Granny Bashing

We probably can't say this enough:

Return of the granny bashers, by Dean Baker, Comment is Free: ...Last month a bipartisan group of prominent budget experts had a press event at the Brookings Institution where they argued that Congress had to make major cuts in Social Security, Medicare and Medicaid. They claimed large cuts in these programmes were necessary in order to prevent the explosion in the budget deficit that is projected...

While there are long-term fiscal issues facing the country, the real problem is not the budget and these core social insurance programmes. The real problem is that the United States has a broken healthcare system, which is projected to get progressively more inefficient through time.

Since roughly half of the country's healthcare costs are paid by the government, primarily through Medicare and Medicaid, the projected explosion in healthcare costs is also projected to lead to an explosion in government spending. If the healthcare system is never fixed, the burden on the budget will eventually be unsustainable, ... exactly as the Brookings contingent claimed.

However, it is crucial that the public recognise that the problem is healthcare costs, not a growing population of elderly. The two issues are easily confused, especially since most public sector healthcare costs go to provide healthcare for the elderly. ...

The country has always been aging - we are living longer - we can easily cover the cost of a growing population of retirees as long as the economy is healthy. With normal productivity and wage growth, our children and grandchildren will be able to support a larger population of retirees and still enjoy a much better standard of living than we do; just as most of us now enjoy a better standard of living than our grandparents, even though we support a much larger number of retirees than they did in their working years.

However, if healthcare costs follow the projected trajectory, then the cost of ... healthcare programmes will be unsustainable. Of course, in this scenario the rising cost of healthcare will also place an enormous burden on the private sector.

Per capita healthcare costs in the United States are already more than twice as high as the average in other wealthy countries like Germany, England and Canada. In the budget projections, per person healthcare costs will be four or five times as high in the United States ... by 2050. In this context, US firms will face an enormous competitive disadvantage if they pay for their workers healthcare costs.

If the companies don't pay for insurance, then most workers will face an enormous struggle paying for insurance costs... In either case, workers will have far less money to spend on food, housing education and other necessary expenses, if healthcare costs grow as projected. ...

If healthcare costs in the United States were brought in line with costs in other wealthy countries, all of which enjoy longer life expectancies than we do, then we would not be looking at scary budget projections 20 or 30 years down the road.

This suggests the urgency of fixing the US healthcare system. Healthcare reform is not only necessary to extend coverage to the uninsured, it is also essential for preventing our healthcare system from strangling the economy. ...

As the Brookings contingent said, the current path is unsustainable. And it is not acceptable to tell our parents and grandparents that they will just have to die because our healthcare system has made their care unaffordable.

That's one of the reasons some people care so deeply about the healthcare issue.

Comments

[save_the_rustbelt]

http://www.youtube.com/watch?v=4WUUnc1M0TA

Everyone evaporates at age 30 = simple solution.

[anne]

"Last month a bipartisan group of prominent budget experts had a press event at the Brookings Institution where they argued that Congress had to make major cuts in Social Security, Medicare and Medicaid."

The think tankers who gave us Iraq, want to kill off your grandparents or parents or you; not me though.

[Julio]

The healthcare discussion, and the attendant calls to throw grandma off the train, may well be the issue that exposes, in a way everyone can clearly understand, the moral bankrupcy of the neocons.

Or perhaps I'm just being too optimistic today.

Speaking of optimism, and not that I wish anyone ill, but when Mark says:
"it's not as dismal as I thought - 85.9% chance of being alive after four years, "
is 90% more dismal or less dismal?

[kthomas]

I'm with anne on this one. Tar and feathers, I say!

[CasualObserver]

If the government can't control healthcare costs when they meet 1/2 of the nations healthcare payments, how are they going to control the costs under a single-payer universal system?

Within the first month of implementation there will be two healthcare systems: assembly line Ford Pinto healthcare for the serfs and gold plate coverage for the rest.

[bob]

If the 72 year old white male has melanoma, as the one in question does (it seems to be in remission, but has not been cured), the odds are far lower.

[This refers to something I removed - see below - M. Thoma]

[don]

What is the average doctor paid in the U.S. compared to Germany? Subsidized medical schools would work as well as subsidized payments for healthcare to expand the availability of medical services, and would probably result in a more efficient distribution of healthcare.

[TigerPaw]

If the US really wanted to control healthcare costs they'd just nationalize the whole blessed thing. Take out the need for profits, the waste of 999 different insurance companies all doing things their own way and spending enormous effort trying to avoid paying up and you'd cut costs big time. That's basically why it costs so much less for essentially the same level of outcome in the rest of the world.

Course that'll never happen. Better dead than red seems to be taken literally. Fair enough, that's what they want, that's what they've got.

[Mark Thoma]

I removed this from the end of the post - it doesn't add much (anything) to the main point:

[Speaking of the elderly, let's turn to grandpa. Please excuse me for doing so, but I was curious so I calculated the odds that a 72 year old white male, perhaps one running for president who would be that age upon taking office, would live for four or eight more years given that they have already lived to be age 72 (using table 101). If I did the calculations correctly, it's not as dismal as I thought - 85.9% chance of being alive after four years, and 68.8% chance at eight years. So around 85 out of 100 would be expected to make it one term. Two out of three people would be expected to make two terms, but one out of three wouldn't. However, it doesn't say anything about physical or mental capabilities, only the chance of being alive.

To illustrate the calculations, P(alive at 73 | alive at 72) * P(alive at 74 | alive at 73) * P(alive at 75 | alive at 74)] * P(alive at 76 | alive at 75)] = (1-..032)*(1-.036)*(1-.039)*(1-.042) = 85.9%. Straight line interpolation was used.]

[Bruce Webb]

It is all bait and switch.

They are simply making a last ditch effort to use Medicare, exposed as it is to a overall health sector cost crisis, to take a whack at Social Security which doesn't. The whole thing is thoroughly dishonest and most of the major participants know this full well.

I would urge informed people to engage on this issue with both Andrew Samwick and Andy Biggs who are both hosting new blogs devoted to privatization with good humor and an open comment policy. From my perspective they represent the face of evil but do so with an actual attention to the data. Biggs in particular is making a principled case while Samwick is a little handicapped by his committment to his titular LMS plan. But if you want a civil, data based discussion on this I suggest one or both. I've had my say, but both sites deserve more traffic and informed commentary.

[german_reader]

Interesting article in the German newspaper "FAZ" about the merger between a Japanese and an American pharma company. According to their information the U.S. is by far the largest market for pharmaceuticals in the world with an annual turnover of $290 billion. Japan is second with $57 billion, Germany third with $27 billion. Per capita that would mean that Americans spend $960 per year on pharmaceuticals, compared to $447 in ( much older ) Japan and $328 in Germany.

Do Americans really need so much more viagra and botox than Japanese or Germans to feel good or are medicaments in the U.S. simply ridiculously overpriced? Guess it's the second.

Besides, the often heard argument that these extremely high prices for pharmaceuticals are necessary to finance the "world class research" of U.S. pharma companies seems to be at least questionable. U.S. pharma companies spend not only more money on advertising than research, their products seem to be also not the real big hit on the international market.

According to the WTO the U.S. exported in 2005 pharmaceuticals worth $25.95 billion. Not much more than tiny Switzerland ( 7.5 million inhabitants ) with pharma exports of $25.17 billion. For a country 40 times as large as Switzerland that's a pretty modest performance.

@don

Self-employed doctors in Germany earn on average €83000 ( $93000 PPP ). Doctors in clinics ( especially assistant doctors ) earn often less.

[David Robb]

CasualObserver:

If the government can't control healthcare costs when they meet 1/2 of the nations healthcare payments, how are they going to control the costs under a single-payer universal system?

Easy: rationing. Instead of bashing granny they'll just throw her out to the street. And her innocent grandchildren who never asked for the system will pay for our use of it.

Incidentally, the correct question to ask is "is there is a correlation between the government paying nearly 50% of health care payments and the dramatically increasing cost of health care?".

Within the first month of implementation there will be two healthcare systems: assembly line Ford Pinto healthcare for the serfs and gold plate coverage for the rest.

Since the US is nearly the nation of last resort for advances in health care, there won't be any gold plate coverage at all.

While "it is not acceptable to tell our parents and grandparents that they will just have to die because our healthcare system has made their care unaffordable." it's also not acceptable to tell them that they will just have to die because the advances in health care that would have materialized under the old system were in fact never invented. But of course it will be easy to evade responsibility for that because that history will never happened (it's all theoretical).

But the truth is that the vast majority of the advances in human (and animal) health care on planet Earth have *in fact* occurred under free market capitalist health care systems in the last two hundred years.

[Alex Tolley]

The fact is that HC costs and insurance premiums have been rising faster than the nominal growth of GDP in the US for at least 15 years. Is this a unique US phenomenon or is it experienced in other countries too? What are the reasons for this rapid growth and what means can be used to ensure per capita HC spending is kept in check?

Does anyone have teh data for this?

[David Robb]

I will retract this statement:

Since the US is nearly the nation of last resort for advances in health care, there won't be any gold plate coverage at all.

since a bit of research shows that this is indeed not the case.

[Casual Observer]

Well done Dave Robb. I suspect you are correct, the gold plate HC coverage will certainly be "relative."

Rest assured the certain unintended consequences of HC provided by the Kremlin won't stop the pawns from marching onward.

[Robinia]

Et tu, Brookings?

We fall all over ourselves to avoid saying that the US healthcare system has a large number of very serious problems-- possibly fatal ones. Let's do ourselves a favor and not persist in the bloodletting until we see if it helps or kills the patient.

Good post.

[Organic George]

I guess I'm the only one here that has had extensive use of the current health care system. I am a cancer survivor, with excellent insurance and bankrupt because of it. (I did pay off all the Dr's and hospitals, fuck the banks)

My premiums go up quartly as do my co-pays, deductables and more of my meds are no longer covered by my excellent insurance.

Forget gold plating, I would be happy with aluminum.

[Vito]

Conservatives go into a real frenzy over the destruction of Social Security. The term I prefer is the "Boys of the Soylent Green Berets"

[David Robb]

The fact is that HC costs and insurance premiums have been rising faster than the nominal growth of GDP in the US for at least 15 years.

Like most complex issues, there are many contributing factors. For the US, here are some of them:

1. New technologies and drugs. From http://content.healthaffairs.org/cgi/reprint/8/3/60.pdf: The single largest factor contributing to the trend [of rising healthcare costs] is technologic innovation and diffusion. We are constantly changing and improving the product that we are delivering. In the 1970s, it was such advances as coronary bypass grafts, total parenteral nutrition, hip replacements, and computerized axial tomography (CT) scanning; in the 1980s, it’s magnetic resonance imaging (MRI), heart and liver transplantation, and a host of other advances. In some real sense, when it comes to costs, we are victims of our own success as a biomedical research community.

2. Decreasing health regardless of age. Obesity is the primary culprit in the USA. We have only in the last few decades begun to see cost pressure from this factor.

3. Medicare and Medicaid payments lower than retail prices, raising prices for insurance and individual payers who often pay retail rates. Because Medicare and Medicaid have become so large and are still growing, today this factor is becoming more and more important.

4. An aging population. Health care costs increase as people get older.

5. Unrealistic expectations. Everyone expects the best, most expensive procedures regardless of ability to pay.

6. Federal tax laws that encourage employer-paid insurance, instead of an open market for insurance aimed towards individuals, the people who actually consume the insurance product.

7. The US free market system is subsidizing many foreign countries' socialized systems. For examples, see my post here: http://economistsview.typepad.com/economistsview/2008/05/im-not-going-to.html#c113301944

8. State regulations limiting access to health care insurance providers, particularly across state lines.

9. A legal system that encourages malpractice lawsuits, and consequently experiences very high malpractice costs and payments.

There are more contributors that I have undoubtedly not thought of, but these are the biggest ones.

Is this a unique US phenomenon or is it experienced in other countries too?

Other countries rich enough to have a "health care system" control costs by rationing many aspects of care, imposing higher taxes, and limiting professional pay rates and care fees. Despite these measures, most countries' costs are steadily increasing, though not as rapidly as in the US. Many countries are experiencing deficits in their health care systems, where costs incurred today aren't being paid for today. And many countries are also facing at least some of the cost factors described above.

What are the reasons for this rapid growth and what means can be used to ensure per capita HC spending is kept in check?

Many solutions present themselves once you understand the factors. One thing is certain: there is no simple single solution - because there is no simple single problem - despite what people in this forum might think.

[BJ Feng]

Organic George, do you mind listing some of the services you received? It's easy to demand health care for all, but the reality is that someone has to pay for it. Organic George, what would be a reasonable price for the medical attention you received? Health care is expensive because we demand the latest and best equipment, drugs, and care. Plus hospitals have to make up for people who either don't, or can't pay. Well someone has to pay the bills!

Tigerpaw, there is absolutely no evidence that the government can run a huge system better than private enterprises. Medical services cost X amount, beyond that there are inefficiencies and waste. How is government going to reduce these inefficiencies and waste better than private companies that have an incentive to do so thanks to the profit motive? A centralized medical system? The IRS has wasted billions on just trying to UPDATE their computer systems from the old 1970's crap. The system they purchased doesn't work, so now they're getting billions more to try again. The census bureau wasted tens of millions on purchasing hand held computer devices to help them go door to door and record names and phone numbers. That system doesn't work and now they need to hire more people to do it by hand. Somehow UPS and Fedex can use handheld computers to track millions of packages, but the Census Bureau can't even get together a system that will keep track of people's phone numbers and information. Now what does that say about government?

National Health Care proponents count on a perfect system to make their arguments. But such a system cannot be executed by the government, it's expecting too much. You can't ask a bench warmer to perform like a MVP type superstar, he doesn't have the talent. Likewise, the government cannot do what it is being asked to do and save us money.

[Francois]

If all others developed nations have adopted the systems they currently have, there has to be a reason other than rabid anti-private sector dogmatic thinking, no?

Assume for a moment they are correct; that is, their system is more efficient than ours. What, then, can we learn from them while avoiding the sacrifice of medical innovation that characterizes our system here?

What I am trying to say is that the issue of healthcare reform is not black and white, us versus them, go-vermin against the plutocracy.

I know...this approach will require thinking, civilized discussion and the certitude that a winner-take-all attitude shall fail. Compromises MUST be made.

It is certainly not in a time of acute crisis that we'll get a better system.

As for those brain dead neocons that propose deep cuts in social programs, here's my counter proposal: *evil grin*

1) Abolition of all the tax loopholes described in "Free Lunch" and "Perfectly Legal"

2) payment to FICA capped at $500,000 of income, progressive up to that amount.

3) Re-instatement of all Federal usury laws abolished by the Supreme Court.

4) Repeal of the bankruptcy laws; go back to pre-2005 laws.

5) All the Bush tax cuts must expire.

Just there, you got more than enough moolah to care for granma, granpa et al.

We are where we are as a specie for one fundamental reason: grandparents. Without them, there is no collective memory of the lessons of history, big and small, thus, no way to learn from them. That is much more important than anything else. Eliminate granparents and we are doomed.

Sorry neocons, but to quote Anne Robinson:

"You were the weakest link! Bye now!"

[cm]

BJ Feng: Citing the performance of the current and a few recent administrations and in particular their willingness to fund effective econometric and sociological research does not make a particularly compelling case against government programs in general.

[Organic George]

BJ

Do you mean beyond the chemo treatments? Do you realize that chemo is the process of killing your own cells in a race to see if you can kill the cancer before the treatments kill you? Most people who die from cancer die actually die from the treatments first. I contracted septicemia, and spent 6 weeks at home, to save on hospital cost, on last chance intravenous antibiotics, that had to be administered by a registered nurse which meant big bucks.

Each time I needed a new med or to see a new specialist I had to pay new co-pays and deductibles.

That was just one of many side effects I have endured in saving my life. My story is better than most since I have a PPO which actually allows Dr's to do what they think is best to treat your ailments, rather than an HOM which has ridged guidelines and new treatments must first get approval from a bureaucrat at in insurance company.

Given an choice I would rather deal with universal health care run by the US Government that a corporation who's stated purpose is to maximize their profits, not to provide the best care to the customers and their health needs.

[David Robb]

These two statements, written back-to-back in the same post, are rather ironic:

My story is better than most since I have a PPO which actually allows Dr's to do what they think is best to treat your ailments, rather than an HOM which has ridged guidelines and new treatments must first get approval from a bureaucrat at in insurance company.

Given an choice I would rather deal with universal health care run by the US Government that a corporation who's stated purpose is to maximize their profits, not to provide the best care to the customers and their health needs.

[Debbie]

Organic George -- I'm glad to hear you are doing well, but sorry to hear about financial toll this has taken on you. It really shouldn't be that way.

Please stay healthy!

[RW]

"These two statements, written back-to-back in the same post, are rather ironic"

Rather, yes, but for real irony one must look to the asinine assumption that bureaucracy is a sole attribute of government rather than an attribute of corporatist organization generally and, even more to the point, one must look to the stunningly stupid and potentially lethal assumption that corporatist entities whose profits depend upon AVOIDING payment of health benefits can provide a basis for improved health outcomes superior to corporatist entities lacking those motives.

The modern alchemy of neo-conservatism and libertarianism possesses even less plausibility than the original medieval version: Instead of one metal, lead, turned into gold, profit may now be forged from a quintessentially non-fungible value, health. Is there no end to these faith-based initiatives?

[David Robb]

This is even more ironic, given the realities of the *actual* government system in force today:

The modern alchemy of ... libertarianism ...

[TigerPaw]

BJ -

There may be no evidence that the US government can run a health care system but governments the world over seem to manage fairly well.

So perhaps the US government needs repairing. Course pretty much everyone outside the US already knows that.

[Cyrille]

Everytime I read this I am dumbfounded.

I happen to live in a country with a population just one fifth of USA. Despite that, many of the medical breakthrough mentioned above (and credit to David Robb for promptly correcting himself on that bit - that at least was very decent) happened here.
Somehow, our "Kremlin"-controlled system is #1 in the world (though it too could be much-improved), at a cost that is less than half that of USA. We have much LESS bureaucracy in our healthcare system.

I have a cousin who just got breast-cancer (at 29 years of age...). It's terrible, but one thing it will not do is have any financial impact on her, even though she's getting excellent care. Which is how it should be.

But of course, that is France, so it must be bad somehow.

[David Robb]

Rather, yes, but for real irony one must look to the asinine assumption that bureaucracy is a sole attribute of government rather than an attribute of corporatist organization generally and ...

I can't believe I have to point this out. The US Government doesn't comprise one of the largest bureaucracies in the US today? Far larger than any multinational company in the world? Let's look at some facts instead of crazed ramblings:

From http://www.brookings.edu/gs/cps/light20030905.pdf:

SIZE OF US GOVERNMENT, in terms of number of employees, 1999 and 2002

                       1999       2002

Total Civil Servants   1,802,000  1,756,000

Total Contractors      4,441,000  5,168,000

Total Grantees         2,527,000  2,860,000

Total Military Pers.   1,386,000  1,456,000

Total Postal Service     872,000    875,000

TOTALS                11,028,000 12,115,000


State and Local Mandated

Employees (1996 est.)  4,650,000  4,650,000

TOTAL w/

MANDATED EMPLOYEES    15,678,000 16,765,000

By contrast:

Microsoft: 63,564 worldwide.

IBM: 386,558 worldwide.

Let's look at the largest multinational companies in the world, from this list: http://www.forbes.com/lists/2008/18/biz_2000global08_The-Global-2000_Rank.html

HSBC Holdings: 296,197
General Electric: 316,000
Bank of American: 210,000
Exxon Mobile: 83,700
Walmart: 1,800,000

I'm sure you get the drift ...

Yes, we are all aware that any organization consisting of more than two individuals constitutes a bureaucracy. All companies form bureaucracies, even small ones. We're all drowning in bureaucracy! Nobody stated that "bureaucracy is a sole attribute of government".

But consider the output of that singular institution known as the Executive Branch of the Federal Government of the United States. What company could come up with this:

The complete Internal Revenue Code is more than 24 megabytes in length, and contains more than 3.4 million words; printed 60 lines to the page, it would fill more than 7500 letter-size pages.

, even more to the point, one must look to the stunningly stupid and potentially lethal assumption that corporatist entities whose profits depend upon AVOIDING payment of health benefits can provide a basis for improved health outcomes superior to corporatist entities lacking those motives.

HMO policies tend to be significantly cheaper, and in the real world, you get what you pay for. However, in a market economy any insurance company that does that *too much* relative to other insurance companies will lose its customers and its profits. Any customer who is displeased with the payout rate of a policy can and will obtain a different policy.

Car insurance providers can do the same thing, but only to the extent they can get away with it: they have an obligation to their customers, if they don't fulfill it they will lose them.

You have choices in purchasing insurance. If the federal government changed some laws you'd have more choices.

An even more "stunningly stupid and potentially lethal assumption" is too assume that a government-run health care system could provide as much, or more, efficiency than the existing one.

[cc]

"These two statements, written back-to-back in the same post, are rather ironic"

Really? In my experience, dealing with private bureaucracies is far more painful than the government kind, especially when the private institution is an insurance company. Government bureaucracy can be a PITA, but I'll take it over arguing with an insurance company any day. BTW, for all the desire for "local control", it seems the bureaucracy gets worse the more local you get. But it's still better than private bureaucracies.

Now, it does seem that the Federal bureaucracy has gotten worse in recent years, but is that a surprise? Do you really expect the current administration to make government more efficient? Do you think it is a priority for them to computerize the IRS, their favorite whipping boy, and make dealing with them easier?

Also, for all the supporters of private health insurance: don't you see the scam? The insurance companies have managed to palm off the least profitable clients - the elderly, the poor, the sick - onto the taxpayer, and have cherry picked the healthy and employed. Any meaningful reform that is short of government financing would require serious coercive mandates, both to individuals to get insurance and to insurance companies to insure the risky. For the record, I don't think single payer will solve all the problems, but it would be a great improvement over the current system.

cc

[David Robb]

Cyrille:

But of course, that is France, so it must be bad somehow.

I wouldn't say that! I've visited France three times and although I haven't had any personal experience with the health care system there I have discussed it with many French citizens whose opinions I hold in regard. I would characterize their feelings as generally quite positive (more so than in Canada or the UK), with reservations. Most of those reservations are the usual ones: increasing costs over time, increasing share of those costs by private citizens, increasing reliance on private "supplemental" providers. The cost increases are attributable to some of the same factors I outline in my post far above.

However, that said, I am not at all convinced that the US government could implement something approaching the quality of your system there. Our country and our currency have been stretched thin by decades of mismanagement by Republicans and Democrats. Pushing significantly more costs onto future generations by dramatically expanding the size of government is something I cannot agree with.

[Cyrille]

Oh but it would not be MORE cost, it would be less.

A French system in the US would, for less than today's GOVERNMENT costs, cover everyone. Without all the private insurance costs. Wow.

And to quote you: "An even more "stunningly stupid and potentially lethal assumption" is too assume that a government-run health care system could provide as much, or more, efficiency than the existing one."

Well, our system is government-run, and provides WAY more efficiency than the existing US system. How then is the assumption stunningly stupid?

[Lafayette]

Less Health Care Bang for Your Buck

Article: Per capita healthcare costs in the United States are already more than twice as high as the average in other wealthy countries like Germany, England and Canada. In the budget projections, per person healthcare costs will be four or five times as high in the United States

From the OECD:

In the United States, which spends far more than any other country on health, the proportion of GDP spent on health reached 13.9% in 2001, up from 11.9% in 1990 and 6.9% in 1970. Following the United States in 2001 were Switzerland and Germany, which allocated, respectively, 10.9% and 10.7% of their GDP on health. Canada and France followed, with 9.7% and 9.5%, respectively.

If America spends twice as much per capita and nearly 4% more in GDP on Health Care -- which it is not universal -- then why? What accounts for paying more and getting less Health Care?

With professional incomes at very high levels it is THOSE COSTS that need reduction. The average salary of a GP in France is 5750 euros. With the euro at inflated prices, that translates into $110,000 per year. With the euro at a more normal rate ($1.25 per euro), the salary diminishes to $86250 -- or 42% less than an American GP's salary (on average $150,000, according to the BLS).

True also, with multiple payer private insurance schemes, there is an administrative surcharge. Between the two cost elements, nonetheless, it is the salaries that contributes more to costs than administrative overheads.

Reducing costs in America will take time and a bit of pain. Meaning this, in bringing down average GP/Specialist incomes from their high level of $150,000 on average, established doctors will not want to give up those juicy incomes. And, the AMA will try to torpedo any Health Care plan that does so. (Just ask Hillary, she knows having lived the experience.)

Still, that's certainly selfish and kinda stupid for a public service as important as Health Care. More so, there are major differences in Health Care systems. Consider this from a recent article by BusinessWeek comparing French and American systems:

In France, the sicker you get, the less you pay. Chronic diseases, such as diabetes, and critical surgeries, such as a coronary bypass, are reimbursed at 100%. Cancer patients are treated free of charge. Patients suffering from colon cancer, for instance, can receive Genentech Inc.'s (DNA) Avastin without charge. In the U.S., a patient may pay $48,000 a year.

Posters here have said, "Well, look at the cost of their education, then understand why GPs make so much money". That may be an excuse but it is not a reason.

If the cost of education is too high, making investments in education (free scholarships and stipends) at universities willing to create affordable programs to produce the number of practitioners (doctors, nurses, medical aids, etc.) that the country needs. It is a long-term solution, but if it works in Europe, it can work in the US.

So, I'll make my own little prediction. I will bet a case of premium French Champagne that Health Care remains a major subject of discussion on this thread for at least another decade -- or until Mark Thoma finally gets tired of bringing it up.

That's an easy bet to make, because American politicians don't want to touch the electoral cash-cow. Barak Obama and his promises of "selective choice" will assure that Health Care remains the high cost sting it is today.

But, Hillary doesn't go far enough either. We shall see, at the end of a presumed Dem Presidency, that one sixth of the population is still without adequate coverage -- even if the one-sixth today who have NO coverage whatsoever is diminished by then by a pseudo-universal HC policy.

It is axiomatic that Preventive Health Care reduces the need of Remedial Health Care. But, if Preventive Care remains expensive, people will not avail themselves of it. It costs anyone in France an out-of-pocket about 6 euros (>$10) to visit a GP -- whether they are employed or not. Further tests (x-rays, echograms, ERMs) cost nothing.

At that price, French ER's are really for emergencies only.

[Cyrille]

That should read <$10. And if you are poor, you don't even get to pay that.

[Real Person from the Real World]

I recently read a NYT article about senior homes where end of life medical is limited. The angle is that the care is invasive and hard on people. Perhaps in some cases, but frankly, I think the article is the tip of the trend toward rationing *limited* health care resources. You have to sell an idea for a long time, and fame it in the best possible light. Ultimately, what limits health care, is more like the profits of interested parties. Why waste money on granny, when selling plastic surgery, botox shots, teeth whitening, and other services to the young and healthy are more lucrative.

[hari]

Predicament of Granny's NOT being provided adequate healthcare is a very sad and dangerous reflection on the professional class whose *mantra* until now was *free market* capitalism, at any cost.

This is the stuff from which you provide the *seeds* of a social revolution....

Alternatively, let's dynamite - yes, literally! - the existing healthcare system to zero. And start all over again with mandated Gov healthcare for all. Politicans who don't approve of it shall not be allowed to regain their seats - even if their own Granny's are at risk!

Until you're capable of over-turning the exisiting *faul* healthcare system, there's no chance of winning the case of Champagne....

[swells]

Can't help but mention this from an article by Mark Gimen posted on Slate titled Stop Blaming the Insurers. In it he says that the profit for the five largest insurers, United Health Care, Wellpoint, Aetna, Humana and Cigna for last year was 11.8 billion and they cover 105 million people. He also points out that health care costs last year were in the area of 2.3 trillion. So, these insurer's profits came to about 1/2 of 1 percent of health care costs

Unless I'm mistaken, it doesn't sound to me like reducing these companies profits to zero would do one iota of anything to solve the crisis with the cost of health care.

I do realize that this figure doesn't count in what their employees are paid, and that their other expenses come off the top before profits are stated, but it doesn't seem to me that profits are the problem. Inefficiency does seem to be the problem and anyone who is sanguine about the ability of the government to administer programs efficiently does need to consider the efficiency with which other life and death systems are administered by the government.

Look at air traffic control with a control system from the 1950s and 1960s and the difficulty in getting a new system to work. Look at the military. How efficiently is that run?

We do need to consider the evidence we have at hand vis a vis the efficiencies of our particular systems but that consideration also needs to consider governmental efficiencies as well.

[anne]

"Can't help but mention this from an article by Mark Gimen posted on Slate titled Stop Blaming the Insurers."

Can't help but mention, wuv insurers; wuv, wuv, wuv, kiss, kiss, kiss.

[bakho]

Typically, elderly have slightly higher health care costs if one excludes the end of life care. That is when costs really skyrocket.

[swells]

Anne, in the peculiar language known as annespeak does wuv, wuv, kiss, kiss translate to anything intelligible?

[swells]

From the same article I mentioned earlier, questions are also raised as to whether government run health programs are actually less expensive to administer than are insurer run plans. He considers the case of the Medicare Advantage program and concludes that, "None of this means the Medicare Advantage program is cost-efficient. The bottom line, though, is that its costs come not from insurance company inefficiency or profiteering, but from the extra benefits shoehorned into it.

It's a good article that poses very limited but interesting questions.

[Patricia Shannon]

Swells & Lafayette, how many insurance companies are there, and how many employees do they have? And how much are there top executives paid in comparison to the heads of government agencies? That's a log of overhead.

[Holly W.]

German Reader, I'm not sure the amount of money spent on drugs in the US quite tells the whole story about how many drugs are actually being used.

My understanding is that in other countries with government-run healthcare, there are caps on what pharm. companies can charge for any drug. In the US, we pay the price set by the manufacturer, which is much, much higher than elsewhere. We are widely viewed as subsidizing the costs of drugs for the rest of the developed world. So while I do think it's unlikely, Americans could be using half the amount of prescription drugs as Canadians or Western Europeans, but we'd still be spending twice as much money overall.

[swells]

Patricia, that was the point I thought was so interesting. You would think that with over the top executive compensation, etc. that if you factor that in that Medicare would be more efficient. However, if his figures are correct, (from the article in Slate) it would seem that even with insurance company profits, salaries and all expenses factored in the insurance companies were doing the job for about 3% less than was medicare.

Now, certainly several possibilities come to mind. It was a "demo" type project (although covering millions of medicare recipients) so maybe the insurance company manipulated their cost accounting, etc. Still, it is something that needs to be taken into account. How efficient is the government "really" when it comes to delivering on core services.

Fred Kaplan pointed out in Slate (article titled The Army's Math Problem) that, "These calculations do point up to a larger set of problems. The United States has the world's most powerful military. This military consumes more money (adjusting for inflation) than it did at the height of the Cold War. Not counting the costs of the two wars, it spends as much on the military as the rest of the world's countries combined. And yet, despite all this money and global reach, the U.S. Army finds itself unable to sustain more than 150,000 or so troops in Iraq and Afghanistan."

I've assumed that health care could be made cheaper if government does it but I have to be intellectually honest and realize that is an assumption. If the government runs the military the way it does, what does that say about it's ability to run large, mission critical operations in an efficient manner?

[Patricia Shannon]

I thought the Medicare Advantage program was run by private companies or something. Somebody out there with more time than I have, please clarify this.
(And of course, the bold-face "log" in my previous post should be "lot". And I had to bold-face it and draw attention to my mistake!)

[David Robb]

Cyrille:

A French system in the US would, for less than today's GOVERNMENT costs, cover everyone. Without all the private insurance costs. Wow.

Care to explain just how this magic works?

[Lafayette]

swells: Unless I'm mistaken, it doesn't sound to me like reducing these companies profits to zero would do one iota of anything to solve the crisis with the cost of health care.

Again, you're missing the point. You think that Health Care is a matter of dollars and cents and profits. And, that the Market Solution is the right one.

It isn't. Health Care is about being a Public Service. That is, a service that must be provided to the nation equitably and fairly. No business can do that, since it is the nature of business to make profit. And, it is not profitable to sell Health Care insurance to the poor and unemployed, because they wont buy it anyway. (NB: One out of six Americans has no Heath Care insurance whatsoever and one out of three of those who do find, sadly, that not all illnesses are covered.)

Would you like a fireman to show up at your house, all ablaze, and ask you to show them your fire insurance policy before they put out the fire?

Firefighting is a Public Service. Get it? So, is Health Care.

[BJ Feng]

Public service or not, someone has to pay for it! Someone has to pay the firefighters to show up, pay for the truck, pay for the equipment. So how could a government run program pay out less? By dictating the maximum that will be paid for any type of care? By dictating the wages of doctors and nurses? Those who are already invested in being a doctor might not have a choice, but don't you think that'll discourage people from wanting to become a doctor? All those years of hard work, but a capped salary? Would the quality of upcoming doctors be the same?

You talk about subsidizing education, but education costs money too. How many years after college does it take, what 6 years or is it 8 to become a practicing doctor? The government will have to pay hundreds of thousands just to train a doctor. I suppose there would have to be an agreement that the person receiving this free education has to practice in the US for X amount of years. Of course a computer system will have to be created to track them and make sure they comply with the agreement. How much could this proposal really save us?

I think the people here are wrong, we DO have universal health care, anyone can get treatment from the emergency room or the free clinics all around the nation. What we don't have is the highest quality health care for everyone, which is what people here seem to want, but also are unwilling to pay for.

If medical care is free, who will make the calculation if a surgery is "worth it" or not? Should a 85 year old man receive non-critical hip replacement surgery? Let's say right now, the man has to pay $15,000 out of pocket and decides it's not worth it, he's lived with the condition for years and although it's an annoyance, he can function without surgery. Well tell him it's free, and of course he signs up for the replacement.

When you decrease the price of a good, more of it is demanded, not less. We would have to provide more health care, not less. How can a government run health care system possibly save enough money to make up for all the additional demand and pressure for health care services that are free or cost much much less? Who in the government is going to say no, you don't really need this surgery, or this treatment isn't worth the cost because you're likely to die anyway? Don't fool yourself. If you think a person should be treated regardless of anything, then costs will have to rise, they can't possibly be reduced under such a system.

[german_reader]

@Holly W.

my intention was not to imply that Americans in general consume more drugs or medicaments than other nations. I guess they don't. But they pay definitely more for medicaments than any other nation. The gap between the United States and other wealthy nations in drug expenditures is enormous. I think the current health care system in the United States allows pharma companies to make giant monopoly gains. Dean Baker for example, an American economist from the Center for Economic and Policy Research in Washington, criticizes this regularly. Exaggerated drug costs are definitely a part of the exploding health care costs in the U.S..

I don't know if pharma exports are really a usable indicator for the competitiveness of the local pharma industry in the international market. But if they are, than the position of U.S. pharma industry isn't exceptional. France, the U.K. or Switzerland with their universal health care systems export as much as the U.S.. Germany, which has strict price controls for most drugs and only a few midsize pharma companies but none of the real big players, is by far the largest pharma exporter in the world. And the EU-25 exports three times as much as the U.S. ( only extra-EU exports, if you include intra-EU exports it's seven times as much ).

Pharma companies tend to justify their high drug prices with research expenditures. In reality they spend in many cases more on advertising than research. And many "new" medicaments are only variations of existing products. The real breakthroughs in medical research often happen in other institutions such as universities or public research institutes. Pharma companies only use their results to create new drugs and sell them to the consumer. If the extra amount of money Americans pay today for their medicaments would be used to finance research in universities or public research institutes, the results probably would benefit the society more than the current commercial research. Pharma corporations search for products which bring the highest profits. And that are not necessarily the drugs which help the people most.

[Cyrille]

Well, there is so much ideology in some of the statements above that to debunk them would take far more time than I can invest. However, we may be pragmatic.

How could a system run by the Government cost less? Well, for one thing the question can be reversed and make as much sense: how could a private system cost less? But while I could venture suggestions as to why that is the case, remember that before analysis must come measuring. I merely point out that it is the case.

There used to be people who asked "how could all celestial bodies not rotate around the earth, the centre of the universe?", later "how could continents possibly drift apart?", but that kind of question is interesting if and only if one, by asking it, is not rethorical but indeed honestly acknoledges that it is, indeed, so. I don't feel it was the cases in the posts by BJFeng and David Robb. So I guess I would be wasting much time hazarding tentative explanations.

However, it is so, and is undisputable. France covers everyone for about half the cost of healthcare in USA, and with FAR better results. Lafayette has floated out many of the possible reasons (health care seen as a public service, not as a business ; preventive care ; much lower cost when something is treated early ; no costs from doctors employing people to fight the insurance lawyers who will try to deny coverage...).
They may not explain everything, some might even be disputable (I say that in theory - I reckon they are all true). But that is the second step. It does not even make sense to get there before acknoledging that, yes, in that particular field, it is cheaper when run by the state. It's that way the world over.

[reason]

In the 70s when people looked at advertising and marketing costs, and duplication of hierarchy in competing firms, they wondered how could a market economy ever compete on efficiency with a socialist country.

Then, the argument was the value of freedom of choice was important than the additonal costs. It turned out that incentive effects, differences in the rate of adoption of new ideas and allocational inefficiency due to price distortions more than cancelled out those advantages of centralisation.

But those additional costs are still there.

Now it is often assumed that the market economy is superior in EVERY way. It is superior in some ways.

[reason]

David Robb,
your argument about the size of the Federal Government payroll is completely irrelevant. The Federal Government is not monolithic. It is a distract and distort tactic.

[reason]

As for the mess that is the US Income Tax code - agreed, there are bad laws on the books. There are also bad firms. That doesn't mean firms are in principle bad. We need improvements an all fronts.

[reason]

swells...
the government is not monolithic and nor are all private sector firms the same. There is no doubt efficiency gains are possible on many fronts. The fact is that America suffers from an expensive, incomplete and inflexible health care system. There are many examples of very different systems that work better than the American system does. I happen to think that it would be easiest for the American to migrate to something like the German system (competing funds funded by payroll tax with a prescribed minimum coverage).

[reason]

In general - please stop saying Government is so-and-so as though it is monolithic and always the same. A government organisation has in principle the same hierarchical structure as a private firm. It is controlled by similar financial planning constraints. The difference is that it has (often) a monopoly position, and suffers (sometimes) from political interference prioritising actions that distract from its main purpose. The second problem can be addressed by legislative independence, the first it shares with many private sector firms.

[reason]

And I say this as someone who has worked in both the private and public sectors.

[Lafayette]

Market-Solution Based Universal Health Care is not possible

BJF: Public service or not, someone has to pay for it!

Who said it was a gift from heaven? Not me.

Americans are blinding themselves in thinking that because their Health Care is among the most advanced in the world (which is true) that it is the best. And, that is why the US found itself 36th on the world classification of Health Care systems by the OMS.

You force me to repeat what I've already said (to you, specifically) a dozen times. In France, specifically, for instance, the funding of Health Services consists of three components. An employee payroll deduction, company contributions and top-up by the state. Meaning state contributions are financed out of general taxation to assure Universal Health Care with freedom of choice of doctors/specialists.

This is expensive Health Care, yes, but apparently only half as costly as the US -- AND it is for universal coverage of medical expenses, regardless of the severity of the illness and totally if the illness is life-threatening.

[Caveat: Because the accent is on Preventive Medicine (a damn sight less expensive than Remedial Medicine), the cost of seeing a GP is kept low (21 euros). And, to prevent abuse, the state only reimburses 70% of the cost. There is Mutual Insurance, which is facultative, that costs from $100 to $160 per month and covers the remainder 30%. This optional insurance is typically taken by the elderly who have more recurring illnesses.]

Nobody monetizes their personal net worth if inflicted by a ruinous disease in France. Cost containment is achieved by state mandated Health Care pricing - and not whatever the market will bear. That is what Health Care should assure in as fair a manner as possible for all citizens of an advanced nation.

You get it, yet? Or, are you begging to be ignored with your persistence in refusing to understand that American Health Care is not up to par compared to other modern nations?

[Real Person from the Real World]

We now have the technology in place for insurance companies to weed out the riskiest bets when it comes to health care. Oh, and I read that the AMA sets prices for care and services in a geographical region based on incomes, not costs, so if you live in a large urban area with high incomes, you pay more. And a nurse practioner friend once told me that doctors do not have to charge the local rates, some charge much more. None of these features are noted anywhere here, but they certainly up the costs, and limit care. Ultimately, insurers and even "not" for profit hospitals are out to make a buck. The non-profits pay very good salaries, part of the rock star pay mentality in the US.

[swells]

Lafayette, you miss an important point in your post about fire fighting. To a very large degree, firefighting is about keeping fires from spreading to other structures. It's somewhat about protecting individual structures but it is mostly about containing the effects of disaster. In that sense, it is more akin to the functions performed by the Centers for Disease Control. Which, by the way, is funded as a public service already.

Underlying your reasoning however, is the assumption that health care is a human right that must be effected for everyone. As I asked before, what's next? Hiring speechwriters for all citizens so they can have their free speech rights effected? Rights, by and large, are things that public policy insists must not be transgressed but it is far from clear that public policy must be to give effect to the exercise of those rights.

I do think there are pragmatic, utilitarian arguments to be made in favor of universally available health care but the whole "must be given effect as a human right" argument seems intellectually bankrupt to me.

[Cyrille]

"Rights, by and large, are things that public policy insists must not be transgressed but it is far from clear that public policy must be to give effect to the exercise of those rights."

Ahem, examples in the declaration of Human Rights...

Article 3.
Everyone has the right to life, liberty and security of person.

Already, this needs public policy to give effect to that. In fact, it may be argued in a broad interpretation that this article implies health care.

Article 6.
Everyone has the right to recognition everywhere as a person before the law.

Ah, this requires the state to give you a lawyer if you can't hire one. Again giving effect...

Article 7.
All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in violation of this Declaration and against any incitement to such discrimination.

Protection? What, EQUAL protection even, despite the considerable power that money gives? Well, that requires giving effect to.

Article 8.
Everyone has the right to an effective remedy by the competent national tribunals for acts violating the fundamental rights granted him by the constitution or by law.

Now that's even stronger, remedy. I wonder, without tribunals (which are created by policy), how could you execute this article?

Article 10.
Everyone is entitled in full equality to a fair and public hearing by an independent and impartial tribunal, in the determination of his rights and obligations and of any criminal charge against him.

Again...

And so on and so forth. All articles not starting by "no one shall be" (and even some of those) apply, and imply that public policy give effect to the exercise of those rights.

[swells]

Cyrille, very, very good points. The point about being provided a lawyer is very compelling. So, I'll take it as established on good grounds that effecting some rights is part of the government's job. I think I mentioned elsewhere that education is another sphere where it is generally accepted (rightly or wrongly) that effecting a right is government work.

Still, I do have a couple of questions. First, in being provided a lawyer what is one being provided? In criminal cases it is the state that is creating the need for a lawyer in the sense that the state is attempting to deprive someone of their liberty. This attempt at deprivation of liberty may be justified or may not be.

In health care, is it the state that creates the need? Well, for veterans injured in combat it certainly is. So, we have the VA.

Do you notice a pattern to the rights the government has a duty to effect that you cited? They seem all to be duties to effect a right when it is 1) the state that represents the danger of transgression of the right or 2) other individuals represent the danger of the transgression of the right.

I do still ask how that is the case with health care? Certainly in the US there is a right to freedom of religion. Is it the government's job to effect that right? Well, in light of your post obviously it is in some way the government's job meaning the government can't infringe your freedom and so forth. But, is it the government's job to build that nice new sanctuary that your church 'needs'.

Same with freedom of speech. The government has to effect your right by intervening when others try to infringe your freedom but is it properly the government's place to hire a speechwriter so you can exercise your right the way you 'need' to exercise it.

Thanks for your post. There is something here worth getting to the bottom of I think.

[swells]

Cyrille, just to be clear, I am coming from a position that is extremely skeptical about the proposition that some people have a duty to fulfill the needs of others on a coerced basis. That was the rationale for slavery in this country in the not so distant past.

In blunt terms, just because person X has freedom of speech, ought I be compelled to listen to that person just because someone tells me to do so?

In general, I am against coercion.

[Cyrille]

Freedom of speech is not freedom of speech carried by someone else, so the comparison with the hiring of a speechwriter does not hold. Nor does freedom of speech require that people listen -although it does require that people not be ordered not to listen.

"Do you notice a pattern to the rights the government has a duty to effect that you cited? They seem all to be duties to effect a right when it is 1) the state that represents the danger of transgression of the right or 2) other individuals represent the danger of the transgression of the right."

Well, then I should just go on:

Article 14.
(1) Everyone has the right to seek and to enjoy in other countries asylum from persecution.

Article 15.
(1) Everyone has the right to a nationality.

That one tops it: there is NO ONE transgressing anything. Indeed, without a state, there is no such thing as nationality. But states are required to provide it, and to arrange things so that everyone may end up with at least one.

Article 16.
(1) Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and at its dissolution.

Again, this requires that an institution of marriage be in place.
However, not all is fine in that brilliant document. I'm not fond of (3) in that article:
(3) The family is the natural and fundamental group unit of society and is entitled to protection by society and the State.

It's fine that it should be entitled protection (something that too can, and indeed should, be read as requiring healthcare). But to claim that it is the natural and fundamental group unit of society, to me, does not reach the status of Human Right (something which would, by its absence, cause major suffering, whatever the culture), and besides would need some seriously broad definition of family.

Article 17.
(1) Everyone has the right to own property alone as well as in association with others.

That too requires the state to organise things, but its absence is not a threat by someone or by the state. We are not talking about deprivation of property, but of the existence of its very possibility.

I'll stop there, but there are others.

"Cyrille, just to be clear, I am coming from a position that is extremely skeptical about the proposition that some people have a duty to fulfill the needs of others on a coerced basis."

I fail to see how doctors in France would be justified in using coercion as a description of their environment. Everyone is against coercion. But regulation is not coercion, despite what some (not all) libertarians try to pretend.

[swells]

Cyrille, okay let's take your examples. Article 14 is clearly about transgression; i.e. a state doesn't have the right to torture one. Article 15 is also about transgression; i.e, it's about states not being able to strip nationality. Article 16 provides a right to marry but does the state have a duty to provide one with a suitable mate? Article 17 provides a right to property. Does the state have a duty to make sure you have some property and if so how much?

There is a crucial distinction here that I guess I'm not making clear although I'm being as clear as I know how to be.

Look, I'm all for calling health care a right if by that you mean that people can't be forced to choke down ferret burgers at 2 meals out of 3. I'm all for calling health care a right if it means people have a right to act in ways that they think are healthy for them; i.e., I'm willing to assert that a jogger has a right to jog.

In your example, I suppose a doctor isn't being coerced if they are getting paid and noone is holding a gun to their head to make them go to work in the morning. However, somebody has to pay the doctor and if it's not a voluntary transaction then whoever paid the doctor was coerced. I don't even know. Can people in France choose not to participate in the health care system? If they can, then I've got no problem with a French style health care system. If they have to participate, then they are being coerced and a system that destroys rights to effect rights strikes me as being a lot like both French and American policy in Indo China when villages had to be destroyed in order to save them. Of dubious logical provenance and something to be resisted.

You may

[swells]

Cyrille, I would go further in explaining the basis for my position. That should make it easy to critique my position. I can't see any reason to hold a flawed position so here goes.

I hold to the social contract theory of the state as a proper beginning point for thinking about actions to be undertaken by the state. I think people delegate some of their rights to the state in order to receive the benefits that a state makes possible. One effect of this view is that states can't possess rights that no one possessed to delegate to the state in the first place. Power, quite literally, comes from the people. Powers the people don't have, can't exist legitimately in such a view.

This has implications. One implication is that states can't legitimately do things like torture people. Of course, as Bushy and Cheney have proven, states can indeed torture people but they can't do it legitimately. Another implication would be that states can't legitimately have things like nuclear weapons for either defensive or offensive purposes. No individual has an absolute right to self-defense that would give that individual the right to toss a grenade into a crowd of innocent people because someone in the crowd was shooting at them. I mention these things to give you some idea of where I'm coming from.

So, my question at this point would be whether a person would have the right to force another individual to provide health care for them against their will. If no individual possessed such a right, then how can the state possess such a right?

I do realize that there is an avenue of attack against my position. It has to do with irrationality. Suppose I needed a medicine that only one person had. Suppose that person had a supply that cost $.50 per dose. Now, suppose that I am going to die without it. Should the person with the large supply be allowed to charge me $100,000,000 per dose? I think you can make the case that the person with the large supply is irrational in not accepting some reasonable price and is, in fact, engaged in coercion that is only made possible by the circumstances.

To my mind, some version of this argument is a proper social contract way to deal with the issue of health care. It's quite a different argument, and I think a much stronger one, than is arguing for universally available health care as a human right.

[Cyrille]

Taxation is not coercion. Don't let your fear of coercion lead you into confusing the two.

With regards to the example, article 15 is not about banning the state from removing your nationality -this can happen. It is about the right to have one. As I already said, without the state, there is no nationality. The state is not removing, it is providing.

By the way, this proves that your belief "One effect of this view is that states can't possess rights that no one possessed to delegate to the state in the first place." is untenable if you accept the existence of a nationality.

In article 14, the persecution would be in a different country, so it has nothing to do with preventing the state from doing something. That state IS doing it, and there is no provision for declaring war to it on this basis. Rather, it is considered a Human Right to get asylum somewhere else.

Anyway, if that is not clear to you by then, they make it crystal clear in article 25

Article 25.
(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

That's far, far more than not being forced fed hamburgers.

Healthcare IS a Human Right. Now, you may be against the concept of Human Rights, but that's another matter entirely.

[swells]

Cyrille, why is taxation not coercion? Of course it is coercion. Please note that I am not an absolutist on matters coercive. I realize some is necessary to overcome irrationality. My position is that it should be kept to an absolute minimum and that the burden of proof for it's necessity should be extremely high (for many of the same reasons that high explosives should be used sparingly and kept locked away in safe places).

The dictionary (dictionary.com) defines coercion as "1. the act of coercing; use of force or intimidation to obtain compliance.
2. force or the power to use force in gaining compliance, as by a government or police force.

Is there some state somewhere where taxes are not based on force or the power to use force? (If yes, then where do I line up to emigrate?) Can you at least admit that taxation is coercion? If not, can you provide some definition of the word that supports your contention?

In respect to Article 25, I would just observe that saying something is so is not necessarily sufficient to make it so. Article 25 starts by asserting the position we are debating. My whole blooming argument is that Article 25 is incoherent and wrong. Am I supposed to be convinced by circular reasoning? I don't hold human rights to exist because somebody writes some words down on paper but to follow from the physical and mental nature of being human.

You said, "By the way, this proves that your belief "One effect of this view is that states can't possess rights that no one possessed to delegate to the state in the first place." is untenable if you accept the existence of a nationality." I don't think this holds. Certainly individuals possess the right of association. The state's power over nationality is no more than this individual right of association writ large and hence consistent with being delegated by individuals to the state. Even further, this right to nationality exists, at its core, on the basis of trumping irrationality ala my argument about someone setting extremely high prices for a dose of medicine. Take public accomodation laws here in the US for instance. Certainly they are coercive. Even if one is a racist, if one operates a hotel then that hotel must accomodate members of all races. It is a coercive measure that is justified ONLY by it's reduction of the amount of irrational coercion extant in society.

The same argument, that of trumping irrationality, applies in the case of asylum seekers.

Can I ask a simple question or two here. You accept that people have a right to marry. Does it follow that the government has to supply suitable mates? If not, why not. Then, lastly, why is health care different?

[Lafayette]

DR: Care to explain just how this magic works?

Do your read the posts here BEFORE rebutting, or after?

If you have a Health Care system where prices are mandated by the state, then you effectively "regulate" the profession.

Which is why the AMA goes ballistic whenever it sees the red flag of "national health care" waved before its face. It wants to protect those 150,000 dollar average GP annual incomes.

[Cyrille]

Money has no value by itself. It only gets value in an economic system. Taxes are just as much a part of the system as that which enables people to earn, own, or spend money. Taxes are just part of the system of earning (for income taxes, say), owning (for taxes on capital) or spending (VAT). It's not the taxes that are coercion, but the attempts at tax evasion that are theft. Theft that is indeed fought by the government, but that does not make it any more of a government coercion than the fact that if you kill your neighbour you risk arrest.

"In respect to Article 25, I would just observe that saying something is so is not necessarily sufficient to make it so."

Well, the text IS the Universal Declaration of Human Rights. It's not just anyone's ramblings. By the way, you will notice that I used the capitals, so that by definition any Right defined in this text is, de facto, a Human Right.
Anyway, you are therefore on record as denouncing the Declaration of Human Rights. You may do so, of course, but it follows that rejection of healthcare as a Human Right requires that. I don't reckon that it is official US policy.

"I don't hold human rights to exist because somebody writes some words down on paper but to follow from the physical and mental nature of being human."

Oh well then that's easy: there are none.

"Can I ask a simple question or two here. You accept that people have a right to marry. Does it follow that the government has to supply suitable mates? If not, why not."

That is devious enough as to being dishonest. Of course, it follows that the Government supplies the institution of marriage, not that it forces someone to say yes. It is the right to marry, not to have a soulmate, and since marrying takes two people, in stating the right to marry there is no implication of having to provide a soulmate.
However, from the Right to have adequate food does follow that the Government feeds the starving.

"Then, lastly, why is health care different?"

It's not much different from the others. It must be ensured that everyone, rich or poor, gets adequate food, and gets adequate health care.

[evagrius]

"In blunt terms, just because person X has freedom of speech, ought I be compelled to listen to that person just because someone tells me to do so?"

You don't have to listen but you don't have the right to shut them up.

[David Robb]

If you have a Health Care system where prices are mandated by the state, then you effectively "regulate" the profession.

But I don't recognize the right of the State to mandate wage controls or price controls. I don't recognize the right of the State to dictate to me what I will sell my labor for (and thus what the value of my life is). I don't recognize the right of the State to dictate to me what I will pay someone for their labor. I don't recognize the right of the State - or you - to enslave me to provide for "rights" to other individuals.

The problem with article 25, and several other articles in the Declaration is that it abrogates the concept of rights by defining rights whose implementation necessarily infringes upon the rights of other people.

All of those "things", such as food, housing, free education, free medical care, pet llamas, declared in the Declaration have to be produced by one or more people. And you necessarily abrogate the rights of those producers to provide for the alleged rights of consumers.

The founders of the US Constitution correctly perceived that there can be no legitimate rights that can be applied to a group (or to everyone) if they violate the rights of a certain subset of the population. They correctly defined basic human rights as "the right to life, liberty, and the pursuit of happiness". And property rights were implicitly understood as a basic fundamental human right at that time.

In the particular example we are arguing about, the right of doctors - and the other professions constituting the Health Care Profession - to sell their labor at rates that they agree to is abrogated. And the property rights of individuals forced to pay for those services when they are applied to individuals who cannot pay for them are abrogated as well.

It is not logical to define a right to violate the rights of others. It's accepting a definition then turning it on its head, all the while maintaining that the original definition still applies. A is not A, yet somehow it is still A.

The end result of your definition of rights, taken to its logical extreme, is the destruction of liberty and of life. The partial application of your definition of rights is the partial destruction of liberty and life.

When it comes time to nationalize the computer programming profession, and I can no longer go to a potential employer and negotiate with him the terms of my employment, I will clearly be deprived of a right that other individuals have: the right to determine the value of my labor, my time, and the use of my mind. I do not recognize a "right" of a society, of a majority, or of any minority, to deprive me of that very fundamental right.

These rights I refer to in my definition are Natural Rights, of course. Read Hobbes or Locke if you need an introduction. Clearly you do.

[David Robb]

Swells:

Cyrille, just to be clear, I am coming from a position that is extremely skeptical about the proposition that some people have a duty to fulfill the needs of others on a coerced basis. That was the rationale for slavery in this country in the not so distant past.

You are partially correct: that was one rationale for slavery. But Natural Rights were well understood by many slaveholders and thinkers of the time, and were correctly percieved as incompatible with slavery in all its forms; thus they had to resort to defining blacks as "non-human" to truly justify the violations of their rights.

It is patently obvious to anyone who actually spends more than a few minutes talking to a black man or woman that they are quite human, just as human as you or I or anyone else. But it seems that at the time there were many people who really didn't feel this way. Recorded for us are many well-documented discussions about the nature of Africans.

The reason why slavery - an institution that existed for thousands upon thousands of years - fell apart after just a few decades of the founding of a country with Natural Rights as its foundation and premise, was because of the fundamental incompatibility of Natural Rights and slavery.

[Lafayette]

Cy: Well, the text IS the Universal Declaration of Human Rights.

You're pissing in the wind with that sort of talk on this forum.

America voted for the Declaration in 1947 and the Senate has steadfastly refused to ratify it ever since.

Yes, we are talking about the Greatest Nation on Earth that refuses to ratify the Declaration of Human Rights. Evidently, it thinks its Bill of Rights is sufficient. The Bill of Rights doesn't go nearly far enough.

[Lafayette]

One Way

DR: But I don't recognize the right of the State to mandate wage controls or price controls. I don't recognize the right of the State to dictate to me what I will sell my labor for (and thus what the value of my life is). I don't recognize the right of the State to dictate to me what I will pay someone for their labor. I don't recognize the right of the State - or you - to enslave me to provide for "rights" to other individuals.

That remark, straight out of the Idiot Right, doesn't surprise anyone.

You are the bulwark of Freedom, defending the Individual Right of everyone to do exactly as they please. Which is why America is in just such a fix.

We enslave you in order to provide rights to other individuals, do we? What bollocks! You wear a ball and chain around your foot, dragging it across the floor?

Have pity on those Poor Europeans, all slaves to the state for Health Care. Which is indeed curious for some of the finest Health Care systems in the world, with state mandated Health Care fees. Those Europeans must be fools, all 400 million of them.

You are one small member of a larger collective and you have not only rights but responsibilities. You might wonder one day what those responsibilities are (to contribute to the community as much as you take from it).

Till then, you deserve to live on a deserted island where you can have all the freedom you want with no responsibility to the collective well being of others. Problem is, there are not enough deserted islands in the world to put up with your ilk.

Lot's of streets named after you in America. One Way -- I see the street signs up all over when I go there. Your kind must be a very popular breed of American.

[Lafayette]

DR: These rights I refer to in my definition are Natural Rights, of course. Read Hobbes or Locke if you need an introduction. Clearly you do.

Oh, yes, please continue your rant by elucidating us poor morons about Natural Rights.

You were born with them, were you? They are an appendage?

[David Robb]

Lafayette, your reply is not a very good one. One would normally provide a cogent explanation of one or more logical fallacies in a rebuttal, or evidence exposing falsehoods in the original statement, or a description of an alternative viewpoint that provides for a higher quality result. You provide few ideas to respond to.

Indeed, a string of rants and condemnations and beseechings instead constitute the bulk of your replies. I usually don't bother to respond to such things because they cannot be responded to in an intelligent fashion. You rarely if ever make a point-by-point rebuttal, or even a generalized conceptual rebuttal. Most of the time, you don't even bother to acknowledge the original post in a conventional way.

That said, I did find a few statements worth responding to:

That remark, straight out of the Idiot Right, doesn't surprise anyone.

The theory of Natural Rights far precedes the existence of the "Idiot Right", sir. Try again.

Which is why America is in just such a fix.

America is not an example of a "classical liberal" state today. Natural Rights have been systematically dismantled, mostly during the twentieth century. Today America is a heavily socialist state, as evidenced by the size of Federal and State governments, the destruction of liberty, the impositions of tortures, the declaration that the state can do anything it pleases in the name of the Public Good or the Public Safety, the initiation of war against sovereign nations, the existence of hundreds upon hundreds of military posts around the world.

America is becoming more and more socialist as time passes. You should not wish for this, because as it transitions into a purely socialist state, it will become far more dangerous than it is today.

If America is in a "fix", it is more probable that is is so because it is a socialist state than because it is a state that honors and upholds the values of Natural Rights, which are completely incompatible with all of the above mentioned characterizations of our country. Or perhaps it is in a "fix" because of some other, non-related reason. Perhaps it is not even in a "fix" at all, as the definition of "fix" isn't exactly clear from your post.

We enslave you in order to provide rights to other individuals, do we? What bollocks! You wear a ball and chain around your foot, dragging it across the floor?

No, but slaves in 18th century America did not necessarily have a ball and chain around their feet either. Balls and chains do not slaves make. They were slaves, nonetheless. Even when they received partial compensation for their labors in the form of food, shelter, education, or clothing, they were slaves.

As I pay taxes, I am partially enslaved, because part of my personal property/time/life is confiscated. If I do not pay, my wages will eventually be confiscated before I receive them. If I choose to work "under the table" I can be subjected to even harsher penalties, as can my employer.

I acknowledge that the level of slavery I endure is not comparable to that experienced by the American slave of the 18th century. But again, beatings and balls and chains are not primary, or even necessary, components of slavery.

As the level of the confiscation of my property increases, so does the level of my slavery. If 100% of my income was taxed, I would be 100% enslaved, regardless of any renumerations passed my way. The situation of the American slave was similar in that respect: regardless of his treatment, regardless of whether he was set free at age 21, regardless of whether he was taught to read during his enslavement, regardless of any niceties his owner cast his way, he was still a slave.

Have pity on those Poor Europeans, all slaves to the state for Health Care. Which is indeed curious for some of the finest

Finest? An opinion. You equate quality with access. They are not the same thing. We could just as easily get rid of the entire medical establishment, and implement "universal bloodletting", at far greater savings, but the resulting system wouldn't be finer than modern health care.

You are one small member of a larger collective and you have not only rights but responsibilities.

I am not a member of a collective. Humans are not ants. I am an individual being. You, and society by extension, do not own me.

If those are your objections to my post, then you stand on very shaky philosophical ground for your beliefs, which you seek to impose, by force, on everyone else.