“What I mean is, if you think trash on the beachs is a problem, encourage a group of people to go clean up a beach with you.”

What the hell are you, some sort of left wing community organizer?

Everyone here or who reads my blog knows that I am not the biggest fan of the American corporation, and usually I love Teddy Kennedy. But reforming health care without addressing one of the biggest reasons it needs reforming is… a mistake at best.

There will always be some external restraints upon health care decisions when people are not paying out of their own pocket. The reality is that it is not feasible to have a system in which people pay out of their own pocket, so we must look at how such restraints are kept the most benign.

At present I must deal with such restraints from both private insurers and government plans. Comparing the average private  employer-paid plan with Medicare, the result is that Medicare is far less restrictive on the choices made by patients and far less intrusive upon physician practices.

With all its problems, and lack of cost effectiveness, there are strong arguments for eliminating the private insurance system entirely, and many make compelling arguments for this. An alternative to scrapping the dysfunctional system is to reform it–which is what the Obama administration and most Congressional Democrats are advocating.

Such a hybrid private/government system is what exists in most of the world–despite the right wing scare tactics of only mentioning Great Britain and Canada. Such systems tend to provide higher quality care than is provided here at a lower cost, and typically with greater freedom than is seen with those covered by private insurance in this country.

Of course the devil is in the details with health care reform. It is even possible that I will oppose a current proposal based upon the specifics, once one is proposed, as I opposed HillaryCare which managed to not only preserve but to worsen the worst aspects of HMO’s and managed care.

I don’t think history has shown that artificial costs in a government bureaucracy can be effectively controlled in the long run.  And the parallel costs in a business can only be controlled through the creative destruction of a really free market.  Which health care is definitely not.

I don’t think anything like an efficient solution (where solution includes universal access) is possible, since everyone has a very strong desire to live forever while third-partying the costs of treatment and research.  I think we will get a system which will provide universal access and decent care and will sacrifice a lot of expensive research (which only American consumers were paying for anyways).  And risky hobbies will be under intense pressure.

Masquerade? The name of this site is Liberal Values, not Libertarian Values. To say one is has leanings towards a viewpoint is also stating that one rejects aspects of that viewpoint, otherwise I would just say libertarian as opposed to libertarian-leaning. I have also explicitly stated that, while philosophically I agree with libertarianism in many areas, I have rejected it as an overall philosophy as it fails to respond to problems such as health care which require government involvement.

If we want to speak of a masquerade, you are the one who is repeatedly bashed by libertarians for pretending to be one while promoting views which are opposite to libertarianism. You have advocated what amounts to a military dictatorship with suspension of civil liberties, including freedom of speech and the press, to wage the war against what you ridiculously call “Islamo-Fascism.”

You do have a habit of grabbing onto Nazism when you attack those you don’t agree with. Besides repeating “Islamo-Fasicism,” a term which only an utter moron from the far right would use, you make the absurd claim that health care reform to give individuals more choice and freedom in their health care would be Nazi-like government health care. You need to learn that not everything you disagree with, even if undesirable such as Islamic fundamentalism, has anything to do with Nazi Germany. This is especially ironic since your views come the closest to fascism of anyone I know. Being libertarian on some victimless crimes and opposing health care reform does not make you a libertarian when you oppose basic civil liberties and support a massive expansion of the state in the guise of a “war on terror.”

Among all your nonsense you actually do make a statement which is very true, and which is often forgotten in the health care debate: “This is not about practicallity. This is about ideology.”

The opposition to health care reform does come down to ideology. If you really look at any other factors of the health care debate, including cost, access to care (or rationing), autonomy for physicians, greater choice for consumers, or quality of care, then the conservative arguments do not hold up and the evidence is in favor of government action to reform the system. It is only when you adhere to blind ideology that you can oppose it.

“What right does the government have to be in the health care business in the first place?”

Government is involved in health care because it is a function which the free market is unable to handle without a significant amount of organization from the government. We have Medicare because without Medicare people would not be able to afford health care once they were no longer receiving it from their employers. Employers can barely afford to provide supplemental coverage to their retirees–they could not afford to foot the entire bill for retiree health care coverage beyond age 65.

Even libertarians, beyond anarcho-capitalists, acknowledge a role for government in some areas. It is possible to envision totally free market solutions for everything the government does, but in reality these are not practical. Anarcho-capitalists do envision private companies handling police and military functions. In reality, these are at a scope beyond where the market can handle them on their own. Even if we can have a massive Halliburton handling these functions, we would be reluctant to have such power in private companies without the type of oversight we can have in government functions.

Under the free market the employer-based system is collapsing and it has become extremely difficult if not impossible for people to obtain coverage on the individual market unless they are young and healthy. The insurance industry has developed a business model based upon taking premium money and then finding ways to avoid paying out claims to save money with disastrous results. Health care costs has became a major cause of bankruptcy in this country, even among those who are employed, and among many who thought they had insurance coverage. We really have no choice but to utilize government to reform the system.

As someone who leans libertarian philosophically I might not like it, but the universe doesn’t give a damn about what we want. Real world considerations force us to utilize government to fix the problem, making it necessary to ignore ideology out of practicality.

However, it is also important to note that ‘single-payer’ does not mean nationalization of hospitals. If patients make their own health decisions with the help of their doctor, instead of government OR corporate bureaucrats making those decisions, then multiple problems are solved that have nothing to do with cost and which are more serious than cost for the majority of people already covered. They benefit as well as people like myself who cannot afford private coverage, but do not have a job that provides such coverage. Working for myself is VERY satisfying, but there are sacrifices entailed therein too.

“have any of you quantified the cost saving of getting rid of the anchor baby policy and refusing all but emergency care to illegals?”

Probably not practical or cost effective. If you deny all other avenues for health care, then people will go to the emergency room where they cannot be turned away. The ER is not a very cost effective way to provide routine care. Limiting routine and preventive care will also increase the chances of true emergencies occurring.

If we are looking at cost effectiveness, then it would be far more cost effective to increase avenues for citizenship so more aliens are productively contributing to the economy and are paying taxes on their earnings.

Of course we are all influenced by our personal biases. As I physician I am biased towards providing health care to all who need its. Xenophobes have different biases.

Speaking in the most baldly utilitarian terms, the most ‘cost effective’ system would provide health care for everyone with a job and cut Medicaid and Medicare entirely. It would also refuse medical service to anyone unable to pay and sick people who were poor and uninsured would simply be allowed to die. This is the real ‘free market’ solution to health costs, but regardless of the financial benefits the social and moral costs would be fairly significant. It would also be a complete violation of medical ethics as I understand them, though Ron could comment on that better than I can.

I’m personally opposed to the ‘Logan’s Run Health Plan’, but there is another extremely cost efficient system. I think most of us posting or commenting here would be dead if it were put into effect, however.

While I believe elements of universal health care policy would save costs in basic ways that conform to the laws of economics (most notably the cost-sharing principle behind health insurance is best realized if everyone pays a dedicated health care tax instead of people buying into hundreds of private health plans and no longer having to subsidize roughly half of the nation’s health care costs would greatly benefit American business), I don’t believe that the hard cost of medical treatment would be greatly reduced in the long run. The costs we would see affected would primarily be ‘soft costs’ generated by the insurance market in the interest of maximizing profit. Assuming everyone makes best use of their health care, we might see less working time lost to illness, but this is a much more difficult call. Some people only see the doctor when absolutely necessary, regardless of the quality of their coverage.

The argument over costs is very murky and unclear and it is important not to pretend otherwise, but it is also important to remember that there is an artificial cost created by the desire for maximum profit and minimum service inherent in our current system. That artificial cost can be addressed, even if real costs cannot or might even rise.

It’s not the conservatives who oppose socialized health care so much. They’ve been rather soft on the issue.  It’s us libertarians. 

And you have the audacity to claim some allegiance to libertarian views? 

This is not about practicallity.  This is about ideology.  What right does the government have to be in the health care business in the first place?  Medicare and all government health care, with the possible exception of the VA, should be abolished, and now!