But as a moral assertion, it's tenable only to a cold blooded Randian.
I don't agree. Allow me to change the scenario up a bit:
Two people - actually, same person - parallel universes, if you will. One make healthy choices, one doesn't - the latter develops a corresponding chronic disease, the former doesn't. The agency (insurer / whatever that might be) acting as their 'payer' will incur significantly more costs for person B than person A, at least in part because of person B's choices. Should they pay the same thing?
Now, let's look at a different situation, a completely different situation. Couple (C and D) goes out for fast food - one has a big appetite, the other doesn't. (This is normal for them, person C has significantly greater caloric needs.) Should their meals (super sized combo v. happy meal) cost the same - because for both it's what they needed to get full?
These are obviously abstractions and somewhat flippant (after all, medical coverage <> hamburger+fries ... not trying to minimize people's hardships here). But it's only a matter of degree in difference from charging people different rates because they will make different demands on the system. One factor commonly used in insurance rating, for example, is industry - coal miners (as a rule) incur higher costs per member than musicologists. Should Jane Miner be charged the same amount as Vaux Hall even though she chose to be in a dangerous profession? (Ok, that was flippant - sorry again.) I can see why someone would say no. I can see why someone would say yes. If you allow rates to vary, then should their be limits to how much they can do so and what should they be? (In most, if not all, states there are - but the top end is huuuuuge.)
Likewise, as much as equality is to be strived for in many instances - we're not truly equal. No matter what I do, I'm never going to be as tall enough to be in the NBA, or brilliant enough to bet the under on Royals wins every the season. So, while I'm convinced that everyone should have (again, this is IMO) the opportunity to secure health care for themselves and for their family at a rate that's tolerable*, it doesn't necessarily follow that nothing other than everyone paying the same price for care is a fair way to do it, much less ideal.

* YMMV as to what this means.

*****

As to rejected claims, I believe that most of the remainder are rejected because of inconsistent or missing info. As for errors / malfeasance - I can't imagine how stupid you'd have to be to do it intentionally if you want to stick around in your market (morality aside) - fixing them is time consuming, embarrassing and expensive. [I can only speak for the corporate environments I've spent time in.]


*****

Did no one comment on Saxman's disincentive bit from a page back? If not, too bad - it merited notice. (I guess this sorta counts.)

So let's all remember to bring our birth certificates or our green cards with us, so if we're hurt in a tragic out-of-nowhere horrific car accident or something, we don't have to scramble around proving we 'deserve' healthcare, okay everyone? That way we can always easily lose it too, so that makes things even more fun!

Worst argument ever.

Oh and I hate the whole must register on Steam.com thing to install the game. So what is going to happen in 5 years when Steam is gone and I want to install the game I legally purchased on my latest computer (which by that point will finally be able to handle the games graphic requirements and doesn't require me to send Bank of Congo emails to everybody to afford it)? What then? I spent 50 bucks for a product and I should be able to use it as long as I want.

So what is going to happen in 5 years when Steam is gone and I want to install the game I legally purchased on my latest computer (which by that point will finally be able to handle the games graphic requirements and doesn't require me to send Bank of Congo emails to everybody to afford it)? What then?

Wait five years, and then buy a copy from these guys.

I'm a little late on this, but this comment was really uncalled for.

Jumping all over bbchick was uncalled for. If you did you are a ########.

That still doesn't address the need to register with Steam.com

And yet jumping all over me for less personal remarks is completely called for.

Can't help ya there. Call them dickheads. It gets things done.

Now you are learning.

And the freakin game has to upload a patch! IT has been about 5 minutes and the bar is at 5%.

drunk Okie

Redundant. As is "malformed Okie", "mentally challenged Okie", and "potential molester Okie".

By the way Empire Total War takes forever to install. Somebody should look into that.

Indeed. I didn't quite see the hype, myself. Didn't really get into it. That was a try and no buy.

-----

As for random racism in surprising places, I took a job in Ft. Worth after being laid off twice in three months in Austin (this was late '01, early '02, and I worked for two dot-coms.) Hired to be the web guy, I moved them off their ridonkulously priced virtual hosting and even though this was a very small company with a very high-dollar product (15 to 80k) and as such a tiny traffic flow, I moved things onto a server at Rackspace. FF a few weeks, I mention to my boss (a good ol' boy/frat boy mix, though an all right guy I suppose), who was about 30, that the logs showed a pretty standard, weak, and failed hack attempt overnight.

He flips out, thinking it's the Koreans (long story, this actually made a sort of sense given the business context), and after I calm him down, he looks at me and says "Watching criminals get theirs is awesome. You know, you're watching Cops and they're chasing the black guy and you're hollering and they catch him and start beating him and you're like 'YEAH HIT HIM!'"

I just backed slowly out of the office, quite literally.

What? Were you the drunk Okie spouting off about the muslim waitress on Saturday? I thought that was you. Oh wait, you have no idea what you are talking about.

Drunk Okies are talking about repealing the seventeenth amendment? Somehow I don't think so.

IIRC, bunyon hails from Oklahoma.

He flips out, thinking it's the Koreans (long story, this actually made a sort of sense given the business context), and after I calm him down, he looks at me and says "Watching criminals get theirs is awesome. You know, you're watching Cops and they're chasing the black guy and you're hollering and they catch him and start beating him and you're like 'YEAH HIT HIM!'"

I just backed slowly out of the office, quite literally.

Because of the "black guy" part or the "watching Cops" part?

So you're saying that that a person with a pre-existing condition should have to pay more than a healthy person of the same age, if (for instance) both had been laid off from work at the same time and had to buy insurance on their own? Or was that merely a statement of fact? The wording is ambiguous.

No. I'm saying insurance should not be linked to employment. If you bought your insurance individually through a voluntary (church, club, etc.) or randomly assigned group you'd never need to change insurance. If your health deteriorates, you just stay will your original carrier, and your premiums go up at the general rate.

Again, health deterioration isn't a problem with insurance you signed up for while healthy. That's the risk the insurer took, and priced for.

Under my system, everyone has and maintains insurance from when they are young. If they choose not to, then the county hospital/free clinic system is there as a backup.

OK, but that still leaves hanging the question of whether a person who is born with a pre-existing condition should have to pay a higher rate the first time he buys insurance than a person without such a misfortune.

------------------------

So you're saying that that a person with a pre-existing condition should have to pay more than a healthy person of the same age, if (for instance) both had been laid off from work at the same time and had to buy insurance on their own? Or was that merely a statement of fact? The wording is ambiguous.

Obviously as a point of fact, it's an indisputable statement, given the way our system is organized. But as a moral assertion, it's tenable only to a cold blooded Randian. Which is why I tend to think you meant it only as a statement of fact.

I don't agree. Allow me to change the scenario up a bit:

Two people - actually, same person - parallel universes, if you will. One make healthy choices, one doesn't - the latter develops a corresponding chronic disease, the former doesn't. The agency (insurer / whatever that might be) acting as their 'payer' will incur significantly more costs for person B than person A, at least in part because of person B's choices. Should they pay the same thing?

I see your point, and there's a certain moral logic to it. And it also makes perfect sense within the context of private insurance for companies to charge (e.g.) non-smokers a lower rate.

But here you have one of the more interesting outcomes of the idea that government has no role to play in goosing the market in order to discourage destructive habits, such as by leveling prohibitive tobacco taxes, banning all tobacco advertising, or severely restricting the addictive properties of cigarettes. That's the classic libertarian view, and it's perfectly consistent.

But then when as a predictable consequence of this principled laisser faire attitude, we wind up with 20% of the population facing tobacco related long term health problems, these same people want to wash their hands of that, and essentially say, "well, it was your choice."

Taken literally, of course this is true. And from a perspective that holds freedom of choice to be the eternal trump card position, it's perfectly fair and consistent. But the societal costs of this are not only undeniable, they fall disproportionately on those who have the fewest resources to be able to resist the well practiced marketing appeals of the tobacco industry (which is a shorthand for other industries that profit from peddling the sort of products that wind up driving up the cost of health care). And not all of us find that "what can you do?" attitude to be the final answer.

Of course one way to square this particular circle would be to tax tobacco companies and McDonalds at a 90% level, and use that money to pay for the added expenses brought on by the use of their products, which they pitch without any concern for the health consequences. That's not a practical solution, but it has a certain appeal. And if it helped to put those companies at a disadvantage, so much the better.

As for coal miners vs musicologists, in the context of our existing system, I suppose that we should be cool with charging higher premiums to the coal miners, just so long as every last penny of their no-deductibles insurance policies is paid for by by the coal companies, and not by the miners, and that these policies are paid by these companies until the day these miners die.

But in a better world we'd simply adopt the French system, and remove the sceptre of medical bankruptcy from everyone, including musicologists, coal miners and stunt pilots. They (the French) live longer than we do, and spend far less on health care in the bargain. We have a lot more to learn from them on this subject than they do from us.

Don't you talk bad about Cops.

The black guy part, of course. It's impossible to quote him and convey the unmistakable, crystal clear opinion that he was putting forth, body language and emphasis being key, but it was twofold:

1) Black people are criminals.
2) I rabidly enjoy seeing black people beaten.

So you're saying that that a person with a pre-existing condition should have to pay more than a healthy person of the same age, if (for instance) both had been laid off from work at the same time and had to buy insurance on their own?

Why not? Shouldn't an 80-year-old pay more for life insurance than a 30-year-old? Shouldn't a person who has been at fault for several accidents have to pay more than someone with a clean driving record? Shouldn't flood insurance for someone next to a major river cost more than flood insurance for someone in Los Angeles and vice-versa for fire insurance?

There are certainly lots of things that could be reformed in the insurance industry, such as increased transparency, de-linking insurance and employment, and coming down tough on insurers who are trying to get out of already agreed-to obligations, but pricing risk is the very basis of insurance.

It's extremely unfortunate when these situations happen, but I just don't get what the justice is to simply transfer the misfortune to unrelated persons.

The compassion issue is a complete straw man - compassion is what you do, not what you force someone else to do.

OK, but that still leaves hanging the question of whether a person who is born with a pre-existing condition should have to pay a higher rate the first time he buys insurance than a person without such a misfortune.

Of course.

Do people honestly not understand the very nature of the concept of insurance?

If your car's brakes have failed while you're driving down I-95, should you be able to purchase auto insurance at the same rate as all the other drivers on the road? If your house is on fire, should you be able to purchase homeowners' insurance at the same rate as someone whose house isn't on fire?

So you're saying that that a person with a pre-existing condition should have to pay more than a healthy person of the same age,

I don't get the hysteria about pre-existing conditions. Why shouldn't the person with the pre-existing condition pay more?

19% and counting!

Indeed. I didn't quite see the hype, myself. Didn't really get into it. That was a try and no buy.


I've enjoyed every single Total War game so far so I figure I'll like this one as well. I've heard the naval part is a big let down, I never really enjoyed the new way they have done the map screen that started in Rome TW as much as they did the old way, and I doubt my laptop will can handle the most of the graphic features but I usually have so much fun with these games that I decided to splurge and buy the game. Plus it helps that I have no furniture, no TV, working a ton of hours, no money, and living in a new city.

The black guy part, of course. It's impossible to quote him and convey the unmistakable, crystal clear opinion that he was putting forth, body language and emphasis being key, but it was twofold:

1) Black people are criminals.
2) I rabidly enjoy seeing black people beaten.

But don't you get it Jeff? Merely by typing a few lines on the internet David is instantly able to deduce that you are seeing phantom racism. Never mind what you saw, never what you experienced, never mind the fact that the internet is not the best way to paint a complete picture. Dammit he knows what you experienced and what it truly means.

The "hysteria" about pre-existing conditions is when you have one carrier who is paying for the treatments, your company changes carriers or you change jobs and your new carrier does not cover the pre-existing condition.

Another happy fun thing that insurance companies are doing now, if you have insurance and have a spouse on that insurance but they work and are eligible for insurance at their company the carrier is dropping them because they can get insurance elsewhere.

There are certainly lots of things that could be reformed in the insurance industry, such as increased transparency, de-linking insurance and employment, and coming down tough on insurers who are trying to get out of already agreed-to obligations, but pricing risk is the very basis of insurance.

Actually, while that's true, the major insurance companies are not in the business of pricing risk. At least, that's not their actual motive for doing business. A typical insurance underwriter actually loses money on underwriting, only grabbing 95-97 cents in premiums for every dollar they pay in claims. What they are in reality are massive raisers of funds who exist to reinvest those funds and make considerable amounts of money there. They're basically the real-world equivalent of the ubiquitous finance example of a company with infinite positive NPV projects, and their business is that of raising as much capital as they possibly can without losing their shirts on that side.

OK, but that still leaves hanging the question of whether a person who is born with a pre-existing condition should have to pay a higher rate the first time he buys insurance than a person without such a misfortune.

Of course.

Do people honestly not understand the very nature of the concept of insurance?

If your car's brakes have failed while you're driving down I-95, should you be able to purchase auto insurance at the same rate as all the other drivers on the road? If your house is on fire, should you be able to purchase homeowners' insurance at the same rate as someone whose house isn't on fire?

Born on third base, and deserving of a triple. Born HIV-positive, and tough shit. And facing a moral question, come up with the most spectacular non sequitur you can imagine in order to avoid it---as if a birth condition is comparable to a burning house or a car with bad brakes. That's your "philosophy" in a nutshell.

------------------

I don't get the hysteria about pre-existing conditions. Why shouldn't the person with the pre-existing condition pay more?

I hate to fall back on the old cliche, Ray, but if by the time you've reached your age in life you really have to ask, you'll never know.

i'm afraid.

you see, i believe that in the end, money talks and they are not simply going to get rid of insurance companies and have every person under a medicare system (and you also have got medicare supplemental insurance too because medicare does not pay for everything). and what i am really afraid of is that the new rules will force us to buy the insurance under my husbands policy which will go up in price and i just don't know where we are gonna get that money and i don't know what we are going to do

and i don't believe for a minute that there will be no increased cost to put everyone on the govt system. and i am afraid of what is going to happen to us.

As far as Canadian health care generally goes, I really don't think that you have as much to worry about as you would think bbc. The mechanics of what's being debated down there are unfathomable to me but as far as paying for it goes - raise taxes on those who are doing well. I have no doubt that there will be an increased cost and I suspect that what Obama is doing is essentially saying "Let paying for it be a problem down the road", which is what governments of a conservative stripe have done with tax cuts.

Leaving aside the libertarian philosophical issues for a moment, I am continually baffled at the horror with which Americans regard higher taxes. Sometimes, the collective can be better off with the money in the hands of the government. A lot of the public infrastructure down there just looks terribly rundown, sort of like Quebec. I've always assumed that that's because the public investment isn't there. Stuff costs money.

There was a cool essay I saw somewhere, a while back, that talked about the comparative taxes in Canada and the United States. As I recall, the tax burden was relatively equal for people earning less than $100K. This would seem to be borne out by wikipedia as well. The lion's share of the cost of things like health care is borne by the higher income earners. I'm not sure why America's working poor - and I'm referring more to the people at the rallies this weekend here - are so vehemently against this.

because he didn't just "die in surgery." he would be alive because here in houston, he would have had the option of going to the ER at one of the medical schools. he told me he did not have that option up there.

Just to clarify something: the reason that he didn't have the option of going to an ER at a medical school here is that, as far as I know, our medical schools don't have ER's. The training is done in conjunction with local hospitals. As I understand it, the major issue in Canada is delay for non-emergency care, not the quality of care that people receive. I see some other, more authoritative sounding Canadian seems to have said the same thing upthread. I'm not going to debate causation in John's case with you but I would be surprised if the issue was one of quality of care.

As far as the secrecy goes, given what I saw of him here, it seems to me that even if he swore you to secrecy, if you were that broken up about it, he'd be cool with you sharing it with people. It doesn't have to be people here - I'm sure you can talk to people who didn't know him about it.

Dude, are you installing that on a Speak 'n Spell? My PC is no gaming horse: Dual Core Pentium D 830 3 Ghz, 4 GB of 333 Mhz DDR2, and a GeForce 9400 GT 512 MB video card (though I have storage, 300 GB internal and 2 TB external.) But it took me maybe 20-25 minutes to install that. Still forever these days. If that game takes that long to install, the gameplay will still be gorgeous but it will be the equivalent of playing chess by mail.

In the end we all pay more if we all have to pay equally regardless of condition. I'm not sure how that is fair to the millions of people who either did what was necessary to stay healthy or are lucky enough to avoid being unhealthy. Why exactly should I pay more because you have diabetes? Shouldn't what I pay be based on the risks that I carry with me and not on the risks I carry as well as the risks you carry?

de-linking insurance and employment
This has huge implications, of course, on the employment market and resultant wages as well. Much of which is good (less market distortion!), some of which some people will think is bad (less people opting to enter the workforce!).

But here you have one of the more interesting outcomes of the idea that government has no role to play in goosing the market in order to discourage destructive habits, such as by leveling prohibitive tobacco taxes, banning all tobacco advertising, or severely restricting the addictive properties of cigarettes. That's the classic libertarian view, and it's perfectly consistent.
Oh, I very much think the government has a role to play here, regardless of how we eventually design our health care system. (Then again, I'm not a libertarian.) Furthermore, I know people in positions of influence who are in favor of sin taxes on fast food / subsidizing healthy food on both ends of the political spectrum. I'm not sure that's practical nor am I 100% convinced it's fair (after all, what's healthy for you isn't completely what's healthy for me + this could easily be politicized), but it will eventually be on the table and maybe even implemented. (Really. Though, I'm not saying anytime soon.)

We have a lot more to learn from them (the French) on this subject than they do from us.
Honestly, most other countries should be looking to us for ideas. After all, our system is more different than theirs compared to other peer nations. We're a lab for liberalization (as well as a showcase for choices you may not want to make).

Actually, while that's true, the major insurance companies are not in the business of pricing risk.
While I'm sympathetic to your analogy, this is an overstatement - pricing risk accurately is the prerequisite, even if you think you'll lose money on the contract. Small mistakes here have huge impacts. Big ones have potentially business collapsing impacts.

Dude, are you installing that on a Speak 'n Spell? My PC is no gaming horse: Dual Core Pentium D 830 3 Ghz, 4 GB of 333 Mhz DDR2, and a GeForce 9400 GT 512 MB video card (though I have storage, 300 GB internal and 2 TB external.) But it took me maybe 20-25 minutes to install that. Still forever these days. If that game takes that long to install, the gameplay will still be gorgeous but it will be the equivalent of playing chess by mail

Ah speak and spell when the word "language" was probably the toughest question.

No, the download took 20 to 25 minutes but now it is downloading a patch which of course in today's gameworld can be almost as huge as the game itself. I'm running at about 40 kb/s on the download and have gotten about 22% of it downloaded.

I played Medieval TW 2 on a laptop that was about 2 years older than this one. The battle screens had to be dampened down and it would still occasionally get slow but it was still pretty smooth. I imagine with this laptop I won't get all the bells and whistles to work but it should be pretty smooth and I generally don't do a lot of battles manually so the biggest graphical problem is that big of a deal for me.

I am continually baffled at the horror with which Americans regard higher taxes.

Some of us Americans share your bafflement.

Well, not bafflement exactly. Exasperation would be a more accurate term.

The compassion issue is a complete straw man - compassion is what you do, not what you force someone else to do.

Sez you.

Some of us Americans share your bafflement.

Well, not bafflement exactly. Exasperation would be a more accurate term.

Well, did you _see_ what was in the "stimulus bill"? Why on earth would anyone be happy to pay higher taxes to fund many of those expenditures?

It's extremely unfortunate when these situations happen, but I just don't get what the justice is to simply transfer the misfortune to unrelated persons.

The compassion issue is a complete straw man - compassion is what you do, not what you force someone else to do.

Where's the justice in someone being born without any health problems? I have some strong libertarian leanings on issues relating to crime, speech, lifestyle, all that but I've always struggled with the libertarian idea that using the power of the state to correct for things that are beyond the control of individuals (or only minimally within their control) is somehow just.

I had the good fortune to be born in Canada to two bright, healthy parents who valued education, so I was brought up in a middle class to upper middle class household, encouraged and supported in the pursuit of an education and have been blessed with good health. While I did the work and put in the time, as far as my basic capacities and good health go, there's no justice in what I got - when souls were leaving wherever they wait before being born, the spin of the wheel went well for me in terms of where I ended up. What makes the results of that initial spin just? How can I seriously say to someone, to use an example from the Canadian context, who is born on a reserve to parents who are plagued by alcholism, where they receive terrible care as a kid, \"#### you, I got mine...and I deserve it." I mean it's absurd.

Actually, while that's true, the major insurance companies are not in the business of pricing risk. At least, that's not their actual motive for doing business. A typical insurance underwriter actually loses money on underwriting, only grabbing 95-97 cents in premiums for every dollar they pay in claims. What they are in reality are massive raisers of funds who exist to reinvest those funds and make considerable amounts of money there. They're basically the real-world equivalent of the ubiquitous finance example of a company with infinite positive NPV projects, and their business is that of raising as much capital as they possibly can without losing their shirts on that side.

This is mostly true but overstated. Underwriting is the most important discipline an insurance company has. Another example from my father in law, is when he helped a rural hospital network setup their own health insurance company because they felt the big guys were pricing too high in their towns. After he left, the new CEO mispriced their products, they figured that out early this year and were shut down about 3 months later. Pricing your products with the assumption that investment earnings will always take care of underwriting losses is a recipe for disaster the one year it isn't true. Warren Buffett and Hank Greenburg, two of the most successful insurance CEOs of all time, both preach this.

And those slim profits include investment profits, so it's not like they are earning massive returns either way. Given the limitations they have as insurance companies, they can't even earn high returns on their float because it has to be invested conservatively.

Ideology aside, I'm interested in what people think will happen here:

1. Obama and the Dems ram a bill through that includes a public option;
2. Obama and the Dems get a watered-down version of what he wants, without a public option;
3. No bill is passed.

If 1, what harm, if any, do the Dems suffer in the midterms?

If 1, do Obama's chances of getting re-elected suffer greatly?

Well, did you _see_ what was in the "stimulus bill"? Why on earth would anyone be happy to pay higher taxes to fund many of those expenditures?

Because not all of those expenditures, but many of them are highly worthwhile, and a sound investment in our economic and general welfare. Precisely as E. Hinske above puts it: stuff costs money. The reflexive rejection of any tax increase that informs the majority of right-wing discourse is can only be described as shallow.

Medical treatment, it seems to me, is separate from the rest of liberal economics. I don't disagree with the notion of an economy that pays CPAs more than musicologists, because of market forces that place the former in more demand than the latter. Such a thing saddens me, because it speaks negatively of human nature, but I logically understand it and know it's the way things are. Medicine, on the other hand, is life and death. If human beings can't rise above their competitive, animal nature to work as hard as possible--at this late date of supposed advancement--for the equal opportunity of their fellows to breathe for one more day, then all our work and sacrifice through the centuries has so far amounted to nothing.

Some human societies, of course, have done this. And their "solutions" have flaws; vast flaws at times. But many of these societies have worked harder, and done better, than ours.

As much as this wanders slightly into the land of hyperbole, what with the "then all our work and sacrifice through the centuries has so far amounted to nothing" line, I think this is a very sober view of the larger issue. I think this debate should boil down to one of basic human rights, and not one of compassion or charity (though, semantically, you may view the latter two terms as synonymous with the former). If we can save lives, we should (and as a strong defender of a woman's right to choose, I would say this also extends to the abortion issue).

Cuba, for all its economic backwardness, is able to train doctors and ship them by the boatload to ideologically friendly regimes. The fact that we can't cover our own citizen's health care is shameful, especially as we send our army and navy and marines half way around the world for decades at a time.

Ideology aside, I'm interested in what people think will happen here:

1. Obama and the Dems ram a bill through that includes the public option;
2. Obama and the Dems get a watered-down version of what he wants, without the public option;
3. No bill is passed.

If 1, what harm do the Dems suffer in the midterms?

If 1, does Obama get re-elected?

My prediction is 2, with the public option traded off as a bargaining chip to secure meaningfully increased regulation of insurance companies. Not my ideal outcome, but a definite step forward. And of course the public option can always be re-introduced somewhere else down the line.

It won't be seen as a total victory for Obama and the Dems, but more of a victory than a defeat, and it will provide him/them with meaningful momentum as they take up the other issues on the agenda, and move into the mid-terms.

As I understand it, the major issue in Canada is delay for non-emergency care, not the quality of care that people receive.

Those are inextricably linked. As it is, the U.S current system produces the highest cancer survival rates in the world, much better than in Canada or Europe. Waiting for care can be fatal sometimes.

http://www.ncpa.org/pub/ba596

1. Obama and the Dems ram a bill through that includes a public option;
2. Obama and the Dems get a watered-down version of what he wants, without a public option;
3. No bill is passed.

By the way, I think 3 is highly unlikely. 1 and 2 are close to each other. I'll go with 2. I don't think enough Dems have the backbone to vote for something that could well cost them their seats. Self preservation.

If 1, I think the Dems suffer huge, sweeping losses in the midterm elections, and Obama's chances in 2012 take a huge hit. I believe that with 1, Obama would be walking his party off the plank.

EDIT: Not that the damage wouldn't be done. If the kind of socialized health care Obama wants is ushered in, it would be decades at a minimum - if ever - before it is reversed. In fact, it would likely morph into single payer before all is said and done.

It won't be seen as a total victory for Obama and the Dems, but more of a victory than a defeat, and it will provide him/them with meaningful momentum as they take up the other issues on the agenda, and move into the mid-terms.

Well, I do agree that if the outcome is 2, the Dems would basically be ok.

2. Obama and the Dems get a watered-down version of what he wants, without a public option;

I'm going with this one. I also expect that it's the solution with which the supporters (by which I mean voters and not money-men) of both parties will be unhappy, and will worst serve the population as a whole.

Unlike Ray, I happen to think that 1. is probably the best outcome for Obama and his party - I expect that there will be a huge number of people who would be grateful for a public option, even if it's just as a chance to get away from whatever private option that they currently claim to hate, and that the people who hate the (existence of the) public option will largely be those who wouldn't be likely to vote for the Democratic Party anyway.

Those are inextricably linked. As it is, the U.S current system produces the highest cancer survival rates in the world, much better than in Canada or Europe. Waiting for care can be fatal sometimes.

Hmm. Interesting stuff. I'm hesitant to just accept the conclusion that universal health care is the cause of this though, because I wonder what they're really catching. Some of it - the pap smear test - doesn't make sense to me, at least in terms of universal care being the cause. The women I date generally seem to see their gynecologists annually and I'm reasonably certain that they're getting that testing.

I'm willing to concede that the numbers might be right; I just wonder what the causes are.

I'll deal with whatever system we end up with, but my main complaint is, like with The War in Iraq, we're getting negatives shooed away by the proponents because the underpants gnomes will magically take care of it.

Are you implying that there aren't underpant gnomes? 'Cause after wading through this long thread involving health care debate, it would be a serious shock to me to find that underpants gnome do not exist.

I apologize that I don't have an opinion to contribute towards this debate, but have learned from reading all of yours.

I played Medieval TW 2 on a laptop that was about 2 years older than this one. The battle screens had to be dampened down and it would still occasionally get slow but it was still pretty smooth. I imagine with this laptop I won't get all the bells and whistles to work but it should be pretty smooth and I generally don't do a lot of battles manually so the biggest graphical problem is that big of a deal for me.

If you are annoyed by the long installation time and having to deal with STEAM, wait until you actually try playing Empire Total War. It would be an awesome game if it was actually finished. You may not get all the bells and whistles like a functioning game. I try to play it on a fairly high-end machine, but the frequent crashes to desktop are nowhere near as annoying as the complete game freezes that lock up my PC. The patches available via STEAM since Empire Total War was released only seem to serve as band-aids. Sorry to be such a downer, but save often. And I hope your gaming experience differs than mine because maybe the underpants gnomes will magically make it so.

I also expect that it's the solution with which the supporters (by which I mean voters and not money-men) of both parties will be unhappy, and will worst serve the population as a whole.

I disagree that it will worst serve the population. The status quo has that title wrapped up, hands down.

A bill that establishes meaningful regulations on the insurance industry is a step forward. It isn't the end of the road, but it's a step forward.

Brian Urlacher is out for the season?!

I think it'll be #2 as well, though (like Ryan) I think #1 is the best outcome politically for '12. 2010 is interesting, though - that's a slightly different crowd to please.

Things can always get worse, Steve. (Which is not to say that they will - there's a lot of low hanging fruit to be picked, as they say.)

Morneau is out for the year as well, per the dugout.

The patches available via STEAM since Empire Total War was released only seem to serve as band-aids. Sorry to be such a downer, but save often. And I hope your gaming experience differs than mine because maybe the underpants gnomes will magically make it so.

I save often as it is so that part won't be a problem and waiting as long as I did was because I figured the game wouldn't be ready when it was launched, they never are. Hopefully the band aids are at least partially a step 2 in the underwear gnomes playbook.

The new Total War is great, especially when you get a simple mod so that you can play any faction. (I don't like jumping in with half a dozen areas to micromanage).

Napoleon Total War comes out in Feb!

How can I seriously say to someone, to use an example from the Canadian context, who is born on a reserve to parents who are plagued by alcholism, where they receive terrible care as a kid, "#### you, I got mine...and I deserve it." I mean it's absurd.

It is, but people have their philosophies and priorities to live by. And this particular one is too common everywhere.

Things can always get worse, Steve.

And they will, until and unless serious reform is enacted. The status quo is the worst outcome.

I disagree that it will worst serve the population. The status quo has that title wrapped up, hands down.

But there are plenty of fixes that can be made to the system without settling for the status quo. In any event, yes, the status quo _would_ be better than what Obama is offering.

Period. End of story. (There. That ought to convince people.)

Morneau is out for the year as well, per the dugout.

And don't look now but since the Cubs lost Alfonso for the season they are making a run at the WC.

I don't even bother with Steam. I have my legal copy still in the box. I like supporting publishers that I like, but I prefer not having to deal with obnoxious extra installs and copyright protection.

I disagree that it will worst serve the population. The status quo has that title wrapped up, hands down.

That's certainly possible, but I can't see how a system that mandates people obtain coverage, but doesn't provide them with either a new option from which to obtain coverage, or a way to ensure that those with pre-existing conditions can even obtain coverage, is really any better or notably different than what's in place now. Really, option two just seems like a great way to ensure that the insurance companies increase the quantity of business without really increasing their risk.

Of course, not actually being subject to your current system, I may be completely wrong.

Well, between 354 and 355 I think we've got this settled. Good night!

Napoleon Total War comes out in Feb!

I never liked the expansion packs. They always seemed way more complicated and much narrower in their scope than I enjoy.

Anyone try the Special Forces edition of Empire?

The new Total War is great, especially when you get a simple mod so that you can play any faction. (I don't like jumping in with half a dozen areas to micromanage).


Isn't there a cheat that usually lets you do this? Basically it lets you declare victory thus allowing you to play almost all of the factions. Granted a mod lets you play all of them but like Hearts of Iron (which by the way I took a look at HoI 3 and it looks like you need advanced degrees in several fields to actually play) a lot of them don't look all that fun to play.

I don't even bother with Steam. I have my legal copy still in the box. I like supporting publishers that I like, but I prefer not having to deal with obnoxious extra installs and copyright protection.

I thought about downloading it but I didn't want to go through hassle of phantom drives and so forth and it seemed like the downloadable versions were extremely buggy. Now from what I hear that may very well have been the actual game but I've bought all the other TW games and like you I like supporting game companies that I think are putting out a good product.

I can't see how a system that mandates people obtain coverage, but doesn't provide them with either a new option from which to obtain coverage, or a way to ensure that those with pre-existing conditions can even obtain coverage, is really any better or notably different than what's in place now. Really, option two just seems like a great way to ensure that the insurance companies increase the quantity of business without really increasing their risk.

Obviously Ray's 2nd option was vaguely articulated, but I don't envision it as being as you describe; I don't think such a bill would be passed by anyone. I envision the 2nd option as including meaningful insurance regulations that solve some of the problems you describe, even if they don't mandate universal coverage.

Because not all of those expenditures, but many of them are highly worthwhile, and a sound investment in our economic and general welfare. Precisely as E. Hinske above puts it: stuff costs money. The reflexive rejection of any tax increase that informs the majority of right-wing discourse is can only be described as shallow.

Many of them? That assertion sounds as detached from reality (or as "shallow") as the typical Keynesiastic assertion that spending our scarce resources filling and digging holes is stimulative.

The bridge to nowhere is the great counter example. It could never come close to repaying it's investment. The locals simply would never spend enough on tolls, they'd rather take boats then pay the difference for a bridge. It's an economic black hole, converting part of this country's savings into an "asset" of lesser value. Those savings can actually create a positive return if invested intelligently, which the free market, for all it's manias and failings, does almost unfailingly, while government can only do by accident.

Another example is virtually every government subsidized sports stadium project. Every unbiased economic study has shown the negative economic value of building gigantic cement caverns that are empty 80% of the year, and that pay mostly minimum wage even when in use. We all should know this on Primer already. So why don't we understand that government subsidized projects for other politically connected industries are nearly all as awful as sport stadiums?

The bridge to nowhere is the great counter example ... Another example is virtually every government subsidized sports stadium project.

Correct me if I'm wrong, but I'm pretty sure that the bridge to nowhere wasn't included in the stimulus bill to which Ray referred. And neither, I believe, were any sports stadium projects.

The stimulus pkg has/had a great many flaws, but it's real money dedicated to real projects to employ real people. Bush's stimulus pkg was nothing more than tax cuts heavily skewed toward portfolio income earners in red states. Rewarding buying a few more shares of the local utility has far less stimulative effect than funding a public works project. Each approach has weaknesses, easily exposed in Econ 101 (or 102, depending where you matriculated) but speaking in terms of EFFICACY -- cuz that is what it's all about, no? -- the current is a vastly better plan than the former.

This is mostly true but overstated. Underwriting is the most important discipline an insurance company has. Another example from my father in law, is when he helped a rural hospital network setup their own health insurance company because they felt the big guys were pricing too high in their towns. After he left, the new CEO mispriced their products, they figured that out early this year and were shut down about 3 months later. Pricing your products with the assumption that investment earnings will always take care of underwriting losses is a recipe for disaster the one year it isn't true. Warren Buffett and Hank Greenburg, two of the most successful insurance CEOs of all time, both preach this.

And those slim profits include investment profits, so it's not like they are earning massive returns either way. Given the limitations they have as insurance companies, they can't even earn high returns on their float because it has to be invested conservatively.

True, I was a bit hyperbolic at the beginning. If anyone is learning something new here, it's probably instructive to think of an insurance company as equivalent to a retailer in a marketspace of razor-thin margins. Underwriting can be thought of as costs, and investment income as income. Absolutely it is critical to keep your costs in line in that scenario, I was more talking about where the heart of the business is. A dollar saved in costs spends just as well as an extra dollar of profit, but nobody is actually in the business of cutting their own costs.

I traveled to Alaska on a cruise with the family last year.
We stopped in Ketchikan and got to see the proposed site for the bridge.
It really isnt a bridge to nowhere; it a bridge tha would cost tens of millions of dollars and serve a very small population. The bridge would link the townsfilk of Ketchikan with their airport whish currently reides on the only flat land anywhere nearby. unfortunately that flat land is on an island across from town, necessitating the bridge.
Even though the money to build the bridge got eliminated in later legislation a goodly amount of money has been and is still being spent to prepare both sides of the two land parcels in anticipation of a bridge eventually being built.
Beautiful part of the world Ketchikan; going their by cruise ship was great.
I urge all readers to take an Alaska cruise at least once in their life.

Well, yeah, it was a bridge to IIRC something like 200 people, not an actual bridge to nowhere. Only Wile E. Coyote can build those.

Jingoist fails to mention that this very small population already has a perfectly serviceable and cheap alternative to getting to that airport which is a ferry. They called it a Bridge to Nowhere but they should have called it the Bridge of No Point.

Correct me if I'm wrong, but I'm pretty sure that the bridge to nowhere wasn't included in the stimulus bill to which Ray referred. And neither, I believe, were any sports stadium projects.

And neither were any projects that had economic value greater than their cost, I just gave you two examples of typical pork barrel spending after you praised a stimulus bill that was full of pork barrel spending. It might be possible that in a perfect world a brilliant, unbiased, technocrat could make more rational investment decisions than the free market can, but there aren't any unbiased technocrats on capital hill making decisions about what goes in the stimulus bill. The "stimulus" was spent on what our representatives decided was most important to ensure their re-election, i.e. handouts to important political constituencies, lobbyists, and donors, wrapped in the flag and sold as an economic savior.

And neither were any projects that had economic value greater than their cost

Do you have some analysis that supports this? Or is this theory?

Part of the point of government spending is to spend money on projects that private industries wouldn't since they are unlikely to make a profit but still viewed as beneficial to society. Things like roads, museums, and yes giant star machines for planetariums. Since when did it turning a profit become a prerequisite of government spending?

The stimulus pkg has/had a great many flaws, but it's real money dedicated to real projects to employ real people. Bush's stimulus pkg was nothing more than tax cuts heavily skewed toward portfolio income earners in red states. Rewarding buying a few more shares of the local utility has far less stimulative effect than funding a public works project. Each approach has weaknesses, easily exposed in Econ 101 (or 102, depending where you matriculated) but speaking in terms of EFFICACY -- cuz that is what it's all about, no? -- the current is a vastly better plan than the former.

There is no EFFICACY in the stimulus package. You are simply arguing there is less INEFFICACY than there was in Bush's budgets. Both take money out of the private sector that would normally be invested only with the expectation of positive returns, i.e. the creation of more economic value than was invested, and are now invested in a bunch of projects that will produce less economic returns than investment, i.e. negative returns on investment. Less negative is still negative.

Saying that this president is less stupid than the last president doesn't make this president smart, or even not stupid. Sure, I'd take Obama over Bush every day and twice on sunday. Bush's inflation of our national debt was a disgrace, esp. for an erstwhile "fiscal conservative republican". But now Obama is going to put us deeper in debt faster than Bush, and our nation is going to be poorer for both of their efforts. How high will your childrens taxes have to be to pay for this binge of borrowing?

How high will your childrens taxes have to be to pay for this binge of borrowing?

Not that high since they won't want to pay for this anymore than we do so they'll push it off to their chilren and so on and so on.

I remember reading something about how the Civil War was finally paid off in the 1990's if that is true then I've paid for part of every single war from the Civil War and on.

Part of the point of government spending is to spend money on projects that private industries wouldn't since they are unlikely to make a profit but still viewed as beneficial to society.

No, that is what your representatives tell you to justify the spending.

Things like roads

Throughout history roads have shown they can be funded directly by usage fees, but since Eisenhower the massive intrusion of federal spending into highway construction came with an edict that basically killed toll roads. For a long time (and maybe still) states and local muncipalities could not charge tolls or fees on federally funded roads. Since the feds gave cities and states massive amounts of free money (actually: gave back them their own gas tax revenues with strings attached) to build highways they made it economically impossible to build toll roads. The result? Massive congestion because roads were built more based on political necessity than economic need, and road usage was treated as free. Cities and states were hamstrung by the costs of just maintaining these roads.

museums,

I guess I can stop supporting all these museums I pay for myself and my children to be members of then...

and yes giant star machines for planetariums. Since when did it turning a profit become a prerequisite of government spending?

Turning a profit is a measure of an economically positive investment. Building a giant star machine makes economic sense if it's users will pay enough to cover construction and operation. If they won't it says all those visions of giant stars weren't worth the cost to the beneficiaries.

Are their external and indirect beneficiaries of and economic benefits to government spending? Sure, but that's true of private investment as well. When a private business builds a large office building because it makes economic sense, they also benefit the restaurants, car washes, and child care centers, in the area.

Where government is needed in places where the free market can't function, typically in "tragedy of the commons" situations where a resource can't have a natural owner with incentives to prudently manage it. Examples are air pollution, the natural populations of sea creatures, etc. And ironically, for all of these massive government spending programs, we still don't have carbon caps, pollution trading rights, or intelligent management of the seas natural resources, things that government can do well, or at least much better than anarchy can.

While at college, I made the horrible decision of following my passion and talent, and becoming a composer and musical scholar instead of the CPA or whatever that I could just as easily have become.

I don't say it was a horrible decision. I do say it was a decision. I play the piano; I compose; I have a minor in music. I'd have loved to become a composer and a musical scholar. I chose to have more stability.

In Ray's world, I very clearly chose not to have health insurance, and if I wanted to have health insurance, I'd have gone into a field of study that allows one to more quickly and easily get jobs with benefits.

You "very clearly chose" a profession that provided you less stability and less financial security.

But the health insurance thing gets my goat. Why should the people who love me have to say goodbye to me if I needed a liver or heart transplant, when the people who love Ray wouldn't? Because I love beautiful music more than I love slide-rules and ticker tape?

On the other hand, why should the people who don't love you have to subsidize your passion for beautiful music by (in many cases) giving you dollars they earned working 70 hours a week, or dollars that came as a result of risk-taking/intelligence/etc.? Because they chose to endure slide-rules and ticker tape rather than following their passions?

I remember reading something about how the Civil War was finally paid off in the 1990's if that is true then I've paid for part of every single war from the Civil War and on.

I'm pretty sure our debt from WWII hasn't been fully repaid yet. Supposedly the national debt reached a peak of 31% of GDP during the Civil War. It is supposed to hit 53.8% of GDP this year. WWII was worse, it hit 122% of GDP in 1946. But in both the case of the Civil War and WWII, we got something for all that debt, we won important wars and ensured our freedom and the freedom of about half the world in the second case. Our current debt is no different than running up credit cards to eat dinners out. We are unable to make tough choices about spending so we choose everything, just like GW Bush taught us to do.

http://www.forbes.com/2009/09/10/national-debt-default-opinions-columnists-bruce-bartlett.html

The reality is that your kids won't have to repay the debt with taxes. They'll repay it through hyperinflation or repudiate it. It doesn't make sense that a future generation would agree to devoting up to half their taxes to paying off the spending of a prior generation. Viva La Bush Con Obama Fiesta, !

I guess I can stop supporting all these museums I pay for myself and my children to be members of then...

You could but that would still leave them money that is granted to the by various government bodies.


Throughout history roads have shown they can be funded directly by usage fees

Yes and until recently roads were a rather primitive thing and building a national road system is probably just as impossible to do privately as it was to build a national rail system or air system.

If they won't it says all those visions of giant stars weren't worth the cost to the beneficiaries.


Nonsense, it simply means you didn't put the proper dollar value on what people want or need.

Read the article and the funniest part to me was in the comments section where somebody starts off his comment with the statement: Deomcracies don't work in the long run. Well, what the F is the long run? 500 years? 100 years? 200 years?

Yes and until recently roads were a rather primitive thing and building a national road system is probably just as impossible to do privately as it was to build a national rail system or air system.

Bad examples, as private business were the predominant builders of our national rail system ( even the transcontinental railroad relied on heavy private investment despite it's subsidies), and our national air system. The fallacy to the argument is the assumption that because roads were primitive before Eisenhower's effort, that they would have remained so, or that if Lincoln hadn't subsidized the transcontinental railroad, that it never would have been built. Government aid speeded these efforts, but they were mostly inevitable. But the building of large national freeways would have been done more efficiently, and produced more economic benefit focusing on specific regions where demand was highest rather than the the political needs to build a complete "national system" that politicians could trumpet to every taxpaying district for reelection. Bad money drives out good, you can't build roads privately if public money is spent to give away free roads.

Nonsense, it simply means you didn't put the proper dollar value on what people want or need.

Nonsense, it simply means THEY put the proper dollar value on what they want and need, and found a higher and better use for their money.

Deomcracies don't work in the long run. Well, what the F is the long run? 500 years? 100 years? 200 years?

Right now it's looking like 250 years. Democracy leads to special interest groups who have very focused goals being able to capture more and more of a countries wealth over time. Current government spending is over 30% which I believe is by far a peace-time record, and many times higher than it was before WWII. I thought that Clinton showed that spending could be contained, and that maybe had reached a post-war peak around 22% of GDP, but the reaction to the Bush recession smashed far past that "barrier".

Perhaps I'm just a gloomy gus, and that Obama will guide spending back down and start paying down debt in his second term. But the long term trend in government spending seems to say that our children will need to forfeit half their annual earnings to taxes just to keep even with debt payments, social security and medicare. God forbid we have a real war.

of course I should correct that to say your children will have to pay confiscatory taxes, I'm taking mine to Costa Rica;)

I don't get the hysteria about pre-existing conditions. Why shouldn't the person with the pre-existing condition pay more?

Possibly they should, but it creates a problem mentioned earlier: people in ill health (but surviveable) have a strong disincentive to have problems looked at unless and until they get medical insurance, otherwise their future insurance will be massively more expensive. Which in many cases means that the condition strengthens and wreaks havoc in their bodies.

Example: Individual A has no health insurance, but is hopeful of being able to get some in 2/3/5 years. A has been feeling bad lately, coughing up bad stuff and in a great deal of pain. Individual A forgoes any kind of treatment, because diagnosis of a pre-existing condition would massively harm their ability to get affordable insurance in the future.

Individual A gets sicker and sicker, with the following outcomes possible/probable:

1) Permanent damage is done to A's body, up to and including death
2) The problem that A has is transmittable, and is promptly transmitted to others
3) While A is sick, A has increasing trouble gaining new employment (which might get A the insurance he/she needs) or indeed doing anything well, including attaining qualifications that might help get him/her new employment
4) In a few cases aside from case 2) above, A puts other people's lives at risk too from being in poor health. Perhaps A has a part-time job preparing food, or driving a bus, or something.
5) And, of course, the stress of being ill with no diagnosis or immediate remedy in sight is debilitating to A too.

The current system creates a strong disincentive for sick people without insurance to have conditions covered, up to (and sometimes including) the point at which they become life-threatening. The treatment itself may be available, but the implications for their future can be devastating.

I've still not seen a straightforward explanation for how to address this problem, in this or any other non-'socialized' system. But I will say that there are surely very strong quantifiable and non-quantifiable benefits to a system in which people are structurally incentivized to get treatment if they're sick.

Require everyone to have health insurance with a maximum deductible of 15% of annual income.

Everyone will have a right to buy insurance nationally, no longer will state insurance commissioners be allowed to restrict insurance offerings. Insurance costs will decline substantially due to reduced regulation, increased competition, and greater economies of scale leading to lower marketing and administration costs. Consumer choice will increase substantially.

Anyone who still can't afford health insurance will automatically get enrolled in a government insurance program. The government program will include free regular preventive medical exams, and full coverage with minor deductibles and co-pays. This program will be paid for by a 15% mandatory payroll tax on each enrollee.

Problem solved.

Everyone has health insurance.

No one will go bankrupt from medical costs.

No one has to worry about pre-existing illnesses preventing them from getting coverage.

Everyone will get preventive care if they want it.

And all at very reasonable costs.

Anyone who still can't afford health insurance will automatically get enrolled in a government insurance program. The government program will include free regular preventive medical exams, and full coverage with minor deductibles and co-pays. This program will be paid for by a 15% mandatory payroll tax on each enrollee.

I'd be interested to see the math on this. Assuming that a large number of enrollees to the government scheme would be unemployed or partially employed, does this add up?

Everyone will have a right to buy insurance nationally, no longer will state insurance commissioners be allowed to restrict insurance offerings. Insurance costs will decline substantially due to reduced regulation, increased competition, and greater economies of scale leading to lower marketing and administration costs.

And then everyone will get a pony!

I mean, if we're all making #### up anyway, why can't I have a pony, too?

EDIT: to clarify, I have little doubt that deregulation of the insurance industry would produce some low-cost plans. I also have little doubt that it would create some really terrible plans that left millions of folks without the health coverage they thought they had. (You can't shop around for a new coverage plan after being billed $8000 that you thought was covered.) We'd end up with a government plan that carried anyone deemed too risky by insurance companies, and it would see its costs skyrocket.

OK, but that still leaves hanging the question of whether a person who is born with a pre-existing condition should have to pay a higher rate the first time he buys insurance than a person without such a misfortune.

Andy,

That's why I said you have to have a government funded network of county hospitals and free clinics. If you can't get insurance b/c of pre-existing conditions, you go there, and you get charged based on your income (probably some maximum % cap).

The person born with a serious condition gets subsidized, but not through the insurance market.

Jumping all over bbchick was uncalled for. If you did you are a ########.

I didn't jump on her (aside from a "WTF?"), but she was the one who raised the issue in the most cryptic way possible. I think the responses were understandable.

I am continually baffled at the horror with which Americans regard higher taxes

An American can be defined as someone who will pay an accountant $200 to avoid paying the government $100.

Back to insurance for a moment: there seems to me a fundamental difference between insurance that covers risks you take on voluntarily (like those of driving a car, owning jewelry, owning a house that might burn down) – or even life insurance, which is a win-win actuarial proposition for insured and insurer, given that death is a 100% certainty and the profit comes in balancing sooner or later;

... and health "insurance," which is, at universal levels, a guarantee by the state of a certain basic level of service.

It gets confusing as heck if you conflate the two in a single concept of "insurance." Yes, people who keep open containers of kerosene near faulty electrical wiring should have to pay more for fire insurance than normal folks. It doesn't therefore follow that someone with Type I diabetes should have to pay more for basic health care than someone who never sees a doctor. That way of phrasing it is going to sound perverse to pay-as-you-go individualists, but it's the basic idea behind national health services.

Isn't there a cheat that usually lets you do this? Basically it lets you declare victory thus allowing you to play almost all of the factions.

In the latest, winning does not unlock all the factions, so you have to dl a quick mod if you want to play as Bavaria or Morocco.

... and health "insurance," which is, at universal levels, a guarantee by the state of a certain basic level of service.

I know of no such guarantee.

How is health insurance any different from life insurance in terms of risks faced? Why is a family being bankrupt b/c of an illness any worse than a family being bankrupt b/c of the death of a wage earner?

OK, but that still leaves hanging the question of whether a person who is born with a pre-existing condition should have to pay a higher rate the first time he buys insurance than a person without such a misfortune.

Andy,

That's why I said you have to have a government funded network of county hospitals and free clinics. If you can't get insurance b/c of pre-existing conditions, you go there, and you get charged based on your income (probably some maximum % cap).

The person born with a serious condition gets subsidized, but not through the insurance market.

Okay, now I get what you're saying. It wouldn't be my preferred solution, but it'd be an improvement over what we have now.

On a slightly related note, there's an interesting story in the today's Post about the walk-in clinics at retail stores such as Wal-Mart and CVS, which have been around for a couple of years. They're only for certain minor ailments or emergencies, and they're staffed by nurse practitioners and physician assistants, but for many people who can't afford either insurance or regular doctors, they're a godsend, especially since they're walk-ins that are often open 24/7 and don't require an appointment, and the costs are far less than they would be otherwise. Obviously it's not the solution for more serious and chronic illnesses, but it's certainly a lot better than nothing.

It's not hard to make the argument (not that I'm necessarily buying it) that "Life, Liberty, and the Pursuit of Happiness" would apply to providing for reasonable health insurance to keep you alive and happy as a public work/good while providing your family after you die only goes as far as it applies to the individual members of it. One could also argue that if the state should recognize and protect the concept of a family unit the same as it does individuals, why not life insurance? If it ever got as out of control as health insurance has, the state should step in per the argument, but it doesn't have to right now.

On a slightly related note, there's an interesting story in the today's Post about the walk-in clinics at retail stores such as Wal-Mart and CVS, which have been around for a couple of years. They're only for certain minor ailments or emergencies, and they're staffed by nurse practitioners and physician assistants, but for many people who can't afford either insurance or regular doctors, they're a godsend, especially since they're walk-ins that are often open 24/7 and don't require an appointment, and the costs are far less than they would be otherwise. Obviously it's not the solution for more serious and chronic illnesses, but it's certainly a lot better than nothing.

There are also an increasing number of doctors who are going "cash only". b/c they don't take insurance, they can cut a ton of overhead, and serve the uninsured or partially insured mush more cheaply.

I didn't jump on her (aside from a "WTF?"), but she was the one who raised the issue in the most cryptic way possible. I think the responses were understandable.

Some things you just gotta let slide. This was one of them.

I know of no such guarantee

Well of course, not in America, snapper. I'm talking about civilized countries :)

Some things you just gotta let slide. This was one of them.

Concur. I don't see why her story is so implausible as to invite attack.

Andy/391 - I'm upper-middle class and (as mentioned previously) use them as well (granted, I've an HSA so this affects the math of how I do things) - they've worked out well for me.

Some things you just gotta let slide. This was one of them.

Concur. I don't see why her story is so implausible as to invite attack.

There was an allegation that one of the more beloved posters here was killed as a result of medical negligence. That statement had about as much chance of sliding as Jeremy Giambi.

I know of no such guarantee

Well of course, not in America, snapper. I'm talking about civilized countries :)

Well, there is of course that sort of guarantee in the U.S. in regards to emrgency treatment.

The issue, which no one seems to want to address, is what is the basic level of service. It can't be the best care money can buy, or you bankrupt the nation. It also should be more prevention, maintenance focused than our current system provides.

That's why I like the two-tiered system. Everyone is guaranteed a basic level of care free (if indigent) or based on your level of income, but not the cutting edge stuff (i.e. you get a coronary bypass, you don't get a heart transplant). The public hospital/clinic system can have rationing/cost-benefit rules like the NHS does in Britain, while giving people the freedom to purchaes better coverage privately.

Everyone thus has an incentive to want to particpate in the private insurance market, if they can possibly afford it, and get the better care. It also lets the insurance market function as insurance, w/o having to subsidize the indigent and the truly uninsurable cases. The continued existence of a private system retains the incentive for the development of advanced treatments that a national system probably wouldn't pay for, but people may want to be covered for.

I find nothing immoral with those who pay to support the system getting a higher level of care than those that don't, in fact I think the other way round is more troublesome. But, i do think a basic, minimum level of care should be provided to all.

There was an allegation that one of the more beloved posters here was killed as a result of medical negligence. That statement had about as much chance of sliding as Jeremy Giambi.

But it could well be true. I've lost loved ones to medical negligence right here in the good ole USA. I've also have distance relatives die from neglect in European socialized systems.

If it is true, wouldn't you feel really bad jumping on her? Given Dan's posts, it seems she's the most likely one here to know the truth.

The issue, which no one seems to want to address, is what is the basic level of service

I agree. Terror is being struck into the hearts of Americans at the prospect that health care will be "rationed." To tone down my earlier facetious comment that some get 100% and meatwad gets 0%, I'll take a more reasonable tack: health care is absolutely rationed by managed-care companies, by "utilization-management" nurses, by the terms of insurance policies, by state regulations. The question is, managed in whose interests, and how equably?

The basic concept of national health seems to me a lot closer to Social Security than to insurance. Of course, Social Security has been sold over the years as a sort of combination of retirement savings and life/disability insurance. God forbid Americans should actually support a program that redistributes money from workers to those who can't work.

Andy/391 - I'm upper-middle class and (as mentioned previously) use them as well (granted, I've an HSA so this affects the math of how I do things) - they've worked out well for me.

Good to hear that, Der Komminsk-sar. And much as I rag on Wal-Mart and CVS, I've got to give them credit for their part in helping to establish those walk-ins. And by now, it's estimated that a full third of the population lives within a ten minute drive of one of them. That's pretty impressive.

And it's best not to underestimate how much the removal of the intimidation and procrastination factors may do in prompting people to seek help for a problem that they otherwise might have let grow out of control. I think that many people forget just how bad it can be to come down with something on a Friday night, and not be able to do anything until Monday morning other than to go to an emergency room. Many times if you've never been to the hospital before, you don't even know where it is; you have no idea what it's going to cost you; and worse, if you don't have a regular doctor, there's not even the option of waiting until Monday to get him to look at you. That's why even though I've never had to go to one of these places myself, I call them a godsend.