46 thoughts on “Repeal”

  1. Was it Thomas Sowell who, when quizzed about “replacing” ObamaCare, replied, “When a surgeon removes a cancer from a patient, what does he replace it with?”

  2. The thing is, Obamacare exists in the first place because the US is perceived to have very expensive health care compared to everyone else (something I think is true in reality as in perception). As long as that state continues, something will return. I guess in cancer-analogy, we would be removing a cancerous growth, but leaving the main tumor from which it came intact.

  3. The American people want three main things out of health care reform: They want health costs to drop. They want the number of people with insurance to rise. And they want to make sure that people with expensive preexisting conditions aren’t going without medical care.

    Get the government out of health care and I think you will see health costs drop dramatically. Caring for those who cannot care for themselves is a responsibility of families and communities, and the government’s intrusion in this area, while well intentioned, has been a financial disaster and the existing bureaucracy adds virtually no value and has no motivation to improve. IMHO, government does have a health care obligation to the armed forces but to no one else. Government could help with tort reform, but politics trumps sensibility every time.

    We want the number of people with insurance to rise? That is ridiculously generic and smacks of unicorns and rainbows. I certainly don’t want the government to forcibly take my hard earned income and give it to someone else so that the number of people with insurance rises.

    We want to make sure that people with expensive preexisting conditions aren’t going without medical care? Okay, but let’s make sure that personal responsibility is added to the mix. Insurance is all about risk management, if you deliberately choose to not manage your risk with an insurance policy, why should an insurer be forced to cover that risk later?

    This is a tough subject, our existing situation is far less than ideal, and there is a lot of money being used to influence decisions and policy. But I can’t help but believe that government intrusion in this area has done far more harm than good. Fixing this will take time and will require those we sent to Washington to make far tougher choices than any they have made before. Having the ability to control that much of the economy likely will be something they are unable to resist.

  4. If you want more people to have health insurance, you should do things that would make insurance less expensive. For starters, we seem to have this foolish notion that health insurance should pay for just about every conceivable medical expense. Imagine how expensive car insurance would be if it covered fill-ups, oil changes, paint jobs, etc.

    A more manageable approach would be along the lines of hospitalization insurance and health savings accounts. For people with preexisting conditions, there might be some subsidizies involved to purchase the insurance but that would be far less expensive and intrusive than the ObamaCare monstrocity. Let people choose the kinds of insurance coverage they want and decline the things they don’t need instead of forcing every policy to cover things they don’t need. For example, my wife and I are well past childbearing years so we don’t need prenatal care.

  5. Caring for those who cannot care for themselves is a responsibility of families and communities

    Not everyone has a family – not everyone likes their family, not everyone wishes to be beholden to their family. Likewise with communities, religions, gangs, charities and so forth. Do you really favor the rule of men over the rule of law with regard to which of the uninsured gets health care? Would that not result in say overt death panels run by local interest groups?

    I think Carl said it fairly well in another thread recently. Insurance should be insurance only, use something akin to a voucher system at the bottom, get employers, federal government and excessive legal liability out of health care, open up competition across state boundaries, and so forth.

    It is fairly obvious what needs to be done – unfortunately a great many people have vested interests in health care not being fixed (lawyers, the medical profession, insurance companies, elected officials – big empires have been built.). So until there is a sufficient elected mandate to overwhelm these special interest groups nothing much is going to happen.

  6. It’s kinda sad, indeed, that as Jiminator quoted, people basically want free healthcare.

    Not so much that they want it, but that they think they can legislate actually getting it, without all the negatives typically they deny even exist.

    Nothing is free, ever.

    And Pete – you left out the Government as the biggest “vested interest”. It doesn’t make money off of healthcare, but that’s not the State’s motivation, or that of Politicians [in general].

    (You did suggest getting it out of the equation, but that’s even harder than any of the existing “vested interests” you mention. Besides, most lawyers aren’t even involved in that area!)

    Healthcare or pseudo-“insurance” is an immense field for the State to demand tribute, exercise power for its own sake, and to be seen to be doing something.

    (It’s also a place for crusaders to try and Fix Everything For Your Own Good, admittedly. But I suspect, a la C.S. Lewis, that that’s actually worse than the preceding.)

  7. Typical cowardice. By all means, equalize tax treatment between employee provided health care benefits and those bought directly. But at the worst let it be deficit neutral.

    That was the problem with the McCain plan: he wanted the public to think that we could hand out new tax credits, not make most people with employer provided insurance worse off, and not notice the big increase in the deficit.

  8. I think Carl said it fairly well in another thread recently. Insurance should be insurance only, use something akin to a voucher system at the bottom, get employers, federal government and excessive legal liability out of health care, open up competition across state boundaries, and so forth.

    Yep, insurance should be insurance and not public charity. People with wealth to protect need not be coerced into buying insurance — they will do so to protect their wealth. But they will only do so when the expected benefit exceeds the premiums. Only a relatively unfettered marketplace can make those calculations. Obamacare sought to destroy that mechanism and turn the entire medical insurance market into a system of cross-subsidization: public charity. Thus the need for “individual mandate”, price controls and every other Rube Goldberg social-engineering mechanism you can imagine, and at the end of the process medical insurance would resemble insurance about as rape resembles love-making.

  9. I guess in cancer-analogy, we would be removing a cancerous growth, but leaving the main tumor from which it came intact.

    Thing is, all this “replace” talk is going to be interpreted, and acted upon in Congress, in terms of government programs — not anything that might actually fix the problem.

  10. Can I just get a Constitutional amendment whereby anytime a government official proposes to “fix” something for me he gets taken out and shot? Thanks.

    If government could confine itself to the activities that were spelled out in the Constitution, the time-immemorial duties of national defence, setting weights and measures, administering interstate and international justice, and maybe helping coordinate interstate trade — and if it could actually accomplish those tasks competently, cheaply and efficiently — I’d be happy. I can handle the rest of life’s challenges by myself, thanks anyway. (Or more precisely, if I want random strange lawyers from Washington to get involved, I’ll hire them myself.)

    It’s got to be the major sickness of the 20th century the delusion that things are better “fixed” for everyone, all at once, with a one-size-fits-all Master Plan. Considering how few people would anticipate with joy a “solution” at work handed down by the CEO or board, it never ceases to mystify that folks think a “solution” handed down from Congress is going to be so much better.

  11. Pete, I think you are deliberately taking it too far.

    Sadly, as you said there are those that no longer have family to turn to. I think you also referred to those who have family they would prefer not to turn to. I definitely have family members and community folks who have made choices that have earned the scorn of both family and friends, yet what kind of man would I be if I refused assistance to them in their time of need? At the same time, us locals are far more familiar with the needs of family and community members than a Washington-based bureaucrat. It’s at the local level that you can pay the utility bills, buy a load of groceries, fill up a car with gas, repair an appliance, or find an odd job here and there to gauge the level of personal responsibility of the person you are helping to ensure that you aren’t enabling bad habits to continue. The existing government bureaucracy does very little of that kind of help, yet their involvement enables family and community to slack up on their own responsibilities in this regard.

    Your comment about community-based overt death panels, like a church or the local VFW chapter, is beyond ridiculous.

  12. Your comment about community-based overt death panels, like a church or the local VFW chapter, is beyond ridiculous.

    If someone is going to pay for the health care of those who can not pay for it themselves then that someone will be making life and death decisions for others. Perhaps I should have referred to it as overt life panels?

    One of the reasons for favoring government in this role (I did not say federal government), is that it is held democratically accountable to the population at large – unlike most of these other community based groups which are special interest groups and inherently prone to corruption towards those interests. Some degree of centralist coordination is likely also favored to catch people that might otherwise fall between the gaps of local care.

    I do favor minimal government interference, but for comprehensive operations (health is too big to fail), I still favor the robustness of governments over unelected non profit organizations.

    Wealth redistribution does not necessarily require big government, a simple fixed sum tax rebate to the poor to cover raw safety net level health care (subsidized by other taxpayers) might be one approach that largely removes the government from the equation. Keep it cheap and efficient enough and most will not mind (I am suggesting here a Medicaid replacement). Low level taxes do not actually tend to offend people if they get value for money – not surprisingly health care has recently offended a lot of people.

  13. I still favor the robustness of governments over unelected non profit organizations.

    That’s exactly their problem. When any other organization screws up, the damage is limited. Not government. That “robustness” you praise is what herded 6 million into the camps in 1936-1945, and what delivered another 30 million or so to the gulag in the 30s through 60s. The bloody monstrous history of the 20th century was the result of folks trying “robust” central solutions to the perennial problems of man. You’d think that would be more than enough to scare the 21st century out of repeating them.

    Oh but that won’t happen, you’ll tell us. Don’t be ridiculous! Times are different! See, OUR intentions are good! We have quite different labels for what we’re doing!

  14. I see that “good ideas” for the Republicans include telling the states that they’re doing tort reform wrong, and that the Federal Government needs to tell them how it should be done.

  15. Not government. That “robustness” you praise is what herded 6 million into the camps in 1936-1945 and what delivered another 30 million or so to the gulag in the 30s through 60s.

    The number was more like 11 million, Carl. In addition to the 6 million Jews murdered in the Holocaust, there were some 5 million others (Gypsies, homosexuals, Jehovah’s Witnesses, and others who got in the way) that keep being forgotten.

    There were also an estimated 40 million who died as a result of government caused famine and in China along with millions more killed in the name of the Great Leap Forward and the Cultural Revolution.

    There are credible sources that claim the “Death by Government” toll (excluding war) for the 20th century was well over 100 million people, killed in the name of expediency and political ideology.

  16. Thanks, Larry. It was all off the top of my head. How anyone who lived through even a portion of the 20th century can want to raise the Balrog again is beyond me — Oh this time it will be DIFFERENT, we’ll ONLY use the One Ring to make the trains run on time! Our forefathers were clumsy fools, that’s why they got in trouble. We’re so very much smarter! And it’s very important that the trains run on time, you know.

    Makes me think humanity doesn’t learn, even by bitter experience.

  17. While I would agree that governments have killed a lot of people, by my reckoning poor health care is currently killing around 57 million people per year and has killed many billions of people over the last hundred years.

  18. While I would agree that governments have killed a lot of people, by my reckoning poor health care is currently killing around 57 million people per year and has killed many billions of people over the last hundred years.

    Uh huh. Let’s keep in mind that all health care is poor since it never saves the patient.

  19. Last I checked, Pete, it was heart disease, cancer, stroke, malaria and so forth that were killing people around the globe. It’s a weird definition you’re using to suggest that they died of “poor health care.” Er…unless you were referring to people using witch doctoring and bleeding.

    But anyway, the problem is, you’re selling the same old 19th century witch doctoring. Comrades, look! With this New Cure, the almighty state, Ultimate Power, we can MAKE things happen, instead of counting on those old weak reeds, human intelligence, judgment, and common sense. It doesn’t work. It never has worked, and it never will. You might as well be the Soviets, commanding by all the power of the Party that the exchange rate be 1 ruble per dollar. You cannot command human beings like robots, and when you try, the results are awful.

    Look at it this way. You’re talking about a “military” solution, where we all get drafted into some kind of “army” and fight a “war” of some kind — a War Against Poor Health Care, not unlike our War Against Poverty, or the War On Drugs, et cetera — with the total dedication to The Cause and neglect of personal liberty and the pursuit of private goals which that involves. Even in the very limited conditions of an actual war, where the goal is the very simple one of killing enough of the other side to make them give up, do draft armies work very well? Are they kind of social structure that leads to positive side effects, improves man’s relationship to his fellow man? Can they be sustained indefinitely?

  20. by my reckoning poor health care is currently killing around 57 million people per year

    18% of the population dies every year from poor health care?

    Really?

  21. xj, I imagine it’s probably a global figure. Although I have trouble understanding how screwing with US healthcare will change the global figure.

  22. And another thing. There’s a tradeoff between keeping insurance premiums low, and insuring a reasonable minimum standard of insurance coverage. To take an extreme example can sell health insurance that excludes most of the things you would reasonably expect to pay for, and sets a coverage limit that most sick people will breach, that’s not worth much.

    Currently, each state mostly makes that decision for its own citizens. Perhaps a lot of states are setting minimum coverage too high, but what’s the alternative?

    One alternative would be for the Federal Government to set the minimum standard. This seems suboptimal, unless it’s a very conservative minimum.

    Another would be for the state with the lowest standard to sell to everybody else. That also seems suboptimal. OK, the citizens of the state of insertname think that their citizens should be able to buy insurance on the assumption that if they have breast cancer, their policy will not cover reconstruction unless specifed in the policy. Fine.

    But why should the other 49 states need to honor that standard?

  23. the major sickness of the 20th century the delusion that things are better “fixed” for everyone, all at once, with a one-size-fits-all Master Plan.

    Bring everyone into the same system makes it much easier for a single mistake to kill everyone. Is that a bug or a feature?

    Good thing humans never make mistakes.

    The 21st century, where better communications ended us all.

  24. Shorter Pete: I don’t care — we can still use the Ring…

    Well, so long as every state gets its own ring and they are willing for it to be a much smaller ring than the one they are already using.

  25. Any objection to my making that trade-off decision myself, Will? I mean, I already make all kinds of trade-off decisions, you know. Buy or rent, take this job or that, major in foo, bar, or baz, marry or live in sin, tastes great or less filling, et cetera. Any reason I can’t be trusted to decide what kind of health insurance I want to buy all by my lonesome?

  26. I don’t want my wealth redistributed, for any reason.

    It’s my wealth. I earned it, with my brain and/or my muscles.

    If the government claims jurisdiction over the wealth I created, then that makes me a slave or a serf.

  27. If the government claims…

    See, that’s the problem. There is no if, they already do. To be more explicit, today we assume government theft is ok as long as it’s only a pint of blood at a time.

    We say, it’s with the consent of the governed. It’s not and can never be.

    With computer technology, a contractual agreement with all citizens is possible but probably not workable or agreeable.

    The best we can do is remove power from them at every turn while they continue to draw power to themselves ‘for our good.’

  28. And another thing. There’s a tradeoff between keeping insurance premiums low, and insuring a reasonable minimum standard of insurance coverage. To take an extreme example can sell health insurance that excludes most of the things you would reasonably expect to pay for, and sets a coverage limit that most sick people will breach, that’s not worth much.

    Currently, each state mostly makes that decision for its own citizens. Perhaps a lot of states are setting minimum coverage too high, but what’s the alternative?

    One alternative would be for the Federal Government to set the minimum standard. This seems suboptimal, unless it’s a very conservative minimum.

    And what happens is that every niche medical specialty bribes (lobbies) their legislature to get their treatments included in the insurance mandates. If you want to see the cost of medical procedures reduced, exclude them from coverage like they do for LASIK and cosmetic surgery. Once they’re included in the insurance mandates, the prices inevitably increase.

    The idea behind health savings accounts is that people can buy high deductable insurance to cover hospitalization expenses, be that from an accident or illness. Routine medical expenses like doctor visits are not covered until the deductable is reached. Coverage for prescription drugs can vary according to the insurance plan. Those who don’t need a lot of medications can opt for a less expensive insurance plan than those who do. The health savings account is tax free and can come out of your pay pre-tax. It’s used to cover the medical expenses not covered by insurance.

    The Obamacare law essentially outlawed health savings accounts. We can’t have people making their own medical decisions, now can we?

  29. Larry J hit the nail on the head. LASIK technology has advanced significantly over the last twenty years, yet the cost of the procedure has dropped almost as significantly over the same period. The market drives both process improvements forward as well as costs downward when it is allowed to operate freely.

  30. While on the topic of ObamaCare, a Columbia law professor asks the question, Are Health-Care Waivers Unconstitutional? (via InstaPundit and with emphasis added):

    The constitutional dispute over the health-care law has thus far centered on the lawfulness of the statute itself — most dramatically when, last week in Florida, a federal judge held the act to be void. Waiting in the wings, however, is another constitutional question, one concerning not the statute, but waivers from it.

    The Department of Health and Human Services has granted 733 waivers from one of the statute’s key requirements. The recipients of the waivers include insurers such as Oxford Health Insurance, labor organizations such as the Service Employees International Union, and employers such as PepsiCo. This is disturbing for many reasons. At the very least, it suggests the impracticability of the health-care law; HHS gave the waivers because it fears the law will cost many Americans their jobs and insurance.

    More seriously, it raises questions about whether we live under a government of laws. Congress can pass statutes that apply to some businesses and not others, but once a law has passed — and therefore is binding — how can the executive branch relieve some Americans of their obligation to obey it?

    The dangers of inequity are obvious. Will only corporations and unions get waivers, or can individuals also get them? For example, if a family physician feels financial pressure under the health-care law to fire one of his employees, will he get a waiver to avoid adding to unemployment?

    Indeed, can even a small corporation get a waiver? Small businesses provide most new jobs, but the answer is obvious: Waivers are mostly, if not entirely, for politically significant businesses and unions that get the special attention of HHS or the White House. The rest of us must obey the laws.

  31. Allow increasing options of deductibles at decreasing rates so that mainline visits to the doctor are paid for by the individual up to the deductible. Do NOT let lobbyists bribe legislatures into mandating coverage for favored expensive 3 sigma procedures that will then have zero incentive for cost reduction. Let the deductible apply here for those unfortunate to contract the problem. Allow insurance company choices to compete across state lines. Reform tort such that malpractice insurance premiums for say obstetricians are less than 6 figures per annum.

  32. I’m all in favor of gov’t programs that serve as safety nets. After all politicians and public workers are always most concerned with with the lowest common demonator of citizen anyways. Only problem is they create all inclusive programs that drag down on the top performers. In fact, the only way that gov’t types let top performers excel is when they look the other way or, “waiver,” exemptions to a select group of champions. We live in a new age of knighthood where the blessed chosen few are touch on the shoulders with the Toastmasters grace of an executive oversight committee. Road to serfdom indeed!

  33. No State shall make or enforce any law which shall… deny to any person within its jurisdiction the equal protection of the laws.

    But Larry that’s just something written on an old piece of paper.

  34. Okay typing 100 wpm and then immediately hitting submit rarely ends well 🙂

    demonator = denominator

    I believe there are tense arguments as well but my head rarely knows which time continuum it is in anyways so no bothers IMO.

  35. We live in a new age of knighthood where the blessed chosen few are touch on the shoulders with the Toastmasters grace of an executive oversight committee. Road to serfdom indeed!

    Brings a whole new meaning to the term “oversight committee”!

  36. Carl said “That “robustness” you praise is what herded 6 million into the camps in 1936-1945”

    Of course, the survivors (and their children) who went to Israel live in freedom and yet somehow also voted in, and benefit from, socialized medicine.

  37. Ah yes, Bob, but what about the influence of desporkelated antineutrino fnord brassiere hooks on the price of tea in China?

  38. Your point was that proponents of Obama’s health care reform need to remember the holocaust. I’m pointing out that people who remembered the holocaust because they actually experienced the holocaust still voted for socialized medicine. Why are you suggesting that this is a non-sequitor?

  39. Nonsense, Bahbwun. My point was that the “robustness” of government is at best a double-edged sword, assuming it can be wielded with consummate skill, and that the history of the 20th century suggested that on average the “robustness” of government is one of its major drawbacks.

    Whether people who remember the Holocaust are more or less aware of this I do not know. I would guess not, however: I think most folks think the direct cause of the Holocaust was anti-Semitism, and the only plausible short-circuit an intervention by the United States early on. Not many think that structural and cultural changes in Germany to prevent the accumulation of so much centralized power would have done the trick. Interestingly, immediate post-war Germans did think so, and took a few steps to make it harder for power to be as centralized as it was before. But for the most part even the Germans though the “solution” was simply to, for example, ban Holocaust revisionism and Nazi paraphernalia. A clear failure to grasp the real nature of the disease, unfortunately.

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