Obamacare is upheld by the U.S. Supreme Court!

Originally Posted by Yoda:
I guess what I'm really asking is this: do you support these things because you think they're actually enumerated in the Constitution, or do you just think that's a way to excuse them without looking like we're violating it? Because it very much sounds like the latter.

I personally think that the expansions you describe are consistent with the foundational principles of the Constitution. At the same time, I think it's illogical, and impractical, to firstly try to divine the exact intent of the Founders, and secondly, to try to apply that exact intent to modern times. The Founders didn't envision the country having 50 states and 300 million people. The Founders didn't envision the technological expansion we've had throughout our history, the Founders didn't envision how in our modern society, the impact of an individual person's decisions, or even a state's, has direct and personal consequences for us all. The Founder's saw nothing wrong with slavery. Today, we do. If we merely applied the Founder's thoughts and feelings, and just simply try to pretend that process is how we determine what is or is not Constitutional, we will frequently make the wrong decisions. Not only that, I don't think that's what the Founders had in mind when they wrote the Constitution. It is simply impossible, and illogical to try to divine the Founder's intent, which is unknowable, and to then attempt to apply that intent to times the Founder's couldn't possibly have envisioned. The fact that "strict constructionists" seem to want to do both of these things is something that I fundamentally do not understand or agree with.

Well, first off, you're assuming the dispute. You just assume we need a "centralized, top-down leader" and ask who's going to do it. But that skips over the actual argument, which is: do we need this? Do we need it so badly that we should expand Federal power that could (let's be honest: will) be used more often and in different ways in the future, too.

But to answer even this very loaded question, what about the States? They can try different approaches without inflicting them on the entire nation. They can adopt different solutions for different types of populations, allowing for both greater customization AND more choice for people who would rather live in one type of state rather than another. If the people of a state demand something, they're probably going to get it. Why can't they elect local leaders that will enact the changes? Why can't they move to a state that does, if theirs won't? Why not give them choices? This is how the country was setup: enumerated powers and "laboratories of democracy." By embracing centralized power, we explicitly undermine both, even though no serious argument can be made that the founders pretty much all thought both were hugely important. These aren't squabbles about whether or not to have a central bank, these are bedrock principles.

When you have a country with 300 million people, and 50 states, instead of 13 colonies, you have to have centralized leadership. Without centralized leadership, what is to prevent individual states from having their own mini-countries that are entirely separate and apart from the union? How else are we to ensure that the policies and principles of our nation are upheld and actualized? What is it to be a nation? What does that mean to you? I don't understand the conservative argument that every state should be able to have wildly different policies and pursue completely different goals. If that is the case, then what is the purpose of having a nation? Why don't we just dissolve the union and have each individual state be run the way the citizens of that state desire? That's the logical conclusion of the conservative position that a centralized government is undesirable.

You're suggesting there's a distinction between what I said ("didn't like some of the things in it") and what you said ("didn't like [it] at first")? It fits just as well. Whether he liked some of it, all of it, none of it, rolled it up and used it like an awesome kazoo, whatever.

A nice history lesson (that's not snark, I hope people see it and then go and read more about it), I'm not sure what it has to do with this discussion. I'm also not "suddenly" bringing up Jefferson; you brought him up, and I replied to it, I just didn't quote the paragraph that mentioned him by name. Nor am I terribly interested in who you think is the conservatives' "go to guy," since I didn't go to him.

Yes, the Constitution is a compromise of sorts. Certainly. I know lots of people talk about it like it was this grand coming together where all these brilliant minds had a unified purpose, but that this is only true in the very broad strokes; the details were hashed out bitterly, just like they are today. But to point out otherwise--and to assert, accurately, that there's no one shining, golden "original intent" for each idea--is not the same as saying no level of intent is knowable or relevant. I'm pretty sure that's impossible, and that the mere idea of "interpreting" the text presupposes some degree of it.

As I said before, everything you're saying about Roberts is equally consistent with the idea that he's simply reticent to overturn major legislation, not because he thinks it's good, but because he recognize it as significant. It's also totally consistent with the idea that he's worried about the court's reputation. These are two perfectly valid, reasonable theories about Roberts' opinion that explain everything you're saying without having to contradict its statement about the law's merits.

I think this is true. As I said in my own comments, these would be perfectly valid rationales for doing what Roberts did as well. I could very well be wrong about Roberts thinking, as could you, but there's no way for us to know, so I agree that we should stop discussing this point.

You seem to have thought somewhat seriously about law (you're studying it, yeah?), so I hope you already see the problem with this. If you say that the "pursuit of happiness" includes any potential impediment to your happiness, there is no problem, ever, that won't potentially qualify as a "civil right." The Declaration mentions the pursuit of happiness, not its achievement, for obvious reasons: trying to guarantee pretty much anything, nevermind a concept so abstract and fluctuating as "happiness," is a fool's errand, and insanely, blatantly outside of the scope of government the founder's had in mind at the time.

I think it's pretty clear that I didn't intend for anything that could potentially interfere with some ambiguous notion of "the pursuit of happiness" to be considered a civil right. Health care is one of the most important and most foundational elements of ensuring the right to, firstly, preserve life, and secondly, to ensure that every individual has the chance to live one that allows them to pursue their goals, live their dreams, and have a functional, and prosperous, society. Those were the intentions of the Founders when they created our union. Health care is not merely tangential to these goals. It is essential for them.

But note my original question: I asked if you thought it was a civil right on part from issues like racial segregation. And I'll throw in another question: do you make any distinction between the fact that the other laws specifically allowed citizens to do something, whereas this one compels people to? Isn't that a fundamentally different kind of judicial review? Do you actually think compulsory health care is so obviously a basic right in the same way racial equality in the eyes of the law is?

I thought I answered this already. Yes, I do consider healthcare to be a civil right on par with other major civil rights issues of our time, including racial segregation. In some ways, I think that healthcare may be even more integral and foundational, and even more of an impediment, than segregation, at least to the ability to have life. Segregation was not a threat to the ability of every individual to exist. The lack of healthcare is. As I stated before, if you do not have healthcare, and you do therefore do not catch diseases early enough to be successfully treated, and you die as a result, there is nothing more important, and nothing that is more of an impediment to having a life, than lack of access to healthcare services.

Right off the bat, you've changed the claim. Note the first sentence, in which you said the President said every citizen should "have access to quality and affordable healthcare." A few sentences later, you say the Republicans never presented a plan to "accomplish universal healthcare." These are not the same things. Pretty much every politician will tell you the former is a good idea, but a bit more than half of them would disagree with the latter.

Universal healthcare is a vital, essential goal. The lack of it strikes at the very heart of what the Founders sought to protect and defend. How can it possibly be "not a good idea?" Do you think that it is good for our society, or moral, or just, to be the only industrialized nation which does not have healthcare for every one of our citizens, especially when we are the wealthiest and most prosperous nation on the planet? How is changing that "not a good idea?" What alternative do we have? Should people continue to die because they don't have access to healthcare?

They admit that compulsory universal healthcare (and compulsion is the only way you're going to get that, by the way) is not a legitimate goal, and I think they're right. That's different than not having a health care plan. I just linked you to literally hundreds of pieces of legislation. And frankly, even that list isn't entirely necessary; they have no hope of getting any of it passed. Crowing about them not having an alternative, apart from being technically false anyway, is a form of political posturing. The notion that presenting a comprehensive alternative would garner any serious consideration from the Senate, let alone the White House, is patently absurd. The politics matter, but let's not confuse them for policy here.

What you have linked to is a piece-mail approach that will accomplish some reform, which is good, but which falls far short of what I believe we need, which is universal healthcare. As such, it is, to me, not a comprehensive alternative. I can't tell you whether a comprehensive alternative would garner consideration from the White House. I suspect that it would, because on a whole variety of issues, President Obama has tried to work with Republicans, including on a $4 trillion deficit reduction plan, which is a goal that Republicans have said repeatedly is our most important priority, and the Republicans have consistently turned him down. They turned him down on what they admitted was the most important issue facing the country. What else do you expect President Obama to do, change his party affiliation and become a Republican, because short of that, I don't see how he could have gotten any serious reform accomplished. What I can tell you is that a serious comprehensive alternative would garner serious consideration by me, and a great many of the American people. The fact that the Republicans have no comprehensive alternative, unless you consider complaining and attacking everything President Obama does as serious policy.

Perhaps your shock comes from the failure to distinguish policies that make healthcare cheaper or more available, and policies that believe government must specifically take it upon itself to make this happen, or to compel people to do so.

Here's where this is a flawed point. In order to have a healthcare system that is affordable, it has to be compulsory. There will always be a lot of people who simply don't feel it's in their economic interest to purchase healthcare, because they are young and feel they are already healthy. In order to ensure that it is economically feasible for everyone to be covered healthy people have to be in the system to spread the risk and help cover the costs of those who are sick. What is another way to do this, if you have one? How else can we accomplish this very important goal? This is a very basic principle, and it is pretty much inarguable. Therefore, if you accept that this is the case, and it seems pretty clear that it is, what then is wrong with the federal government ensuring that this happens? Why is that not the role of the government to ensure that its citizens, every one of its citizens, has one of the most basic fundamental services that are necessary to preserving the very principles the Constitution was written to protect?

Let's explore this, please. It seems to me quite obvious that the founders were very distrustful of centralized authority. I assume you agree. And it seems to me that the entire structure of our government reinforces this distrust, particularly the enumeration of Federal powers. Still in agreement, yeah?

So the question is: if these things are true, and if the people who felt this and designed the rest of government wrote the Constitution, and if this idea had a strong consensus among them...why would you interpret the Constitution to be consistent with this huge expansion of Federal power? Obviously people can technically interpret something however they wish, so it's not something that can be proven, but it seems to go against both a reasonably straightforward reading of the document, its very structure, and the clear inclinations of most of the people involved in creating it. So I pose the same question over again, with added emphasis: is it that these ideas are genuinely consistent with the Constitution, or just that you feel we can invent ways to maintain deniability about it?

This is a particularly salient question because you just spent a couple of thousand words talking about how Roberts bent over backwards to find some way to make Obamacare plausibly Constitutional. So it sounds very much like you're talking about plausibility and deniability, and aren't terribly concerned with anything more than finding legal fig leafs. And I hope you'll agree that working backwards from "I like this law" to "can I find some way to make it seem like it could be Constitutional?" is a pretty awful way to approach the law.

We agree. But our two options are not "exact intent" and "totally malleable." How about a standard where an obvious, significant change in society is required to start making major reinterpretations and expansions?

But again, they weren't stupid. They didn't think the world was unchangeable. They designed the Constitution knowing full well that it would have to withstand the test of time.

Also, try this argument on for size: we can't have free speech or freedomof the press any more! The Founders didn't envision the country having 24 hour cable news. The Founders didn't envision the technological expansion that would let everyone have a blog. The Founders didn't envision how, in our modern society, the impact of an individual person's opinions could have major consequences for us all.

I hope you begin to see the problem. Societal change--even though they were certainly aware of it and wrote the Constitution knowing that accounting for it was one of its hurdles--can be used to justify any contortion of the Constitution. Things are always changing. That's exactly why we need things like the Constitution: to establish big rules that apply to human nature itself and protect us from common abuses. The changes in society give us more reason to hew to it, not less. The temptation to bend and make exceptions will always exist. And each time, someone will say this time it's different. The Court suggested as much in its consideration of this case.

A strict constructionist doesn't have to have any concern for founder's intent, at least not by definition. They simply have to hew more closely to a straightforward reading of the document. Everyone agrees it is not completely literal, nor completely rewritable. A constructionist just hews much closer to the former than we currently do. Just as the Federal government only gets the powers SPECIFICALLY granted to it, a constructionist may only uphold laws that are CLEARLY within the enumerated powers. Before you say, again, that sometimes it's not clear, I will say yes, of course not. But when it's not clear you hew towards the negative, because granting Federal power is a far more significant act than restricting it, in the same way it's better to let a guilty man go free than to jail an innocent one. And I'm sure we can both think of lots of examples where we would both agree that, even though the opinion held that it could sorta be justified under the Constitution, it certainly wasn't obvious or clear that this was so.

Right off the bat, you're arguing something different. I didn't say we shouldn't have ANY centralized leadership. Our system was created with a President and a Federal government and both serve clear, necessary functions. So clearly, some of it is necessary and wise.

See above. This is an argument for having a Federal government, not a defense of continually expanding its powers.

And what's the point of having States if so many things are centralized? I don't know what you consider to be "wildly" different policies, but clearly significantly different policies are intended and reasonable, because there'd be no purpose in having States if the only differences between them were insubstantial. I might move to Georgia because I think they have a more market-based healthcare exchange, but I'm not going to go because I like living in a place that has the Peach as its State Fruit.

These discussions would go much quicker, and be much more productive, if you did not construct arguments against the extremes of the debate. The conservative position is not to abolish the Federal government, it's to give it less control. It's a matter of degree, not an absolute. And just as I do not post long replies directed towards you that erroneously assume you think the Federal government should have TOTAL power, it would make more sense if you did not post ones directed at me that act like I think the Federal government should have zero power. Make sense?

Does the Constitution give the United States the power to create a bank?

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So why wasn't it provided back then?

Also, does it follow that anything necessary for the existence of life should be Federally controlled? Food? Water? And obviously, mere existence isn't worth anything if you're not healthy enough to do something with it, so we need to be healthy, too. So how about the much talked about "broccoli mandate" hypothetical? The questions go on and on. Once you attach provisions to the mere pursuit of happiness that include anything that make a certain level of that "pursuit" a right, it just spirals outward and touches any number of other things.

Also, the idea that health insurance is necessary to pursue happiness only argues that we provide it; not that it be enacted via mandate. It is equally satisfied by a simple tax, which would be unambiguously Constitutional.

But even if you assume all this, for the sake of argument, you still have an asymmetry: Jim Crow laws and the like are struck down because they violate the Equal Protection Clause. The government has a clear obligation to stop those things from happening. The healthcare law, justified either under the Commerce power or the Taxing power, would still only grant the ability to regulate. So the bare minimum difference, even if I grant everything you're saying above, is that the government has a legal obligation to stop segregation, but has no corresponding obligation to compel people to buy healthcare.

Geez, a thousand reasons. It can not be the government's job. It can be implausibly expensive. It can stymie health care innovation. Have you honestly never encountered any argument against socialized health care before? Do you not know any conservatives? Do you not read or listen to anything written or spoken by conservatives? I get why some people might not be convinced and all, but you seem stunned that anybody even holds the position, which is why I ask.

Because the worth of an idea has nothing to do with how widespread it is. None of these countries had it a few hundred years ago. Back then the argument would've been "well nobody else in the world has it! How is changing that a good idea?" The idea must be considered on its merits, not by an international show of hands.

Also, if you want to use international systems as a barometer, it can't be done selectively. You have to note, for example, that the cost is almost invariably structure as a clear tax, so the electorate has a clear picture of what they get and what it costs. Costs behave erratically and irrationally in situations where the connection between cost and service are hidden somehow, so that's bad no matter what you believe. And I'd argue that this is why health care is confusingly expensive in America already. There are so many layers of abstraction.

Man, there are so many assumptions in this question. First, people will die under any healthcare system, always, forever. There is no system under which people will not die, either through wait times, rationing, or not having enough money. It's sad, but we're only trying to minimize these things.

Second, this is true of everything, healthcare related or not. Every major economic issue is also a life and death issue. Technological progress effects who lives and dies. Medication, medical equipment, transportation, food, whatever...it all helps people live longer or more often, and therefore delaying its creation or improvement causes people to die. There is no major economic decision, even if it's not explicitly about healthcare, about which this is not true. Even deciding which type of social safety net to have, or which direction in which to direct government aid, will cause some people to live and others to die.

Third, you're acting as if conservatives are just saying "screw it, everyone for themselves" just because they think that's the way it should be. But they think that's the way it should be because they believe that leads to better outcomes in the long-run. You will, I'm sure, disagree with this, but there's no point in pretending they don't think that and arguing with something else.

Fourth, there are more considerations than just general welfare. There are lots of things we could ban or compel that would force people to live longer and healthier, or reduce certain types of accidents, etc. But we don't automatically do them, because all such benefits are balanced against a baseline of freedom. Part of the discussion is technical (what reduces suffering long-term?), and part of it is conceptual (how much compulsion and restriction is worth how much more health for people in general?).

You see the trick here, right? You say anything short of universal healthcare is not "comprehensive," so therefore no alternative proposals are "comprehensive" unless they're also universal. Which means when you say the Republican alternatives are not comprehensive enough, it's just another way of saying "this isn't universal healthcare." Once again, you've ruled out the mere possibility of alternative ideas right off the bat.

"Tried to work with Republicans." By offering them universal healthcare, which he knows they don't like at all? That's not trying to work with them, and it sure isn't an "olive branch." It's more like an ultimatum. If Republicans countered with a proposal to make the entire system market-based, I don't think you'd say they were "reaching out" to the President, or offering to work with him. Also, working together is only good insofar as it accomplishes something worth accomplishing; if someone thinks universal healthcare is a bad idea, they shouldn't bend on that just so they can say they're working together.

Regarding deficit reduction: what plan are you talking about here? I can't address it if you don't say what it is.

Er, that's my whole point. What do you expect Republicans to do: change their ideology and start supporting universal healthcare?


That's a great summary of the issue. And it leads me to one point, and three questions:

1) When you say we need young and healthy people to have insurance, that's just another way of saying we need young and healthy people to subsidize people who aren't young and healthy. So you're merely talking about forcing people into a system specifically so that some people pay for the health care of others.

2) Do you think it's possible to rationally decide that health insurance doesn't make sense for you? You say such people "don't feel" it's in their interest. Does that mean you think they're wrong? If so, why do we know better than they do?

3) If you grant point #1, that this is essentially just one group subsidizing another, why structure it as insurance except to hide that fact? Why not just tax one group to pay for another? At least then it's upfront. I see no reason not to do it this way except to obfuscate what's actually happening.

4) How are you defining affordable? Because things get less affordable for the people forced to pay for others. And while it'll probably cost more in general if some people don't have to have health insurance, that's not the same thing as saying the cost is prohibitive.

Because 1) I don't grant that it's a "basic fundamental service" that government is obligated to provide, and 2) I don't think it can do a good job in the long-run, whether you think it ought to or not.

Under the Necessary and Proper Clause, yes. But the individual mandate doesn't fall under that, as the Court found.

I hope you begin to see the problem. Societal change--even though they were certainly aware of it and wrote the Constitution knowing that accounting for it was one of its hurdles--can be used to justify any contortion of the Constitution. Things are always changing. That's exactly why we need things like the Constitution: to establish big rules that apply to human nature itself and protect us from common abuses. The changes in society give us more reason to hew to it, not less. The temptation to bend and make exceptions will always exist. And each time, someone will say this time it's different. The Court suggested as much in its consideration of this case.

I do understand your larger rationale justifying your belief that the expansion of government pose is undesirable. What I don't fully understand is how you expect us to determine what is clearly consistent with the Constitution as written, and what is not? Let's break it down here. What do you think are the main responsibilities and powers of the government that you would seek to protect and defend, and that you feel is consistent with a more literal reading of the Constitution and which are not? Why? You clearly have specific ideas about what you feel is Constitutional and what is not, so I'd like to hear the basis for those beliefs and objections to their expansion.

These discussions would go much quicker, and be much more productive, if you did not construct arguments against the extremes of the debate. The conservative position is not to abolish the Federal government, it's to give it less control. It's a matter of degree, not an absolute. And just as I do not post long replies directed towards you that erroneously assume you think the Federal government should have TOTAL power, it would make more sense if you did not post ones directed at me that act like I think the Federal government should have zero power. Make sense?

I apologize if you feel I am not addressing the salient points of this debate. I understand that from your perspective the federal government has too much power, but to me, it seems like you do want to abolish the vast majority of what the government does, so it seems to me that what you are calling an extreme is fairly close to your own views. This could be a misinterpretation on my part, which is partly why I asked you to enumerate more about your specific views so this conversation can be more productive, and more responsive to your concerns. Ron Paul, who is the clearest articulation of true and pure conservatism, pretty much wants to get the government out of virtually every aspect of our lives, so when you say that you believe in government, but that it should be smaller, how small do you want it to be? To me, if the government is rendered powerless to do much of anything, that's pretty close to an extreme, and is close to the functional equivalent of a kind of decentralization that makes the existence of a federal government superfluous.

The issue should be limiting federal power, if that is what you want, through the political process and not through the court system.

Judicial review regarding interpreting the Constituion is usually a pollitical game, not a legal one.

Roberts decison is clearly that.

And Scalia's dissent is that also.

Originally posted by Yoda:

Also, the idea that health insurance is necessary to pursue happiness only argues that we provide it; not that it be enacted via mandate. It is equally satisfied by a simple tax, which would be unambiguously Constitutional.

Given this line of reasoning, it would appear that single payer healthcare is constitutional. If you feel that it is necessary to provide healthcare, then do you support single payer healthcare, or some form of taxation to accomplish this goal? If you agree that it is necessary to pursue happiness, and is on balance an important goal, than how do you recommend that we provide it, in a manner that is consistent with your own more conservative principles?

But even if you assume all this, for the sake of argument, you still have an asymmetry: Jim Crow laws and the like are struck down because they violate the Equal Protection Clause. The government has a clear obligation to stop those things from happening. The healthcare law, justified either under the Commerce power or the Taxing power, would still only grant the ability to regulate. So the bare minimum difference, even if I grant everything you're saying above, is that the government has a legal obligation to stop segregation, but has no corresponding obligation to compel people to buy healthcare.

Don't you think the federal government has an obligation to stop free riders from using our healthcare system, incurring huge costs, and passing on those costs to the rest of us? It seems to me that the federal government has the obligation, an affirmative obligation, to stop that kind of abuse from happening. The only way to do that is to do one of two things, either change the law so that anyone who does not have healthcare will not be treated for emergency health issues, or institute some kind of system where everyone is forced to take responsibility for their own health? So, I ask you, would you be in favor of changing the law to deny people who have no healthcare the right to seek emergency services? If you do, that is an intellectually consistent position. If you don't, how else would you recommend that we address this issue?

Originally Posted by AKA23
Universal healthcare is a vital, essential goal. The lack of it strikes at the very heart of what the Founders sought to protect and defend. How can it possibly be "not a good idea?"
Geez, a thousand reasons. It can not be the government's job. It can be implausibly expensive. It can stymie health care innovation. Have you honestly never encountered any argument against socialized health care before? Do you not know any conservatives? Do you not read or listen to anything written or spoken by conservatives? I get why some people might not be convinced and all, but you seem stunned that anybody even holds the position, which is why I ask.

I am very familiar with conservative's opposition to government-run healthcare. They claim that it will be too expensive, that it will lower the quality of care, that it will take decisions away from doctor's and hospitals and patients and put them in the hands of government bureaucrats, etc, but I have never heard a conservative say that they don't feel that healthcare for every American is an important and worthwhile goal to achieve. I am stunned at that. I understand the philosophy in general.


Also, if you want to use international systems as a barometer, it can't be done selectively. You have to note, for example, that the cost is almost invariably structure as a clear tax, so the electorate has a clear picture of what they get and what it costs. Costs behave erratically and irrationally in situations where the connection between cost and service are hidden somehow, so that's bad no matter what you believe. And I'd argue that this is why health care is confusingly expensive in America already. There are so many layers of abstraction.

I agree with this. There needs to be more transparency in the system, and consumers should be aware of cost when making their decisions about what kind of treatments to pursue.

Originally Posted by AKA23
What alternative do we have? Should people continue to die because they don't have access to healthcare?

Third, you're acting as if conservatives are just saying "screw it, everyone for themselves" just because they think that's the way it should be. But they think that's the way it should be because they believe that leads to better outcomes in the long-run. You will, I'm sure, disagree with this, but there's no point in pretending they don't think that and arguing with something else.

How is it better for people to die prematurely because they have no access to care than for everyone to have access to care so that no one dies prematurely for this reason? This seems like an inarguable point. What is the other side to this? How does some people having healthcare and other people not having it lead to better outcomes in the long-run?

"Tried to work with Republicans." By offering them universal healthcare, which he knows they don't like at all? That's not trying to work with them, and it sure isn't an "olive branch." It's more like an ultimatum. If Republicans countered with a proposal to make the entire system market-based, I don't think you'd say they were "reaching out" to the President, or offering to work with him. Also, working together is only good insofar as it accomplishes something worth accomplishing; if someone thinks universal healthcare is a bad idea, they shouldn't bend on that just so they can say they're working together.

Regarding deficit reduction: what plan are you talking about here? I can't address it if you don't say what it is.

I actually would say that the Republicans offing their own market-based solutions to accomplish universal healthcare, or close to it, would be an attempt to work with the President, but they haven't ever presented that plan. President Obama's plan was an attempt to work together because what President Obama wanted was a single-payer government run healthcare system. He has said so in the past. As a second option, he wanted a public option. He got none of those. He did not fight for either one. The plan that he proposes was a market-oriented program with a market-oriented solution. President Obama's plan leaves the private insurance industry in charge. How is this not market-oriented? How is this not a compromise position?

Originally Posted by AKA23
Here's where this is a flawed point. In order to have a healthcare system that is affordable, it has to be compulsory. There will always be a lot of people who simply don't feel it's in their economic interest to purchase healthcare, because they are young and feel they are already healthy. In order to ensure that it is economically feasible for everyone to be covered healthy people have to be in the system to spread the risk and help cover the costs of those who are sick.
That's a great summary of the issue. And it leads me to one point, and three questions:

1) When you say we need young and healthy people to have insurance, that's just another way of saying we need young and healthy people to subsidize people who aren't young and healthy. So you're merely talking about forcing people into a system specifically so that some people pay for the health care of others.

Yes, you accurately describe my position on this point. The reason for this is that every healthcare expert has said that it is impossible to accomplish this goal any other way, and these kinds of trade-offs are part of having a society, and these values lead us to make investments in the society in a whole myriad of ways. The whole idea of social safety nets is built on the principle that those who have more should make sacrifices to help give those who have less the basic things necessary to live. It is also based on the premise that everyone should be treated equally and that we as a society must all sacrifice in order to make that a reality. The fact that this is what I want is perfectly consistent with how we operate in society in a whole variety of ways. There is nothing unusual about this.

2) Do you think it's possible to rationally decide that health insurance doesn't make sense for you? You say such people "don't feel" it's in their interest. Does that mean you think they're wrong? If so, why do we know better than they do?

No, I don't think it's possible to rationally decide that health insurance doesn't make sense for anyone. If you get into a car accident, and end up being in the hospital, and it costs tens or hundreds of thousands of dollars to get care, and you end up going bankrupt because you cannot afford it, you are screwed. This happens all the time, and in no way is putting yourself at that kind of risk rational.

3) If you grant point #1, that this is essentially just one group subsidizing another, why structure it as insurance except to hide that fact? Why not just tax one group to pay for another? At least then it's upfront. I see no reason not to do it this way except to obfuscate what's actually happening.

I would have no problem with a direct taxation that everyone pays in order to accomplish the goal of universal healthcare.

4) How are you defining affordable? Because things get less affordable for the people forced to pay for others. And while it'll probably cost more in general if some people don't have to have health insurance, that's not the same thing as saying the cost is prohibitive.

I don't understand what you mean by this. Do you have an example. Please clarify? This is a confusing statement.

Not quite; I feel strongly we've gone way beyond the limits, but there certainly comes a point at which those limits are hazier. Obviously the limits of power are tricky, but we don't need to pinpoint them to see that we've expanded them dramatically. A lot of rulings related to the Commerce clause seem to have a lot to do with the fact that something else was ruled Constitutional, and this new thing only goes a little further, so it's okay. Death by a thousand cuts, in other words.

As for what the Constitution empowers; heck, I think we need to narrow the scope first. It empowers lots of things; the creation of a Congress, a Senate, extradition, the right to vote. There's too much to list. Can you shrink it down to the parts you feel are more contentious, so we don't just end up with a huge list? Off the top of my head, the big things are that the Federal government definitely has a right to tax, and a right to regulate commerce that travels across state lines, and the right to form and operate a military.

No apology necessary, but I think we have a misunderstanding, anyway. I'm not saying you're not addressing salient points. And certainly not intentionally. I'm just saying that you can safely assume I'm not advocating a completely literal interpretation. We both agree that there's some wiggle room here, necessarily so. The dispute is a matter of degree.

Re: Ron Paul. I don't think he gets to define "conservatism." It's a fluctuating term, anyway, that means different things at different times, so I'd rather just discuss specific ideas than waste too much time arguing over who gets to claim that label. I think Ron Paul goes too far in a few ways, but I think he's closer to the truth than, say, a statist.

The key thing to remember here is that being against the Federal government having a power is not being against any government whatsoever do it. I agree that the government has to do a lot of things; but it doesn't have to be the Federal government. Our system was specifically setup to give the government in general plenty of power, but a centralized, distant Federal government much less. The best rule of thumb (though probably not a perfect one) is that the Federal government does clearly necessary things that the states clearly cannot do individually. Like, say, fight a war.

No, I don't. There are lots of things that are Constitutional, but still bad ideas. But a straight tax to pay for health care subsidies would be perfectly Constitutional, yes. The plaintiff's in the Obamacare case said the same.

What of the other questions from this section? Would your rationale about happiness not include healthier food, and the famous broccoli example? And if health care was so integral to the notion of this pursuit as to necessitate that we guarantee it, why wasn't it provided then? Why are so many obviously necessary things not also provided? It seems like highly selective logic.

This is a great response, because it gets right at the question of the matter. I don't think we have the kind of obligation to stop free riders that we do to make sure people are not racially discriminated against in public institutions, no. But let's assume I did: Carvin already addressed this idea in the oral arguments, quite effectively. That's an argument for a much smaller, more focused bill. Maybe just an expansion of Medicaid, for example. But the free rider issue is being used to justify the entire behemoth bill, which covers all sorts of things completely unrelated to this. The law mandates health insurance across the board, not just for people who skip out on their bill. The argument sort of skips over this distinction, as if the financial delinquency of this group empowers government to regulate a much larger group.

Well then the problem is probably in the vagueness of the phrasing. I don't know what "important and worthwhile goal to achieve" means. The way I take it is that it's an important goal for the Federal government to achieve, which I think is wrong. I also don't feel that, if some American somewhere can afford healthcare and still decides they don't want it, that this is a grave injustice which must be rectified. But sure, we all agree that we want to make healthcare cheap and accessible, and pretty much everyone (though not literally everyone, to be sure) thinks that the very poor and destitute should probably have some level of financial assistance for health problems. So any shock here is probably just a result of how ambiguous the phrase is.

Put another way: you can safely assume that nobody in this debate is an evil cartoon villain who hates people having health care or wants it to be expensive. The disagreement is always about how to balance freedom with the safety net, and what produces better long-term outcomes in both regards. It's not "people should have health care" vs. "no they shouldn't."

Glad we agree here. I want to come back to this, too, because I think it's tied to an assumption that we haven't discussed specifically yet.

Oh, lots of ways. There are a few ideas behind this:

1) That health care is expensive, always will be, and that any such system will eventually need to institute rationing, which means people will still not always have access to the care they need, or may not get it soon enough, given that many nations with socialized health have trouble with waiting times.

2) That by removing some restrictions and layers of abstraction from the system, it will spur innovation and growth and improve health care in much the same way other products and services improve when not heavily regulated, making the great health care of today the merely adequate (and therefore, affordable) of tomorrow. Whether someone likes the current system or not, nobody could say with a straight face that it represents a market-based approach. It's not even close.

3) Moral hazard. Nobody wants to talk about this stuff, but the fact is when you insure a dangerous behavior you encourage it. In some cases this doesn't matter--very few people are getting lupus out of carelessness, for example--but in other cases it does. This makes people uncomfortable, because it sounds like an argument against helping people. But it isn't. It's simply an observation: that helping people has to be tempered, because you don't want to incentivize carelessness, or dependency. This should not be used as an excuse to wipe our hands of helping anyone, but it's something liberals have to acknowledge. It is a downside of even necessary government aid.

Again, this is not an argument for ditching the idea of helping people. But it does mean that all the emotionally charged rhetoric about leaving people to die on the streets has to go. Not that you were employing any.

Well, Ryan proposed a plan, if I recall correctly, and there are all sorts of market-based ideas in the bills I linked to earlier. And I'm not sure why they have to propose one big, sweeping reform that has less chance of being enacted--or even tested properly!--to qualify as participating in the solution. Maybe we should go piece by piece; easier to isolate problems that way.

All that said, part of the problem is that when the Republicans DO propose something, they say it's not going to fly, and so they get to keep saying the Republicans haven't really proposed anything even though they have.

Re: compromise. If I give you a drink of water and you offer me a dollar for it, and I demand a billion, I've "compromised" by only asking for $1,000, but it doesn't mean I've actually been working with you. The problem with compromise is that it's only valuable when you consider what the initial demand was. You get points for reasonable concessions, not for staking out an initial position so far to one side that it looks like you've given up all sorts of things.

Also, didn't Obama play down his earlier (likely; not sure if it was stated publicly) belief in single-payer? I seem to recall that he's sort of disavowed the idea to seem more moderate, so he sure can't get the benefit of supporting it in this discussion now, assuming my memory is accurate.

What's unusual is that it's passed through a couple of layers of obfuscation, framed as insurance, mandates, etc., when it amounts to a transfer payment. It's not hard to see why. It barely passed even with all this confusion, and even after resorting to reconciliation, and even when they swore up and down it wasn't a tax. If they had to actually say "we want to take money from healthy people and give it to sick ones," it wouldn't have stood a chance. Perhaps you think it should have, but it didn't. And that makes the law's conception and implementation pretty darn sneaky.

We have a major disagreement here, then. There's nothing to stop that young person from simply banking the money saved by not having insurance--and, given the likelihood of certain accidents, that's often a perfectly sound financial decision. If we actually crunch the numbers, it seems obvious to me that there are going to be some cases where someone can rationally decide to forego it for awhile, either to take the risk (people do get to take risks, after all, without getting other people's permission) or to save the money and "self-insure." The latter, in particular, clearly has merit, provided people actually do it.

Try the food analogy again. We have to pay for their healthcare, right? So why don't we get to influence what they eat? Stop them from drinking, or smoking? The logic extends far, far beyond merely compelling healthcare. People are allowed to do all sorts of things that don't seem rational, because by and large we try not to make that judgment for people. And we have to clear (or ought to have to clear) a significant bar when we want to.

Do you think such an idea would have a prayer of passing? And if not, doesn't that speak badly about how this bill was constructed?

I'm saying two things. First, that it's not more "affordable" for the people who end up subsidizing others. For them, they're paying more. For another, the fact that premiums would be higher without forcing these people onto the rolls doesn't necessarily mean the prices otherwise are prohibitive. Health care IS expensive, and so is health insurance.

New question: is this actually about health care, or just about access? A lot of the rhetoric talks about health care as a basic right, but all that logic applies to things like food or water, too, which nobody feels we need Federal exchanges to facilitate. The reason is probably obvious: because food is cheap and easy to come by, right? If so, then the argument doesn't seem like it's really about the "right" to health care, it's just about making it reasonably easy to get, and a mandate happens to be (according to some people) the best way to do that. Which means the rhetoric isn't entirely accurate, it's just couched that way because it helps the cause to call the thing you want to mandate a "right."

If this is the case, then what would your position look like in a world where health care was significantly more affordable, and therefore almost all people who didn't have it genuinely had chosen not to get it, and hadn't foregone it just because it was too expensive? This is how Obama framed the issue during the campaign, by the way: that people don't get it largely because they can't afford it, and not because they don't want it. He used this idea as an example of a difference between himself and Senator Clinton, even though he's since completely gone back on the idea. Do you think this is accurate? If so, that means that a plan that brought costs down sufficiently would be acceptable, right? And it would have the added benefit of not forcing anyone to do anything, it wouldn't expand Federal power, and it also wouldn't force people into a big one-size-fits-all solution that has everyone paying for things like birth control, whether they use it or not.

Originally Posted by Yoda:
As for what the Constitution empowers; heck, I think we need to narrow the scope first. It empowers lots of things; the creation of a Congress, a Senate, extradition, the right to vote. There's too much to list. Can you shrink it down to the parts you feel are more contentious, so we don't just end up with a huge list? Off the top of my head, the big things are that the Federal government definitely has a right to tax, and a right to regulate commerce that travels across state lines, and the right to form and operate a military.

You have stated repeatedly during this discussion that you feel the government's powers have expanded in ways that are unconstitutional. In order to analyze whether this claim has merit, I'm asking you what are the main areas where you feel the government has solid constitutional support to act, and the government has overstepped its bounds, and why you feel that these expansions go too far? In order to understand your main arguments, I need to know what to you is acceptable, and what is too far, and why one thing is too far but the other is perfectly constitutional, since these are fluid concepts. Does that make sense?

What of the other questions from this section? Would your rationale about happiness not include healthier food, and the famous broccoli example? And if health care was so integral to the notion of this pursuit as to necessitate that we guarantee it, why wasn't it provided then? Why are so many obviously necessary things not also provided? It seems like highly selective logic.

Whether someone does or does not eat broccoli does not have a direct and deleterious impact on the rest of society the way that not having healthcare clearly does. The costs incurred by people who seek care, do not have insurance, and choose not to pay for that care are passed on to the rest of the society in the form of higher premiums.

At the time of the writing of the Constitution, our nation was in its infancy, and did not have the resources to provide these kinds of services. It would be insane for a nation in its infancy, with no resources and no certainty about their ability to even exist, to start promising healthcare for all of its citizens. As the most prosperous and wealthy nation in the world, we are clearly in a much better position now than we were then, and it is a huge injustice that the United States is the most prosperous nation on Earth and is the only major industrialized nation to not insure that every one of our citizens has healthcare.

I don't think we have the kind of obligation to stop free riders that we do to make sure people are not racially discriminated against in public institutions, no. But let's assume I did: Carvin already addressed this idea in the oral arguments, quite effectively. That's an argument for a much smaller, more focused bill. Maybe just an expansion of Medicaid, for example. But the free rider issue is being used to justify the entire behemoth bill, which covers all sorts of things completely unrelated to this. The law mandates health insurance across the board, not just for people who skip out on their bill. The argument sort of skips over this distinction, as if the financial delinquency of this group empowers government to regulate a much larger group.

An expansion of Medicaid would only cover the poor, not the many young and healthy people who merely choose not to purchase insurance and then end up incurring huge costs when they get involved in a car accident and it costs $200,000 to keep them alive. The vast majority of the money needed to ensure everyone, including the poor, is to collect premiums from healthy people to help pay for the costs of insuring the old and sick. The only way to stop free riders from using services they don't pay for and then passing the cost on to the rest of us is to mandate that everyone have insurance. The problem with the healthcare bill is that the mandate doesn't go far enough. The fine needs to be much higher than it is for people to comply with it. Even under Obamacare, there will be people who feel it is in their economic interest to merely pay the fine and continue to not have insurance. In order to ensure that everyone complies with the mandate, the fine needs to be higher than the cost of insurance would be to purchase.

I don't know what "important and worthwhile goal to achieve" means. The way I take it is that it's an important goal for the Federal government to achieve, which I think is wrong.

Why is this wrong? Is your objection to a federal mandate the main problem? What about a state mandate? Would you be in favor of that? That's what Romney did in Massachusetts, and it worked. 98% of Massachusetts residents have health insurance. If you don't support a federal mandate because it, in your view, gives the federal government too much power, what about doing this on the state level? What if the federal government passed a law that states needed to have a state mandate, but that the manner in which to achieve coverage would be left to the states, allowing them to craft their own state-specific solutions to ensure all of their citizens? Would that meet with your approval?

Originally Posted by AKA23
How is it better for people to die prematurely because they have no access to care than for everyone to have access to care so that no one dies prematurely for this reason? This seems like an inarguable point. What is the other side to this? How does some people having healthcare and other people not having it lead to better outcomes in the long-run?
Oh, lots of ways. There are a few ideas behind this:

1) That health care is expensive, always will be, and that any such system will eventually need to institute rationing, which means people will still not always have access to the care they need, or may not get it soon enough, given that many nations with socialized health have trouble with waiting times.

In your view, is it better to have no rationing, but have a huge swath of our citizens have no access to care, or is it better to have some rationing, and longer wait times, but to ensure that every one of our citizens has at least a minimum standard of care? To me, the choice is clear. Not only that, rationing is already occurring, but the rationing is done by health insurance companies whose sole aim is to lower their own costs and make as much money as possible. Wouldn't you rather have the government, which at least arguably has the best interest of its citizens at heart, rather than having their one and only consideration be cost, taking a larger role in these decisions? If there is going to be rationing, and there is going to be rationing, because we simply cannot afford the system we have today, then isn't it better to have doctor's groups and the government, which have as their main responsibility the best interest of the citizens, rather than profit, be involved in these decisions?

As for waiting times, waiting times for emergency services are comparable with our own, in most cases. Waiting times for having non-essential services, like a hip replacement, or back surgery, do happen, but what is wrong with that? Don't we already do this in our hospitals with the triage system, where the sickest and those in most need of care get treated first, before everyone else? The idea of having healthcare for everyone is to ensure that everyone has a minimum standard of acceptable, quality care. Even these socialized systems, which you decry, have doctors outside of the socialized model who can provide services, at a higher cost, at a faster rate? This makes healthcare like any other service. If you pay more, you get better service, in a shorter period of time. The problem with the model in this country is that we have this kind of service, but then we also have a large percentage of our citizens who get no care whatsoever, because they simply cannot pay for it. This ties your ability to live and be healthy with how much money you have. You can't possible agree with that, can you?

2) That by removing some restrictions and layers of abstraction from the system, it will spur innovation and growth and improve health care in much the same way other products and services improve when not heavily regulated, making the great health care of today the merely adequate (and therefore, affordable) of tomorrow. Whether someone likes the current system or not, nobody could say with a straight face that it represents a market-based approach. It's not even close.

Healthcare is an essential service that everyone, at some point, will need. It is not a market of luxury goods, where people can opt out of purchasing it, and where because it is not essential, companies must lower their prices to remain in the market. Healthcare is something that everyone needs. It is not an optional good. If it were an optional good, this analogy would make sense, but because it is not, it does not.

3) Moral hazard. Nobody wants to talk about this stuff, but the fact is when you insure a dangerous behavior you encourage it.

Sorry, I have no idea what you're talking about here. I understand the concept in general, but how does this apply to healthcare?

Well, Ryan proposed a plan, if I recall correctly, and there are all sorts of market-based ideas in the bills I linked to earlier. And I'm not sure why they have to propose one big, sweeping reform that has less chance of being enacted--or even tested properly!--to qualify as participating in the solution. Maybe we should go piece by piece; easier to isolate problems that way.

Ryan's budget radically slashes spending on the poor, the sick, and those who need help most, while at the same time dramatically reduces taxes on the wealthy, and does nothing to cut the military budget, which is the highest in the world, and if deficit-cutting is such a huge priority, should be the first thing to be cut. The Republicans act like cutting one dime from building nuclear weapons and aircraft carriers will somehow endanger our national security, but this is ludicrous. See, that's the thing that bothers me about the Republicans. They talk about cutting the deficit, and loudly decry the Democrats as socialists who want to redistribute income, but in reality, they're doing exactly the same thing. The Republicans merely want to transfer the distribution to the wealthy and the military, rather than the poor, the sick, and the old. Both parties spend like drunken sailors. Both "redistribute income." I'd much rather "redistribute income" to the poor, the sick, the old, and the most vulnerable in society than redistribute it to give more and more money to the wealthy and the military so we can build yet another nuclear weapon that nobody is every going to use that will destroy the world. I am shocked that nobody else has picked up on this very obvious point.

Originally Posted by AKA23
If we actually crunch the numbers, it seems obvious to me that there are going to be some cases where someone can rationally decide to forego it for awhile, either to take the risk (people do get to take risks, after all, without getting other people's permission) or to save the money and "self-insure." The latter, in particular, clearly has merit, provided people actually do it.

This may have some merit, but nobody actually does this, so it's really not a legitimate argument. The people who are not buying insurance are not saving for a catastrophe by saving the money in their bank account, they're spending it on things they don't need and taking the risk that any accident will make them bankrupt. Given that medical expenses are the number one reason for bankruptcy in the United States, the idea that forgoing insurance is a perfectly legitimate, rational, calculable risk seems belied by the facts. Not only that, this argument only works if you feel the only purpose of the individual is to protect their own economic interests. The fact that we live in a society where we all have to contribute to helping each other and ensuring that we all have a basic level of goods and services to survive and prosper is completely denied by the idea that all I have to do is protect me and mine. I'm not sure you'd really want to live in a society that operated that way. I know that I wouldn't.

Try the food analogy again. We have to pay for their healthcare, right? So why don't we get to influence what they eat? Stop them from drinking, or smoking? The logic extends far, far beyond merely compelling healthcare. People are allowed to do all sorts of things that don't seem rational, because by and large we try not to make that judgment for people. And we have to clear (or ought to have to clear) a significant bar when we want to.

You're talking to the wrong person here. I fully support taxes on cigarettes, junk food, drinking, etc. Social science research proves that by far the most effective way to reduce undesirable and unhealthy behavior and life choices is to tax it. I'm all for taxation to create a disincentive for people to do things that are unhealthy, and unwise.

What would your position look like in a world where health care was significantly more affordable, and therefore almost all people who didn't have it genuinely had chosen not to get it, and hadn't foregone it just because it was too expensive?...A plan that brought costs down sufficiently would be acceptable, right? And it would have the added benefit of not forcing anyone to do anything, it wouldn't expand Federal power, and it also wouldn't force people into a big one-size-fits-all solution that has everyone paying for things like birth control, whether they use it or not.

In theory, I would support this, but how are we going to accomplish this goal? Conservatives haven't proposed any kind of comprehensive plan to accomplish this. A piece meal approach to healthcare, which is what the Republicans have proposed, will not get you to this goal.

Slightly off topic i know but I'm so glad Australia has had a medical system in place for so long now it's just our way of life. There is no need for debate and for the most part it works. Now if only we could get universal dental cover I would be happy $311 for 15 mins work is extreme.

Sure, I understand the question and its necessity. I'm just saying we need to reduce the scope, because the list of things the Federal government (and I feel obligated to point out that, when you say "government," it's not really referring to State government, which doesn't have these issues) can do is pretty sizable and I'd hardly know where to begin, other than just checking off articles and amendments.

The biggie is that I think the Federal government has the power to tax, and it has the power to regulate commerce that travels across state lines, but not the power to regulate anything and everything that merely affects commerce that travels across state lines. The reason being pretty simple: that puts very, very little limit on what the Federal government can regulate. And whether you believe in trying to factor in any degree of intent or not, limiting that general power was a pretty clear point of consensus at the time of the Constitution's writing. It's the basis for the entire manner in which it was written, and the sorts of things that were on the docket back then indicate a much, much different idea of what was even up for discussion.

To say that you can regulate things that affect the market is pretty much the same as saying you can regulate anything, because the entire point of markets is that they're affected by all sorts of information. More on this after the next quote, where it's directly applicable.

The effects of bad eating in general have a direct effect on health care costs, though, even if no one person eating or not eating vegetables does, just as health care costs in general affect the market even if no one single person creates any kind of difference in overall costs.

Also, this describes literally every market! By not buying a car, you make the cost of cars for others who buy them more expensive. You reduce the economy of scale. Anything you do not buy, you raise the price of, and anything you do buy, you help lower the prices of, in ways both direct and indirect. Health care is not special in this regard.

This is also another area where proponents of the law start fuzzying the lines between things. They act like health care and health insurance are the same thing, and they suggest (through the law itself) that anyone without insurance is to be treated as a potential freerider. And it further implies that anyone without X minimum of care, with birth control and all sorts of other random things included, should be treated the same as a potential freerider simply because their health care insurance doesn't include those things.

So, basically, it takes the existence of free riders and decides that, because of them, we need to push everyone into the same system. It's a bit of a leap of logic.

Question: if the problem is freeriders, why not tougher penalties for people who ignore their bills? And if the problem is that we just don't feel right doing that to people for medical care, why not tougher penalties along with straight, tax-based federal assistance? There's a disconnect here in the description of the problem and the application of the solution. There's a point at which supporters of Obamacare describe the problem, but then use that problem as if it justified this all-encompassing attempt at a solution. But the problem is much, much narrower in scope than the solution.

Precisely. Which means it's a question of cost, not of rights. It's not a fundamental right that we simply must have to have a free nation and a free people, it's a luxury that some people think we can now afford. Which completely changes the angle of the conversation. It turns into a technical discussion about costs and benefits, not a civil rights struggle. Which, frankly, is better, because once you lump health care in with freedom of speech, what point is there in arguing? It's not like I can show you data that would convince you to deny someone a basic right. To say it's a right is to effectively end the conversation.

I've never really understood this argument. What other countries do should be a guide, but not a rule. Maybe every other country does it because we're uniquely focused on the individual. And maybe that's good. Maybe that's why we're also the only country with a $14 trillion GDP. There are lots of ways in which America stands apart; some might be good, some might be bad, but the mere differences themselves are not an argument to fall in.

The tendency of a wealthy nation is to start indulging in things it can afford, even if they're not a good idea. The fact that other countries do this may not be a reflection of its wisdom, but of the natural inclination of wealthier nations to do this. Rich people tend to buy more lavish things they shouldn't, too; but that tendency doesn't mean it's good or bad. A tendency can exist for rational reasons, or it can be a pitfall roadmap, showing us what patterns wealthy nations fall into.

And if we want to cite them in one direction, we must cite them in the other: by looking at results. And when we do, we see straight taxes (meaning the cost-benefit ratio is a good deal more direct, at least), we see everything outside of emergency rooms to be very sketchy (I've known multiple Canadians who say, if they want attention anytime soon, they have to go the "emergency" room), and we see continual reforms and rationing because of cost outlooks.

Well, this is the worst-case scenario, sure, but how likely is it? Nobody denies that it happens; the question is how often it has to happen to make the decision not to have insurance an inarguably unreasonable one.

Or we admit what it is and make it a straight welfare program, rather than hide it behind broad abstractions.

I'd say it only needs to be close, seeing as how at that point you'd pay just a little more and at least have health insurance, but sure, once you decide the law needs to exist, the penalty needs to be significant.

No. I wouldn't have a Constitutional objection to that. Just a policy one. And even then it might be very helpful if other surrounding states were able to take more market-based approaches, because we could gauge the results and people could decide which kind of place they wanted to live in.

But it cost twice what was predicted! There's a circular argument here, in that people say these things "work" because they actually do make sure people have health insurance. But people don't just object to them because they think they won't cover people, they dispute that it'll lead to better overall care and higher overall standards of living. It could cost us trillions of dollars and still "work" by the very narrow definition of "does this get people insurance?" But that's not the only question. It's not a worthwhile goal at absolutely any cost, and even if it were, at certain cost levels it would be doomed, anyway.

See above. Constitutionally, sure. And if we can let other states try a very different, unencumbered approach, we can let the ideas duke it out in reality rather than rhetoric. That's one of the reasons we have States in the first place, so why are we deliberately removing that benefit to try to impose top-down solutions?


Depends on the rationing, obviously. But again, notice that the conversation never takes place. We have to go five rounds (we meaning me and anyone else, though it applies here, too) before we even START talking about the downsides of costs and rationing. All the stuff before then is just abstract stuff comparing health care to civil rights and talking about what a big problem it is, and comparing us to other countries. It takes a great deal of effort to even get the supporters to come around to the idea that, hey, we actually should sit down and look at what this sort of care might look like in the end.

Health insurance companies can't actually "ration." Rationing is when someone controls something and decides how to dole it out, which means private insurance companies can no more "ration" care than your grocery store can "ration" eggs.

I'm a tad skeptical of your assumption that the government puts its citizens first (which is the real question, not whether or not they wish us well in ways that don't conflict with their own self-interest). Politicians have their own set of incentives about perception and handouts (which are asymmetrical in terms of political potency when compared to their cost), and I have little reason to believe they lead to better outcomes. You could frame the question this way: wouldn't you rather have health care provided by people who lose business when they don't provide it properly, as opposed to people whose success or failure is tied up more in how they can make things seem? I trust someone to protect their livelihood more than I trust them to merely keep his word. Especially a politician.

There's another asymmetry here, too: the fact that something happens through a series of independent decisions is inherently better than something dictated from on high. It may be that the market price of milk is $3 a gallon, but that doesn't mean that there's no problem with government setting price controls so it stays there. Situations arrived at through market consensus are more flexible to changing reality, less subject to political posturing, harder to abuse (because more people contribute to the outcome), and are the result of free choices. Even if the outcomes end up being the same to some degree, they're not equal, any more than it's equal for me to decide not to say anything and for the government to forbid me to do so.

Also, the kind of system you're describing, again, doesn't sound similar to the actual law. The actual law calls for the IPAB, a board that decides what things are and are not cost effective. These are what you've probably heard referred to as "death panels," and whether you agree with that incendiary label or not, they will definitely be making choices that decide who lives and dies. And get this: it can change these standards (IE: where the money goes) without Congressional approval! We might even have another Constitutional challenge based on that part of the law, as it puts such an insane amount of power in the hands of a few completely unelected people.

These are separate things: waiting times are how long it takes, triage is priority. Triage exists in both a very fast system and a very slow one.

As for what's wrong; well, it depends. What's classified as non-essential? In some countries, it seems to be quite a bit. Does it mean anything if a freer system means people suffer for smaller periods of time? How do you weigh that against essential care? Nobody likes to admit that there's a tradeoff between quality of life and life itself, but clearly, there is. And again, there is the difference between the result of free, independent choices, and government imposition.

I think these questions would benefit from precision. You ask if I "support" people not having health insurance, or "agree" with the fact that some people can't pay for care. Both are strange questions. If you're asking if I like it, then the answer is no, of course not. But that doesn't really tell us much about what we should do, except that it probably rules out doing nothing.

I don't think the real problem is that some people can't get care. The real problem is whatever stops them from doing so. And I don't think it's just that health care is expensive. I think it's that we keep trying to split the difference. We have some market elements in health care, but not many. We have complicated regulations and many layers of abstraction. You can't buy health insurance across state lines. Few people have much idea about what things cost. Healthcare is inexplicably tied to employment because employer-based health care receives tax benefits that independently purchased care doesn't, which is insane. These are huge market distortions. People talk about the necessity of some form of socialized care and imply that the market has simply failed here, but we don't have anything approaching an open market. Not even close.

What cost you that for fiftten minutes?

Clearly, it confuses the issue (and again, this is an area where proponents of Obamacare just sort of mash unrelated things together into one big abstraction) to say that everyone will use "health care." That's kind of like saying everyone will use "transportation," and then using that as a reason to regulate everything from sail boats to tricycles. Everyone will use "health care," but most of us will never have a triple bypass, half of us will never need the pill, many of us will not need pregnancy care, etc. And while some health care is essential, a whole lot of it isn't, in the strictest sense. In your last post you made a distinction between essential and non-essential care arguing the other way, but here you equate the the two.

It seems to me that the entire argument for socialized care, and Obamacare in particular, centers around ignoring specifics. Health care morphs into health insurance. Free riders dictate policy for everyone. We're all forced into a market when the only real goal is to make some people pay for the care of others. We're all forced onto some minimum plan (which is hardly bare bones) whether it's a good fit for us and not. This is the problem with top-down solutions: they're one-size-fits-all. Even if you think this is necessary, it comes with some very clear downsides.

In short, moral hazard is an economic concept that says, when you insulate people from risky behavior, you encourage it. So, to use a (currently) outrageous example, if you guaranteed that everyone was entitled to a new car when their old one broke down, very few people would take good care of their cars. If it's really easy to declare bankruptcy and have your loans forgiven, then there's less reason to pay them back.

Thus, any form of charity has to account for this. It has to weigh the benefit of helping people with the downside of encouraging the behavior that's led to people needing help in the first place.

There are some areas of health care where this doesn't apply. But there are plenty where it does. Much has been said and written about the costs of unnecessary testing. To someone who doesn't see a direct connection between tests/care and cost, the tendency will (quite rationally) always trend towards more tests and more care, if you can get it. Which leads to more demand than supply, which leads to rationing. It's literally the same concept as price controls, and it's why they almost always lead to shortages.

Well, first off, I think you're talking about his budget, not his health plan.

Second, I think we probably should cut defense spending, but that's an ideological argument, not a practical one. And I'll gladly have the "cuts spending on those who need it the most" argument, and Ryan's central argument is that his plan will lower costs, but it's ultimately a separate question. The fact that you don't like Ryan's plan doesn't mean you get to pretend he doesn't have one. But people don't want to, because it sounds much better to say "they have no plan!" than it does "they have a plan but we don't like it for these reasons."

Except it's false. It's not redistributing income to simply not take it in the first place. These arguments assume that the current situation is some kind of normal baseline, and that any change is "giving" money to this group or that. But that's not the scenario. It's only redistributing when you take from one person and explicitly give to another. You may not like the policy, but it cannot be called redistribution.

As for the idea that Republicans can spend like drunken sailors...you'll get no argument from me. They are absolutely capable of doing that, and if they have all the power, they seem to do it, too. All the more reason to lower the amount of money they get to collect in general. I trust the Republicans more than Democrats on this point, but that's faint praise. I only argue for the underlying ideas, and that Republicans are more likely to follow through. I can't argue that they'll definitely do it. But why would I vote for the party that says they're going to do the things I don't like, as opposed to the one that says they won't and sometimes does?

I don't think this follows, for a few reasons:

1) It's the number one casue, but it's a plurality, not a majority. The majority happen for other reasons.

2) Something like four-fifths (depends on the study, I imagine) of the people who file for bankruptcy actually had health insurance, anyway.

3) By itself, the frequency of these bankruptcies doesn't demonstrate that it's an unwise risk. Car accidents are the number one cause of death among teens, I believe. Does it logically follow that they shouldn't drive? If four people out of a million died from something, that could be the "#1 cause of death," but that doesn't mean four out of a million is a lot. So there's some missing data here, if you're trying to connect the two.


I sure wouldn't. But nor would I want to live in a society where everyone was largely society's responsibility. And what I'm for privately is not what I'm automatically for through government intervention. I can think taxes are too high, but still strongly support that people give to private charities. I can be a Christian and not want a State Church.

The one thing I really want to emphasize is that freedom has both value and cost. There are many, many ways that we can make people safer (at least in the short-term) by restricting what they're allowed to do, or taking more of their money. But clearly, there's a trade-off there. Having a national curfew wouldn't be okay just because it would, say, lower the murder rate a couple of points. Being free means tolerating some things we don't like. I feel like people in wealthy societies start to forget that. They start to forget why they're wealthy, and start trying to fix every problem. On some level, this is a very understandable, human reaction to the ills of the world. But it's also a potentially dangerous idea.

Well, it goes from taxes to bans in some places, which is pretty awful. But yeah, I think we do have a very fundamental disconnect here. I think people have a right to know the risks, and do it anyway, with few exceptions.

Why not? How do you know? The system is riddled with interference and abstraction. There is very little connection between cost and result, which is the fundamental mechanism behind markets. Why don't we try more freedom first, before we write it off?

Also, note, again, that like before, you admit that cost is the real issue. That cheaper healthcare would essentially fix the problem. That's an important point to agree on.

One of those new MRI/lap dance combos.

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