And so it begins...CO and MD offer bill for single payer

[fisherman]

You seemed to have interpreted my position as a pro Republican one. You are incorrect, my position is a strict interpretation of the Constitution. I agree Bush's part D should not be allowed.

That was not my intent. I just thought I would mention one from the Republicans also that fit since one from the Democrats was already being discussed. You know Fair and Balanced.

In regards to your position the Supreme Court does not appear to agree with you from many rulings over several decades so I cannot provide any better information than that.

You really ought to look into the books I mentioned as I think you would really enjoy them. I have loaned copies to friends who are Republican, Democrat, Libertarian, and Independent and all have fund them to be enjoyable reads. There is a lot of information on how the Constitution was developed and what each person wanted in it. That time in our history was truly a miraculous time and the books shed considerable light on the inter personal workings.

 

[eridanus]

There is a huge difference between interstate highways and rural roads. If I recall correctly the justification for the interstate system was for the movement of troops throughout the country. It was very easy for the troops to move throughout the country when they were on foot or horseback, so there was no need for the federal government to become involved with the local roads. It is also kind of difficult to have interstate commerce when the road only goes to the state line. That is one of the powers the government does have is to regulate interstate commerce for the general welfare of the country. Without twisting the reading of the Constitution to mean something that was not intended.

There were roads, there were states, and there were troops (with supply wagons). If the founders wanted an interstate road system, they would've written it into the Constitution. They didn't. The Commerce Clause was meant to stand as is, without the federal funding of a transportation network. To suggest otherwise is a revisionist reading of the Constitution.

 

[samclem]

Article 1, Section 8 of the Constitution gives Congress the enumerated power to "establish post offices and post roads." The term "post road" is no longer in common use, but at the time it denoted a major road between major towns. Later laws and Supreme Court rulings interpreted the clause to include railroads and clarified that "postal roads" could be used for other purposes.
So, roads are in there, at least in some form that has a clear lineage to the present.

Sorry, no mention of hospitals, doctors, alms for the poor, old age pensions, free bread and circuses.

 

[eridanus]

Later laws and Supreme Court rulings interpreted the clause to include railroads and clarified that "postal roads" could be used for other purposes.

So...later laws and Supreme Court decisions affected the interpretation of a clause in the Constitution? Who woulda thunk it?

 

[samclem]

So...later laws and Supreme Court decisions affected the interpretation of a clause in the Constitution? Who woulda thunk it?

That's what they do, I could have told you if you'd asked me.

What we're talking about is whether they've done it correctly, or if they've taken a very general two word clause from a 7000 word document and twisted it so that it now accounts for over 40% of what the federal government does (when measured by expenditures).

I showed you were the federal government's role with regards to roads is mentioned in the Constitution. Show me where the federal government's role with regards to health care is mentioned. Look for anything about old age pensions while you're in there.

There's also a handy provision for changing the Constitution. If we want health care to be a job for the federal government (and it would be a huge one, well worth a specific mention) then that's how ya do it. Start gathering those signatures. At the same time, insert a clause that allows the government to direct people to buy private health insurance and you can head off the present challenge to the latest health care law, killing two birds with one stone.

 

[modhatter]

There are a lot government agencies that have been instituted that are not covered in the Constitution that are meant to help protect the safety of citizens. We have the FDA, to make sure our food and drugs are safe. We have the Clean Water programs, we have the EPA to try and reduce pollution and health hazards.

Though I greatly admire the founders and the work and thought and wisdom of the Constitution, we are simply not living in that century. You can be sure, if they were alive today, there would be additions made to the Constitution and new perspectives. We are evolving and the world is changing as we discover new information.

We no longer use candles for light and firewood as our only source for heat. We no longer treat illness by blood letting, have slaves, women can vote, own property and inherit property. Black people are considered a 100% citizen, not a 3/4 citizen/

We are evolving as our world evolves and consequently our lives are changing. We have to deal with those changes. Many many things will continue to change as time goes on, and i hope we will be able to have some wise men who will be able to deal with the current issue and problems of the day. (which may not be covered in the Constitution)

 

[lets-retire]

We no longer...have slaves, women can vote, own property and inherit property. Black people are considered a 100% citizen, not a 3/4 citizen/

We are evolving as our world evolves and consequently our lives are changing. We have to deal with those changes. Many many things will continue to change as time goes on, and i hope we will be able to have some wise men who will be able to deal with the issue of the day. (which may not be covered in the Constitution)

Each of these issues present at the time the Constitution was written was handled correctly, with an amendment. That is how the Constitution should be changed for issues that were present at the signing, not through legislation or activist judges. If a development was made after the Constitution was signed, like the advent of airplanes or automobiles then it is understandable that interpretations of the Constitutions change.

 

[M Paquette]

So...later laws and Supreme Court decisions affected the interpretation of a clause in the Constitution? Who woulda thunk it?

I'm surprised nobody's pulled the dictionary gag yet. Generally one of the first arguments to come out is 'the meaning of that word/phrase today is far different than the meaning held by the Founding Fathers.' This is followed by an excerpt from an old dictionary that happens to have the desired definition of the word.

WEL´FARE, n. [well and fare, a good going; G. wohlfahrt; D. welvaard; Sw. valfart; Dan. velfærd.]
1. Exemption from misfortune, sickness, calamity or evil; the enjoyment of health and the common blessings of life; prosperity; happiness; applied to persons.
2. Exemption from any unusual evil or calamity; the enjoyment of peace and prosperity, or the ordinary blessings of society and civil government; applies to states.

- American Dictionary of the English Language, Noah Webster, 1828

​

Next up... We demonstrate that the long form birth certificate isn't valid, because Hawaii isn't legally a State.

 

[eridanus]

That's what they do, I could have told you if you'd asked me.

What we're talking about is whether they've done it correctly, or if they've taken a very general two word clause from a 7000 word document and twisted it so that it now accounts for over 40% of what the federal government does (when measured by expenditures).

I showed you were the federal government's role with regards to roads is mentioned in the Constitution. Show me where the federal government's role with regards to health care is mentioned. Look for anything about old age pensions while you're in there.

Hey, no need to get bent out of shape. I was just repeating what you wrote.

Later laws and Supreme Court decisions supported the Constitutionality of Social Security ("old age pensions"). That's what later laws and Supreme Court decisions do. They interpret the US Constitution in modern times.

Cardozo wrote in the Helvering Opinion, "Congress may spend money in aid of the 'general welfare'." He also wrote, "The discretion [of welfare programs] belongs to Congress, unless the choice is clearly wrong, a display of arbitrary power, not an exercise of judgment. This is now familiar law."

No offense but a still-standing Supreme Court Opinion takes precedence over an internet "strict Constitutionlist".

 

[modhatter]

A final note on Medicare on the chopping block.

Insurance companies make a good profit insuring the younger healthier population

The government is seriously in the whole insuring the old sicker population.

What would combining the two age groups under one roof do for saving Medicare?

Wouldn’t the younger people help to finance the most expensive part of medical care (Medicare) ?


Just sayin....

 

[winger]

A final note on Medicare on the chopping block.

Insurance companies make a good profit insuring the younger healthier population

The government is seriously in the whole insuring the old sicker population.

What would combining the two age groups under one roof do for saving Medicare?

Wouldn’t the younger people help to finance the most expensive part of medical care (Medicare) ?


Just sayin....

Stop making sense. After we try 14 ways that don't work, we will end up at Medicare for all.

 

[donheff]

A final note on Medicare on the chopping block.

Insurance companies make a good profit insuring the younger healthier population

The government is seriously in the whole insuring the old sicker population.

What would combining the two age groups under one roof do for saving Medicare?

Wouldn’t the younger people help to finance the most expensive part of medical care (Medicare) ?


Just sayin....

That is the socialist approach the rest of the industrialized world takes. We know better.

 

[samclem]

Wouldn’t the younger people help to finance the most expensive part of medical care (Medicare) ?

Which is just exactly what is already happening every time a worker under age 65 pays Medicare payroll taxes. There ain't no "lock box"--most of the money from Mr Smith's Medicare payroll tax goes right out the door to rent a $500 wheelchair for ol' Mrs Biffle for $200 per month. So, we don't need to combine the systems to attain the inter-generational sharing of costs which you seek. How's that working for us? (Hint--Medicare is the government program that's in the worst financial condition).

I think it's useful to separate the approach to Medicare reform passed by the House (support payments to individuals for use in purchasing private insurance in a regulated market) from the idea that Medicare cost growth will be reduced. After all, the amount of the vouchers/support payments is still subject to lots of negotiation. In theory, we could wind up dedicating more money to Medicare under this new construct than we would have otherwise, with people choosing to spend the vouchers in the way that best meets their needs. Sure, the plan is pitched as a way to improve Medicare services while cutting cost growth, but we might end up (after all the negotiations) with the same costs and better service. I guess some folks would find a reason to object to that, too.

Remember--private insurance (through the Insurance Exchanges) and government payments to help people buy policies is the medical insurance model the government is pushing under the new reform for those who don't qualify for Medicare or Medicaid. So, if we combine the "under 65" system with the "over 65 system", it's just as logical and likely that we'd choose to make everything private rather than some type of "super Medicare." I'm guessing that wouldn't make you happy.

 

[swampwiz]

The major reason a person wouldn't qualify for Medicaid is because they have too much money. When they have less money, they will be insured by Medicaid.

Not so. I am destitute (outside of my retirement account) enough to get SNAP benefits (i.e., food stamps), but because I am childless, I am not allowed to get Medicaid in my state (although I can go to the state hospital and essentially get free care, but not at a physician's office or pharmacy.) Adults with children are allowed to get Medicaid, however; I suppose that it's OK for a childless adult to die, but not a parent, since the children would become orphans.

 

[ERD50]

The major reason a person wouldn't qualify for Medicaid is because they have too much money. When they have less money, they will be insured by Medicaid.

Thats just the point Sam. You lose your job and your guaranteed group insurance and find yourself uninsurable due to a preexisting condition...

And it was government involvement that led to this insane lock between our health insurance and our jobs. Imagine where we would be today w/o the consequences that little wrinkle created.

If that is hard to imagine (because it has been that way for most of us most of our lives), just imagine if our car insurance was tied to our job, and employers got tax benefits for providing it. During times of low unemployment, when employers are competing for employees, they'd offer 'better' car insurance than the next company. In this case, 'better' means low/no deductible, coverage for every little detail, even things we could easily pay out-of-pocket. We'd get every little ding and scratch fixed - it's 'free!'. So insurance keeps getting more and more expensive, but it always appears that "somebody else" is paying for it (OPM), so "nobody" cares. Companies would get good group rates for this insurance, as employed people on average are more responsible drivers.

So now you lose your job, and your car insurance. It's tough to get private insurance, nobody wants to deal with such a small account, and you are now "high risk" as an unemployed person. How to drive to the next interview?


None of these would be "unintended consequences", they are just "consequences", foreseeable and predictable. The term "unintended" just lets the offenders off the hook. It is their job to take the consequences of their actions (the laws they pass) into account.


That is basically what has happened, thanks to government involvement in our health care. Why is anyone surprised when some/most of us are highly skeptical when we hear, "I'm from the Government, and I'm here to help you."?

-ERD50

 

[samclem]

Not so. I am destitute (outside of my retirement account) enough to get SNAP benefits (i.e., food stamps), but because I am childless, I am not allowed to get Medicaid in my state (although I can go to the state hospital and essentially get free care, but not at a physician's office or pharmacy.) Adults with children are allowed to get Medicaid, however; I suppose that it's OK for a childless adult to die, but not a parent, since the children would become orphans.

I'm sure the food stamps help out. It looks like the state has provided a means for you to get health care (maybe not the way you'd like it) which is paid for by others.

 

[Beryl]

Not so. I am destitute (outside of my retirement account) enough to get SNAP benefits (i.e., food stamps), but because I am childless, I am not allowed to get Medicaid in my state (although I can go to the state hospital and essentially get free care, but not at a physician's office or pharmacy.) Adults with children are allowed to get Medicaid, however; I suppose that it's OK for a childless adult to die, but not a parent, since the children would become orphans.

My heart goes out for you. Personally, I'm fine with health coverage but I still hope we can get a single-payer system here in CO for those who are not so fortunate. It is how I want my tax dollars spent.

My 34 year old niece is unmarried and childless, has MS, and could no longer work regularly. When she could get a job, her pre-existing condition kept her from getting health coverage. When not working there is no Medicaid, of course.

I wanted to let her live with me as a dependent and hoped my employee medical benefits would cover her. Nope. She is too old and didn't live with me as a child.

She is rushed to ER regularly where she gets temporary relief but nothing more. Her bills mount up along with the pain until there is another episode requiring ER. In addition to the MS physical pain she is in emotional pain from not having health coverage. I guess she hasn't died quickly enough for some people.

She has revisited SS disability with attorney assistance and she might finally get some relief.

(There, but for the grace of God, goes I.)

 

[swampwiz]

Effectiveness: I suppose there are lots of things the government could seemingly do better than private businesses or individuals. For example, why do we need 100 kinds of bread churned out by thousands of small bakeries? This is clearly inefficient, the government could take this over and make bread in a few factories much more cheaply. Cars--do we really need 30 models of mid-size sedan? Lots of design costs there, and a lack of commonality causes huge logistics and maintenance inefficiencies. And the marketing! How much does that add to the price of a car? Clearly the government could make one or two sedan models and crank them out much less expensively. Somebody should try this setup somewhere, the attraction should be obvious.

When you buy a loaf of bread, there is a clear price for it, and you don't have to worry about any complications. And there could a plethora of different types of bread that you may enjoy. And the labor that goes into making & selling the bread - the farmer, the baker, the stockboy - are all easily sourced. And a bread making factory is not too expensive.

Contrast this with medical care. You cannot go into a physician's office or a hospital and look at a price sheet. And if you did ask, you would get the rack rate, not the street rate paid by insurance companies and the gov. You could not get guarantee that there would be no complications, and thus no way of getting a probability assessment or price on those complications (which would need to have to be able to do a proper economic assessment.) If you got a specific ailment, there would be only a few worthy alternatives as it what would be appropriate (something that the "best practices" protocol of the medical review board would be able to analyze and make judgements on) - and you wouldn't even have a choice in an emergency situation. There is the whole expensive education & training and malpractice costs baked into the labor, to say nothing of the cartel behavior of the artificial shortage of physicians enforced by AMA. (Nurses are also rather expensive, but not alarmingly so.) Finally, medical equipment is prohibitively expensive.

I definitely think that the government can do a better job.

 

[swampwiz]

Which is just exactly what is already happening every time a worker under age 65 pays Medicare payroll taxes. There ain't no "lock box"--most of the money from Mr Smith's Medicare payroll tax goes right out the door to rent a $500 wheelchair for ol' Mrs Biffle for $200 per month. So, we don't need to combine the systems to attain the inter-generational sharing of costs which you seek. How's that working for us? (Hint--Medicare is the government program that's in the worst financial condition).

I'll agree that there a few examples of this kind of wasteful spending. But obviously, the history of the Medicare Advantage (private insurance for Medicare) being MORE expensive then regular Medicare must mean that the type of inefficiencies that can be wrung out is less than the "enhancement of shareholder value" and executive bonuses, etc., that accompany private enterprise.

 

[ERD50]

When you buy a loaf of bread, there is a clear price for it, and you don't have to worry about any complications. And there could a plethora of different types of bread that you may enjoy. And the labor that goes into making & selling the bread - the farmer, the baker, the stockboy - are all easily sourced. And a bread making factory is not too expensive.

Contrast this with medical care. You cannot go into a physician's office or a hospital and look at a price sheet. ...

True. However, I fail to see that the only solution is "let the govt run it". If we do that, we still won't see the prices, or make the kind of rational decisions that we might make if we were exposed to this information.

-ERD50

 

[samclem]

Contrast this with medical care. You cannot go into a physician's office or a hospital and look at a price sheet.

Yes, I agree that the lack of information on the pricing of treatment options is a huge problem. This would help drive down costs.

to say nothing of the cartel behavior of the artificial shortage of physicians enforced by AMA.

A cartel that is enforced by the US government. The government has granted AMA the monopoly on management of the "CPT" codes used for Medicare and Medicaid billing. More fundamentally, the government has granted AMA's Council on Medical Education and Hospitals a monopoly on accreditation of medical schools and hospitals. Through this mechanism, AMA restricts the number of physicians and the number of hospitals. They have set targets for the number of graduates from each school, and can withhold accreditation from any school that exceeds these goals. This government involvement (or abdication of a governmental responsibility to a trade guild) restricts the supply of services and definitely increases medical costs.

I definitely think that the government can do a better job.

I definitely agree with you. What they've done to date has reduced the supply of medical services (driving prices up) and dumped money into the market to purchase health services, which increases demand and prices.

We all know that medical costs have risen faster than inflation. I'm trying to find the source I read, but it said that 1/2 of the difference between the general inflation rate and the higher medical inflation rate was due to government spending in Medicare and Medicaid.

All this is not to say the government can't play a useful role in helping Americans get affordable medical care, but it needs to be done intelligently.

 

[samclem]

I'll agree that there a few examples of this kind of wasteful spending. But obviously, the history of the Medicare Advantage (private insurance for Medicare) being MORE expensive then regular Medicare must mean that the type of inefficiencies that can be wrung out is less than the "enhancement of shareholder value" and executive bonuses, etc., that accompany private enterprise.

Medicare Advantage is costlier than standard Medicare because of the bizarre cost target bidding system established by the government. It's ridiculous, and if I believed in conspiracies I'd suspect that it was designed this way to assure Medicare Advantage produced higher costs and therefore "failed".
None of us have seen the benefits true competition would bring to medical care in the US. As you point out, it works well for giving us great products and services in other parts of our economy. Medical care is different is some important ways, but not so different that human nature doesn't apply anymore.

“It is not from the benevolence of the butcher, the brewer, or the baker, that we can expect our dinner, but from their regard to their own interest”
Adam Smith

When it comes to improving quality and lowering costs, I trust enlightened self-interest much more than any committee. Let's put that force to work.

 

[haha]

All this is not to say the government can't play a useful role in helping Americans get affordable medical care, but it needs to be done intelligently.

Surely you jest.

Ha

 

[REWahoo]

Surely you jest.

Don't call him Shirley...