Personal Independence

Well this will sound a bit utopian, but government is an expression of community. Communities create governments, not the other way around. One reason they do is that it provides a way for them to address problems they cannot otherwise fix.

The software analogy hits home since that’s my field as well. Yes, chances are that every upgrade will break something somewhere in the system, but over time the product will improve and become more functional. If the alternative is to ditch the system and go back to working manually, most of us choose to stick with the software.

Government at the federal level in the US doesn’t work. I would classify it as totally dysfunctional. Government at the state level has to work within the constraints imposed by the dysfunctional national government and some states are pretty good at it and others (perhaps most) are not. That said, we are still left with problems for which we have no solution and the only entity with the resources to solve those problems is government, and government is usually the only entity over which we can hope to gain sufficient control to cause the problems to be addressed. But there is an overriding problem, a meta-problem perhaps – and that is the corruption and dysfunctionality of government itself.

Can we fix government? Can we make government respond to the people instead of the corporations? Can we change our priorities so that funding is available to work on the nation’s problems rather than bomb others? If the answer to these questions is no, then we have to return to the set of problems and come up with another plan. I don’t know of one. When you have developed systemic problems, you need to find resources strong enough to change the system and resources that can be made willing to do so.

David, you raise a large economics issue here. The US Dollar is, like it or not, the world’s reserve currency. Debts between nations are usually settled in dollars and the US can, if it chooses, act as a sort of mega central bank to the world. I don’t necessarily think this is a good idea, but that is the rationale as I understand it.

It is possible and sometimes prudent for the national government to go into debt. The question, like it is for individuals, is whether the money borrowed is invested in something that can be expected to provide a return in excess of the amount invested, or whether it is spent on goods and services that have no long term value. Also, as with individuals and families, there are times when it may be necessary to borrow for basic everyday expenses for a short period so that the family will remain in a position to generate income in the future.

Using this analogy, I find it generally irresponsible to borrow to spend on weapons systems to fight enemies that no longer exist, or to project a military presence into parts of the world where we are not wanted. It might however, be responsible to borrow to educate new engineers or doctors, or to build infrastructure since the nation’s economy is likely to be boosted by a better educated and healthier workforce and a strong infrastructure. That boost should enable the government to pay back the debt over time.

I realize that those in Washington who call themselves conservatives do not represent your viewpoint David, and those who call themselves liberals don’t represent mine, but both groups are guilty of maintaining spending at a level far above revenue. They differ mostly about what to spend money on and whether or from whom they should get revenue.

Myself I am a progressive/liberal leaning third-wayist.

A traditional Third-wayist of course being someone that believes in a fundamentally free market but with the government subsidizing the welfare state.

I believe that interaction between government and private industry leads to corruption and that interaction between private industry and the welfare state leads to corruption, So I differ from the traditional third-wayist in that I believe the government should run the welfare state. I don’t take this to the absolute however, I merely think that government should set the floor but not the ceiling, in that vain the way Social security works I think is great such that their is a basic amount of savings that occurs through Social security but it doesn’t prevent anyone from obtaining savings beyond what it provides. And social security is isolated from the corruption breed from the interaction between government and corporation. Social security also is protected from the rise and fall of markets that is the cause for 401K’s/Pensions being such a gross failure of a retirement savings system.

Medicare has generally had very low levels of fraud and corruption until 2003 when Republicans passed Medicare advantage and Medicare drug benefits. Both of which create huge payments to private industry through the government program. Medicare advantage has been used by private industry to defraud the government of Billions in tax payer dollars, In fact the largest fraud settlement ever was from a private company that defrauded the Medicare advantage program in 2004-2005. *Medicare advantage being a program where a Medicare recipient opts out of Medicare part A and receives coverage from a private provider instead of Medicare via a government payed subsidy to that private provider*

20 Largest Fraud Cases EVER!!!!! *I think you will get a kick our of this!*

Their is a resent settlement involving Pzifer that may end up being larger involving Medicare Advantage and privately administered Medicaid plans.

Allowing private industry to touch the welfare state is a mistake, if the sole purveyor you end up with huge swaths of people left out, gross abuse of customers, gross administrative complexity, etc.

If subsidized you get gross across the board fraud and corruption, and you will still have people left out, abuse of customers, likely worse levels of administrative complexity then left alone.

So neither is really a good option. Medicare Part A is beautifully efficient well beyond what any private provider can do. Medicare supplemental plans are a great way for people to get services beyond Medicare’s offerings and they are segregated from the problems of government interaction with private industry.

Medicare for all would allow the government to use nationally standardized forms/paperwork, Bulk payment and Global budgeting which would slash administrative costs in health care to the tune of $300-$400 Billion dollars. It would remove over $400 Billion in Medicaid mandates from the States allowing those state to cut tax’s or fund programs etc.

David, aside from Medicare and Medicaid there is little public manipulation of the health care system. Medicare and Medicaid function within the private model and to a great extent with privatized components (Medicare [Dis]Advantage). They each carve out a portion of the market that private insurers don’t want anyway so what effect the have should be helpful to the remaining private market. It should reduce costs by removing the highest-risk groups from the pool. I fail to understand how a private for-profit market can provide goods and services to people who have no ability to pay for those services in an effective way. That’s the current situation.

Is the military directly protecting us David? They don’t need $1T a year to protect the United States from attack by small groups of fanatics hiding in caves with Kalashnikovs. There’s not a direct benefit there, at least for most of that expenditure.

I would wager that most of the people who report they are satisfied with the current private health insurance plans haven’t had the unfortunate experience of needing to use the policy. Once you’ve discovered how difficult it is to get them to pay the significant amounts of money promised in the policy, you tend to be less satisfied. Customer service, such as it is, is quite varied because the customer is the employer, not the insured. If you are employed by a big corporation you get pretty decent service, but if your employer is a small business or if you have an individual policy then you should reserve at least an hour for any phone call to the insurer and make sure you listen carefully because our menu has changed.

Would this improve if we eliminating employer-based insurance? Hardly. Employers are picking some percentage of the cost and they wouldn’t be passing that on to their employees as wages if we switched. They’d pocket that money and the insurers would give us a choice of premiums that take a huge chunk out of our income or benefits that expose us to the risk of bankruptcy if we get sick. And while Oracle Corporation, for example, might have the leverage to get good service and prompt payment, David and Charles acting alone would get bubkes.

I suppose we could run through the arguments pro and con on health care reform but I doubt we’d find complete common ground. Clearly if you and I were sitting in a room trying to figure this out instead of Reid, Lieberman, Collins, et.al, we’d make a lot more progress than they are likely to do.

What I have learned through the last year is that the Congress is not capable of producing worthwhile legislation on anything beyond naming of buildings. They will react to serious pressure from an administration determined to accomplish a goal (like when they passed TARP or the stimulus bill), but if asked to perform their Constitutional function of originating legislation, they are incapable of action. The only exception is when action can benefit large corporations or banks – the ones funneling millions into their campaign funds and surrounding them with lobbyists every moment of the day. I wish I had learned how to turn that situation around, but so far I haven’t heard a viable suggestion from any quarter. Obviously turning power over to the other political party isn’t the answer.

“Right now 85% of the nation has some insurance”

Every last person in that 85% would benefit from lower costs and the public health benefit of 100% coverage. To say nothing of the abuse they are exposed to from their current insurance company’s.

“I think you are generalizing too much to say that the private health care market has no interest in the recipients of Medicare and Medicaid.”

Being old is considered a “pre-existing condition”. Being poor means you can’t pay a premium, hell being lower middle class generally means you can’t pay a premium. Hell a family of 4 who makes less then $80,000 will pay more for Health insurance/co-pays/deductibles then All Federal tax’s, State tax’s, and food costs COMBINED. And though co-insurance will still go bankrupt from any major health events.

The second flaw with this statement is the idea that Health care functions like any other market, It doesn’t. Health care suffers from 2 huge distortions that no one so far has been able to explain their way out of,

1. Dysfunction of supplie and demand, in that demand is set by the disease rate not the price or availability of a certain curative.

2. Cost vs Risk ratio, 90% of health care costs are from 10% of people and the costs on those 10% are huge, so much so that most of that 10% can’t afford those costs and nobody knows if they will enjoy the pleasure of being in that 10% so the only reasonable solution is some sort of “risk pool” insurance if you will. These third party systems will always have distortions inherent in what they are.

I have seen a few non-functional attempts at devising systems of savings accounts, and medical loans. I have yet to see a libertarian system that would actually work, at least without leaving huge swaths of people out and having enormous negative economic effects in the process.

“Programs that provide for the general welfare in a rather direct manner, should first of all be a response to an actual need.”

This is where liberals and third-wayists disagree, its one of the things that makes the left so mad at Obama right now. Dems are going to have a bumpy ride in 2010 is Obama doesn’t stop ignoring the base of the Democrat party. We third-wayists are in that magic spot between ideology’s that seems to piss everyone off =p.

“(I notice in your example that the insurance companies are responding to government manipulation.)”

This would be the case with or without Medicare as Health insurance is tied to the employer and is a cost that grows with high inflation(Medically high inflation) making it unaffordable to people on a fixed income as are all retired people. Without Medicare the situation would still be the same as after retirement you are no longer the private providers problem.

Further in the modern day the average person will change jobs 4-6 times in their life and through manipulation of risk pools to smaller sizes can often cause small company’s to have to switch insurance company’s every few years weeding out pre-existing condition patients in the process, which further incentives the insurance company’s to push problems into the next insurance company or the government.

“Besides, I made no claim that the cost of covering preventive care had a large impact on premiums (although look at the difference between plans with small co-pays and plans where the patient has to pay for preventive care themselves through large deductibles).”

My Dad’s insurance is $640 per month with a $3,000 dollar deductible, 20% co-insurance, and co-pays out the wazoo, He gets the group policy from his work. This policy only covers my parents, none of my siblings qualify for coverage on their plan anymore.

My mom’s colonoscopy bill was $1,200 dollars, the government pays for her mammograms so that not a cost to the insurance company, the industry is completely out of control.

“My claim was that high premiums encourage people to use extra care in order to “get their money’s worth” since they have already spent so much.”

I disagree, nobody wants to be sick, nobody wants to be poked and proded with needles. Generally speaking most doctors will likely tell you that Americans don’t get enough Primary visit care, The cheapest end of the care spectrum.