Obama Schadenfreudarama

Obama Schadenfreudarama November 15, 2013

Jonah Goldberg is, I must say, very very funny as he gleefully performs the autopsy on the disastrous rollout of Obamacare.  As is always the case with people in revolt against a regime, he has a pretty good sense of what’s wrong with the Obama Administration–particularly Obama’s massive hubris and belief that his godlike word can simply bend reality to his will, as well as his mendacity, and the curious way in which his circle seems to have insulated him from hearing or knowing about anything in the real world that might contradict this fantasy building.  He also gets that Obama, well, doesn’t really *like* democracy all that well since he’s, you know, better than the rest of us.

On the other hand, I don’t get the sense from him or pretty much the rest of the movers and shakers in the Thing that Used to be Conservatism that he has any actual ideas beyond gloating at the failure.  So it’s a fun read, but pretty much an empty one too.  Don’t get me wrong.  I enjoy casting down the mighty in their arrogance as much as anybody.  It’s just that the GOP’s sole idea in response is to make one of their arrogant ones mighty in Obama’s place. Sure, I’m glad they have the presence of mind to propose the “Let people keep their insurance” bill in order to score political points. But that’s all it is: a play for points that accidently benefits their constituents.  They certainly have no interest or will to actually try to fix our ridiculous medical system because that would offend their corporate cronies.  The goal, as ever, is money and power, not the common good–for both parties.  Any one of my readers, chosen at random, does more actual good for real human beings, than all the members of the Ruling Class, scrambling to steal the football of power from one another, do in a lifetime.

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  • S7

    I enjoyed Mr. Goldberg’s article, as I, too, am enjoying heaping helpings of Schadenfreude over the mighty’s well-deserved comeuppance.

    But it is rather reckless of you to say that Mr. Goldberg, and others who opposed Obamacare, have no other ideas. The National Review–where Mr. Goldberg’s article appeared–has offered quite a few very reasonable alternative approaches over the years.

    The criticism has often been that none of the more free-market/small-government approaches were comprehensive solutions. Ah, well, it appears neither is Obamacare, is it?

    But why spoil the fun? I’m going to go have another helping of Schadenfreude. Mmm! It’s good hot or cold!

    • Odd that, when Mitt Romney introduced his version of ACA in Mass., it was considered the epitome of Republican/conservative “free market/small-government” health care.

      When Obama embraced it, as he has so many of the Right’s objectives, it suddenly became liberal socialism.

      That’s some amazing sleight of hand you guys have there! I’m no Obama fan but the double standard and ridiculous knee-jerk animosity is telling.

      • Stu

        Mitt Romney is a conservative?

        • Ye Olde Statistician

          A liberal, a conservative, and a moderate walk into a bar. The bartender says, “Hi, Mitt.”

          The praiseworthy thing about Romneycare is that in true federal fashion it was limited to the sovereign Commonwealth of Massachusetts. Hence, this should have afforded an opportunity to observe its actual practical effects over an extended time. Also the damage from its eventual implosion would be limited to a single state.

          • Bill

            This is an impossibility as Mitt Romney would never walk into a bar.

            • Mike Petrik

              Yes, which is why the proper punch line is, “Sprite again, Mitt?”

      • AnsonEddy

        It was? I didn’t pay that much attention to a state issue at the time, so I really don’t know. Could you point me to a George Will column or National Review editorial that was lauding it when it was implemented?

      • S7


        You claim Romney’s version of ACA “was considered the epitome of Republican/conservative ‘free market/small-government’ health care.”

        By whom, madam? Not by me. Not by all my right wing, knuckle-dragging friends. Feel free to support this claim with evidence. If you think it’s too much work, I’ll make you an offer: let’s agree on a price per fully-cited quote; and once we agree–say, $1 or $5 a quote–the proceeds will go to Catholic Relief Services. Deal?

        • Sean O

          PricillaC’s comment is true. RomneyCare was based on the HealthCare blueprint designed by the Heritage Foundation in the late 90’s. The Biggest winners in Obamacare are the Insurance & Pharma industries. Most of the right wing call themselves conservatives but what they are are Corporatists. Obama is one too with libertine sexual politics mixed in.

          • Please explain the 8 section vetoes that Romney issued and were overridden by the Massachusetts legislature.

            I actually agree with you that corporatism is a bipartisan political temptation and a sin that is widespread in today’s politics but this particular charge simply doesn’t hold water.

          • S7

            I missed the memo where the Heritage Foundation was appointed the sole interpreter and spokesman for all conservatives. Do you have a copy of it?

            And where did you get the idea that “corporatist” = conservative?

            Do you actually know anything about the history and the guiding principles of the conservative movement in this country? From the southern agrarians and limited government/hard money post-Civil War Democrats, to the anti-imperialist members of the GOP in reaction to the Progressives (TR, Wilson), to Taft-vs.-Eisenhower battle, up to the modern movement since Buckley and Goldwater, particularly involving lots and lots of small groups and outsiders? I.e., the Tea Party?

            Your comments don’t betray any understanding of any of that.

      • This is historical revisionism. The practical right viewed Romney’s compromise proposal as the least horrific thing that could possibly be expected from the lunatics of the Massachusetts legislature. Romney himself vetoed eight sections of “Romneycare”. All eight vetoes failed to be sustained (though two temporarily were).

        Like you say “[t]hat’s some amazing sleight of hand you guys have there!” Legislation that gets shoved down a Republican governor’s throat over 8 section vetoes is now the height of GOP policymaking while all the free market medicine legislation that is actually proposed in Congress gets ignored as inexistent.

    • S7

      Heh–part of the fun of feasting on Schadenfreude is the fury it ignites in the other side, soon to break out here. The indignant comments on Mr. Goldberg’s column are priceless, and they make the meal even more delicious.

  • Guest
  • Stu

    Lot of this going on too.

  • kenofken

    I find it real hard to do a happy dance over Obamacare’s failure, even though I saw it as mostly as a corporate welfare bill. The opposition has absolutely no solutions for this or anything else except frank social Darwinism. Our country is circling the drain by any realistic measure of economics and quality of life out there, but boy, we sure stuck it to the other guy!….

    • SteveP

      What a bigoted, hateful thing to say. There is NOTHING WRONG with wanting to stick it to the other guy. Keep your normative bias to yourself.

      • I think this is a joke, Mr. Downvote.

    • peggy

      “Social Darwinism”? What are you talking about?

      Where do you people get this stuff?

      • “Social Darwinism” is where the rhetoric of extreme freedom without an sense of mutual interdependence and responsibility leads to: a war of all against all. The ones who “make it” are the hard workers, the virtuous ones, the survivors. All the “takers”, all those jerks who just live off the government: they had their chance, and they’re not my problem.

        • peggy

          We are called to help those in need. We are called to be responsible for ourselves and our families as well. We are not islands, but the answer is not socialism. We share with others what we’ve been given.

          While there are indeed, “takers” there are those truly in need. We are called to lift them out of poverty. Do you believe that all those in poverty have no way out, can’t improve their lives? Must remain dependent? I would not want that for myself or my children. I want them to stand on their own inasmuch as possible and help others in need. That doesn’t mean we don’t need other people, but we need to take responsibility for ourselves and not allow others to take on the responsibilities we’ve been given.

        • peggy

          P.S. I have never met/heard/read one conservative person say every man for himself, screw the sick and the poor. Most people on the right are of a Christian viewpoint that we are called to help the sick and the poor, just not through webs of public transfers. I have no idea of any American person or group that espouses this point of view. Maybe libertarians or anarchists? There are positions in the middle of extremes that can be and are pursued.

          • Most people on the right are of a Christian viewpoint that we are called to help the sick and the poor, just not through webs of public transfers.

            Um, what did you have in mind? Churches? Out of all that tithe money we’re rolling around in? I’m sorry, but this is as unrealistic as the dictatorship of the proletariat.

            • peggy

              Many social institutions, schools and churches, various organizations in which we may be involved, ask for members and the community to contribute to this or that…food pantries, coats and gloves for winter, children’s toys, old clothes, and so on. It is becoming very ingrained in our society. Kids in our public school district have to have public service hours to graduate. I don’t agree that it’s the school’s business, but my point is that our society from top to bottom is training those of us with something, however little, to offer, to share with those in need.

              I can’t help but wonder sometimes whether we are doing too much for the poor. I know that will freak you out. But, yes, between so many govt programs and private service agencies–many of which are funded from public grants by the way–people have many resources when in need. We never did anything like this when I was a kid. It boggles my mind sometimes.

              No solution is ever good enough, I’ve noticed. Life happens. We’ll always have the poor, Jesus said. We have to care for them. We can never do it perfectly. We do the best we can, individually and as a society.

  • Anna

    “Any one of my readers, chosen at random, does more actual good for real
    human beings, than all the members of the Ruling Class, scrambling to
    steal the football of power from one another, do in a lifetime.”
    This is actually the solution proposed by a coworker of my husband’s. He thinks Congress should be kind of like jury duty, citizens chosen randomly for one term and then back home they go. I can think of several difficulties with this, but I also don’t think it would really make things worse.

    • Stu

      I don’t think capuchin monkeys jacked up on whiskey could do much worse.

      • Anna

        True dat, though I think a jury duty-style Congress is more of an actual solution…

        • Stu

          I think the monkeys could be slated in such a manner.

    • Barfly_Kokhba

      Isn’t this closer to how Athenian “democracy” actually worked in its heyday? I should remember this, but I don’t. Weren’t important positions basically picked by lottery, with service in public office being compulsory and limited?

      • Smithgift

        I am not a historian, but I believe it was suffrage by lot: voters were randomly chosen, and only their votes counted.

  • Mark S. (not for Shea)

    “I don’t get the sense from him or pretty much the rest of the movers and shakers in the Thing that Used to be Conservatism that he has any actual ideas beyond gloating at the failure.”
    Sure they do. The GOP solution is what it’s always been: Let the big insurance companies do whatever they want. And let the rest of us eat cake.

    • Ye Olde Statistician

      Is that so much worse than: Let the federal government subsidize the big insurance companies by compelling people to purchase their products?

      • The Deuce

        And don’t forget the “and bail them out even if that backfires” part!

      • Perhaps not, but conservatives are not going to find many people willing to buy their brand when their solution is: life sucks unless you’re rich, so everyone else might as well just bend over.

        • peggy

          That is Obama’s plan. He’s caused insurance rates to skyrocket, offer limited coverage and higher co-pays. He doesn’t care. The Dems are the party of the rich at least as much as the GOP is, if not more. Rich won’t be hurt by socialism, but the middle class will. There will be no middle class, just very rich and very poor, the latter of whom are govt dependent and funded by rich as much as rich will allow.

          You don’t believe in a man’s right to make his own way in the world?

          • “a man’s right to make his own way in the world”

            What does that even mean? If it means we’re not responsible for each other, then no. No, I do not believe in that philosophy from hell.

            • peggy

              I am responsible for myself, my spouse and my children in the first instance. You are not. I am responsible for my parents as they age. You are not. I need not be your burden. You should not be mine, if you can help it.

              We have a right to make our own way, whether we succeed or fail. That’s my problem if I fail. Not yours. I expect you to take responsibility for yourself as well. Yes, we have quite a social safety net to help in times of need, but too many are unreasonably dependent, from one generation to the next. I can’t imagine what more our govt needs to do for the poor.

              Now, we pay SS and FICA so we can benefit from a return and medical costs covered as we age. I’d rather be free of those to invest on my own, but for now that is how we help one another. We may also engage in private charity. In fact, we are called to that as Christians. We are not called to socialized medicine or to forfeit our property or income to the government for that purpose.

              • I’m sorry, but this is downright wrong. We are all responsible for one another. Your responsibility to your family is far, far greater than my responsibility to your family, but that doesn’t mean I have no responsibility to your family.

                But I suspect you actually do believe this, since you talk about the “social safety net”. Your complaint, like a lot of conservatives, is that too many people are “unreasonably dependent” on that social safety net. But this unreasonable dependence has been created by our individualistic economy and society, which conservatives are responsible for just as much as, or more than, liberals.

                • Clare Krishan

                  you have a too-narrowly constricted view of “responsible” – anyone who trains and submits to being permanently scrutinized to maintain hard-won selective credentials as a healthcare professional is being ‘responsible’ for you and their neighbor by being there for you when you need them. They do not need to become serfs to the state to be “responsible.”

                  • I agree with you that being responsible to your neighbor does not have to look like what it currently does in our society.

                    What I am objecting to most is the rhetoric of “not responsible” that enables a sick kind of insouciance towards these problems on the part of “conservatives”. I end up having arguments with conservatives, usually Christians, both Catholic and Protestant, in which it becomes apparent that they think that their responsibility to their neighbors really is a matter of personal choice. They may feel that Christian “charity” calls them to help out, but that strict justice would let an uninsured person die of cancer or starve to death if they didn’t get food when they had the chance.

                    But this is not true. Not even plain old justice would be fulfilled in their fantasy American Republic, let alone Christian charity.

                • peggy

                  You and I may have Christian responsibilities toward each other and one another’s families, but not a governmental responsibility. It has to be what we choose to do willingly and with love.

              • Clare Krishan

                Peggy very wise, that’s how its been done for twenty years or more in Singapore since I was last there on business. Employees pay withholding deductions for three portions of social care that they can use as they see fit, the first an HSA-type vehicle for routine maintenance, a second catastrophic hospital plan and a third old-age fund, any of which can be dipped into and used for any expense, even buying a house for example, that can be sold to pay for a move to a nursing home when needed, or bequeathed to the children if they’d rather take you in and care for you. Much more civilized IMHO.

      • Mark S. (not for Shea)

        Worse? I don’t know. That’s like the question: Would you rather burn to death or drown? My answer: Neither.
        But this is exactly the problem with our current political make up. We’ve been talked into choosing the lesser of two evils for so long, that all we’re left with now is evil upon evil.

        When it comes to health care, I’m ready for a sane, moral, practical solution. And neither party is offering that.

    • The Deuce

      In an actual market not dictated and subsidized by the government, a business’ ability to “do whatever they want” is rather constrained by what customers will actually pay them for.

    • peggy

      While the issues are very complex, a huge cause of our current problems is actually state over-regulation of insurance companies for most of this past century. The more mandated items for coverage, the higher the premiums. Insurers have NOT been UN-regulated. Insurance covers too many basic medical items; we don’t pay ourselves and cost compare as a result. Insurance has boosted prices for services. Some folks have talked about that here. There have been too few competitors in many smaller low pop states. Interstate markets would help that.

      Further, many new diseases and new technologies have been discovered. We didn’t need pills for various things in prior times. (Yes, some medications actually do help many people today.) We rely on very expensive technology that without which some may have died in prior times. We didn’t have the moral dilemmas or cost concerns we have today.

      I do think the GOP Congress missed an opportunity to address insurance reform under W, but there are many good ideas emanating from GOP congressoids. Some are clearly about lip service, though.

      I’m a regulatory economist, having working on utilities. I had to study insurance to understand where the market failures were and what policies would best allow most beneficial results for most people.

      We could have taken care of the poor without changing every one’s insurance experience and costs. But this was really about control, not improving the lives of Americans.

      • We could have taken care of the poor without changing every one’s insurance experience and costs.

        In all seriousness, I would love to hear this solution. I’m not in any way a fan of federal action or federal overreach or pretty much anything else that goes around state and local governments. However, I don’t hear anybody else with a workable solution. It’s all free-market fairy-dust that doesn’t address the realities of the situation as we have it now.

        Or else tries to convince us the current situation is actually fine.

        • peggy

          We already have programs for the poor. Did we need to expand their scope? Maybe. Maybe not. If we had catastrophic-only widely available, that would help people greatly. Ocare outlawed it. States limited it already.

          “Free market magic fairy dust” Goodness. Have you not had a class on economics? Do you not understand how markets work? You need to know factually how markets work to see where the failures are and where to correct with regulations, market liberalizations, subsidies, etc. We should minimize distortions to the market and provide great latitude so insurers can provide plans that meet various stages and situations in life. We all don’t need the same thing. Health savings accounts are a good tool many can use. Flexible spending accts were outlawed by Ocare. Nice, eh? Now, we can’t use pre-tax money for eye glasses, co-pays, OTC meds, etc. Those were great tools we enjoyed just a few years ago.

          If people don’t want insurance, they don’t have to buy it. Medical facilities and professionals provide uninsured rates, too. It may often be cheaper than co=pays in some cases. But, again, Ocare’s limited so many market choices, we may not be able to do that in a cost-effective way.

          The Ocare way is to make healthy people pay a lot more than they need, beyond our abilities in fact, and also deny care to more costly people. The idea for them is the health of the population, not of the individual.

          Socialism and complex subsidies are not the answer.

          • We already have programs for the poor. Did we need to expand their scope? Maybe. Maybe not.

            This is what I find disheartening. Republicans: there are already government systems in place for the poor. And they’re working … fine. Or … maybe not.

            But we can’t do a thing, because
            Gub’mint has no business doing anything!

            To continue: I don’t get why catastrophic only was outlawed. I assume someone ran the numbers and figured out it wouldn’t work. Please tell me that was the reason.

            If people don’t want insurance, they don’t have to buy it. Medical facilities and professionals provide uninsured rates, too.

            Now this I think is unrealistic. We can’t just look at someone with cancer who didn’t bother to get insurance and say, “Sorry. No treatment for you.” Treatment for stuff like that has become normative in our society, which means it’s a common good, and we all have to pitch in to make sure it’s paid for.

            • Clare Krishan

              re: Or … maybe not. see my comment re: indentured servitude under Medicaid above. I recall meeting a young European GI-bride during my years in employ with a large US multinational who was seriously in-hock to the US govt. for her first born (born in the US without health insurance BEFORE she married the father who had service-employer benefits). Did you know that the two lowest grades in the services pay wages BELOW the poverty limit for a family like hers? Insane but true… and yet Americans spend more on welfare than anyplace else in the world… ever wondered why the wealth imbalances are so great … and getting greater (see Janet Yellen’s confirmation hearings on CSPAN)

          • Clare Krishan

            re: “We already have programs for the poor” no you don’t what you have is indentured servitude to the public teat if you ever get seriously sick and let Medicaid pay for it. The government is entitled to every penny you will ever have in discretionary income until you croak, and then they’ll come after your unclaimed property (that life-insurance policy grandma took out for you to pay for college, nope not yours, the gummint will confiscate it to recover the Medicaid expenses you incurred).

            Seriously this is evil people, its not a program for the poor… no other modern democracy socializes healthcare the way the USA does, and no other Western Democracy spends as much as the USA does on welfare. Europe spends 7% of the world’s welfare pot percent percapita of the world’s citizens, while the US? Even more at 8.5% percent percapita of global population. You may claim you don’t have socialism, that’s your perogative. But don’t delude yourself: you have the most inefficient social care system the world has ever seen.

            • peggy

              I hear ya!

              As for helping the poor, there are ways to make market reforms to lower the cost of insurance, to offer some packages that cover only things that people in certain situations would need. Catastrophic-only is important and prevents bankruptcy in times of serious illness. That was the point of insurance. If primary services are provided without insurance coverage, doctors will have to offer low retail prices to get folks in the door, thereby making basic medical services affordable to more people. Many dr’s are going to cash services for this reason. I don’t know how folks will pay on top of having to buy over-priced Ocare insurance, however.

              We need to also increase the number of competitors available to consumers. Interstate pooling is necessary to get this going especially in low pop states.

              We do need a provision for pre-existing conditions, one that won’t bankrupt insurers, however. The high risk pool idea in general has merit, whether this admin carried it out sensibly is another thing.

    • Clare Krishan

      Exhibit A: Romneycare is Obamacare “Massachusetts Edition”.

  • Barfly_Kokhba

    “Let He Who Is Willing to Attend Medical School, Obtain an MD, and Provide Free Medical Care to All Americans Cast the First Stone.”

    The problem is health care costs. Costs have to do with supply and demand. Supply shortage is directly related to our broken higher-education system.

    Oh, and solutions to any of this will not be forthcoming, because the system is working great for those who are fighting to control it.

    • S7

      I think the huge problem is someone else paying. Imagine if, in your neighborhood, instead of everyone paying his or her own electric bills, you all had something called “electricity insurance”; and it worked like this. Everyone used whatever electricity they chose, and the costs were divided up amongst all the neighbors.

      Is it really necessary for me explain, in detail, why this drives up everyone’s electricity costs?

      • Barfly_Kokhba

        But people don’t have a choice about most of their health-care needs, like they do about electricity usage.

        Also, electricity is not required to be administered to each individual person by someone with a twelve-year, $250,000 degree.

        Yes, there is certainly a moral issue with insurance or any sort of “shared-risk” scheme.

        But cost is also a separate issue. And if costs were lower, then the stakes of the “shared-risk” issues between various citizen demographics would be lower, making that issue much less inflammatory and thus much easier to address.

        • S7

          You’re missing the point.

          We have created a system in which people are encouraged to consume services while distributing the costs in the worst way possible.

          In the “electric insurance” example, imagine you are a responsible person who is aghast when he sees (a) his neighbors wasting electricity and (b) his own electric bill.

          But the real kicker is this: if he sits in the dark all night, thus reducing his own electrical usage down to the barest minimum, as he watches his neighbors’ houses all ablaze in light, he knows he can’t do much to reduce his bill. In that situation, more than a few people will say, why buck the system? And turn on the lights.

          That’s precisely how our health care system works, and that’s a huge reason costs continue to spiral. And because not enough people want to do the obvious, sensible thing and shift predictable, non-catastrophic costs (like we do with auto insurance: does your insurance policy pay for oil changes, brake jobs or engine overhauls?) to the consumer…

          The only other answer is rationing. Which is what we’re already doing, and will be doing more of. Hence the death panels.

          So the consequence of “electric insurance” is electric rationing. Enjoy it!

          • Barfly_Kokhba

            Yeah, you’re just beating this analogy way past the point of usefulness. Shifting non-catastrophic costs to the consumer would be impossible at this point because costs are too high. A broken thumb is “non-catastrophic.” Do you know how much it costs to treat a broken thumb, out-of-pocket? Many people–many children and elderly–simply wouldn’t get care at all. And all the analogies in the world won’t change that.

            Health care, like electricity, is an inelastic good. That shared economic characteristic is where the commonalities end. I have already explained why electricity is not totally analogous to health care, I’m not going to keep repeating myself.

            • S7

              No, I don’t think I’m stretching the analogy at all.

              I don’t have to know how much fixing a broken thumb is, to know that it doesn’t *have* to be included in a “health insurance” plan–any more than many of the very expensive things we repair on our cars, or our homes, are not included in auto or home insurance. Have you ever put a roof on your house? Or bought new heating or air conditioning? It’s expensive, as are a lot of auto repairs, or just buying a new car.

              This is why health savings accounts make sense; especially when you can put aside pre-tax dollars (i.e., a health savings account). The more things that are predictable and the costs of which are comparatively manageable, are shifted out of the “insurance” into the you-pay category, the better off you will be.

              Now, whether that has to include repairing a broken thumb isn’t the point. But it could have included the colonoscopy I had this year: I’ve known that was coming for decades; while the scope wasn’t a thrill, having paid for it myself in this way would have been a thrill! Because it would have meant I’d have been allowed, all these years, to set aside money in an HSA, pre-tax, earning interest, waiting for that colonoscopy. But the gov’t won’t allow that.

              And almost no one is arguing that only those who have money get health care. That’s a total red herring. It’s a question of how things are paid for.

              So you said, what about a child? If we did it as I suggest, parents would be able to create HSA’s for their children, perhaps even before they are born. And if a parent had an HSA, paying for the broken thumb that way would be a better deal all the way round.

              Same for grandma–who, under my system, would have been allowed to accumulate money in an HSA her entire life. You do realize, don’t you, that grandma pays premiums to Medicare? And to any Medicare supplement? It’s not “free” to her unless she’s flat broke.

              But OK, some folks are flat broke.

              No problem: then why not have the government create HSA’s for people who can’t create them for themselves?

              The gov’t is spending a fortune on subsidizing health care for lots and lots of people. If that money were directed into HSAs–precisely for problems that are non-catastrophic, EVERYONE* benefits!

              *Everyone, that is, except for those who benefit from overpayments and wasteful use of health care.

              My analogy still holds.

              • Barfly_Kokhba

                The electricity analogy would only really work if people who use the most electricity did so as the result of unforeseeable personal disaster, with no control over how much electricity their household requires; if, in fact, they desperately wished that they did NOT require so much electricity.

                To me, as a believer in God, that imparts a moral element to health care discussion that electricity does not bring with it. “Life is in the words of the comforter.”

                I understand that from a strictly academic perspective, health care and electricity usage do have important economic characteristics in common. I just think that the usefulness of the comparison in this case is pretty limited. But…I am good at being wrong.

                Furthermore, though it’s pretty early and I haven’t had my coffee, I still strongly suspect that we don’t actually disagree on much of substance.

          • not enough people want to do the obvious, sensible thing and shift predictable, non-catastrophic costs […] to the consumer…

            I’ve been wondering about this forever. Why is all health care lumped into one weird, esoteric category? There should be at least two categories: normal, health maintenance, like check-ups and dental cleanings and vaccinations, etc.; and then large, catastrophic care for things like cancer, heart disease, broken bones, etc.

            • S7

              It could be done that way. In my judgment, it *ought* to be that way.

              But one reason it’s not, is because of preferential tax treatment for “health insurance”: your employer can buy an insurance program for you with pre-tax dollars; but if you pay for the very same services yourself, it’s with after-tax dollars.

              The proposal was made, some time back, to allow everyone to have a “Health Savings Account” that would be tax-sheltered, and you would use those dollars for such items.

              The gov’t allowed it; but as far as I know, you can’t roll those dollars over year-by-year! Incredible! If you don’t use it within the set term, you lose it!

              So I’ve never created an HSA, because the only thing I’d use it for are prescriptions or things I know I will spend for sure in that 12 months. But, I’m blessed to need no prescriptions except glasses, yet those don’t get replaced every year.

              My (partial) solution is everyone gets HSAs, and they persist until death–at which point they are an asset that can be bequeathed.

              Imagine starting an HSA for your child, once the pregnancy test is positive. Combine that with a much cheaper health insurance policy, parents would have more money available to put aside in the HSA; and they would have more money for other things. Even if the employer pays for the health insurance, because there’d be more money for cash compensation to the employee.

              I first starting seeing this when I was about 25. I’m 51. I’d have a pile of money right now in that HSA, because of my very good health. My insurance premiums, all this time, would have been lower–even if more of my premiums were going to subsidize others, which is what Obamacare does. That asset, under my control, would be there as a tremendous hedge; and of course, it could be tapped, if needed, for other things, just the way an IRA can be, with a tax-penalty.

              And when you start wringing out of the system some of the tremendous cost-overruns, scarce tax dollars would buy more health care for the poor. There’s no reason the gov’t couldn’t use that money to create HSA’s for the poor.

              • Clare Krishan

                HSA’s are the answer short term, but they are not going to do much long term for the monopolozed centrally-panned CPT codes that Medicaid and Medicare necessitate…

              • Mike Petrik

                HSAs are most certainly roll-overable. I’ve been rolling over mine for years, and do in fact have a “pile of money” that stands ready to be used for my senior years health care needs.

                • S7

                  Hmm–that’s interesting. I was told I couldn’t roll mine over, that I had to use the money in it by the end of the year, or lose it. That’s very interesting…thanks I’m going to do some more checking.

                • peggy

                  Hi Mike!

                  I just heard a lady on a radio show advise folks to get HSAs, especially with post-retirement health needs in mind. Yes, that money can sit around (under current law anyway) and be used tax free for health purposes.

                  • Mike Petrik

                    Hope you are well, Peggy. Susan and I are heading back soon to good old Southern Illinois for Thanksgiving family reunion. If you ever make it to ATL give us a shout so we can meet for dinner or drinks.

                    • peggy

                      Sure. We are back in South. IL (since ’06). Not sure if you knew. Been enjoying EF at the Log Church in Cahokia most of this year…depends on family needs and all that, as you can imagine.

                      Happy travels.

                  • introvert_prof

                    Have you ever *had* an HSA? I put in the absolute maximum allowed by law; it doesn’t amount to much. Eight wisdom teeth pretty much wiped out this year’s contributions.

                    I can’t imagine what a serious health problem would do. Oh, wait, I do: my daughter had a two-day hospital stay a few years back, and it took about 1/4 of that year’s HSA to pay for it.

            • Mike Petrik

              The reason fundamentally rests with the tax-preferred nature of employer-provided insurance coverage. Without the exclusion of such coverage from income, employers would have no incentive to provide it, and consumers would shop for insurance just as they do for life and property/casualty insurance, and normal market incentives would limit these insurance produces to catastrophic care.

        • This is simply not factually true. Most of the time people can shop around for medical care. They simply don’t. If you’ve torn up your knee and are hobbling around, your doctor may send you to an MRI. Too many people pick the $3000 MRI when there is a $500 MRI around the corner. Just survey your friends and family and ask them if they’ve ever price shopped for non-emergency care and how often do they do it.

          • Barfly_Kokhba

            Where did I say that people can’t shop around for medical care? Not that you’ve actually provided any facts of your own that would dispute such a claim if I HAD made it, other than pointing out that MRI’s can cost different prices at different facilities.

            Yes, I am aware that medical services have different costs at different places. Patients often have more than one option for a particular medical service. And often they don’t.

            But you just made a broad, fact-free argument against a statement I never made.

            • I was reacting to “But people don’t have a choice about most of their health-care needs”. In fact, they have several choices, one being not to utilize the service at all, both as to a specific service or entirely or, to choose a different provider.

              Update: Personal fact, I have a medical need, a deviated septum, that I have known I’ve had for decades. I’ve never treated it. I likely never will. Having someone take a chisel to my skull to carve out a properly aligned hole for my nose breathing to be marginally better just never seemed like a good investment.

              • Barfly_Kokhba

                I was not clear–I meant that people have no control over what kind of, and how much, medical treatment they require, whereas the vast majority of electricity usage is totally discretionary.

                Anyway, keeping track of these various discussion threads is starting to feel like work. I usually like your comments quite a bit, so I’m just going to bow out of this whole little imbroglio and declare you the victor. Cheers and thanks for the replies

          • Mike Petrik

            You are right, and the simple reason is that those people either know or perceive that they are not the one paying the bill. There is a legitimate role for insurance in family budgets. It is to shift or share risk associated with unpredictable catastrophic events. The use of employer provided tax-sheltered insurance to share risk of commonplace non-catastrophic events is nuts, and the problem with ObamaCare is that it universalizes rather than retreats from this approach.

            • I use the MRI example because it is the product of a real conversation with a union laborer working at a BP refinery. He not only chose the $3k MRI but he had a 20% copay so his out of pocket costs ($600) were higher than if he had shopped and paid cash.

              He was absolutely insistent that his doctor would not have accepted his results if he had not gone to the MRI place the doctor recommended. That such activity is considered professionally unethical and is actually illegal had zero impact on him at the time.

    • The problem of health care costs is not one of a lack of medical ascetics willing to provide free care. It is the problem of the $10 aspirin pill and the $2000 wheel chair when there are ways to deliver the pill for less and patient mobility for less. Get rid of the CPT royalty issue and within a decade that one change would fix the medical costs crisis, turning it into a much smaller issue that we can handle sustainably.

      • Barfly_Kokhba

        You’re right. Doctors–how many we have, how they’re educated, and how they’re paid–are irrelevant to this debate about health care in America.

        Let’s keep our focus on the career attorneys in Washington DC and their massive stacks of legislative paperwork and propaganda. Surely that’s where the solution will eventually be found. The politicians will save us. Doctors can just go to hell.

        • That’s a gross misstatement of what I said and what I advocate. Do you have anything productive to contribute?

          • Barfly_Kokhba

            The consensus of the world at large seems to be, “No.”

            I’m pretty much socially worthless because I refuse to grab a hammer and start helping build this latest Tower to the Heavens.

            Very Serious People are deeply engaged in a Very Serious Discussion about how the new elevator should be wired on The Tower to the Heavens.

            I’m on the ground, desperately running for my life in the opposite direction.

            • Why continue stuffing words in my mouth? I simply don’t think of people in terms of being socially worthless. Nor do I find criticism and alternate pathways to be a bad idea per se. I just resent people asserting my opinions are wrong when they don’t even know my opinions. All they have are some wisps of supposition they’ve cooked up in their own head.

              If you would like to know my opinion as to the number of doctors needed by society and the appropriate standards of education as well as their pay, I have an opinion I don’t even know if we agree or disagree because I don’t know your opinion.

              So what is your opinion on these questions?

      • S7

        “CPT royalty issue.”

        Even after I googled that, I’m not confident what I found is what you’re talking about. Would you be so kind as to say a little more about that?

        • The Current Procedure Terminology (CPT) code book is copyright of the AMA for every print usage of the thing they charge $14.50 per distributed print copy and $14.50 per user per product for electronic distribution. If I have to pay $14.50 for every window shopper, how likely am I to publish my prices on my web site?

          The AMA collects approximately $80M in royalties, mostly from the CPT (they don’t break it down that far in their reports) so they have a major interest in not allowing too liberal an interpretation of fair use and they provide absolutely no guidance as to what their interpretation is. Is a price list with the office’s 50 most common codes going to trigger a practice devastating bill from the AMA a couple of years down the road?

          So we end up with a shortage of pricing data and nobody doing the work of educating the american public that for commodity items when there is time, you should price shop.

          • S7

            Ah, OK, thanks.

            I’m all for copyright protection, but I think you’re right; this would be a good thing to bust open.

          • Clare Krishan

            more illogical rhetoric re: “a shortage of pricing data”
            a market price either “is” or “is not.” If can’t find data you haven’t been able to do price discovery, an essential of activity in a market. The fallacy is calling this chicanery a market in the first place.

            • Imperfect price discovery is a real concept. If you press hard enough, one can get prices but the cost of doing so is so uncommonly high that most people don’t bother and don’t bother has turned into didn’t realize you could do that for a disturbing number of people.

              When there were no stock pages in the newspapers and stocks were sold under a buttonwood tree on Wall St. that was still a market even though nobody in Maryland meaningfully participated.

              • Clare Krishan

                TMLutas while I find it easy to agree with your earlier premise The expense of health technology is not unresolvable. you’re tendency to abstract your arguments to theoretical generalities found in high-school economics textbook is exasperating: If you press hard enough, one can get prices but the cost of doing so is so uncommonly high that most people don’t bother this is hokum! Price = value – cost. Thus if the costs entailed in the pursuit of the end (purchasing healthcare) exhausts the means, you have no price and no healthcare, duh! May I redirect the argument away from a solidarity turf-war (market participants vs charity recipients) and return the argument to subsidiarity and the value proposition? Price discovery presumes low cost of entry to the market.

                The Medicaid “market” has an infinitely high barrier to entry to the healthcare system: its not ‘social’ nor is it ‘insurance,’ its mass-serfdom to the medical industrial complex — that’s logical Christian-grammatical pro bono communis rhetoric, not hyperbole on my part. Perhaps that’s why Tennesee’s truck-stop heir governor http://www.nytimes.com/2013/11/17/us/politics/tennessee-governor-hesitates-on-medicaid-expansion-frustrating-many.html is sticking to his plan to convert the Federal govt. bribes into real commercial ‘product’ with an actual ‘truth in advertising’ price. His state depends on it – the commerce of healthcare is their leading employer and Obamacare threatens to tank it!

                • Price discovery has its own costs. If getting legitimate prices is expensive, people will shy away from it. If they are taught that you just present your card and pay your deductible and copay then a surprisingly large number of people won’t go beyond that.

                  It took a year and a half, several blood pressure raising conversations and the repeated threat of lawsuit to get a legitimate bill out of an urgent care place to justify their billing $1100 for 7 staples on my daughter’s scalp. The structure of the fake bill they gave (no CPT codes, all internal lines that could have meant anything) led us to believe that they were billing us illegal ER charges. We ended up settling for the legitimate bill of $400 because the alternative would have been us launching a class action on behalf of everybody they billed ER charges to illegitimately and for them to have to justify the practice in court. They knocked the $700 we asked off the bill.

                  Price discovery does not presume low cost of entry to the market. The poor do not have a tattoo on their foreheads that obligates them to use their Medicaid insurance. In fact, some of them would prefer my wife’s $40 office visits for cash to getting ‘free’ care via Medicaid after the effort it took to get someone to actually accept that insurance.

                  I think we’re actually in relative agreement on matters medical but we’re so far apart in history and communication style that we strike sparks without there being good reason.

                  • Clare Krishan

                    TMLutas it may be nice to pontificate from where you reside in pie-in-the-sky land In fact, some of them would prefer my wife’s $40 office visits for cash but if your wife accepted their cash she’d be breaking the law. Medicaid insured patients are coerced into Medicaid-only fee-for-service “tier 1” providers (yes there are three classes or tiers of service in our area: a PPO-reserve plan lets you choose how much of your HSA funds you want to expend on medical reputation and expertise) the poor aren’t afforded the dignity of using the subjective free will God gifted them with in subsidiarity, they’re the lumpenproletariat, whose fellow citizens appear to regard them as a solidarity of ‘mindless’ serfs as I already noted in an earlier post.

                    Your use of the adjective ‘legitimate’ to modify the term ‘price’ betrays you again: whose legitimacy are you refering to? The free-will of the acting persons engaged in healthcare services or by “betters” like you and your wife perhaps? Who’s to say $400 is legitimate? Is it fixed in stone? A pris fixe is no price at all actually its a fee. A price can always be negotiated, for example a seat on an airplane flight is sold for certain fees and charges, but the price at any moment in time is dependent on the costs associated with the fees and charges. An airline can realize more profit by double-booking certain seats in the knowledge that the cancellation fee of a known percentage of customers who reschedule will cover the losses of offering that seat again at a discount in the final days before the flight. Hotels do the same thing to maximize occupancy, hospitals can too – I told the orthopaedic surgeon who checked my FOOSH fracture and removed the fibre-glass caste that I would not pay his $795 dollar fee, that as a self-payer the highest price I would pay would be half that. We were made to feel like the scum of the earth by his office staff, but I’m pretty sure that via Medicare the most he could get for the same service would be half again. There are no ‘real’ prices in American healthcare as currently purveyed by private insurance collectives. Its not a matter of “teaching” anyone how to operate efficiently or not. Its a matter of letting go of the false security of relying on planners and bureaucrats, the false idol if you will, of objective prices. Subjective value prices are consonant with subsidiarity, if a physician can earn a living by setting fees for service that include a little component that covers his charitable free services then no harm no foul. Most retailers do this – Target sets aside 10% of their receipts for “giving back” as do many other corporations pro bono communis. Walmart already sells most generics for $4 – PPACA wants you to pay your insurer 150% markup ($10) for the privilege of being your bill-paying concierge service – what a load of bunkum!

                    • Clare, there is no polite way to respond to your attempt to get me to legally incriminate my wife in writing, so I will not. Use your own imagination as to what is in my head at present.

                      Instead I give you something from the Beatitudes to close our conversation.

                      “Blessed are you when they shall revile you and persecute you, speaking all that is evil against you, for my sake”

                      I wear your insults with honor.

                    • Clare Krishan

                      TMLutas honor is as honor does – you ‘owned’ the interpretation of the insult by claiming solidarity with the burden of the poor enrolled in Medicaid paying “legitimate” prices. Do you know what the legitimate Medicaid price for the office check-up I paid $350 for?

                      $20.64 to $111.22 * depending on where in the USA your doctor sees you.

                      Let’s not allow the deceiver’s divisive tyranny of relativism to rend asunder the works of mercy of the Catholic Church by having its members play ‘stakeholder’ on each other’s hearts like some perverted Bram Stoker fiction. Solidarity gets us to recognize our brother as ourselves, subsidiarity gets us to love him as we love ourselves by granting him the use of his free will capacity to make the subjective value decision in his own personally contingent circumstances what price is legit for him and his family.** I desire not to legally incriminate you, nor your wife, not indeed myself (I get those expensive medicines from overseas via mail order, and if the new ‘free trade’ law passes I’ll have no choice but to pick a Silver plan and pass all those costs on to the rest of you via a deeply skewed understanding of ‘solidarity’ that insults and persecutes me for my faith as $1 of EVERY premium paid by you and other Americans to secure me “legitimately priced” medicines will now go to… you guessed it, paying for elective abortions). So more importantly I desire not that positive law contradicts God’s law that no one be incriminated at the final accounting that will be demanded of us – for God has only one “legitimate” price, paid in full by himself on the Cross, we have all been ransomed already, the Catholic church is the concierge healthcare plan of last resort!

                      All is gift. Even insults.
                      * CPA codes do not equal prices, they equal fees that are then negotiated state by state into legitimate prices. “Medicaid payments are not the same across the country”

                      ** as the typhoon-deluged priest interviewed by the BBC earlier this week affirmed a price of zero is legit for those requisitioning necessities of daily living from the ruins of their neighbors homes and businesses, what Calvinist protestant-work-ethic (labor theory of value) types decry as looting we Catholics use God’s gift of free will to justify as a subjective theory of value.

    • Paxton Reis

      Part of the cost issue is for us the user/consumer to take a look in the mirror and make sure we are eating healthy meals and getting enough exersize.

      • Clare Krishan

        oh don’t worry, the nursing home will make sure that you can be kept alive indefinitely if necessary if they need your Medicaid check to stay afloat…

  • Paxton Reis

    From the president’s press conference yesterday:

    “What we’re also discovering is that insurance is complicated to buy.”

    Yes it is, and Obamacare made it more so and now the backtracking appears to be taking complication to an entirely new level.

  • There are 2 central problems (one technical and one a matter of faith).

    1) Health Technology has advanced beyond our means. Even if fat was stripped from the system, as a nation we couldn’t afford the high level of medical technology we expect. There is a reason space exploration has maxed out. The difference between space technology and medical technology is that people’s lives have become dependent on medical technology.

    2) People have made medicine (and science for that matter) their god.

    (1) is unresolvable. (2) is a deep matter of faith. I certainly don’t have answers.

    • The expense of health technology is not unresolvable. It is clearly resolvable and the solution is not that complex. It is educating americans to act with regard to healthcare as they act in most other areas of their lives as price shopping consumers.

      Besides medical devices and medicine, healthcare in this country is defined by the CPT codebook. While it is true that certain healthcare events are emergency, “take it or leave it” moments, most of the time that’s not the case of healthcare. You can shop for a hospice bed. You can shop for MRIs. The vast majority of people do not. We have set up the system to encourage them not to price shop. Certain codes only happen in non-emergency cases. There is no significant emergency use of 11200 (skin tag removal). That always should be price shopped. There are also a huge number of codes that sometimes can be price shopped because there is no emergency and other times are emergency and cannot be price shopped.

      All codes that can be price shopped would come under pricing pressure and would bend the cost curve downward. 2 out of 3 use cases are susceptible to this simple reform as, I suspect would be the vast majority of codes. But that’s something that someone with domain knowledge in health economics (which is not my credential) should sit down and list.

      So the problem can be drastically reduced, if not completely solved with so simple a reform as a better educated consumer that demands price information. There are other reforms that would shrink the issue yet further but I think this is the really big missed opportunity.

      As for space exploration, you should read more widely. Go watch the Space X trials of their grasshopper technology. Two minutes is all it takes to explode the idea that space exploration has maxed out. We’re just now coming out of the shadow of a very nasty distortion of the space exploration economy.

      • You are certainly right that we could do far better. The costs are outrageous and must be made more reasonable. If ObamaCare falls a part, it could be a blessing, we might be forced to restructure in a way that actually works. I know, I’m dreaming.

        The simple idea is that human technology has limits. It’s simple calculus. I remember seeing a boy with a t-shirt when I was traveling in Argentina, it read something like, “Know No Limits–Mountain Dew.” Human technology has limits. It’s the modern Tower of Babel. For most, technology is the manifestation of Pride. Now I certainly could be wrong, but that’s what I’ve come to understand. We must be humble and we must be a poor. That is the way of Christ.

        However, all that said, our relationship with God is unlimited.

        • I actually agree that human technology has limits. The idea that you or I know those limits in any meaningful way is what I am against. God gave us reason and muscles. We should not belittle those gifts but use them to the fullest.

          Just as at the turn of the 20th century, it is still not near time to close the patent office as a cost saving measure.

          I was reading this morning that the South Koreans got graphene super capacitators up into the range where they might be useful for electric vehicles. This is a cause for great rejoicing as that ripples across the world and permits us to accommodate many more of the billions who are knocking on the entrance doors to the middle class.

          • You’re right. I certainly don’t know the limits. That’s for sure! “What I am against” is when we turn it into god. That’s our instinct and that’s what usually happens because we are sinners. Technology also spreads the vertical class system the height boundaries of haves and havenots increases, not because of technology but because of who we are. We will never have a democracy of technology. Utopias never happen. I understand that’s probably not what you’re arguing, though some certainly would.

            • I’m generally opposed to alternate gods as well. One’s quite enough for me. It’s nice when it turns out that disagreement was just a superficial difference in style and term usage.

              One small demur, technology can increase the height differences between the classes but it can also reduce them. Distributed production technology like 3D printing is an example of the latter effect. Ultimately it’s all God’s pity gift for coping with the world outside of Eden.

              • Part of it is superficial and part of it is the ‘fantasy’ world that I live in–rightly or wrongly. Growing up an x-gen and having technology a full-time part of my life has given me a different perspective. I long for simplicity and think that a lot of our problems would be solved if we humbled ourselves. It’s my ‘sehnsucht’ experience in life that drives me to simple, child-like ways of existence. Pope Francis calling us to be a poor church. I think I understand why. Jesus’ parables continually call us in the direction of humility, simplicity. It’s from that low perspective that we truly learn how to love.

          • Clare Krishan

            re: “close the patent office as a cost saving measure.” may I aver, closing that part of the bureaucracy that depends on tax-payer funded force to protect a corporate privilege that harms tax-payers indirectly may be the speediest cost-saving measure out there. Ever since the steam engine was delayed for three decades with patents in UK,
            economic development and technological progress have been hampered by statist-corporatists using our monies to feather their own nests… not a tradition I can condone to my colonial American cousins who threw off the tyrannt’s Joch, chuckle!

            • The philosophical argument of patent vs trade secret to promote the useful arts and sciences is of long standing and unlikely to be resolved in this thread. I would suggest that this is different than closing it for cost motives which would only be justified if we had actually succeeded in mapping out God’s masterwork of the universe and there truly was nothing significant left to discover and improve. I hope we can agree that we haven’t come near to doing that, which was the point of my writing that bit of prose.

      • Clare Krishan

        re: “You can shop for a hospice bed… The vast majority of people do not.
        Hallo? …a spoonful of callousness helps the medicine go down? Have you not considered perhaps they’re dying and have more important things to do? And if you check those ACA policies, many only cover hospice AFTER exhausting the new hefty $5,000 deductible, so in fact more people WILL be shopping for hospice now than ever before, and a less joy-filled activity could not be imagined something we have had direct experience of this past year, twice in fact, for close family and a close friend. The caregivers can be wonderful, but there’s no guarantee you’ll see the same face twice in one week the churn is so great… and if you’re in an institution and you’re health deteriorates to the point of meals being life-threatening, any hospice care bought and paid for takes a back seat to the institutional policy of ‘supervised’ eating in the dining hall, with all that entails. I do truely understand why so many of those without any faith say “Shoot me” before they want to be placed in a nursing home, its that bad at the end… There but for the grace of God…

        • Clare Krishan

          and no I am NOT condoning assisted suicide, I’m just saying I can empathize with those who cannot face the prospect of going through what they have seen done to their loved ones…

        • Having personally helped a few people wake up and actually figure out that they had the money to get the medical care they need if only they asked the basic shopping questions they do in the rest of their lives, I find your charge of callousness to be misguided. Wasting your resources on overpriced metal and plastic when you could have paid for a stable caregiver with the same money, now that ticks me off. The most stable caregiver, by the way, is simply paying the economic cost of a relative who loves the person who is dying to take a leave of absence.

          You seem to mistake me for an advocate of the present system, either pre or post ACA. I am not. We have been on the wrong economic path with medicine since at least the 1960s and it’s rotted out the system leading to a desire for reform whose inappropriate expression in the ACA has made things even worse. We have a lot of work to do before medicine gets fixed.

        • S7

          I may be misunderstanding your reaction, but–I don’t see anything “callous” about the notion of people who are facing terrible, and even terminal, illnesses, having the task of figuring out their options for care, even as they face death.

          After all, most people, in most of human history, have had to cope with death quite a lot more than most people in the U.S., and other highly developed places are accustomed to. For affluent people (of which I count myself one, although my annual income is about $40k), we shield ourselves from death–rather too much I think.

          So, while of course it’s a terrible thing for anyone to be facing a terminal illness, the fact is, all of us will, one day, face some sort of death. Why should it be thought to be “too much” for people to deal with this reality?

          After all, you could look at it this way: when faced with something that is so overpowering, and feeling so powerless, being able to have *some* choice, some options, can go a long way to helping people cope. And in my own experience, I’ve seen a lot of people deal with crippling illness and death, not by being rendered inert, but by wading in and doing what they can–and being highly practical and astute as they do.

          • Clare Krishan

            Have you ever purchased hospice care yet or been responsible (we are/were power of attorney for a number of incapacitated adults) for a bed-ridden invalid ? I’ll give you the benefit of the doubt on your rose-colored spectacles view of the current state of service delivery, but reality bites. I’m not as gullible I’m afraid.

            • S7

              I’ve seen both my parents die, one of cancer, one of old age. And my job involves caring for people who are dying. I have had LOTS of contact with people who are in hospice care. I am well aware of the wide range of ways people handle these things.

              I’m sorry for your trials, but I’d appreciate if you would respond to me without the condescension and moral preening. Thanks.

              • Clare Krishan

                Allow me to borrow “I may be misunderstanding your reaction” to ask for the same consideration re: your own condescension and moral preening. Even the President it appears is “well aware of the wide range of ways people handle these things” for which I am grateful but that hasn’t stopped him running roughshod over those of us who don’t earn a living providing healthcare or underwriting the tax-free investment funds that fund them; we who provide the income to the insurance pools directly via cash or indirectly via taxes and inflated fee structures.

                More important than taking umbrage – as I said elsewhere on this thread – is taking stock of what relationships are being abrogated and how to respond. Three major bonds have been strained in our household: we cannot keep our PPO plan that permitted relationships with providers nationwide, now we must shop in the Marketplace for relationships in one county alone; we may or may not be able to keep our doctors depending on which carrier we choose to establish a new relationship with; we cannot keep our relationship to our income stream, the carrier will part us from more of our financial sustenance and we will have to separate ourselves from a yet even greater sum to be reserved in an HSA to pay for things that cost a heck of a lot more to buy via concierge contract “insurance” than out-of-pocket over-the-counter outsourcing (see my Walmart anecodote above). These relationships are where we exercise our intellect and will to economize, reduce risk and sustain customs in care as we see fit. The President and folks like yourself it would appear don’t trust our capacity to form mutually-beneficial relationships as we see fit at the sacrifice of relationships with things we value, you want to tell us what to value, to tell us what is best for us. Well I’m sorry but we don’t appreciate your meddling – however well-intentioned you think your experience makes you.

                I still maintain it is callous to expect a terminally ill-person to wait until initiation-of-service before they can determine the cost and availability of a service provider and service delivery (which the deductibles in the ACA make inevitable, you cannot know in advance what will be covered or what will be out-of-pocket). Its archaic and barbaric and unworthy of the most advanced economy in the Western world. But it appears people are so politically wedded to ideology they cannot imagine a true root-and-branch reform based on state-of-the-art technology for just-in-time logistics and global outsourcing of manufacturing. Anyone across American can by almost anything in bulk online via alibaba, but perish the thought that a patient-person can elect to save money the way most modern corporate-persons do. I offer one last example of the insanity: I manage my asthma with several medications some generic, some not. In more economically-minded countries certain of these meds are sold in dosages that allow the patient to ‘refill’ so to speak the delivery mechanism. Not so in America, the plastic tool contains three dozen doses. If you were ever unlucky enough to be hospitalized, the hospital is not permitted to allow you to use your remaining doses, they will prescribe and administer a new tool which your health insurance pays for on the bill at the end of your stay. You can take the plastic wash basin and any unfinished disposable items of personal hygeniene the hospital furnished you with in your visit, but YOU MAY NOT TAKE THE UNUSED MEDICATION WITH YOU IT IS THROWN IN THE TRASH. If your stay was two days, you will have paid via your insurance premiums for $200 dollars worth of valuable medicines that you DO NOT OWN, the hospital retains ownership of and trashes!!! When I spoke to my pulmonologist (who hails from an Asian land where this medication is manufactured in dosable form) about the injustice of such blatant waste, why was the refillable doser not available in the US like it is in less affluent lands, he said not to worry, he can give me free samples to compensate for my perceived “losses” – ARGH!!! Free samples taken from the generous merchandising budget that BigPharma funds from the extortionate markups added to meds sold domestically…!!!

                The system is so deeply corrupted from corporatism that I despair sometimes …

                • S7

                  You can take your lectures somewhere else. You tried to play the moral superiority card on me–brandishing your personal experiences–and it backfired. I’m simply not interested in pursuing a conversation with people who take that approach.

                  • Clare Krishan

                    Fair enough – Schadenfreude isn’t one of my pastimes either

    • Clare Krishan

      I disagree with your value proposition as rhetoric that fails logically as being unactionable. May I parse again for logic (featured fact) rhetoric (proposed advantage) and grammar (verb action)

      Jon W. says “All they have is rhetoric” but rhetoric assumes a certain logic and presumes that grammar “rules” or has the actionable power to move an argument forward.

      Rhetoric is thus a subsidiary of grammar, its servant if you will.

      Logic meanwhile is the where the rubber hits the road, launching the syntax of our dialog featuring:
      – fact and counter-fact
      – discourses rising out of edifying advantages (or collapsing from unedifying disadvantages) and finally
      – benefits morally chosen and intentionally acted on. These may involve material detriments — the sacrificial embrace of certain contingencies in this life to sustain our path to beatitude in the next — but if we’re sticking with healthcare and Hippocrates, may never embrace harm, an uncertain trade-off that hazards life and limb, or bars the path to eternity of ANY of the acting agents.

      There can be no objectively perfect health system, only objectively perfect acts taken to sustain health. The first of these is one of abstinence, do no harm (to body or soul). Such a grammar of omission conserves life AND grace. From heaven’s eternal perspective a wounded body with a healthy soul is preferable to a healthy body with a wounded soul.

      Could the problem be, not (1) means disproportionate to ends nor (2) ends justifying the means but rather too many people wanting to be seen to “do something” in solidarity with those suffering injustice by changing the social justice goal posts, dignity-of-life ends and state-of-the-art means that they know nothing about nor can meaningful improve? Solidarity only gets you so far…

      The President has demonstrated that neither he nor his HHS secretary Mrs Sebelius has a clue. So now the insurance companies are about to demonstrate the only thing they have a clue about is their financial underwriting (no solidarity with delivering healthcare itself) meanwhile one of the greatest in the “business world” of US healthcare, the largest non-profit hospital chain in the US, the Catholic Church, is forced to expend precious resources defending itself in court from expropriation at the hands of a hostile takeover from for-profit competitors eager to increase their margins via rent-seeking off the backs of the sick and vulnerable, aided and abetted by political hacks they bought and paid for.

      No sir, subsidiarity is the grammatical solution to your rhetorical “common good” problem. Perhaps subjective-value judgment in a free market would set free forces of pro bono ‘charity,’ where healthcare practioners and their healthcare patients parse the feature-advantage-benefits directly themselves rather than being forced to follow the fake-solidarity of central-planning CPT-style via the PPACA?

  • Scott

    Not that I am a great lover of the GOP, but they have put forward myriads of bills geared towards reforming healthcare only to have them die on dingy Harry Reid’s desk.

  • kmk1916

    I just saw a bumper sticker: Two terms for politicians: one in office, one in jail. : )
    (I know there are good politicians, I personally know and am friends with at least one who is striving for personal holiness, but I did laugh out loud and read it to my kids. They sorta got it!)

    • Mike Petrik

      Illinois has already adopted this practice.

      • peggy


  • What the Republicans need – what “conservatives” need – is someone from their own ranks on the national stage who is willing to say, “The system is broken, and it’s going to take cooperation from the business world, active participation by state governments, and – yes – some serious intervention by Washington to fix this big, gigantic problem.”

    But the “conservatives” are completely stymied because their constituents are nothing more than a disjointed mob who don’t even share as much as an ideology. All that these “conservatives” share is a piece of rhetoric, the sole purpose of which is to make other people and their problems GO AWAY: “Government is not the solution; government is the problem.”

    Wherever you find Republicans and “conservatives”, you find this weird call-and-response between groups of people who have absolutely NOTHING in common beyond a desire not to cooperate with anyone else, groups who see their neighbor essentially as, if not the enemy, someone who has nothing to do with them.

    • Stu

      The fact that we look to the Federal Government as the first line of defense for any challenge is a problem.

      • But I did not say that the Federal Government was the “first line of defense”. I consciously listed it last. But it doesn’t matter, because as long as you can plausibly portray the government as acting in any way, the rhetorical knee will jerk, and that will be the end of any solution and any reform.

        • Stu

          Fact remains, the “Feds first” attitude prevails and that is what many are reacting to. At this point, the best thing that the Feds could do is stop “helping” and get back to worrying about things that truly need Federal involvement. Good starting point would be things called for in the Constitution.

          • No, we’ve gone beyond that. Since the Civil War, local power may wax and wane, but it’s essentially nominal. Corporations are more powerful than many states and pretty much all towns, and given the mobility of labor that pertains in our economy and the extreme philosophical individualism that rules our social lives, real reform pretty much has to be spearheaded by Washington.

            • merkn

              By “extreme philosphical individualism”, you mean liberty and freedom? Right?

              • If and only if by “liberty and freedom” you mean “extreme philosophical individualism”, yes.

                [edit: and I suspect that your question reveals an attitude that is exactly what I’m talking about. “Conservatives” don’t have any coherent philosophy, nor do they understand what “freedom and liberty” mean. All they have is rhetoric and desire for other people’s problems to go freaking away.]

                • merkn

                  What does “conservative” as you and the editor use the term have to do with my post. What do you even mean by the term? My point is that citizens of this nation are free people. If some 30 year old wants to spend his money on beer and videogames it’s his right. The state has no business telling him what to do. When the state does intervene and tries to take over healthcare in a quixotic attempt to “fix it”, the Obamacare train wreck is inevitable. Central planning can’t fix it. There is no “republican ” solution. If you want to read some “philosophy” on this read Hayek. If you want to reach out to address a social problem why don’t you try appealing to your fellow citizens with reasoned appeals to their charity and dignity instead of coercing them through the power of the state. You can’t fix health care, its impossible, but you can help the sick and the poor if you act with the charity and good will toward others that you claim to represent. Read Dorothy Day on that. She would be horrified by the federal takeover of Charity, yet I don’t think she was a lackey of big business or your insurance industry boogeyman.

                  • If some 30 year old wants to spend his money on beer and videogames it’s his right.

                    And if he gets sick and needs expensive medical care, what then?

                    • Merkn

                      As a catholic I have an obligation on charity to help j. As all Catholics do. We care for the less fortunate even of less fortunate includes the prodigal. Government has nothing to do with it. I don’t discharge my obligation on charity by taxing those who may not share my views.

                    • Stu

                      Indeed, what then? Do we pass laws forcing him to hand over money to some Big Business? What about those among us who don’t eat healthy or exercise? Tax them? After all, they are a greater risk to run up our medical costs.

                      Yes, I think people should want to do thing for the common good and live in a responsible way that takes into account their neighbor but I don’t think in this case I want “holy mother the State” getting involved because the “cure” is just going to be bad for everyone.

                      Part of living in a free society is that sometimes we have to do the “right thing” even when individual members make bad choices.

            • Stu

              You don’t cure cancer with more cancer. Washington needs to just stop doing what it is doing coupled with some governors having the “stones” to stand up to DC and say “no”.

              • The action of the Federal Government is not “cancer.” If you want a closer analogy, you might say, “You don’t cure a stubbed toe with amputation.” And I agree. But we’re not talking a stubbed toe. We’re talking full-on gangrene. The right’s solution is to … see what happens or, as kenofken pointed out below, some really thoughtless and ill-considered social Darwinism.

                • Stu

                  The action of the Federal Government has become a “cancer”. It’s mutated into something that is in many areas toxic.

                  Now is there a place for the Federal government? Of course. But we are so beyond that now that many people do in fact embraces the opposite extreme as the “answer” which of course it isn’t. I liken it to people supporting Ron Paul. He isn’t the “answer” in my opinion but I do like the fact the he at least drives the line of debate back towards the proper direction.

                  But regardless, I don’t have much hope for the Feds to heal themselves. They don’t even know they are sick.

                  • Well, then, we might as well just give up, because church-based charity and town governments sure aren’t going to solve this problem.

                    Or do you have a real idea what might be the proper direction to drive the debate? I’ll be very happy if you have something other than “get the federal government out of it.”

                    • Stu

                      What is the “problem”?

  • Stu

    I’ve offered this before. Probably will again. But it’s a good example from one of my favorite distributists (John Médaille) of the type of thinking we need to regain if we are going to get out of the Big Government/Big Business paradigm. It’s time to reconceptualize the challenge.


    • Elmwood

      I regulate big business (not really, i have little to no real authority) but it’s very true in my experience as a federal oil and gas regulator that big business and big government go together hand in hand.

      The problem is complex and is why i hate both political parties.

      GKC said it best: “The whole modern world has divided itself into Conservatives and Progressives. The business of Progressives is to go on making mistakes. The business of the Conservatives is to prevent the mistakes from being corrected.”