If You Ask for Half a Loaf, You Will Get a Quarter of a Loaf

"[Public health care] is actually already the compromised position."

It's certainly mathematically compromised. I find it ethically compromised as well, stacking up bills for our grandchildren to pay off. We owe them an efficient, sustainable health care industry. We're failing them, and more irresponsible government programs like Medicare would do so even more extravagantly.

This is why the the prevailing view of "compromise" is flawed to begin with. If the definition is just finding a middle ground between two extremes, then that just pushes the two extremes farther apart, to the point where neither side really believes in their proposals but are just advancing them in order to get the optimal "compromise" for themselves.

How about this. Let's just debate over what works and what doesn't. Let's not get caught up in the "well, you got two things you wanted, and I only got one thing, so this plan isn't fair." Let's debate the proposals, both in detail and overall, based on their merits. But this is politics we're talking about, so I suppose that's not likely to happen.

Dr J--

When you complain about how unethical it is for us to stack up bills for our grandchildren, are you saying we should increase our taxes to pay our own bills?

So one "extreme" is public programs, what's the other end of the spectrum? The wy things are now.

If we continue as it is, we'll be bankrupt in just a few years. The current system guarantees year after year increases in costs and an ever increasing number of people who have no insurance that are paid by those who have insurance.

We're constantly told that public options will be the death of Medicine, but what's not said is that the current system is also the death of the system. Compromise starts with a true definition of the current system, but the lobbyists of the medical industry never mention that unsustainable fact.

Personally, I'd like a refund of the money my insurance company is spending on lobbying. It would be the first time my costs would have gone down. Clearly, pocketing a few Senators is good business when 70% of the people want a public option.

An option, yes:

72 percent of those questioned supported a government-administered insurance plan — something like Medicare for those under 65 — that would compete for customers with private insurers.

But the fear is that the 'option' will soon morph into a 'mandatory', and that is where support falls down:

77 percent said they were very or somewhat satisfied with the quality of their own care.

My response to Kathy's response is at:

http://www.poligazette.com/2009/06/25/14823/

I'm banned from Jason Arvak's site.

They're not exactly committed to the free exchange of ideas over there.

George,

That is not true. You were banned previously because you made repeated personal attacks and thread hijacks. If you are willing to just avoid doing that, your comments are welcome. In fact, I don't know if you are still banned. We periodically "amnesty" banned addresses so that few bans are actually permanent. I don't know your email address, so I can't verify your status, but if you contact me by the email link, I can check and I can rescind any current bans for people who are willing to just stay on-topic and civil.

The way I see it, rules that prohibit personal attacks help rather than harm the "free exchange of ideas". Of course, if the only ideas you have available to exchange are personal attacks, I can see how you might perceive that differently.

Anyway, I will flatly state we are totally committed to the free exchange of different ideas. In fact, I spent much of yesterday trying to rebalance our contributors to include more from the liberal perspective. :)

Jason considers disagreement with him a personal attack.

I'd guess you'll all see it soon enough.

Jason considers disagreement with him a personal attack.

Not true. If it were true, I would be unable to work with any of my fellow contributors, since I disagree with all of them.

We periodically "amnesty" banned addresses so that few bans are actually permanent.

They have to have periodic amnesties because they ban so many people.

The current total number of banned accounts (not counting spam) is 4. The last "amnesty" was 2 months ago. And as I said above, I'll rescind even your ban if you'll just be civil and on-topic. I think those are modest requests.

Now could you please stop trying to hijack a thread about health care, George?

What you're seeing from Jason here is what you're going to get over there.

Hmm - this thread being 'hijacked' by GS and Jason. BAN THEM BOTH!!!

HA HA HA HA!

:)

Sorry, Austin. I didn't want to let the false accusations go unanswered. I should have said nothing.

Far be it from me to ever want to fall out of your good graces, George, but, you actually never provide any ideas for exchange. Your posts almost always fall into one of two categories: (1) simply a link to another person's ideas (aka Kattenburg/Stickings School of Journalism) or, (2) parsing another person's post into a contorted leading question all-too-obviously attempting a "gotcha" moment (aka "trolling").

To get the thread back on track and to implement "idea exchange", please provide us with a paragraph explaining why Kattenburg has an unalienable human right to have casualobserver pay Kattenburg's medical bills and how that does not simultaneously violate casualobserver's rights.

True compromise — meaningful compromise — only happens when each side’s starting point is a whole loaf.

Strictly speaking, one extreme would be health care completely controlled by the government and the other would be no government health care at all. Since we already have significant government health care programs we already have a system that's a compromise and asking each side to start with a "whole loaf" isn't realistic.

I think we have to be honest - a public option is really just a bridge to socialized health care. The concept of government competition leading to lower private insurance premiums can only succeed if there is a level playing field. A public health plan would have no cash reserve requirements and pay no taxes, so would have a huge financial advantage from the onset. Theoretically the government could configure a public health plan to be just competitive enough to lower private premiums but not so competitive as to kill the private health plans. That's a very narrow target to hit and I don't see any reason we should expect the government to be able to do it successfully.

"A democracy cannot survive as a permanent form of government. It can last only until its citizens discover that they can vote themselves largesse from the public treasury. From that moment on, the majority (who vote) will vote for those candidates promising the greatest benefits from the public purse, with the result that a democracy will always collapse from loose fiscal policies..." - Lord Thomas MacCauley

Casualobserver--

People who don't drive still pay taxes that support roads.

The childless still pay taxes that support schools.

Vegetarians still pay taxes that support cattle farmers.

Nate Silver has a good post on the pragmatic argument I support in the matter of health care.

Austin Roth--

I'm sure you remember the Jason era as fondly as I do. Well played!

As for Maccauley, he died before they built the interstate.

@JS & GS
LOL They even allow my comments over at the Poligazette. Do they do an occasional edit - yes. But a banning isn't usually permanent, unless you really go on a rant.

casual: You want to keep your money. Kathy wants to not die. Of course, we're already assuming that she's sick and you're not. Suppose the opposite - you are suffering from an expensive but curable disease. You can't pay for it - are you going to shrug and go coffin-shopping?

Nate Silver's argument appears true until you think about the way he misperceives the role of profits. He is implicitly treating them as what marxists call "surplus value" -- simply wasted money accumulated by the ruling class (in Silver's scenario, the insurance companies) for selfish ends. This interpretation assumes that the profits are never used for any purpose other than the enrichment of the ruling class.

But when we recognize that profits serve two additional roles, this argument weakens severely. Specifically, profits are used for investment, which is good for the overall economy. The government can't do that because it must ultimately extract (either directly through taxation or parasitically through soaking up other investment capital by the sale of bonds) everything that it expends.

Profits also serve as incentives to innovation and efficiency. Government programs have a dreadful record of trying to recreate these incentives, as testified to by the shortages of available care and, in particular, available equipment infrastructure in single-payer systems like Canada and the UK. This issue is consistently one that single-payer advocates avoid talking about at all costs because, I think, they don't have even the slightest idea how to answer it while maintaining their purist approach.

So while Nate Silver's post is a good example of the "gotcha" style of game-play that is popular for some reason in the blogosphere, it is not actually sound policy analysis because it fundamentally fails to engage with the interactive effects of the real-world economy of health care and government spending.

Cross posted in expanded form at PoliGazette.

@@casual: You want to keep your money. Kathy wants to not die. Of course, we're already assuming that she's sick and you're not. Suppose the opposite - you are suffering from an expensive but curable disease. You can't pay for it - are you going to shrug and go coffin-shopping?@@

I'm not going to just "shrug", but assuming I have exhausted all my resources, abilities and options to get it covered myself, I might then well appeal to the voluntary beneficence of others, but will I accept I have to die before I have the "right to confiscate" another's property?.........Absolutely, unequivocally.......YES.

Ryan - what about an expensive, incurable disease? Does that change anything?

The bigger question always comes back to cost. There is all this railing about the expense of health care, while at the same time blaming private insurance for their (admittedly sometimes overzealous) attempts at cost containment.

Contrast that to Medicare and Medicaid, two programs that are the epitome of cost over-runs (exceeded only by Defense contracting). Then there is the government bureaucracy mindset. In private enterprise, good managers are those that increase revenue while keeping costs under control. However, bureaucracies function under a different set of rules. They get rewarded for increasing their budgets and spending it all.

Not spending all your budget means it will be cut next year, and that reduces your power base. Anyone who has been involved in government knows the truth of this. There is a negative incentive to keep costs down. There is a positive incentive to force your bureaucracy into more and more areas of the sector you are involved in.

Also, accountability within Federal bureaucracies is an oxymoron.

So, how over the long run, any government program will expand its scope and cost, become more inefficient and top-heavy, more dominated by process and procedures, more risk adverse about new ideas (and in the case of medicine, treatments), and less responsible to the taxpayers.

Sorry, that is not what I want in my health care provider.

Here's what Nate Silver has to say about profit and the insurance industry:

It's possible, certainly, that the profit motive in the insurance industry has driven more innovation than we're giving it credit for. But that isn't my bet, and it isn't George Will's: There's no obvious reason that the government couldn't provide more for less. And if we are wrong, we would find out soon enough: if the public option can't deliver more bang for the buck than private insurers, it wouldn't gain much market share from them, and Will will have nothing to worry about.

The "public option" (and other things sought by the Dems), the co-ops, and other ideas are incrementalist moves by the Dems toward complete public health care (and complete public control) and there's no reason that some or all of these should be conceded in any measures purported to change (or "reform") health care.

"I want what I want [everything], NOW!" is not reasonable, Kathy. You lose again.

It also reminds me of the deceptive advertising currently on CNN about the Obama plan (I don't know what group has sponsored it and don't care). This also mischaracterizes the nature of negotiations in general as well as deliberately attempts to deceive viewers to get them to believe Obama's not only interested in "compromise" (which isn't part of the ad) but is a "third way" (triangulation!) "forward." [sic]

Superficially this ad was laid out as was described below, for other reasons (the ad indicated or implied with its tone that both of these are bad and that has left us at an impasse; Obama offers a third choice, "to go forward" [sic]):

"Strictly speaking, one extreme would be health care completely controlled by the government and the other would be no government health care at all."

(The ad says "Do Nothing" as the [false] second extreme.)

" the current system is also the death of the system."

You are incorrect. However, it could move closer toward failure ("death") if we not only decode the genome but insurance companies use genetic information someday to predict and to routinely exclude vast numbers of people in the future from specific (if not general) medical care coverage because they have much better predictability of pre-existing conditions (which is how genetic predispositions will be viewed logically and actuarily), even applying this to existing (previously covered) people. This has been anticipated for years, decades.

(It's kind of like Obama and Dems predictably dwarfing and greatly subsuming GOP deficits and debt into their own vastly greater deficits and debt. And note that the Dems are irreponsibly rushing to push this health care public sector growth without any revelation or discussion of costs or how to pay for it. Talk about exploiting the so very exploitable!)

To everyone who thinks they'll get stuck with somebody else's medical bills--guess what?

You are already getting stuck paying for the uninsured:

# People without insurance use the most expensive source of care when they need it – the emergency room – which adds unnecessary costs to the health system.

# The cost of care for the uninsured is shifted to people with insurance, in the form of higher premiums, co-pays and deductibles.

# Through this cost shift, the average person with insurance pays about $100 per month to cover the cost of care for the uninsured.

Also:

The current structure of the US health care system results in higher taxes, lower wages, increased health care costs and, often the inability to get timely access to needed care. We have "universal access" but only through the emergency room, which is both expensive and inefficient.

GS - and when you cut to the chase, those items you cite are required by Federal law (the first item is, and as private insurance is just that, for profit, they have to recoup the cost somewhere, as would the government if it was fully running health care).

So we can already see the effect of inefficient and poorly thought out Federal initiatives at work. And you want MORE of this?

Austin Roth--

The government would have an easier time recouping costs because it would have a larger pool (a point made by Nate Silver).

Because the government would have no interest in making a profit, that would also reduce costs.

Austin Roth--

I believe that the government has made it illegal for emergency rooms to dump patients without insurance back onto the sidewalk.

What's the alternative that will impose zero costs for them?

George,

I guess people like C.O. prefer paying more at the back end than paying less at the front end.

GS - The government would have an easier time recouping costs because it would have a larger pool

Indeed they do - our money.

GS -What's the alternative that will impose zero costs for them?

Why, there is none, of course. Well, I guess we could use your favorite method, and make the government directly reimburse hospitals.

And by the way, your initial point 2 was wrong. The increased costs are due to inflated charges TO the insurers, as they do not cover the costs of the uninsured, the hospitals themselves do (which is not limited to insurers - everyone who pays for medical services kicks in for those who the hospitals cannot recover from directly)

Austin Roth--

People who don't drive still pay taxes that support roads.

The childless still pay taxes that support schools.

Vegetarians still pay taxes that support cattle farmers.

There is nothing intuitively obvious to me that says it's better for the pool of our money to go to several private, profit-seeking companies whose policies impose extra costs on us.

DLS

I'll stand by my original statement. The current system suffers from year over year cost increases while the number of uninsured who present at Emergency Rooms also increases. These uninsured costs are covered in ever higher medical costs going forward.

Predicting human frailty does not require a genome project, everybody eventually gets sicks and dies. Every time I hear people say they want to join a "low risk" insurance group, I can't help by laugh. Insurance companies thrive on the naive assumption that health is anything but temporal. They'll catch you later when you're old or just unfortunate.

Austin Roth--

The hospitals raise their costs to cover the people who don't pay. Since people who have insurance pay with insurance, those increases get passed along to the insurance company. So the insurance company raises its premiums.

If there is no zero cost alternative to the costs of the uninsured, the costs will always be passed to someone else.

People who don't drive still pay taxes that support roads.

The childless still pay taxes that support schools.

Vegetarians still pay taxes that support cattle farmers.

You running out of other peoples ideas to crib? :)

GeorgeSorwell said: "Jason considers disagreement with him a personal attack... I'd guess you'll all see it soon enough."

Well said George. And yes, Mr. "Avark" (sic) does have a way of making his position known... a quick trip to the link he posted above will tell you all you need to know.

Austin Roth--

I'm always happy to crib a good idea.

I didn't originate this idea either:

There is nothing intuitively obvious to me that says it's better for the pool of our money to go to several private, profit-seeking companies whose policies impose extra costs on us.

Thanks, SteveK.

GS - here are some more unoriginal but relevant quotes:

A large family and Democrats have a lot in common: teenagers and Democrats are always happy spending other people's money.

Governmental subsidy systems promote inefficiency in production and efficiency in coercion and subservience, while penalizing efficiency in production and inefficiency in predation.

First rule in government spending: why have one when you can have two at triple the price?

"A government that is big enough to give you all you want is big enough to take it all away."

The state is the great fictitious entity by which everyone seeks to live at the expense of everyone else.

The marvel of all history is the patience with which men and women submit to burdens unnecessarily laid upon them by their governments.

AR

George's points, cribbed or original still are valid points. Personal cost to cover society's needs are an acceptable part of of our society. Or would you prefer the "every man for himself" theory of social Darwinism?

I certainly don't need Federal highways where you live, just near me.... Sounds kind of silly.

I don't need health insurance for other people, just me and mine...... same logic.

HemmD - but I reject the concept that health care insurance should be funded by the government; you don't.

Your logic only holds water if we start from the same position.

How about flood insurance, disaster response, and unemployment aid to States that can't afford to keep their own citizens alive, fed and cared for?

No one has said that a public plan would be cost free to those who pick it, you got to pay just like private insurance. You're currently paying for the uninsured now; why are you afraid of that fact like you say you are about the public option?

You can't believe the current system that charges us for the uninsured is the way you prefer it, do you?

HemmD - where did I say I was afraid of paying for the uninsured under a public option? I did talk about my fear of government inefficiencies running medical programs, and someone else started that part of the conversation, but that was more of one specific example being discussed than any major item of itself.

I thought I have been clear that my 'fears' are that this will become a mandatory program, not an option, over time; that will make the current cost structure seem like the good old days within a decade; it will decrease the quality of care for all but the poorest; it will reduce and retard innovation and new technologies; and it will effectively be the largest tax increase in history, and the creation of the largest federal agency in existence eventually (yes, larger than the Defense Department).

Again,not the health care or health care provider I want for me, or my children and grandchildren.

GeorgeSorwell and SteveK,

Whatever I have done to make you hate me so much, I apologize for. Hopefully, we can set these issues aside and start over in the interests of a real discussion. I have dedicated three posts to this discussion already, including one specifically in response to George's comment. Hopefully, you can take this effort as an indication of good faith on my part.

P.S. All commenter bans at PoliGazette have been lifted.

All commenter bans at PoliGazette have been lifted.

I can take care of THAT! ;)

AR

I knew the phraseology of "afraid" would go over like a lead balloon.

"Again,not the health care or health care provider I want for me, or my children and grandchildren."

That's my point, not providing a public option is not the same as making it mandatory. The only people who gain from pushing that meme are the profit oriented private insurers. If the public option is doomed to complete governmental chaos and skyrocketing costs, let it fail in the market. I freely admit that I fear that private insurance is doomed to the same skyrocket going forward too.

Their concern is not cost, it's profit. That difference means that increasing costs make for ever larger contracts and ever larger profits. If your margin is only 3%, wouldn't you want 3% of a hundred million over 3% of 75 million? Their profits grow due to the upward climb. Now that I find scary.

The way to cost containment is through establishing medical "best practices" that help to eliminate defensive medicine. Clearly, not running a test that symptoms do not warrant is expensive and wasteful. I'd certainly like to see the end of frivolous law suits too. We both know, however, some lawsuits are more than warranted.

No one from the health care industry has said anything to make me 'fear' the government morphing their 'option' into a 'mandatory'. The government has done that for them, all by itself. I do not trust Congress on this issue. Period.

And I still say the private insurance has a stronger incentive to reduce costs, because of the profit motive, than government bureaucracies.

We just fundamentally see the world differently on this.

well, that's the first time that's ever happened.

I can take care of THAT! ;)

Only the greatest comment in the history of the Moderate Voice!

Jason--

I don't hate you.

But you ban people over there, and once, one of them was me.

And of course, there's plenty of real discussion here. There always has been.

"Their concern is not cost, it's profit. That difference means that increasing costs make for ever larger contracts and ever larger profits. If your margin is only 3%, wouldn't you want 3% of a hundred million over 3% of 75 million? Their profits grow due to the upward climb. Now that I find scary."

profit = income - cost. So if cost goes up, how exactly does profit go up with it? We're talking about insurance here. If insurance has to pay more, profits go down. They can try to recoup that loss by increasing premiums, but they can only do that to a point. So it seems to me there is already a pretty good incentive to limit costs. That's not to say we don't need changes to make controlling costs easier, and there certainly are aspects of the system were the incentives are skewed. But I think the above statement is a gross simplification.

To address the original post, if Obama and the left had started with single payer, there would have been a backlash and the debate would have died like it did with Clinton. Obama is a pragmatist. By proposing something more moderate, he was able to get some of those on the other side on board right away (I'm not talking about politicians, I'm talking about the industry). That will likely by the key to success. So Obama compromised a little to start, and that triggered the industry to recognize it needed to compromise. So neither side is starting with the "whole" loaf here. As someone else said, the "whole load" on the right is not the current system, as the government is clearly very much involved in health care as it is.

If anyone cares, here's my plan:

1) Get rid of employer-based health plans
2) Regulate private insurers such that they cannot deny coverage, but they can adjust rates according to formulas they must publish (auto insurance companies must do this), and those formulas must be based on lifestyle choices that affect health, not on current health status. For example, a smoker with lung cancer pays the same as a smoker without lung cancer, because the premium isn't based on the disease but the behavior.
3) Subsidize health coverage on a sliding scale for the poor, and pay for it by taxing insurance companies basd on the number of high-income person they insure. Yes, this is re-distribution of income. Yes, I'm a conservative, but I believe that the free market has flaws, especially with regards to healthcare and education.
4) Mandate insurance coverage. A civilized nation can't turn away people who need care, so the only alternative is to require at least a very basic level of insurance for all.

GS -

Only the greatest comment in the history of the Moderate Voice!

Thanks for the love! Right back at you, big guy.

You're welcome George. Jason and I go back a long way... So far that I know him by his maiden name.

I'd have more to say on the topic except we (Mr. "Avark" [sic] and I) came to a PRIVATE agreement that we would not intrude on each others 'personal space' (internetually speaking) and that is why I have limited myself to a single comment on his recent "remarks" here at TMV.

His latest personal ad hominem attacks on Kathy both here at TMV and on his censorial site (blanket amnesty... right!) and his smart assed remarks about me and my position may very well have nullified our offline agreement. Come on if you want Jason but you ought to think twice before you open it up again... I kept my OneNote copies of the ENTIRE thread in our last go round.

Note to TMV editors: I have waited until this thread was off the front page before responding to Jasons attack on my comment about him... If you take away his power to censor he has nothing and that's why I'm saddened that TMV has given him the ability to "moderate" (read censor) comments here... AGAIN.

Isn't it time to allow a coward and fool to be called a coward and a fool without having to fear that your comment will be "(Edited by a moderator)"?

SteveK -- Knock it off. Your threatening comments cross the line. Continue on this path and you will be banned from further comments on this site.