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

[eridanus]

When it comes to taxes, evidently under any conditions whatsoever. Just because something is not in the Constitution, that doesn't make it unconstitutional.

From a strict constitutionalist's viewpoint, the US Air Force was not provided for in the Constitution. It only mentions the Army and Navy.

You're also not "innocent until proven guilty." It's not in the Constitution either.

 

[lets-retire]

Just because something is not in the Constitution, that doesn't make it unconstitutional.

Technically this is incorrect, at least according to the 10th Amendment. I know in practice it is a bit different. In my thinking (I know not really a good source) if something had been invented when the Constitution was written and it wasn't provided for in that document it is a fairly good indication that the writers did not want the government to provide that item to the populace. As pointed out the Air Force was not mentioned when the document was written, but then again airplanes hadn't been invented yet either. I think it could be reasonably interpreted that when the founders wrote about the Army and Navy (the only military forces at the time) they were referring to the entire military. Just like when the founders failed to include to health care. They knew about medicine but did not include it because they did not want the federal government to provide it.

 

[fisherman]

Technically this is incorrect, at least according to the 10th Amendment. I know in practice it is a bit different. In my thinking (I know not really a good source) if something had been invented when the Constitution was written and it wasn't provided for in that document it is a fairly good indication that the writers did not want the government to provide that item to the populace. As pointed out the Air Force was not mentioned when the document was written, but then again airplanes hadn't been invented yet either. I think it could be reasonably interpreted that when the founders wrote about the Army and Navy (the only military forces at the time) they were referring to the entire military. Just like when the founders failed to include to health care. They knew about medicine but did not include it because they did not want the federal government to provide it.

My understanding is the debate is about access to health care insurance as anyone who can pay can get care now. Paying is a problem for many however. Health Insurance like the Air force did not exist when the Constitution was written as a point of clarification only to your statement. I am certainly not a constitutional scholar or a lawyer and I have very mixed feelings about the issue being discussed but my point above is a valid clarification only.

 

[donheff]

My understanding is the debate is about access to health care insurance as anyone who can pay can get care now. Paying is a problem for many however.

Only under Obamacare. Without mandates under the new law many people are uninsurable. Some (but not all) states have high risk insurance pools but some people are simply uninsurable.

 

[eridanus]

I think it could be reasonably interpreted that when the founders wrote about the Army and Navy (the only military forces at the time) they were referring to the entire military.

Revisionist.

Just like when the founders failed to include to health care. They knew about medicine but did not include it because they did not want the federal government to provide it.

They had roads in the 1700s but they didn't provide for an interstate highway system. Surely they would have provided for it in the Constitution?!?

During the 1700s, health care was a visit to the local bleeder or dentist. If you didn't die, you lost a leg. Times have changed. It can be reasonably interpreted that, given the changes since then, the founders would have created universal health care.

Modern society simply needs an Air Force, highways, and universal health care. The founders were not clairvoyant.

 

[Zathras]

I'm in favor of guaranteeing a basic level of care, but we simply can not afford Cadillac coverage for everybody. Example would be to provide expensive cancer treatments or organ transplants to people in their 80s. I know that sounds harsh, but it's reality.

Absolutely, I agree with you as well. I don't believe there are very many proponents of a health care system that would disagree with you.

 

[Zathras]

... In my thinking (I know not really a good source) if something had been invented when the Constitution was written and it wasn't provided for in that document it is a fairly good indication that the writers did not want the government to provide that item to the populace. ... They knew about medicine but did not include it because they did not want the federal government to provide it.

You might be interested in this: PHSChat for USPHS Officers - Founders favored "government run health care".

Showing how many of the actual founders passed legislation which provided health care for a group of people (sailors basically, not everyone) and required all members of said group (yes, civilians), to pay.

I am guessing the founders that passed this had a pretty good grasp of what the founders intended.

 

[GregLee]

I am guessing the founders that passed this had a pretty good grasp of what the founders intended.

Rao's article Sailors’ Health and National Wealth is very interesting, but after reading it over, I'm unable to figure out exactly which founders favored the user tax-supported marine hospitals.

 

[BigNick]

And I'd like to hear of a single country that provides every type of medical care to anyone, regardless of ability to pay. Go ahead--I'll wait. There are none. So the situation you describe is a matter of degree, not a binary situation.

France comes pretty close. Srsly.

A heart surgeon and surgical team can save a life and give a patient a drastically improved standard of living in less than two hours. It represents a tiny contribution of their time to do this. It's nothing, really. Should government force them to do these surgeries for people who need them? Why not--if it's wrong to deny patients care, then why not compel medical people to do the surgeries for free?

This is a tota straw man argument. Nobody is suggesting that doctors should work for free. What is being suggested, broadly, is that everyone should contribute collectively - probably with a income-related component - to a pool which would provide health care for those who need it.

I read that the US government *already* spends more on health care per head of population than most European governments, by the time they've covered Federal employees, military, Medicaid, Medicare, etc. The scandal is the tariff charged for each individual operation. Ask any American who has brought their prescriptions to Europe and got them filled here for about one-fourth of the US cost, even with the lousy exchange rate. The French government tells the pharma companies how much it's prepared to pay, and we all get a better deal.

 

[samclem]

This is a tota straw man argument. Nobody is suggesting that doctors should work for free. What is being suggested, broadly, is that everyone should contribute collectively - probably with a income-related component - to a pool which would provide health care for those who need it.

Again, recognizing that this falls into the realm of political philosophy:
-- "everyone should contribute collectively" is subtly but significantly different from the reality of "about half of the people must contribute under penalty of imprisonment."
-- If (contrary to my contention) the government has the right to seize the property of individuals for the personal benefit of other individuals, then what is the limit? Someone is going to be compelled against their will to give up the product of their skills, talents and time without compensation. If Mrs. Smith needs an operation, is it not a lesser affront to liberty for the government to confiscate 20 hours of labor (from the surgical team) than 1000 hours of labor (from "regular folks"--the number of hours of average labor needed to pay for this operation)? If it is right for the government to require only 50% of the people to pay income taxes (due to their incomes), why not also subject people with special skills to special "takings"? 20 is a lot less than 1000.

I read that the US government *already* spends more on health care per head of population than most European governments, by the time they've covered Federal employees, military, Medicaid, Medicare, etc. The scandal is the tariff charged for each individual operation.

In a nutshell: Based on EU per capita spending levels, the US government is already spending enough that it should be able to provide quality health care to all Americans without a penny more in spending. But, instead, we have lots of people without health insurance and a far larger number paying high premiums (through their employers). Hmm--if the present US government health care spending is so inefficient, many would say the real "scandal" is the call to expand the US Government health care delivery without fundamentally reforming it first.

Regarding drug prices: No, I don't like the fact that higher prices in the US effectively subsidize the R&D by pharma companies, and that they can therefore make money selling in other markets around the world at the "cost of pill production" +5% rather than the "cost of pill production plus R&D plus marketing" +5% rates. When there is downward pressure on US drug prices (either through market forces or top-down government decisions) then the free ride for much of the world will end. I expect a decrease in development of new drugs as capital is channeled to more productive pursuits. In most cases this will be okay (do we really need another version of the same drug that is re-patented just because it's mixed with something else and now is in time-released form?), but I think we'll likely also lose out on some important drug developments. Still, if people (individually or collectively) want to spend more money on nicer cars and less on pharmaceuticals, that should be up to them.

 

[fisherman]

Only under Obamacare. Without mandates under the new law many people are uninsurable. Some (but not all) states have high risk insurance pools but some people are simply uninsurable.

I do not disagree with what you are saying. let me clarify my words. When I siad anyone who can pay can get care I was trying to state that if you have money you can go to a doctor and pay him without insurance as I have never met a doctor who would not take cash! I was not saying that if you have money you can buy insurance as that is certainly not the case today,

 

[BigNick]

Again, recognizing that this falls into the realm of political philosophy:
-- "everyone should contribute collectively" is subtly but significantly different from the reality of "about half of the people must contribute under penalty of imprisonment."
-- If (contrary to my contention) the government has the right to seize the property of individuals for the personal benefit of other individuals, then what is the limit? Someone is going to be compelled against their will to give up the product of their skills, talents and time without compensation. If Mrs. Smith needs an operation, is it not a lesser affront to liberty for the government to confiscate 20 hours of labor (from the surgical team) than 1000 hours of labor (from "regular folks"--the number of hours of average labor needed to pay for this operation)? If it is right for the government to require only 50% of the people to pay income taxes (due to their incomes), why not also subject people with special skills to special "takings"? 20 is a lot less than 1000.

This is still a straw man argument, but since we're having it, would you also argue that the government should implement national defence by drafting a percentage of young people against their will, or by raising money through taxes to pay salaries to those young people to attract them to sign up voluntarily?

I've never been able to decide whether this apparently highly simplistic anti-taxation message which many Americans seem to go for, is indeed highly simplistic, or in fact philosophically brilliant. I guess we'd find out for sure if there was ever a libertarian government. My bet is that it would last about two weeks before people discovered that it's not quite as simple as the message would have us believe, and that it is in fact perfectly legitimate to have some things funded by taxation without the need for the word "Socialist".

Incidentally, France's health care system was enacted under postwar anti-Communist governments, and Germany's by Count Otto von Bismark, a man not known for his tree-hugging tendencies. And in both of those countries, health care is not funded by taxation (the UK model) but by a system of mutual funds with government guarantees (true, participation in them is mandatory, via payroll deduction; if you want to portray this as "under penalty of imprisonment" then knock yourself out).

 

[samclem]

Bold section added for consistency

This is still a straw man argument, but since we're having it, would you also argue that the government should implement national defence by drafting a percentage of young people against their will, or by raising money through taxes paid by people against their will to pay salaries to those young people to attract them to sign up voluntarily?

We've strayed significantly (since I recognize national defense but not medical care as a proper role of the US government under the Constitution), but I'd say that mandatory conscription for everyone (during a particular age range) is the moral equivalent of raising taxes on everyone to pay for a volunteer military-- in both cases people are having thousands of hours of their time (or the product of that time--money) taken by the government. I don't see that one is on higher moral ground. In the conscription model, no one could be turned away (we could have the present provisions for conscientious objectors, whose service is no less honorable or "valid" than those who fight directly). As a practical matter, I think getting volunteers works a lot better in today's type of warfare. But if national defense is a valid function of the government, then all citizens are bound to support it. To the degree we let some people avoid this responsibility (e.g. through draft deferments or a tax system that requires them to pay nothing) either method would become less defensible on moral grounds.

Do you see a moral difference between the two approaches?

 

[haha]

This is still a straw man argument, but since we're having it, would you also argue that the government should implement national defence by drafting a percentage of young people against their will, or by raising money through taxes to pay salaries to those young people to attract them to sign up voluntarily?

I've never been able to decide whether this apparently highly simplistic anti-taxation message which many Americans seem to go for, is indeed highly simplistic, or in fact philosophically brilliant. I guess we'd find out for sure if there was ever a libertarian government. My bet is that it would last about two weeks before people discovered that it's not quite as simple as the message would have us believe, and that it is in fact perfectly legitimate to have some things funded by taxation without the need for the word "Socialist".

Incidentally, France's health care system was enacted under postwar anti-Communist governments, and Germany's by Count Otto von Bismark, a man not known for his tree-hugging tendencies. And in both of those countries, health care is not funded by taxation (the UK model) but by a system of mutual funds with government guarantees (true, participation in them is mandatory, via payroll deduction; if you want to portray this as "under penalty of imprisonment" then knock yourself out).

I consider myself basically a fiscal conservative, social liberal- but I think that the arguments against European type health insurance schemes in Europe are just absurd. These systems get more care to more people with better results at less cost. What is the problem with that?

What I am not sure is that it could work here. Both competence and work ethic of low level federal bureaucrats are astonishingly poor.

Maybe our best bet is closer to Japan, or France, or Germany (there are others too) rather than the UK publically run system. The role of US government would then be limited to making and enforcing the rules. The health insurance companies that actually did the billing could then be private, better run and lower overhead entities. Most of what US health insurance companies do now would go by the boards under the new rules and regulations.

Ha

 

[samclem]

These systems get more care to more people with better results at less cost. What is the problem with that?

It sounds logical. Two issues:
Limitations on government power: I want a clear limit on what we ask the government to do for us so more people don't vote themselves more bread and circuses. Right now, the USG spends more money on health care (just through Medicare, federal funds for Medicaid, and CHIP) than it spends for national defense. National defense is in the Constitution, let's put health care in there, too, if we think it is a role of government.

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.

Total Conjecture: If we had something closer to a free market in health care services in the US, the advantages would be so clear that the number of folks arguing for a single-payer plan would equal the number of folks arguing for central planning of other aspects of our economy. Very small.

 

[GregLee]

Hmm--if the present US government health care spending is so inefficient, many would say the real "scandal" is the call to expand the US Government health care delivery without fundamentally reforming it first.

Why "first"?

You see, no one is going to disagree that our health care needs fundamental reform. But there is enough disagreement about what exact reforms it needs that we can expect fundamental reform to take some time. Maybe a lot of time. In the meantime, what happens to the people who can't get health care, while we argue? Is it moral to make the welfare of others hostage to satisfying you that our society has been ordered in absolutely the best way?

 

[samclem]

Maybe a lot of time.

Medicare established: 1965
Medicaid established: 1965

Forty-six years is enough time to know when an approach is screwed up.

Regarding the rest of the medical care system: The "HURRY, we must pass this change NOW" thing is very tired. We saw it with TARP, we definitely saw it with the stimulus plan. That doggie won't hunt, it won't even raise its head anymore. The speed, coarseness, and carelessness with which the recent health care law was drafted and passed is a major factor in its ongoing disintegration.

 

[modhatter]

The reason it has taken so long is because the insurance companies have been almost 100% successful in effecting their propaganda to the American population.

If Americans could agree that some form of universal care would most definitely be more cost effective and in their best interest, we could get on with examining other countries systems and adapt the necessary changes to make it work here in the US.

But as long as we continue to buy into this anti-government anti-tax mentality which is very cleverly orchestrated by the insurance companies, we will never move forward. There is much to be learned by other people's successes. America is not so special.

 

[samclem]

America is not so special.

Well, I couldn't disagree more.

But, yes, we can learn from the successes and the failures of others.

 

[M Paquette]

I eagerly await the Medicare reforms. There are too damn many old people in the waiting room.

 

[M Paquette]

America is not so special.

Oh, sure we are. We are a country of Rugged Individualists who have all been planning and saving for our retirement for 50 years prior to retiring, with carefully invested funds and the ability to cover all our own medical expenses in retirement, or at the very least cover the insurance payments.

 

[lets-retire]

My understanding is the debate is about access to health care insurance as anyone who can pay can get care now. Paying is a problem for many however. Health Insurance like the Air force did not exist when the Constitution was written as a point of clarification only to your statement. I am certainly not a constitutional scholar or a lawyer and I have very mixed feelings about the issue being discussed but my point above is a valid clarification only.

You are correct in that health insurance did not exist. Health care did exist, even in it's most rudimentary form. The founders did not include it in the Constitution. They did not think the federal government should provide health care. If they did they would have included it. Airplanes did not exist, even in a rudimentary form when the Constitution was passed. There was no way for the founders to have been able to predict one would be invented.

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.

 

[donheff]

You are correct in that health insurance did not exist. Health care did exist, even in it's most rudimentary form. The founders did not include it in the Constitution. They did not think the federal government should provide health care.

Good luck with that analysis. Tell it to the Supreme Court. Medicare has been around for 45 years and no one got them to dig up this factoid about the minds of the framers?

 

[fisherman]

You are correct in that health insurance did not exist. Health care did exist, even in it's most rudimentary form. The founders did not include it in the Constitution. They did not think the federal government should provide health care. If they did they would have included it. Airplanes did not exist, even in a rudimentary form when the Constitution was passed. There was no way for the founders to have been able to predict one would be invented.

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.

The best example to the contrary of your point is by former President Bush. Medicare part D. Which is the government providing drugs to people over 65. Drugs did exist when the framers wrote the Constitution and they did not provide them so this piece of passed legislation by Republicans even should therefore be declared unconditional by your logic expressed in your response above. If I have misunderstood your statement or incorrectly summarized it that was not my intention.

There are two books I have recently read that you might enjoy: Benjamin Franklin by Walter Isacon and John Adams by David McCullough. They are not political and I found them to be very interesting. The John Adams book has many chapters about Thomas Jefferson also. It uses letters between Adams and Jefferson to look into the minds of two of the Constitution framers. The Benjamin Franklin book also follow a very similar path. These books are well written and a lot of fun if you are into history.

 

[lets-retire]

The best example to the contrary of your point is by former President Bush. Medicare part D. Which is the government providing drugs to people over 65. Drugs did exist when the framers wrote the Constitution and they did not provide them so this piece of passed legislation by Republicans even should therefore be declared unconditional by your logic expressed in your response above. If I have misunderstood your statement or incorrectly summarized it that was not my intention.

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.