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

Originally Posted by AKA23
Sorry, I have no idea what you're talking about here. I understand the concept in general, but how does this apply to healthcare?
In short, moral hazard is an economic concept that says, when you insulate people from risky behavior, you encourage it...

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.

I agree that unnecessary testing is a problem, which is why I support a change in the fee for service system. This is something that Republicans generally oppose. I also would support transparency regarding cost. Even though I am a liberal on these issues, I do support cost containment. I do this routinely in my own life. I come from a family of physicians, so I do ask about cost and about the likelihood that tests are necessary. I have a fast heart rate. I am young and mostly healthy, but when I was in college, the doctor wanted me to do a heart scan. This heart scan was fairly expensive, but the college insurance would cover the overwhelming majority of the cost. My out of pocket cost was limited. The doctor said it could be possible that I had some kind of heart defect that this scan could catch that could be causing this problem. I asked how much this scan would cost. He told me the cost. It was a lot. I then asked the doctor, what is the likelihood that this scan is really necessary, and to what degree do you think it is likely that I actually have this problem? The doctor told me on balance the probability that I had this problem was quite low and that he didn't think it was really necessary. I didn't have the scan. If I were a conservative afraid about "socialized medicine," I probably would have had the scan, because there could be a one in a million chance that I actually had this problem, and we of course won't know until we do this scan, so we should do it "just to make sure." This is the kind of argument conservatives routinely make about why healthcare costs are legitimate and why cost shouldn't be a part of the conversation when determining care, but that's not a sustainable way to run a healthcare system, and is a large part of the reason why the cost of healthcare in this country is out of control.


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."

Ryan has a plan for the budget. Ryan doesn't have plans for a comprehensive overhaul of the healthcare system. The Republicans do have some proposals, as your link detailed, but they don't address the scale of the problem. The debate about the military budget is not an ideological one entirely, this is very pragmatic. If we cut our military budget dramatically, we'd have a lot more money to reduce the deficit and to fund a lot of these social programs that the Republicans tell us we don't have the money to do.

Originally Posted by AKA23
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.
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.

It is very much redistribution of income to give tax advantages to the wealthy rather than spending that money on social services for the entire society. The federal government takes money in the form of taxation. President Bush dramatically reduced the rate at which money was taken from this group. This money was previously going to the federal government, and the federal government used this money to pay for social services that we all need. President Bush, and President Reagan before him, dramatically reduced taxes, and reduced them the most for those who are at the top end of the income scale. This money, instead of going to those who really need it, instead was distributed to those who were wealthy. The same is true for the military budget. The government takes money from everyone. The government uses these funds to fund needed social services. Conservatives often want to use these funds instead to increase military spending. This money that was previously going to fund social services is now going to the military to build more weapons systems. This is distributing income from one group to another. That is what it is. These are just the facts.

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?

This is more than a philosophical debate, though. It is highly relevant to examine whether the Republican party is successful at doing the types of things that you feel need to be done. If they are, great, that's a good reason to vote for them, but if they're not, and the evidence indicates that they are rarely any better than the Democrats on federal spending, than it makes very little sense to vote for them. If I care about the budget, and philosophically believe that federal spending should be dramatically reduced, and that these market based principles should be infused into social policy, but when I examine the record, I find that the people that I vote for consistently aren't actually doing that, that's highly relevant, and essential to know and understand.


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.

The notion that we should tax behaviors that are unhealthy and unwise in order to discourage their use is not incompatible with the notion that people have a right to know the risks and do them anyway. Taxing something isn't making it illegal. It is increasing the costs for doing it. I find it somewhat surprising that the supposedly free market, rational economist conservatives balk at the notion of taxing something to discourage its use as an attack on freedom. This is, again, another example of the inconsistent application of market principles. Why shouldn't we tax things to discourage their use? This is a free-market conservative principle. Why not use it to improve the society? Why do these things only get to be used to cut spending for the poor and the disadvantaged rather than on things that would truly make a difference to improve the health of the individual and our society?

Originally Posted by AKA23
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.
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.

I think that both cost and access are "real issues." I also think that it's virtually impossible to work on one without addressing both, which the conservatives consistently fail to do.

No it doesn't. That's sheer nonsense. Being for states' rights is not saying states should be little islands with no interaction between one another, it's being against overreaching Federal control of states. It has absolutely zero to do with whether or not the people in them trade with one another openly. Zero.

If a state pasees a law that does not allow buying of insurance out of state and Congress passes a law that overrides that, well, Congress is violating state rights.

__________________
It reminds me of a toilet paper on the trees
- Paula

Yeah, and that's a huge "if." It depends entirely on how you go about supporting this. If you support a Federal, top-down rule that states cannot regulate health care in that way, then yes, you're in conflict with Federalism. If you just think people ought to be able to, that's another matter. A Federalist doesn't have to abandon the idea, they just have to fight for it on a state level.

Basically, like so many sloppy claims of this nature, the problem is just saying "right" and not distinguishing whether or not that right comes from the State or the Federal government. Only one poses any kind of problem.

Because when I ask whether or not making health care more affordable would be an acceptable solution the problem, they generally say yes. And if they say that, they've already conceded that the issue is about cost/outcome.

Depends on the progressive. Which is why the question is posed: to determine who really thinks we need more basic rights, and who just isn't nuts about the current outcome and is open to fixing it within the system. Which makes it not only a fair question, but a necessary one.

Because they think both/either a) the free market does not always distribute resources very well, and b) even if it does distribute it better, having some minimum level of care is more important than having better overall care. Sort of like the justice system, in that it would be unacceptable to swap in any more efficient system that had some kind of built-in error rate.

There are any number of issues on which it is rationally coherent to say "this is what people choose, but we don't want to live in that kind of society. Upholding X principle is more important than efficiency." That just first involves admitting that you're willing to tolerate worse overall results for some other purpose. People seem loathe to do this, but they have to, if they want to talk about health care as a right.

This describes non-progressives, too, though. I don't support absolutely anything that increases economic efficiency. We all think there is a baseline of rights and decency that must be maintained, efficiency be damned. The question is invariably one of degree, and where that line is drawn.

I happen to agree, but you'll notice that lots of people don't think so. A lot of people think it is unique enough and that all the normal rules of markets don't apply. Or they regard it as one of those "I don't care if it's better or worse, I just don't want to live in a society where X can happen" things.

Keep in mind you're commenting on someone else's argument here. The fact that the solution is obvious to you is fine. But if that's the case, you should be addressing this to AKA, or anyone to whom the solution is not obvious or not settled. It doesn't make sense to ask me to resolve this just for posing the question. You should address it to the person answering.

Why do you get to just declare that the "real" question is how to get universal healthcare? You're just excluding anyone who rejects the premise of the question, or thinks universal healthcare is a good goal, or even someone who thinks it's a good goal but thinks we sacrifice too much else in achieving it.

Again, the problem is that you keep saying this is the "real" issue, but you have no position from which to say this. It's what you want to talk about--nothing more or less. If AKA agrees with you, and says health care is a right guaranteed independent of efficiency, then they can do that. But I dunno why them not doing that is supposed to indicate some Jedi mind trick. I think it just indicates that rhetoric is being used carelessly.

Correct. But this doesn't mean the statement isn't dogmatic. Axioms are dogmatic. And it's fine that they are. The point is to get this all out on the table and show the other side the implications of their rhetoric. If they can embrace those, great. It's my experience that they don't, which means they need to decide what their position is before we argue about it.

Also, it occurs to me that you're using axiom in a very mathematical way. But when someone says health care is a "right," they almost never mean "and I will posit this hypothetically in order to bring about some other outcome that proves the value of that which is posited." They almost always mean "this is the morally right thing to do regardless of outcome."

If the federal governemnt passes laws that says states can't do something, where do they get that right according to conservatives?

The Commerce clause?

They don't. The problem is that you keep adding an "if" and then acting like no other non-if scenario exists. If state law says that, then Federalism can't stop it. That doesn't mean you can't be for it. It just means you probably can't support mandating that at the Federal level (I only say "probably" because I haven't made any attempt to see if a decent Constitutional argument exists here).

The only scenario that exists to stop the states from preventing residents to buy out of state insurance is for Congress to pass a law that prevents it, which is what many conservatives propose.

Yeah, the problem with what you just said is the "stop states from preventing residents." You seem to be constructing your sentences to specifically exclude the perfectly reasonable position of being for this right, but not being for mandating it at the Federal level. Being for something doesn't mean being for any method of making it happen. Which is why I said two posts ago that your use of the word "right" was too ambiguous.

It also uses the really old rhetorical ploy of using wishy-washy terms like "many conservatives." As if the fact that some conservatives are Federalists and some are not poses any kind of problem for the entire ideology. The only problem posed here is for any conservative that tries to have both at once. If you want to produce such a conservative, you are free to question their consistency. Otherwise, you're not really saying much.

The GOP's Folly On Buying Insurance "Across State Lines"

January 19, 2011 4:28 pm ET
In preparation for the House's show vote on repealing health care reform, Republicans have spent the day criticizing the Affordable Care Act and calling for Republican proposals to replace those in the current law. In particular, Republicans have been stumping for legislation that would allow insurance companies to sell policies across state lines — a ridiculous proposition given that the Affordable Care Act already provides for the formation of health care choice compacts that would do just that, with interstate policies subject to some minimal regulation. Without the consumer protections afforded by the health care reform law, simply allowing insurance companies to sell policies across state lines would drive companies to states with the least consumer protection, allowing them to sell cheap, minimal policies to those who are young and healthy, but resulting in wildly expensive plans for those who need more comprehensive coverage.

Yeah, some Republicans are for total, unambiguous Federalism, and some are fine with some exercise of Federal power. That isn't news. Are you even reading the text of the posts you're replying to any more? Specifically, re-read the second paragraph of the last one.

You'll have to define the terms, then, because I don't understand the distinction you're making. Though I'll point out that people often say "access" when they really mean "funding," usually because they want to advocate more spending without actually saying it. The cost of health care is the primary problem, to my mind. Candidate Obama (though not President Obama) said the same thing, by the way.

So what do you mean by "access" and why does it require that we impose a top-down solution, rather than a targeted response?

Well, now I'm confused. If you say it'd be an acceptable alternative to merely bring health care costs down, then you can't be talking about a "fundamental right."

You have (sort of) argued that the Founding Fathers actually would have included health care among our basic rights if it were affordable to do so at the time. I find it difficult to accept that you actually believe this (and I don't know if it's true--wouldn't they just have had more primitive care?)...but even if I grant that for the sake of argument, then that means we're not talking about a right any more because rights don't vanish just because they're expensive. That's what makes them rights. The fact that they're not contingent on things like political popularity or cost. You wouldn't say we have the right to freedom of assembly, but only at a certain level of wealth, or that we get freedom of speech once it becomes easier to police, or something. Rights are things you get no matter what. You can't bargain them down or sell them away, even if you wanted to.

I don't think this answers the question, though. I explained the statistical jump involved in thinking that, because something is the #1 cause, it must therefore be a very serious problem. That doesn't follow, logically. And as I pointed out before, the overwhelming majority of medical bankruptcies happen with people who have health insurance.

And I have to again point out how vague the rhetoric is. You say it's "often enough"--but how often? You say it's often enough to be "something that our government should be working to combat," but what does that mean? Combat how? With a massive one-size-fits-all minimum health care plan mandated at birth? We can potentially agree that the government should do something, but that doesn't automatically lead us towards something like Obamacare.

You kind of went off the topic here; you were saying Romney's plan "worked," and I pointed out that it cost twice what was projected. Then I pointed out that saying it "worked" is circular, because you define "worked" not by measuring efficiency, but by the binary question of whether or not it added a lot of people to the insurance rolls. So I'm not sure how this got onto military spending.

I mean, we can talk about it, anyway, I guess. Regarding that, the broad response is simply that there's nothing inherently contradictory about thinking military spending is necessary, and some other types of spending are not. We all thinking spending needs to be cut (well, all the reasonable people, at least), and we all think some services are important enough to be exempt from that. We just don't agree on which ones. I personally think we should cut some defense spending, but this isn't an example of any sort of self-contradiction or any problem with core conservative principles. Some things have to be done by the state, and some don't. Some things are best done by the state, and some things are best done by individuals. I'm pretty sure making stealth bombers falls into the former category. So we can argue about how much we should be spending on that, and you and I might agree a fair bit, but there's no internal problem with the position.

I'm confused by this. It sounds like you think the IPAB board only provides end-of-life counseling.

True or false: it's a panel of people who will make decisions that decide who lives and who dies. If true, then how can you say, with a straight face, that the phrase "death panels" is not based on reality? You might find it incendiary or overly dramatic (I know I do), but I'm not sure how you could say it's detached from reality.


And every study says you should eat your vegetables and exercise. Therefore...establish a panel to make sure people do it? Surely the burden of proof for giving government authority to do something is a hell of a lot higher than "is this generally a good thing to do." So why keep saying these sorts of things, as if all you had to establish is what it's probably a good idea, and government intervention is suddenly justified?


This is really, really stunning. Look at these statements:

"We don't have an unlimited amount of funds."
"None of us can live forever."

Both true. But do you recognize that this sounds exactly like a libertarian argument? It sounds just as valid as an argument against intervening when people need help paying for health care. Would you accept these sorts of arguments in that context? If you said health care is a major problem because lots of people can't pay for it, would you accept "Hey, none of us can live forever" as a valid conservative response?

Also, does it bother you just a little that you're talking about making value judgments on people's lives? That you say money is "wasted" on older people, as if their lives are simply worth less? If you're willing to just let older people die, then why do we need this system anyway? I thought the younger, healthier people were just there to keep costs down for the others...now we're sacrificing the senior citizens so the more valuable younger people can live?

This is without even getting into exceptions. Hell, what if the 70-year-old is a wise, responsible grandfather and the 25-year-old is a druggie burn out? Trying to assign them each Life Points and choosing one of the other is playing God in the worst way. If we're going to have finite resources either way, and people are going to die either way, let's use a system that at least gets us there through the result of free, independent decisions, and doesn't have small handfuls of peoples assigning arbitrary ration value to human lives.

This is kind of confusing, for two reasons. First, because we already went over this, and I pointed out that this "balance" is just a transfer payment from younger people to older ones. And I believe you ended up agreeing that it's kind of a sneaky to achieve this with a layer of abstraction, rather than a straight tax, and that the only reason to do it this way is that the policy, in plain English, wouldn't have had a prayer of passing.

The second reason is that we weren't talking about this; the point you were replying to is what a free health care market might look like, though. You say that health insurance is too expensive, but the entire point here is that it doesn't necessarily have to be. We have a convoluted system with arbitrary benefits and many layers of abstraction between consumer and producer. It should not be merely assumed that this hodgepodge of ideas has produced a genuine market price that we can use as a baseline of what's realistic.

Also, it's interesting to me that you talk about a wide disparity in premiums, but don't seem to realize that this is reflecting the underlying reality of what health care costs. It's kind of bizarre to me to insist that premiums should be flat across all demographics, all types of people, no matter their actual level of risk or health. That's kind of like saying all food should cost the same, even though some of it's much harder to grow or produce. The fact that premiums would vary in a free market isn't a bug, it's a feature. It's a response to the unavoidable reality that some people need more care than others. If you want to combat this somehow, we can discuss it, but it's odd to me that there appears to be no recognition that this fact reflects an actual set of facts about risk that don't go away just because we mandate something.

Those cable packages are market solutions. Not everyone likes them all the time, but it's actually cheaper on a per-channel basis. If they were not bundled, and you could pick channels, each one would cost quite a bit more. It'd cost less for consumers that consumed very few shows, yes, but more for others. And the fact that it's non-essential makes it less relevant, not more: people are much less likely to demand alternatives when their life doesn't actually hinge on whether or not they have CNBC.

And, of course, you also don't have by cable simply because you were born.

I don't think a conservative is more likely to get that scan than a liberal, or an independent, or whatever. If the system dramatically lowers the cost of the test, far more people will get it than they should. And it'd generally be a rational choice, since they (or someone else) is bearing most of the cost.

I'm betting the word "comprehensive" is the escape hatch here. It's nearly circular: you say they have no plan. When I show you plans, you say the plans aren't "comprehensive." When I ask you what that means, you say it's not "comprehensive" unless it achieves universal (or nearly universal) coverage. Thus, when you say they "have no plan," all you're really saying is that they don't believe in universal health care.

Imagine the same thing in reverse. Republicans say Democrats have no "realistic plan." Then they define "realistic" as a health care plan which doesn't try to mandate coverage.

Republicans have lots of plans and lots of ideas. You just don't like them. And you can say you don't like them. But you don't get to say they don't have any. Democrats are bleating this incessantly, but when you ask them to define their terms it becomes clear that it's all rhetorical bluster. It's just a more forceful, misleading way of saying they don't agree.

You're sort of just repeating the initial claim, though. I replied to all of this here. Here's the basic idea again:

"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.

There is no earthly way to call this "redistribution." For one, it's pretty much embodying an accusation that conservatives like to hurl at liberals that they think everybody's money is already the government's and they just decide how much to allow you to keep. For another, you can't pick one moment in time and decide that that's the "normal" tax rate, and anything more or less is distributing money.

I wouldn't say they consistently fail to do it, so much as they fail to do it consistently, if you get my meaning. But they do it a whole lot more than the other party, so that's the one I support. I don't grant the premise that they are "rarely any better" on spending. They are often better. They're just not always better. And, of course, spending is not the only issue I care about, either.

Please don't mistake my general distrust for politicians for the idea that there's no difference between the parties. There absolutely is. Just not as much as there should be.

But as I pointed out, in some places these things are banned. And at a certain point taxes can become prohibitive enough to be a de facto ban, anyway, for many people. There's no actual difference, for example, between a ban and a $1 trillion fine. We're obviously nowhere near that, but this isn't binary.

I think you're confusing free market "principles" with a free market ideology. The "principle" here says that when you tax something, you get less of it. But that's a technical claim. It doesn't say anything about whether or not this is good, just that it happens.

Adding to the thing I said earlier about Romneycare costing far more than projected, here's an article on Forbes about how Medicaid is expanded in "blue" states by paying doctors less.

Government programs are notorious for going over budget, so much so that it's trumpeted to the Heavens when one of them breaks even or has a temporary surplus. We've seen mini versions of these things before, and we've seen government-funded health care before, and it almost uniformly involves cost overruns. It's one thing to be for a health care mandate in the abstract, but if you are, you have to grapple with this reality. You can't back a bill that counts on such conservative cost projections, and would quickly become perilous if we start going past them.

These are some very basic, very core problems with these ideas. Maybe they can be overcome. But mostly, I don't think they even really get talked about. If the whole point is to provide a base level of care, you have to ask a) how much is that worth lowering the ceiling for care? and b) at what cost level do we have to ration so much that we struggle to even meet that minimum? How long do we maintain that minimum before parts of it are sacrificed to inevitable reform? The more we try things like this, the more they look like half-measures that we're constantly trying to rescue from insolvency.

Adding to the thing I said earlier about Romneycare costing far more than projected, here's an article on Forbes about how Medicaid is expanded in "blue" states by paying doctors less.

Government programs are notorious for going over budget, so much so that it's trumpeted to the Heavens when one of them breaks even or has a temporary surplus. We've seen mini versions of these things before, and we've seen government-funded health care before, and it almost uniformly involves cost overruns. It's one thing to be for a health care mandate in the abstract, but if you are, you have to grapple with this reality. You can't back a bill that counts on such conservative cost projections, and would quickly become perilous if we start going past them.

These are some very basic, very core problems with these ideas. Maybe they can be overcome. But mostly, I don't think they even really get talked about. If the whole point is to provide a base level of care, you have to ask a) how much is that worth lowering the ceiling for care? and b) at what cost level do we have to ration so much that we struggle to even meet that minimum? How long do we maintain that minimum before parts of it are sacrificed to inevitable reform? The more we try things like this, the more they look like half-measures that we're constantly trying to rescue from insolvency.

it's the socend month Consecutive that the Romney and Republican National Committee, raising more money from Obama and the Democratic National Committee.
Until March this year (which actually ended Republican primaries) Obama raised 260 million dollars while Romney raised approximately $ 122 million. The reason for the big difference was that Obama was the only candidate in his party, While Romney stood in front of are eight other which together raised nearly 140 million dollars.

Once Romney left alone, the oily mechanism built from work:
The first step was carried out in imitation of the democratic model of union bodies savvy of his campaign financing and campaign for the party (to avoid duplication and streamline the apparatus). Soon after, he made ​​contact with major donors who supported his rivals in the primaries.

The result:
In April, Obama raised 43 million dollars, and Romney has been hot on his heels with 40 million.
in May Obama and the Democrats raised $ 60 million - but Romney and Republicans crossed the 76 million.
This month, As aforesaid, Romney broke the barrier of one hundred million dollars a month, while Obama raised 71 million dollars.

the Huge gap in fundraising, put the Obama campaign on pressure,and they opened a mail campaign supporters calling them to contribute additional amounts.

These data are excellent for Romney - and it is important to note that they do not include the full contributions after the court ruling on ObamaCare. first two days after the ruling, the Republicans reported a flood of donations, continued in the days that followed. the election will not be decided only on the money - but at least one front where the Republicans defeated last time unconditionally - they are well now. In 2008, McCain was forced to give up the campaign in some states because he had no money - Romney, however, will be much more competitive states, and thus forced the Obama effort in countries which did not plan to do so.

Originally posted by Yoda:

So what do you mean by "access" and why does it require that we impose a top-down solution, rather than a targeted response?

By access, I mean that everyone should be able to get quality medical coverage regardless of socio-economic status. A wealthy person should not get vastly superior care to someone who is not because they cannot afford to pay for their coverage. I think that is pretty simple. Conservatives always talk about a "more targeted response," but even you admit that the only response that will lead to everyone having healthcare coverage is a mandate or single-payer, both of which conservatives refuse to support.

...we're not talking about a right any more because rights don't vanish just because they're expensive. That's what makes them rights. The fact that they're not contingent on things like political popularity or cost. You wouldn't say we have the right to freedom of assembly, but only at a certain level of wealth, or that we get freedom of speech once it becomes easier to police, or something. Rights are things you get no matter what. You can't bargain them down or sell them away, even if you wanted to.

I do think that healthcare should be a fundamental right, whether the Founders intended it to be or not. The right to quality, affordable healthcare for all of our citizens, should, in my view, be a right. If there are less expensive ways to do that, or more market-oriented approaches, that is fine with me. By a right, I don't necessarily mean that the government has to provide everyone healthcare and pay for that to be done or that the government should or has to run the healthcare system. My conceptualization of it being a right is that everyone, regardless of ability to pay, should have a basic level of quality, affordable healthcare. I don't think that this care should depend on your socio-economic status. You appear to, which I think is fundamentally immoral, and wrong.

I explained the statistical jump involved in thinking that, because something is the #1 cause, it must therefore be a very serious problem. That doesn't follow, logically. And as I pointed out before, the overwhelming majority of medical bankruptcies happen with people who have health insurance.

I think you've just defeated your own argument here. You start out saying that medical bankruptcy is not a serious problem, but then you say that the vast majority of bankruptcies happen to people who already have health insurance. In my view, the idea that anyone should go bankrupt, who has been responsible, and who already has insurance, is a very serious problem. The fact that most of those who go bankrupt actually have insurance is even worse. Before, at least you could partly blame the bankruptcy on people not taking responsibility for themselves. That argument falls apart completely when people are going bankrupt who already have insurance. Let me be clear, nobody should go bankrupt because they cannot afford their medical expenses, especially when they have been responsible and already have insurance. That should never happen in this country. The fact that it does is a very serious problem.

Regarding that, the broad response is simply that there's nothing inherently contradictory about thinking military spending is necessary, and some other types of spending are not. We all thinking spending needs to be cut (well, all the reasonable people, at least), and we all think some services are important enough to be exempt from that. We just don't agree on which ones. I personally think we should cut some defense spending, but this isn't an example of any sort of self-contradiction or any problem with core conservative principles. Some things have to be done by the state, and some don't. Some things are best done by the state, and some things are best done by individuals. I'm pretty sure making stealth bombers falls into the former category. So we can argue about how much we should be spending on that, and you and I might agree a fair bit, but there's no internal problem with the position.

There is an internal problem with this position. The conservative position is that we need to use our resources judiciously, and wisely, and should be cutting the deficit and not supporting bloated government programs. The military budget is the best example of bloated government that I can think of, yet conservatives never cite this as a problem, or rarely do. Those that do are few and far between, and their rhetoric doesn't match the scale of the problem. We could cut our military budget in half and not affect our national security one iota. The fact that we don't is insane, and the fact that conservatives only support cutting government in some sectors but don't support it in others, even when there is clearly huge amounts of unnecessary waste and spending in those sectors, is inconsistent, and wrong.

This is really, really stunning. Look at these statements:
"We don't have an unlimited amount of funds."
"None of us can live forever."
Both true. But do you recognize that this sounds exactly like a libertarian argument? It sounds just as valid as an argument against intervening when people need help paying for health care. Would you accept these sorts of arguments in that context? If you said health care is a major problem because lots of people can't pay for it, would you accept "Hey, none of us can live forever" as a valid conservative response?

No, I wouldn't support that as a valid conservative response, because it isn't applied equally to everyone. Saying, gosh, I guess you have to die because you're poor and don't have money to pay for this care, while your neighbor down the street is wealthy and does, so he gets to live, is shockingly morally bankrupt, and something that I don't think any reasonable person could support. This is very different than saying that someone with Dick Cheney's health history should not, as a matter of policy, be given a heart transplant. Dick Cheney has had more than 3 decades of heart trouble, 4 heart attacks, an implantable ventricular assist device, and multiple surgical heart procedures. How many procedures must we as a society commit to to keep this one person, who is very sick, alive, especially when our resources are limited? By doing all these procedures on Dick Cheney, we don't have resources to give to people who have a much higher likelihood of benefiting from these treatments who are younger and in better health. The fact that we do this makes no sense. This standard of using finite resources on those who have the age and health history to benefit from them is totally different than what you are outlining. One is a consistent standard applied fairly to everyone in a similar condition to conserve what is a limited resource, the other lets people die because they are not wealthy. These are completely different arguments.

Also, does it bother you just a little that you're talking about making value judgments on people's lives? That you say money is "wasted" on older people, as if their lives are simply worth less? If you're willing to just let older people die, then why do we need this system anyway? I thought the younger, healthier people were just there to keep costs down for the others...now we're sacrificing the senior citizens so the more valuable younger people can live?

No, it doesn't bother me that we use age and health status as criteria to determine how to allocate what is a finite resource. What other system do you propose using? We have finite resources. They are expensive resources. Every treatment cannot be given to everyone regardless of their age or health history. This is common sense. The idea that you find anything shocking about this is the only thing that startles me.

This is without even getting into exceptions. Hell, what if the 70-year-old is a wise, responsible grandfather and the 25-year-old is a druggie burn out? Trying to assign them each Life Points and choosing one of the other is playing God in the worst way. If we're going to have finite resources either way, and people are going to die either way, let's use a system that at least gets us there through the result of free, independent decisions, and doesn't have small handfuls of peoples assigning arbitrary ration value to human lives.

This sounds good in theory but is practically impossible. If someone is 85, and has two or three years to live, I don't want to give that person a heart transplant. I'm sorry, but that's just common sense. I'd much rather give the heart transplant to someone who is 50 and has two or three decades to live than give that finite resource to someone who is 85 who will in the best of circumstances end up dying from something else a couple of years down the line. This is what is done in virtually every other country but the United States. It, again, is common sense. These are not arbitrary valuations on people's lives. These are logical and rational calculations to preserve finite resources, and to allocate those resources where they can do the most good. Again, what else you propose that we do?

The second reason is that we weren't talking about this; the point you were replying to is what a free health care market might look like, though. You say that health insurance is too expensive, but the entire point here is that it doesn't necessarily have to be. We have a convoluted system with arbitrary benefits and many layers of abstraction between consumer and producer. It should not be merely assumed that this hodgepodge of ideas has produced a genuine market price that we can use as a baseline of what's realistic.

What evidence do you have that if we had a more conservative approach to healthcare that we could achieve a system that everyone could afford that would end up costing drastically less than what we have now? I see none, yet this is continually touted as an option that liberals refuse to implement. What is it that you propose we do instead, and what evidence do you have that this is the right solution?

Those cable packages are market solutions. Not everyone likes them all the time, but it's actually cheaper on a per-channel basis. If they were not bundled, and you could pick channels, each one would cost quite a bit more. It'd cost less for consumers that consumed very few shows, yes, but more for others. And the fact that it's non-essential makes it less relevant, not more: people are much less likely to demand alternatives when their life doesn't actually hinge on whether or not they have CNBC.

If you are fine with many of us paying for channels that we don't watch because it's cheaper overall, and more efficient, for everyone who watches TV, why don't you support these same principles being done for healthcare for every American? You appear to be fine with paying for lots of channels that you don't watch so that the system as a whole functions better, and costs are lowered. This sounds exactly like what Obamacare is designed to do. Why don't you support it?

Defining access as the ability to get care regardless of wealth makes it basically identical to cost.

I think it's pretty clear they didn't intend it at all. If you'd rather just argue that the policy should be considered a right today, that's fine, but in the service of that belief you've thrown out a lot of other arguments, like the idea that health care is somehow implied in the phrase "pursuit of happiness." And, again, it seems weird to call something a "right" when it only becomes one if it becomes sufficiently affordable. That means, for example, that if we ever suffered a terrible depression and dipped below a certain level of wealth, it would stop being a "right" again. Which is another way of saying it isn't a right at all. It's just something you think we should do. It just sounds much more forceful to call it a "right" for rhetorical purposes.

If there are less expensive ways to do what? Guarantee care for everyone? Well, no, there's no way to do that at any cost, so saying you're open to the idea is a meaningless concession.

So I'll ask the question again: if an alternative plan significantly lowered health care costs so that they were reasonably affordable to the vast majority of citizens (but not necessarily everyone, all the time, no matter what), would this be acceptable? Before you said yes, but based on the above, it sounds like the answer is "no." Which means that the problem isn't that health care is expensive, the problem is that it costs anything. Because there will always be scenarios under which someone cannot always afford even cheap insurance. And since you find that acceptable, that means you don't care if some other approach makes health care cheaper, because nothing short of a universal mandate can ever stop this from happening completely.

Also, you make reference to a "basic level" of care. I feel pretty safe saying that Obamacare mandates far more than what you actually consider "basic." If the goal is really just to prevent the kinds of nightmare scenarios you've been detailing, then why is birth control there? In most of this argument, you've defended the abstract notion of universal coverage, but as I keep pointing out, Obamacare is not synonymous with this abstract ideal. There are any number of ways in which it goes beyond what you're advocating.

This is another example of the ambiguous wording I mentioned at the end of this post. Back then, you asked me if I "support" people not having health insurance, or "agree" with the fact that some people can't pay for care. And here you ask if I think wealth "should" determine care. In each case you seem to be suggesting that there's no difference between disliking something and thinking we need broad federal intervention to stop it.

There's nothing contradictory about those two statements. As I've explained in each of the last two posts, you're trying to draw an objective conclusion from a relative statistic. Saying something makes up the majority of something else doesn't tell you anything about its total size. If I have two cats and a dog, cats are the "majority" of my pets, but it doesn't mean I have way too many pets, or need to get rid of some. That's a separate question.

And why apply this selectively? I asked this before, but it bears repeating: if car accidents are the leading causes of death among 18-24-year-olds, does that mean we need to stop teens from driving?

Except that you were citing medical bankruptcies as an example of why everyone needs to have insurance. So the fact that most of these bankruptcies take place even when people have insurance invalidates that point.

What falls apart completely is the idea that having insurance can stop people from going bankrupt. Obviously, it doesn't, so it's not a good argument in favor of mandating that everybody have health insurance.

So, somebody going bankrupt because health care is expensive should never happen, but somebody old dying because health care is expensive is totally fine. Zuh? Death for the greater good of rationing care for younger people is a necessary price, but bankruptcy is beyond the pale?

That's because a lot of them believe that the military is too important to be cutting corners or worrying too much about costs. That the importance of the job means tolerating some inefficiencies. You know how horrified you are of the idea that some people would die because they can't afford health care? That's how horrified a lot of conservatives are at the idea that some of our soldiers might die because we didn't pay for everything they might need.

You may disagree, and you have every right. I might even agree at times. But there's nothing inconsistent about it.

Half? This strikes me as a metric ton of hyperbole that even most liberals wouldn't agree with. But even if I pretend you'd chosen a reasonable example like, say, 10%, the response is the same: lots of people don't agree with you. You are free to argue with them, and to try to explain why you're right. But that's different than saying they're being hypocritical.

Sure it is, it's just that it's freedom that's being applied equally. You wouldn't say people aren't being treated equally under freedom of speech because some get more people to listen to them, or have louder speaking voices.

Well, something like half the country thinks this, so I think you probably do know a few reasonable people who support it. Though, again, I'd remind you that you don't make policy by asking "Do I think this is perfectly fine?" and, if the answer is "No," arguing tooth and nail that some government solution is utterly imperative.

The thing is, the results of freedom are really, really easy to demagogue about. It's really easy to list all the things that freedom costs us. Look at the Due Process clause. Sometimes, it causes murderers to go free. Sometimes they kill again. But I'm guessing that isn't "morally bankrupt," and I'm guessing reasonable people can support that as the unfortunate price of freedom, too.

Those sorts of questions are beyond all of us. Which is why we shouldn't have a dozen unelected people sitting on a board trying to answer them for all of society.

Yeah, and you know what else doesn't make sense? The fact that really ignorant, hateful people get the same rights to free speech as really smart, thoughtful people.

And look at the weird circle of justification here. We need to force younger, healthier people into the insurance rolls so they can save older, sicker people. But to keep costs down, we have to let older, sicker people die. Are we trying to save them or not?

Since when is "consistent" a synonym for "good"? And why do you think it would actually be consistent at all? What if the choice is between a 30 year old with lots of health problems, and a 50 year old in perfect health? There's no consistent, rational standard to apply there, so even that meaningless consistency has to be tossed out. What about life vs. quality of life? What if we can save someone's life, and it'll be expensive, but they'll be a quadriplegic? Now we're trying to quantify how valuable handicapped people's lives are compared to others. How about a 50% chance of saving a 10 year old versus a 70% chance of saving a 30 year old? Do you go with age or probability? What "consistent standard" answers all these questions?

The same way we allocate every other finite resource: freedom. Free people make free choices. Not because this is perfect, but because freedom is inherently more valuable and usually leads to better overall outcomes.

Note the assumption you're making here. It's "common sense" to use that specific criteria if you first assume that we should be doing this at all. But whether or not we should do it is the question being asked.

Also, forget the argumentative implications and just ask yourself the question honestly: can you really not figure out why anyone would have a problem with a handful of unelected government officials deciding whether or not your life is worth paying for?

Why is it practically impossible that a young person might waste their lives? You just got done telling me that young people stupidly forego health insurance and get into car accidents.

And as long as every health care decision we ever have to make is as clear-cut and obvious as this hypothetical one, there won't be any problems. Fingers crossed!

They're only logical if you start with the assumption that the value of life is only determined by its length. Do you believe that?

Before I answer, I feel compelled to point out that you very often change the question before you repeat it back. I said health care doesn't have to cost what it does now. You've casually morphed this into a question whether or not "everyone" could have health care that costs "drastically less."

That said, my answer is pretty simple: the evidence is that relatively free markets have caused virtually every other good and service in the world to become better and more affordable. And our current system has, as you've admitted, many layers of abstraction been cost and benefit, and has lots of ad hoc stipulations. So...it might be worth a try.

Because nobody forces me to buy cable, of course. Which means, when I think it's no longer a good deal, or they start doing this too much (or inefficiently), people can stop paying for it.

Also, for all the talk about how important it is that this stuff never happens...Obamacare won't actually stop it from happening (emphasis added):

So, if the reason to reject more piecemeal, market-based approaches is that we need to hurt overall care just to make sure every last person, no matter what, has insurance even if they choose not to, that doesn't argue for Obamacare, because Obamacare doesn't achieve that, either.

So there are two arguments going on. One is conceptual: what kind of system should we have, ideally, and why? The second is pragmatic: is Obamacare that kind of system, even if we agree that we ought to have it? We can keep talking about the first question, but I think it's increasingly clear that the answer to the second question is a resounding "no."

The more I think about the arguments that you're advancing, and the more I try to respond intelligently, and respect your point of view, the more I realize one thing, which I don't think can be overcome. This discussion reflects a profound difference in values. Because I see universal healthcare as a worthwhile and important goal, and one that I see as vital to the health of our nation, I am willing to make certain sacrifices, and overlook some of its complications and problems. Because you don't feel that universal healthcare is a worthwhile or important goal, and because even if you did, you don't feel the government has any role in realizing it, you're not. Every argument you advance is designed to illustrate how universal healthcare has problems, and entails sacrifices. This is true, however, of any public policy that is as broad in scope or as vital to our society. In other areas, you're perfectly willing to make all these sacrifices, because you believe in the importance of the goal. I can't really continue to address your arguments because they're all the same, and they reflect a profound difference in values that I don't think can be bridged. I'd love to continue this conversation, but unless we are going to agree on the basic terms, and the worthwhile nature of the goal, I don't see how we can.