Monday, April 5, 2010

Battle of the witless

So, an acquaintance of mine posted a remark on his page about the tea party, which prompted a number of responses. I got in on the debate to point out to these so-called “idealists” how the world works. One of them decided to try and debate me but, as you’ll see, their responses mostly ignored the issues actually raised. The most vehement respondent, besides being barely coherent at times, couldn’t even dispute the mechanics of how things work coherently. Being told “you’re wrong because your numbers are wrong” is an attempt to make the debate about the numbers. The problem is, when you attempt to do that, you’d better be able to show the numbers you’re talking about. I didn’t try and introduce what the numbers are because my point was not about that – my argument was about the natural endpoint of the recent healthcare bill.

Anyway, feel free to read for yourselves.

Original Poster drinks tea. Enjoys tea. Has many kinds of good tea at home. Sometimes even makes a pot when other people are over. This does not make him a tea partier, and he wishes the insane branch of the libertarians would stop besmirching the drink's good name. Repeat: ROSCOE DRINKS TEA. IS NOT A TEA-PARTIER.

Insane libertarians? Far from it, I think us tea drinking, tea partying libertarians are some of the only sane ones left. ^_^

Original Poster
Do you accept, at the very least, the de-facto existence of a president of the United States named Barack Obama?

I ask only because most of the tea partiers I have read about seem to be advocating a combination of coup d'etat followed by complete elimination of the federal government. I have struggled on more than one occasion to explain to those I've met on the Internet the concept of "common good," which they summarily rejected when I suggested that a power with exclusive legitimate use of force (e.g. a government) may be better at providing national security and public order than private interests. One of them then explained that all the private interests would have a contracted court that would have the power to regulate their contracts, and seemed very annoyed when I explained that was a kind of government.

Others seemed to believe public health was not a common good, and became agitated when I asked if they'd ever had a flu shot or any sort of immunization. Yet others became incredibly angry when I demanded proof that they had never had immunization, as most children in this country are immunized against a variety of diseases at a year old. Demanding to see the health certificate, they insisted on their right to privacy. And became angry when I pointed out this was basically what the birth-certificate movement, which seems to be very closely related to the tea party movement, was doing to Obama. Except with the added fun of rejecting the certification when they saw it.

Now, does this excuse the continued privacy and civil rights violations, committed by our government, such as wiretapping, imprisonment without trial, and torture? Hell no, it don't. Does this excuse what *almost* amounts to criminal negligence in handling public funds demonstrated most profoundly by the California state government in the past year? No it does not. Does this absolve the governor or the President from criticism in terms of partisan politics and organized grievances such as questioning the budgetary decisions of his party or the direction he's chosen to pursue the common good? Often misguided (Congress controls the budget) but not at all.... See More

Does it therefore follow that we should, as one person recommended, suspend the funding of public universities and community colleges? Or any other government program you, personally, don't approve of? Or of all government programs, including the Department of Defense and INS, which I presume many of the tea partiers to be generally in favor of? much.

Original Poster
I also find a lot of related bunk ideas floating around nearby (again, this is based on internet conversations and the news) such as goldbugging and mercantilism.

But the reason I posted *this* status update is that I went to get a cup of hot water, and when I pulled a tea bag out of my pocket some asshole got all up in my face about politics I ... See Moredon't support and opinions I don't have. Being, as I was, between wakefulness and tea, I couldn't give him the proper rhetorical wringing he deserved. And so when I returned here I vented on FB.

I don't support forcing insurance companies to accept any and all comers and pay for all things. Insurance is based on the concept of paying in along the way to get the benefit when you need it. The companies, if required to pay out in excess of what is paid in, will go out of business. They refuse people with pre-existing medical conditions in most cases - except that some will accept them with significantly increased rates - because those people aren't taking it on a "if they need it in the future" basis. They're going to pay in less than the benefit they get and the insurance company will make no money on their policies. Follow that to its logical conclusion, when you force the companies to pay out continually more than they take in, and you find the companies going bankrupt. Those people lose their coverage unless the government takes over the entire thing, either paying out and covering all medical expenses (and going bankrupt as they pay the demanded rates) or taking over the providing of healthcare itself.

Completely aside from the inefficiency of government compared to private industry, that leads to a motivation problem. Like it or not, there are certain basic truths we have to accept. Healthcare is subject to the laws of supply and demand. There are only so many healthcare professionals to provide care to those seeking it. There's been a shortage of healthcare professionals for years compared to the number of people seeking care. I've heard many arguments about how "doctors are paid too much anyway." That argument completely ignores the fact that the money is a significant motivator for people who go into the medical field. If 20% fewer people decide to go into the medical field, our healthcare shortage gets even worse. And, like it or not, numbers matter. No matter how passionate the doctors out there are, if there aren't enough of them to keep up with the demand then we can't provide adequate healthcare.

Even among doctors who don't go to med school just for the money, med school is expensive. By the time they get through undergrad, go through med school, do residency, get certified (assuming they don't do a specialty, which takes even longer) unless they come from a family that could afford to pay for all of that, they'll be in loads of debt. Probably 30k or more a year in tuition & school costs, 20k or more a year in cost of living(and that's assuming they live in areas with such a low cost of living, NY, CA and other more expensive areas are even worse) all in debt. About 50k a year. For about 10-12 years, most likely. They'll be half a million or more in debt, most likely. Most people, when faced with that kind of debt in order to pursue a career, will choose a different career path if you start telling them they'll only make 40k, 50k, 80k a year, are gonna seriously rethink their career choices.... See More

Not all doctors make the big money, though. The big money is generally paid in big hospitals or boutique medical facilities. General practitioners, family practitioners, local doctors don't make nearly that much money. They also see fewer patients. Hospitals are flooded with patients and their doctors have a never-ending supply of patients demanding their time and attention. They work long, arduous hours, with few days off and in a high pressure environment always worried that if they make a single mistake, the patient will try and take them for everything they have. I knew a doctor who worked at a hospital. He had one day off a week. He worked 12 or more hours a day - many times, he'd work straight through for days in a row, living on coffee and hospital food. He didn't even bother renting an apartment. He showered at the hospital, slept on a couch or a cot in the break room and wore scrubs all the time. He made a very good salary but he worked his butt off and had no life.

If you want someone to be willing to take a job that demanding, which consumes that much of their life, you'd better be willing to compensate them.

No, this government healthcare program is not a good idea. It will not serve any public good. If everyone had insurance, they'd have better access since private doctors wouldn't refuse them as often. But they don't. And you can't force everyone to buy insurance. Nor can you force the people who are working and making money to pay for the people who don't. I've been one of the people who can't afford insurance because I didn't make enough money. I had to choose between having a place to sleep or having insurance. I chose to have a place to sleep. I chose to spend my income on my day to day necessities, counting on the fact that I was a healthy young adult, less likely to need expensive medical care. That was not the best scenario but it was a choice I made. If I had gotten hurt or ill, I'd have had to pay out of pocket. But just because I didn't buy insurance doesn't mean YOU should have to pay for me to get treatment. That was my choice and I accepted the consequences of it.

It's called freedom of choice. Freedom of choice is meaningless without the freedom to take the consequences of your choice. If the government is going to pay for everyone to be taken care of, the government will go bankrupt as long as we live in a system based on some form of money exchange. Unless we do away with money and just pay people through distribution of resources. Won't work, since money is the basis of the GLOBAL economy. Further, that gives the power to distribute resources to the government. Which also means that the government has the power to deny resources or take them away. It's the same principle with our rights. Our rights don't come from the government, the presumption is that we already have rights unless they are limited by legislative action. That's why our laws and system is a proscriptive, not a prescriptive, one. We don't tell people what they are allowed to do, we tell them what they are not allowed to do. And try to only do that when it is something which causes harm either to another individual or to the public as a whole.

Our government wasn't designed to provide for the public good. It was merely designed to prevent public harm.

This is your basic civics lesson for today.

You did not touch on the topic of how preventative treatment provided would decrease expenses by avoiding (generally expensive) emergency treatment and surgery. Your first argument also seems to function on the premise that everyone who will be forced to get health insurance will be in need of expensive long term treatments and no healthy people ... See Morewill be added to the pool like say students who werent able to buy it because they needed a place to sleep. And I would think that (because treatment is expensive) it would be less costly for us to pay their monthly premiums than it would be to pay for their emergency surgery when they cant. I also would think that adding healthy people that were without care to a health insurers pool is probably more beneficial to them than it is hurtful to add people with pre existing conditions. Not to mention you might be able to curtail the abuse from the insurance companies of retroactively denying coverage for a heart attack to their members for undisclosed pre existing conditions of say knee pain.

Which brings us to the last point about the government providing protection which is spot on at the point of inception but we also have evolved to a point where without help we would never be able to advance or provide for ourselves and this bill is designed to protect us from the abuses of those who exploit our inability to care for ourselves and those people in this case happen to be the insurance corporations. Its just reality that we depend on other people to survive and that we depend on services to function and advance and in a modern society. And while we depend on things there is a power to control and a chance for manipulation and exploitation of that power. Personally in the specific case id rather have an organization I have a say in (our government) to have control over that power of whether I live or die or whether I get a transplant or not and not a for profit corporations who make more profit by providing as little care as possible.

To NC: So, according to the last part of your argument, you'd prefer to be in Canada or Cuba, where the government pays for your healthcare and decides how long you'll have to wait for what you need?

As for the first - I never assumed or stated an assumption that there would be more people in need of treatment than healthy people. All I pointed out was ... See Morethat if you increase the outflow beyond the income, the end result is bankruptcy. And all of that was simply the basis of the bigger point - that healthcare is subject to the laws of supply and demand and how the system works, and how the interplay of forces work to create an unsustainable and ineffective system that leads to the only alternative of the government taking over health care in its entirety and the consequences of that.

Not to be terribly anecdotal, but as I recall the average time from arrival to treatment in Canada is actually -lower- than the US.

In Japan we have unlimited government healthcare and you don't have to wait for anything. I could walk in there today and tell them I have a broken finger and I'd be treated EXTREMELY well. Even as a foreigner!

I should note that in Australia, at least (and I beleive it's similar in Canada) the government health care provides a basic set of services (quite comprehensive, though) that everyone should be entitled to. If you don't want to wait for months on end for elective surgery, by all means join a private health fund. If you can't afford it, and you're ... See Moreinjured in a car accident, you can rest assured that you won't be refused care by a hostpital because of your lack of private cover. The well-off get quick service, the rest of us get to take a sick day from work without losing a weeks wages in doctors fees. Win-win!

If it came down to a choice between an insurance company deciding how long I wait or the government deciding how long I wait id choose the government. But thats not really what this is about this is about a market that determines the wait time and who controls that market. I would much rather have someone who has a stake in my opinion control the ... See Moremarket rather than someone who has a stake in my money.

And of course if expenses you exceed income you go bankrupt but what I believe you were saying is that all these people who the insurance companies are forced to take on with make their expenses exceed income which is not necessarily the case. It may in fact lower the cost of care overall and even possibly increase their profit thus a government option was excluded thats what they truly fear for their profits. Not to mention that insurance company profit margins are high now anyway so it does not seem for the moment they are in any danger of bankruptcy.

Without continuing the off topic, Roscoe, I'll respond directly to you. I accept that there is a president, and love him or hate him he has two more years. If the people you have been talking to have been as described, you've been talking to "crazies".

The tea party movement - and the vast vast majority of the republicans, libertarians, and democrats involved therein - can be summarized as follows:

Let us return to the government set up in the constitution.... See More

Add in a dash of "fiscal responsibility" and "anti-entitlement" sentiment, and you've described the tea party. Just as every liberal gathering has at least one 9-11 truther, every tea party will have one anarchist whacko. You'll always have the lunatic fringe, but a more wide reading of the group should cure that poor notion.

To NC: One person with a serious medical concern, particular someone who needs ongoing treatment, costs more to treat than ten healthy persons will pay into the system. It doesn't require that the number of persons needing expensive treatment exceed the number of people paying into the system who don't.

As for responding with anything more specific, you're going to have to be more clear in your own responses. I honestly can't figure out what you're saying in most of your response.

To Ben: That's nice that Australia has done that. What's the Australian debt load like? How is Australia's government's tax structure set up? How do they handle the nation's economy and the nation's debt and/or surplus? My point is this: Australia has an entirely different system(by which I mean the entire structure of the government and, realistically, the entire nation). That system may be better able to handle certain things and worse in handling others. I don't believe it's an overall BETTER system, I'll tell you right off. Could the US system be restructured in such a way as to do the same thing? Possibly. Do the American citizens WANT it restructured in such a way? Check the polls. But, under the current US system, the only realistic endpoint is government takeover of the healthcare industry - which also means the ability to deny care (particularly if you're a political dissident). Even if we were to restructure the US, that's not the kind of thing you can make happen by ramming an unsustainable bill through congress against the great weight of the voting public's will (If you are going to try and say that since not everyone responded, that's not accurate, I have to point out that the people who care the most are the ones who respond. If you agree, you'll respond with agreement. If you disagree, you'll respond with disagreement. If you don't care enough one way or the other, well, you're not going to respond. So, among those who care, most of them are opposed.).... See More

Same thing for the issues with Japan.

The US system is based on multiple governments. We have a federal government, a government of "supreme but LIMITED powers" whose role is to defend our borders and facilitate regulation between the states. They've taken on some extra burden over the years but we've always tried to keep them limited where possible. The state governments are the ones who regulate their local economies, local codes, handle running the day to day affairs of their citizens in line with the wishes of their constituents. Or at least, they're supposed to. Compared to a system of one, centralized government, the US system has some advantages and disadvantages. Disadvantage: Decentralization of power means extra inefficiency and that the federal govt has to use indirect means to exert political pressure on the state governments, limited powers means that the federal government has to - in areas which are within the sphere of the local governments - defer to the states. Advantage: Decentralization of power and lack of supreme power being located in one seat of power makes dictatorship less likely and more difficult to achieve.

There are more advantages and disadvantages. I'm not going to go into detail. The point is that each system has advantages and disadvantages. Any system that consolidates power into the hands of a few individuals, though, is less desirable to me because I DO trust human nature. The spreading of power among multiple systems, which are comprised of a larger number of people necessarily, is more desirable even if it comes with more inefficiency. Comparing the US system's approach to healthcare to another government's approach is not apples to apples, it is not even apples to oranges, it is apples to onions. I.E. not even fruit to fruit, but fruit to vegetable. They may both be food but they are entirely different types.

And whether one system is better than another is another debate entirely. And one that will necessarily be subject to strong personal bias on all sides.

Also, Chris: I'd love to see your sources on that. My sources say the opposite. That being said, the point of my remark wasn't "Canada is so much worse!" it was to point out the discrepancy involved, i.e. "I get to go to the doctor, explain my problem, get checked up and have my problem dealt with or get a referral to someone who can better help me who I can see at my earliest opportunity" compared to "I get to go to the doctor and if it's not something that can be diagnosed and dealt with then and there, I get to wait until the government finds and approves of a specialist to see me regarding my problem." I actually suspect that the Canadian system may handle minor issues as well as or better than many hospitals and doctor's offices in the US. But I can't see them handling bigger, more specialized issues as well. In particular because specialists are kind of a limited resource. But I'll admit that's not based on personal experience or statistical information, it's based on my own understanding of the system, the laws of supply and demand and limited resources and access to those resources, as well as simple "where people are" considerations.

Well you said

"you'd prefer to be in Canada or Cuba, where the government pays for your healthcare and decides how long you'll have to wait for what you need?"

and I said... See More

"If it came down to a choice between an insurance company deciding how long I wait or the government deciding how long I wait id choose the government."

But I believe what you were inferring is that "the market" decides and that this bill amounts to a government takeover of that market which is and isnt really the case because the market consists of only a few major players who can decide to do what they want to this market which basically means it is a government controlled market only we dont have any control over that government.

and obviously a sick person will cost more than what a healthy person pays but eventually there is a ratio that will even the costs out and I dont think this bill will force that ratio to be uneven in a way that has more money going out. I believe that you underestimate the amount of unsick uninsured.

I never mentioned the market. I never addressed the forces driving the prices, only the requirement that income exceed expenses and the issue of scarcity of resources, with healthcare professionals, equipment and time as resources.

The bill has a lot of other problems anyway but sticking to the points raised without going to the possibility of not previously paying in and getting insurance AFTER you get sick and other major flaws...

The number of unsick uninsured who will be forced to pay? Or the number of unsick uninsured who will be government subsidized? Because if they're paying in out of pocket, they're supporting the system's ability to perform its function. If they weren't buying insurance before because they couldn't and they have to be subsidized, the whole damn point is moot and it leads to the problem I mentioned before - the government losing money on the deal until they feel forced to step in and forcibly arrange prices effectively(if not actually) taking over the healthcare market in its entirety. Which leads to the rest of the issues I mentioned - number of available healthcare professionals, compensation, motivation to go into healthcare, etc.... See More

The number of unsick uninsured were accounted for in my point, you see, as part of what costs the government in order to provide these services and will lead to the problem with prices - which is probably what led you to assume I was talking about the market. I didn't mention the pricing issue in the market context. I mention it in the resource context. If the government subsidizes these people, they're going to be spending a lot of money. If they don't, then you have to remember these people probably didn't buy insurance because they can't afford it without subsidies. The government will, when they realize how much money they're losing, attempt to control the price they're forced to pay through the subsidies. Which means attempting to control the price of healthcare since they can't reduce the probability of illness in a given person based on that person's physical fitness, age, race and genetic history so the price of the care that a person is likely to need is the simplest part of what determines the price of insurance to try and control. Which is going to in turn wind up, as they try to force the cost of healthcare itself down, result in either regulation of salaries or outright takeover of the healthcare system. And I think you know the rest of the point I was bringing up by now.

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