to what people should be expected or worse, required [compelled] to do in the name of wellness or prevention, or what restrictions, taxes that aim at medical-related social engineering, or prohibitions people should be subjected to. Wellness at the cost of too much freedom or quality of life ends up being the well-meaning equivalent of keeping the very elderly and sick (near death) alive at an effort that some routinely argue is not justified, and in fact is inappropriate.

Food for thought…

Many in academia (”experts”) are more liberal than the public and form a liberal community; I would look at doctors, and others who are actual _providers_.

Many of the providers are ready to go to public health care, to simplify and ease paperwork as contrasted with what they face with the insurance companies.

They also want the lawsuit-abuse problem corrected, but I doubt a Dem administration will correct this.

Vouchers (for health care only, even without monetary value, but denoting what the person can receive) — the alternative is to end all such assistance programs of all kinds (not only health care) and just give people cash (even a “guaranteed minimum income” or “basic income guarantee,” to use the two favorite terms that describe this concept and objective). The simplicity is appealing, as well as the termination of so many counter-productive and harmful programs and bloated bureaucracies. (AFSCME and other organizations would never want the programs ended, but expanded instead, in addition to the income entitlement.)

* * *

“Haggling is actually the sign of a market inefficiency.”

I'm not sure. The potential is always there, as no two people or parties are alike, and moreover, we're seeing an upswing in haggling (the ability of buyers to negotiate prices downward, to be more specific here), which is a sign of a continued downward movement, decline, recession, depression, you name it.

Consumers are in no better a position to negotiate with grocery stores or oil companies or airlines. But grocery stores compete aggressively on price and quality. Oil is a competitive, efficient commodity. You don't even have to talk to an airline to shop for the best flights and prices, just go to a search engine that lets you choose. A far cry from anything available to us for health care.

Haggling is actually the sign of a market inefficiency. If people don't have good information about what the real market clearing price is, they test each other to try to find such a middle point. Doing it can be expensive, too–for example a strike may go on for weeks as both sides try to figure out where the real bottom line is, during which both labor and management are losing a lot of money. Provide a stable, transparent market, though, and no one has to bother.

Nicera, I brought up Krugman and did not ever imply he is “beyond reproach”. So many straw men here. I also mentioned a couple doctors, the WHO, and glad to cite others if you want. My point is independent of your opinion of Krugman. It is that experts in relevant fields think nonprofit health care is a sensible and timely idea, most of the public wants it (convenient dismissals of the NYT poll are irrelevant. Other polls show the same thing), and most doctors want it (again, according to multiple polls.)

To the concept of competition, in terms of patients negotiating down costs or going elsewhere, I'm surprised anyone thinks that would work. Patients are not really in a position to negotiate with doctors or hospitals, even if they didn't need care urgently. Additionally, that idea that we could chisel down costs with savvy patients holding the purse strings, is in stark contrast to the assertion that doctors won't accept lower payment e.g. from Medicare (though 97% of docs do take new Medicare patients). Then we have the idea of using less expensive care givers, further reducing the income of doctors. Also kinda reminds me of the cynical 70s era joke, “cut your employee expense by a third. Hire women.”

We also have the assertion that a single payer (or public option) system might not save anything (”we can't assume the savings”) but yet doctors are shifting costs to insured patients because Medicare doesn't pay enough. (BTW, Medicare pays about 19% less. Think we could negotiate any lower than that?)

In my own experience it isn't true that docs can shift costs, thus “subsidizing” the Medicare patients, but I'm open to evidence. My doctor takes Medicare patients (ahem. I'm not one of them). A close friend who's a physician doesn't. My own doctor is not allowed by insurance companies to charge more than the doc who has no Medicare patients. I frankly don't believe hospitals are allowed to either, but please enlighten me with something credible if so.

As to the points about “rights,” I have avoided using that term, though others did. Rather, it's a public policy decision about whether or not we will care for our citizens. That's hardly a new or progressive idea. It's strictly caveman. The health of every tribe member was considered essential to the success of the tribe. That concept of taking care of our own *for our own good* is as ancient as we are. Perhaps with some military background people could understand the idea of not leaving someone behind, even if it costs us, inconveniences us, or even presents a mortal risk to us.

Don't get all touchy Jason. These comments are general and not from some script or aimed at you. Sheesh.

Well, maybe this is the disconnect going on. My position has never been that we shouldn't help the poor. It's that we should split health care reform into two problems and address them separately:

1. Building an efficient system of doctors, hospitals, drug companies, regulators, etc that can deliver the maximum health per dollar spent.
2. Providing financial help to people who can't afford #1.

The way to do #1 is a free-market system where competition forces all the players to work hard to deliver results, while minding the dollars being spent. It should be built around consumer choice, demanding transparency from providers, and should not be controlled by big bureaucratic gatekeepers like today's system is.

The way to do #2 is by writing checks, or giving tax rebates, or issuing vouchers, or I'm sure other approaches would work fine too. The only requirement is whatever we do must not micromanage the providers by dictating prices or policies, but should let them stay focused on goal #1: maximum health per dollar spent.

We have to do both of these things. We can't just do #2, because today that group consists of darn near everyone, more than we can subsidize. We also can't just do #1, because we'd leave darn near everyone high and dry without coverage.

1) Let's not confuse “positive” freedoms with “negative” freedoms. “Negative” freedoms are based on the classic liberal interpretation of “rights”–that is–the freedom to not have others coercing you into doing something or forcibly preventing you from doing something. “Positive” freedoms are a much newer concept and based upon the rather progressive notion that some things are so important, that people are entitled to these things, even if it comes at the expense of someone else.

When someone argues that “healthcare is a human right” it's important to get past the feel good rhetoric and decipher exactly what that person is implying. To the extend that everyone has to right to health care without someone else forcibly preventing them from obtaining it–that's an example of “negative freedom”, and I doubt that anyone would argue against this right. But to the extent that everyone is entitled to health care, even if it means forcing others to pay for that person's health care–that's an example of “positive freedom”, and that is a far more debatable point.

Personally, I don't think it's intellectually consistent that call something a “right” or a “freedom” when it calls for violating someone else's rights.

2) On Krugman being a Nobel Prize Winning Economist and therefore beyond reproach. I'm not going to question Krugman's intelligence or knowledge of economics, but Krugman is not by any stretch of the imagination a balanced source on economics. As others as pointed out above, Krugman is extremely left wing when it comes to fiscal/economic issues, and by that, I mean he unapologetically supports Keynesian economic theory as well more expansive government in the economic arena.

3) Good intentions do not necessarily make for good political policies, and even those programs with the more sincere of intentions end up having negative unforeseen consequences. Government programs rarely cost what politicians say they will–they always end up costing more. So before you start criticizing those for who oppose univesal health care/single-payer health insurance/public health care or any other flavor of government involvement in the health insurance arena, I suggest you come up with a way to pay for it.

4) Arguing that public health care will “compete” with private health care is not the most accurate way of painting this new proposal. Public health insurance–by its very nature of being controlled by the government–will have overwhelming advantages over private insurance companies such that private insureres will never be able to truly “compete” with it. For one thing, since the government is not concerned with making a profit (as evidence by our nation's mounting debt), it can mandate price controls for public health care and set prices as low as it wishes. Private insurers, on the other hand, have to make a profit in order to stay in business and therefore cannot set prices below a set amount. Under such a situation, no private insurer would be able to compete with public insurance on a level playing field.

5) Before we go name calling bloggers at other blogs whom we don't agree with, I suggest we have a firm footing from which to do so. Don't get me wrong, there are jerks, liars, and partisan hacks out their in the blogosphere that ought to be called out. But before we start calling people “intellectual midgets” I suggest we ask ourselves whether our comment passes one simple test test–that is, i.e. is this negative characterization of another blogger so important that it's worth risking the reputation of TMV?

Well, that's an interesting idea.

And then if, based on the database, you decide to play the odds, you've got an extra $200 to spend on liquor and gigolos.

Okay, you definitely have a better sense of humor than Jason.

Ah, but it does. We should help people get health care by simply sending them a check. That's a much better way for government to be involved. And then if, based on the database, you decide to play the odds, you've got an extra $200 to spend on liquor and gigolos.