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Monday, March 26, 2007
Herman Cain :: Townhall.com Columnist
Universal Choice Can Fix the Health Care Roof
by Herman Cain
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Will the Dems' health care Christmas Present to America be an improvement or detriment to our health care system?


A simple change in the antiquated tax code would create an avalanche of universal choice in health care, instead of current proposals that produce universal dependence on government. Namely, the U.S. should eliminate the deductibility discrimination between employers and employees for health insurance premiums.

The ideal solution would be to replace the tax code with the Fair Tax, which essentially replaces the income tax with a consumption tax. But since few politicians with a bully pulpit have shown the moral or political courage to lead the sizeable Fair Tax movement, let's start with the second best approach, universal deductibility.

Universal deductibility of health insurance premiums by employers, employees, the unemployed, individuals and business owners would connect the consumer to health care costs. When people spend their own money, they spend it more wisely. Most people will purchase health plans they can afford, instead of expecting more benefits from their employer or the government.

The flagrant flaw in most of the ideas proposed by the presidential candidates is that they are variations of socialized health care.

Hillary Clinton, Barack Obama and John Edwards have all offered health care plans that eliminate individual choice and increase government mandates on employers, individuals and health care providers.

RomneyCare in Massachusetts is already experiencing a cost explosion. The only Republican to propose a market-based solution is Newt Gingrich, who has not yet declared his candidacy.

The proponents of socialized health care do not believe individuals and doctors possess the ability to make their own health care decisions. They would rather take advantage of what Steve Forbes recently described as "the abysmal ignorance of so many – including boatloads of business executives and entrepreneurs – about what it takes to bring rationality, productivity and lower prices to the U.S. health care market."

The greatest flaw of Health Savings Accounts (HSAs) and President's Bush's new proposal is that they are tied to the disastrously flawed tax code in the form of yet another tax deduction. These plans are improvements on the current discriminatory system, but they further complicate an already incomprehensible tax code.

The president's proposal, which allows deductibility of health insurance premiums, has a hidden "sneak-a-tax." Under the Bush plan, if your employer pays more than $15,000 for your annual health insurance premium, you pay tax on the excess coverage. Below that amount for a typical family, the plan provides only small, non-game-changing savings. Worse, the plan is not indexed to inflation. When inflation eventually catches up to the $15,000 deduction, families will suffer the same tax penalties posed by the Alternative Minimum Tax.

HSAs are another concept that was supposed to "move us in the right direction" of more affordability and accessibility of health insurance. HSAs have worked for many, but way too slowly as health care costs and insurance premiums have increased at annual double digit percentages.

The socialists among us object to universal choice because they fundamentally believe that government can spend people's hard-earned money better than the person who earned it. The bureaucrats object to universal choice because it would force them to cut wasteful spending to "offset" the "lost" revenue from allowing the deduction. That's political speak for "our job is to continue to rearrange the deck chairs on the Titanic."

Even with universal choice, the liberals will still scream about the 47 million people who do not have health care. They will ignore the 63 percent of the uninsured who work for small businesses that cannot afford health insurance coverage because the costs keep rising faster than their profits. Conservatives ought to counter with the 253 million people who have private health insurance that four of the presidential front runners want to take away.

As I stated on an NBC health care special in 1994, if you have a leak in the roof of a building and you know that the roof is leaking, you don’t blow up the building to fix the leak in the roof. That's what total government control would do to our health care system. The system will work if government would get out of the way. We don't have to blow up the system to fix a few leaks.

Universal deductibility would stimulate universal choice, which would fix the leak in our health care system's roof while making the building stronger.

The free market system, in which the consumer has access to information, choices and his own money, has driven down the prices of all goods and services that government has not overregulated or over-controlled. With a simple change in the current tax code to eliminate discriminatory deductibility for health insurance and eventually health care costs, free market dynamics can solve another problem that Clinton, Obama, Edwards and Romney want to make worse.

Universal choice in health care is a choice the public must demand. Otherwise, they will have to live with the disease of socialized health care.

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About The Author

Herman Cain is the National Chairman of the Media Research Center’s Business & Media Institute. He is the former president and CEO of Godfather’s Pizza, Inc., and currently is CEO and president of T.H.E. New Voice, Inc., a business and leadership consulting company.

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It's a moral imperative
The US tax code is a despicable, lengthy entanglement of pieced together unconstitutional drivel the likes of which Imperial England could only drool over when our ancestors fled the punative king. It is legalized entrapment for the sake of money.

Only the trifecta of a Republican president, Republican congress, and a conservative Supreme Court has any chance of pulling this off so it is 6 years away (minimum).

People's choices for health care
Good analysis of what real health care reform includes. Re: "few politicians with a bully pulpit have shown the moral or political courage to lead the sizeable Fair Tax movement"-- few will. A simple/fair tax system will mean less power for the political elites and more for the people.

Universal Choice
After being in the military for 24 years and am still a part of the military system. There is nothing I want more than freedom to choose my own health care using my own discretion.

Some questions not answered...
Look, I prefer to run my own affairs, too. But the reality is that we spend much more on our health care than (I believe) any other industrialized country (if not all, then it is most). Various studies have shown that we have worse outcomes OVERALL. In other words, if you want the very best care imaginable, yes, the U.S. is the place to go. Trouble is that most people, including probably most people who frequent this site, can't afford the very best. Further, by virtue of the preceding, the very best only helps a very small number of people (those who have access to it and can afford it). So, by "overall," I mean that the American population in the aggregate appears to be sicker than the population of any other industrialized country, even if a few among us are attended to like kings.

This means that, in reality, health care in America is rationed every bit as much as it is in other countries. It's just that here we blame sick people for not getting treatment. When it comes to other countries, we blame their system for allegedly not providing adequate treatment (I say "allegedly" because I have yet to meet an actual European or Japanese who would prefer living with out health care system). So my question is, isn't it time to reexamine the market-based health care system, since it seems to deliver worse outcomes than "socialist" systems?

I have another question which troubles me greatly based on personal family experience. In a market-based system, what is the fate of those Americans who have had a major illness, usually cancer, and who are thus asked to pay unaffordable premiums or who are denied coverage altogether?

I think there is a philosophical difference at play, to some extent. Our public realm is so debased after decades of extreme individualism, there is almost no sense anymore that we are all in this together. Witness the low military participation rates, the lack of sacrifice for the "global struggle against terror," suburban development that isolates people and giant houses that isolate family members from each other. For better or worse, we're a nation of loners. Why should we care if the lady down the street has health care?

Side Comment for Fuzzy, on wishing for a "Republican trifecta". If I'm not mistaken, we essentially had that trifecta for the last six years and it didn't exactly result in a better tax code. Even slightly. If I were you, I'd wish for a zombie invasion of Washington, D.C. That way, maybe we could get some innovative thinking around there.

The big fallacy
"the liberals will still scream about the 47 million people who do not have health care"

There's nobody who doesn't have health care. That's what the emergency rooms are for, which all of us working stiffs are paying for through our taxes.

The 47 million (a nonsense number anyway, unless you add in the 25 million illegals...Oh! Yeah!) may not have as great coverage as I do, but....

I'm working my butt off, and they aren't!

Killer
Your plan is moronic. You want to penalize car owners who bother to insure their cars an additonal grand to pay for universal health insurance? Which I assume would include people who don't own cars?

Why the he11 should they do that?

How about this? Add a $500 per shoe tax on every shoe sold.

That makes just about as much sense, but would be a whole lot fairer.

Insurance deductable, health care not?
Herman, what you advocate seems not only right but fair.

The combination of the following is fascinating:

1) No one wants health insurance. Think about it. Do you like bills? Does paying that bill do anything for you directly?

2) Just about everyone wants health care.

3) A lot of talk and energy seems to equate the two.

4) Should there not be extra taxes on health insurance? It is, after all, not a good thing in almost everyone's opinion. And taxes are routinely used to discurage what people think is a bad thing.

5) Shouldn't the tax deduction be for health care, itself?

OK, so there's a little right-brain jogging in those items, so to speak.

People are built to want to help other people who are victims of catastrophy. If health insurance is the way that's done, so be it. It can't be the only way. It's probably not the best way. But, perfection will have to wait a while.

It does seem more than a little suspicious to this outsider when the pros all seem to talk #3, though. Wool, meet eyes? :)

Imagine..
where auto insurance would be if people abused it as they do health insurance! Turning tune-ups, tires, scratches in the paint, etc in to your insurance company wouldn't get you far - yet it's what is expected from health insurance. In the 50s, one went to a hospital only if there were broken bones, cuts requiring multiple stitches, or catastrophic illnesses where as today, one goes in for minor events - all of which the person expects to be paid for with insurance.

What is insurance for?
Insurance is not for everyday medical expenses. Insurance is for those things that happen unexpectedly that nobody could be expected to stump up for: a baby born with multiple problems, a bad car wreck, a fire, an explosion, 9/11, etc. It is also designed as a supplement when one is disabled, to help shoulder the burden until one is back at work.

The huge flying fallacy of insurance is that it is supposed to cover the sniffle you get when a cloud goes over the sun, the latest fad way to lose weight without actually doing any exercise or altering one's diet, or one's boob job. (In Kanukistan Universal Medical Care covers boob jobs and sex-change operations, but you'll wait two years for a hip replacement and three months for a biopsy.)

The ideal insurance coverage should be a catastrophic policy with a high deductible, which a person would choose according to the amount of money he expects to be able to pay in medical care costs. This is not the amount he WANTS to pay; it is the amount he CAN pay.

Otherwise you're operating as if you can have everything you want and never have to pay for it. Think if we handed out Universal Grocery Cards and you could walk into Loblaw's and walk out with everything you wanted and just swipe your card at the end. You and I both know what would happen. The store would be stripped bare by the first stampede, and everyone else would starve.

That's what you have with Universal Health Care.

Think of the USPS at Christmas time. Then think of yourself at the end of that line with a desperately sick baby. That's Universal Health Care.

Universal Care is already available
My roommate was ill last fall and went to the emergency room. Come to find out he had a 90% blockage of one of his aortas. The hospital scheduled an operation and did an angioplasty. The operation cost approximately $20,000. Why do I bring this up? Because he did not have any health insurance. The hospital knew this and still did the operation. Will he every pay? Maybe, maybe not, but the point is that very few if any ever get turned down for a necessary operation or treatment if they go to an emergency room, even if they don't have insurance or the means to pay.

Good points
Cain makes a good point. If politicians were serious about lowering the cost of health care (or health insurance) they would not tax it at any level (including the sales tax on a bottle of aspirin or a box of band-aids). They would make it tax deductible instead.

But, as Jude points out, too much of the health care debate is about politicians trying to use the federal budget for social engineering.

And anti-socialist and AudiR10 also have it right. Health insurance was not originally conceived to pay for ordinary, minor health expenses, such as a 6 month check-up or a visit to the doctor for a prescription for a cold or the flu. Anti-socialist accurately compares this to sending the bill for an oil change, new shocks and tires, or a tuneup to your car insurance carrier.

The kind of mandatory, universal, cradle-to-grave, head-to-toe health care proposed by Queen Hillary and her ilk is just another thinly disguised power grab. It robs all of us of our ability to choose whether we want coverage or how much coverage we want.

And like all entitlement programs, it rewards those who don't take care of themselves at the expense of those who do.

Health Care Costs
Having lived under a socialized medical system for a number of years, I saw some severe limits that the system caused through the law of unintended consequences.
The income of doctors is capped by category. Brain surgeons, heart surgeons, etc. make more than family practioners. The doctor you see first can make the same income when he treats a defined minimum number of cases as he when he treats 5 more a day. So why would you expect the latter to be standard practice? For this reason practices become "closed" to new patients.
This funnels an increasing number of people into hospital waiting rooms with problems more appropriately treated in an office.
Similar effects have been observed on pinch points in the system such as radiology, high tech based specialties, and the access to the brain surgeon who has as many cases as he can deal with without heroic efforts.
Most of the new doctors in such a system are those who can not manage a way to practice where they have more say about their income. A large proportion are immigrants with limited language skills, impacting their effectiveness.

please educate me
You don't have to be Werhner von Braun to realize socialism in any form does not work. All you have to do is study a little history. That said, I would like to challenge any socialist to please give me an example of any program our so-called leaders have initiated that has actually succeeded in its stated goals. Please, I'm begging you, I want to understand.

Sciolist
good point about the "closed" practices. even with relatively free market insurance I see this happen.

I suffer from a pain disorder, and, for some reason, doctors believe anyone who doesn't have a "primary care physician" is a drug addict looking for a fix. So, to get medication I need I had to find a PCP. (This is not a formal rule, but a few doctors and nurses have told me lacking a PCP is considered a telltale sign of a drug seeker.)

Problem is, I ahd been unemployed for a year some time back, lost my insurance, and just never bothered to find a PCP since I was relatively young, in good health, and not interested in spending my copay to hear "stop smoking or else" every six months. (Doctors can't help but lecture endlessly to eveyr smoker they meet. They would get better responses if they cut the sanctimonious tone a little.)

Anyway, I have insurance and started looking for an "in plan" PCP. After hours of calling, I finally found one, only an hour drive from my home. (I live only 40 minutes from 2 major cities, and in the 3d largest city in my state, so it is absurd to drive an hour to get anything...)

If a free market system produces these sad results, how much worse will the socialized medical system be? Especially once profits start to decline and fewer and fewer choose to enter medicine (as in every country so far who tried socialized medicine)

And sorry for the long personal digression. Still irked that I am called a drug addict because I don't have a PCP. I have seen dozens of specialists, all of whom agree I am ill, but to play CYA against the DEA, they have to enforce nonsense rules.

Anyway, enough of my rambling. Bye for now.

Health Insurance as a "Utility".
The genius of America has been its ability to take what was once a luxury, that has become a necessity, and make it a utility. This avoids nationalizing and its subsequent decrease in the quality of the product or service.

Health care insurance only, should be reformed on the business model of a public utility. Yes, just like the electric company. Edison is a private company, owned by stockholders, that is permitted to operate as a monopoly as long as it submits to public regulation.

Hospitals should not be either public or private, but "Not-for-Profit" institutions.

Doctors are best left on their own. They can be self employed and charge what the market will bear, or be employed by "not-for-profit" organizations and accept salaries. That doesn't meant that they will not be well paid, it means that they will have a choice to practice the kind of medicine they want. For money, self satisfaction, or both.

The problem with the above solution is just where does the money come from to run a "Utility Model" health care system? Good question. One that I have no answer for other than everybody will have to pay something from the time they turn eighteen to avoid the creation of a National Health Service like Canada or the U.K.

Socialism that works
Isn't the military an essentially socialist enterprise? Anyone here care to argue that the military is a piece of garbage?

To Mencken
Our founding fathers feared the military and they knew better than to meddle in the affairs of other nations. They wanted a militia force to defend America, not a national army for offensive purposes. This worked fine until the government started meddling in the affairs of others. Look how that worked out. Socialists started the war in Vietnam and hamstrung the army with their crazy rules of engagement (vietnam never attacked us). Same in Korea (North Korea never attacked us), or Bosnia (bosnia never attacked us).

I can and will argue that the military is not all it could be and I'd be right. This is precisely because of government meddling (socialism). Of course I'm talking about the bureaucracy not the fighting spirit of our warriors.

Tell me I'm wrong but please give me some examples and not empty rhetoric.

Bucko
Considering the rank inefficiencies and poor service of the old utility monopoly model, I think it would be a terrible idea to sue that as a plan on which to base medical care.

Far better would be for the government to truly deregulate medicine. Get rid of all the government regulation of hospitals and doctors, stop providing Medicare/Medicaid (and thus kill the unpleasant DRG system), provide some meaningful tort reform, and see how well the free market solves the problem.

It is the one solution we haven't tried, and the only one that seems to have a chance of working.

(Lastly, I would eliminate mandatory medical licensing, and allow competing non-mandatory private licensing, but most seem to think that is an unrealistic plan, so I will just go with the steps I mention at the beginning.)

Mencken
There is no way to evaluate the economic efficiency of the army as (1) it is almost impossible to make a meaningful measure of the amount it contributes to the economy by protecting us, and (2) there is no competing private army or armies against which we can measure it.

Regarding point 1: There is no way to tell who would ahve attacked us or how much damage they would have done had we not had an army, so economically, there is no way to measure the "return on investment" for the army.

Regarding point 2: All armies are state funded monopolies, so we can't know whether a private army would be cheaper nor how much so.

And, to be honest, the army is something that could not be done privately. Courts, police and army are still valid governmental functions under all but the most extreme libertarian theories. So, talking about the army being "socialist" is absurd. It is not intended to produce a profit, and is not a valid private function.

Medicine, on the other hand, is a valid private function, and should not be socialized. And there is plenty of data around the world to prove socialized medicine is less efficient and more costly.

andrews
I could not have said it better myself. However, I would take it one step further and eliminate all mandatory licensing. Let the individual decide with whom they choose to do business.

Of course that would rob some government bureaucrats of power and we can't have that.


Socialism
I simply don't have time at the moment to provide any full response, but this did stick out:

"Medicine, on the other hand, is a valid private function, and should not be socialized. And there is plenty of data around the world to prove socialized medicine is less efficient and more costly."

Can you tell me where you get this from? I, too, have seen the data that show that America spends more per capita on health care than virtually any other industrialized country and yet has worse health overall than most. Socialized medicine may be less efficient in any particular circumstance, but how is it that it appears to deliver overall superior results? (Anyway, I think that it is foolish to say that our system is "market-based" and that "their" system is "socialist". In truth, most systems have elements of socialist and market principles. The difference is in the approach towards good health for all vs. great health for some, poor health for the rest.)

For example
Johns Hopkins University's Center for Hospital Finance and Mangement, Baltimore, USA.

In 1997 the United States spent $3,925 per capita on health or 13.5 percent of gross domestic product (GDP), while the median Organization for Economic Cooperation and Development (OECD) country spent $1,728 or 7.5 percent. From 1990 to 1997 U.S. health spending per capita increased 4.3 percent per year, compared with the OECD median of 3.8 percent. The United States has the lowest percentage of the population with government-assured health insurance. It also has the fewest hospital days per capita, the highest hospital expenditures per day, and substantially higher physician incomes than the other OECD countries. On the available outcome measures, the United States is generally in the bottom half, and its relative ranking has been declining since 1960.

PMID: 10388215 [PubMed - indexed for MEDLINE]

Available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10388215&dopt=Abstract

Mencken
I don't understand the point of that article and I read it several times. Are you saying that since government started meddling in healthcare that it has become more inefficient? Kind of proves my point.

Mencken
I have not the time to look up quotes, but let's look at two measures:

1. The "brain drain" that took doctors from all over the world and deposited them in the US. If doctors would flee their homes and friends to practice medicine elsewhere, doesn't that suggest adopting socialized medicine here woudl either drive our doctors to other countries, or keep people from entering the medical field at all? And if so, how do you have medicine without doctors?

2. When someone anywhere in the world needs difficult treatments where do they go? England? Sweden? No. The US. Why is that?

3. Rationing and waiting lists speak for themselves, don't they?

You know, I never thought after the 1980's that I would have to explain why socialism doesn't work. I thought it had become obvious to everyone but college professors and politicians.

Ooops
Should read three measures. I can't count, apparently.

What??
"I don't understand the point of that article and I read it several times. Are you saying that since government started meddling in healthcare that it has become more inefficient? Kind of proves my point."

Where do you get that comclusion from?

The summary of the study says:

(1) "In 1997 the United States spent $3,925 per capita on health or 13.5 percent of gross domestic product (GDP), while the median Organization for Economic Cooperation and Development (OECD) country spent $1,728 or 7.5 percent." ME: We spend more (more than twice, at the time) per person on healthcare than the median industrialized country.

(2) "From 1990 to 1997 U.S. health spending per capita increased 4.3 percent per year, compared with the OECD median of 3.8 percent." ME: Our healthcare spending increased at a faster rate.

(3) "The United States has the lowest percentage of the population with government-assured health insurance." ME: Of all the industrialized countries, we have the lowest percentage of people with guaranteed health coverage.

(4) "It also has the fewest hospital days per capita, the highest hospital expenditures per day, and substantially higher physician incomes than the other OECD countries." ME: This suggests that in America sick people are sent home more quickly but charged more for the time they do spend in hospital and, obviously, we pay doctors more.

(5) "On the available outcome measures, the United States is generally in the bottom half, and its relative ranking has been declining since 1960." ME: We rank below most other OECD countries in quality of outcome, and our position has been slipping.

Of course, and I'll make this assumption about you, your hatred of "socialized" medicine is so entrenched that you see this study as evidence of government meddling mucking up otherwise utopian free-market American healthcare (if pressed, you'll probably say that 1960 was the start of a moral decline and government expansion in the U.S, and therefore all healthcare declines since then are attributable, not accounting for the fact that other countries had similar social changes). Of course, that doesn't help explain why other OECD countries, with much MORE government meddling, seem to do better.

If my assumption is wrong, please feel free to correct me. But the fact remains, as best we can tell, we spend more and get less. Again, tell me what is so bad about healthcare that costs less and delivers superior results?

Hum. More answers.
1. The "brain drain" that took doctors from all over the world and deposited them in the US. If doctors would flee their homes and friends to practice medicine elsewhere, doesn't that suggest adopting socialized medicine here woudl either drive our doctors to other countries, or keep people from entering the medical field at all? And if so, how do you have medicine without doctors?

ME: I see a lot of doctors who fled India or Pakistan and the like. My guess it had less to do with socialized medicine than with the fact that those countries are/were, ahem, not desirable living locations. I don't see too many doctors who have fled France or Belgium. If you have any evidence, I'm open to it.

2. When someone anywhere in the world needs difficult treatments where do they go? England? Sweden? No. The US. Why is that?

ME: Because if you have a lot of money or connections, the U.S. will deliver superior healthcare. I'm not disputing that. (Although plenty of people go to Europe, too.) I am disputing the idea that the vast majority of Americans can access that level of care.

3. Rationing and waiting lists speak for themselves, don't they?

Yes, have you been to an E.R. lately? We already ration healthcare in this country, we just do it unofficially and haphazardly. Do you think that we don't?

Mencken
1. Actually the term "brain drain" was specifically started to describe the flight from England and NHS to the US. But ok, believe what you want.

2. Tell me specific cases of people in the US being denied life saving care because of inability to pay. Go on.

3. And waiting in an ER for 12 hours is not the same as being told you must wait 3 months for an MRI. You are obfuscating, not answering.

sigh
(1) I don't know if you are right. According to one source (Wikipedia), "Spokesmen for the Royal Society of London coined the expression “brain drain” to describe the outflow of scientists and technologists to Canada and the United States in the early 1950s." I would hesitate to conclude it was because of the NHS. More likely it was because the UK was in a post-war funk and the U.S. was in the midst of rapid postwar expansion. At any rate, I don't know that this continues today, or that we need to copy the NHS. There are other ways to go. But again, if you have any evidence...

(2) Whether people are denied life-saving treatments is not the point. The point is that many people are financially ruined by live-saving treatments. The point is that many people do not get the care that could have *prevented* the need for life-saving treatments. The point is that we deliver these life-saving treatments at a *higher* cost to society than in other countries. I don't doubt your statement that Americans are never (or virtually never) denied life-saving treatments. I just think it's irrelevant. I also think there is a world of difference between emergencies and non-emergencies. I don't know that many people, if any, are put on waiting lists in the UK if they are in the middle of a heart attack. But maybe you have some evidence...

(3) See the end of my comment above. Also, not every MRI is needed for life-saving treatment. Further, I don't see how it is that *I* am the one obfuscating when nobody has addressed my sourced and cited authority that the U.S. spends more and gets less.

Mencken
We spend more and get less in education too. Please explain that. And yes I was going to suggest all that started in the 60's for the reasons you said. I'm glad you said it before I did.

Mencken
Addressing these one by one is a bit much.

Yes, brain drain was used in the 50's, you are correct. I was actually thinking of the 80's revival in terms of medical research, with which I am more familiar due to age if nothing else. My error there. However, once again, why did british doctors of the 80's come to the US? Why so many doctors from EVERYWHERE? Not just the "bad" regimes you argue, but everywhere on earth.

(Again, my mistake in forgetting the 50's use of the term.)

And, an MRI is not a procedure used only for life threatening conditions. I have ahd 4 in the past year and I am hardly dying. Sick, but nowhere near death. So, I think you are quite wrong on that.

In addition, the fact that care is not denied, but costs too much, is a silly argument. It costs what it costs. Someone will eventually pay, either the patient or the tax payer. Which is more fair? (I know the answer you will give, so don't bother.)

So, your argument isn't that people are being denied care and dying in the US, but that they have to pay for their services and that is just worng. In other words, doctors should be enslaved and forced to work for below market wages. Or the taxpayers should be robbed to pay for care for other people. Those are the two true meanings of universal health care.

I have a feeling this point by point could go on forever. So let's try something different:

OK. Let's forget specifics and speak in general principles.

Without prices to guide allocation of resources, there is no way to rationally assign scarce resources. As a matter of pure theory, socialism cannot work, as there is no way to know where resources are more urgently desired.

Assuming the goal of economics is to maximize the satisfaction achieved by individuals, then socialism cannot achieve what a private market can.

Read vonMises Socialism. This argument is now 80+ years old. And I thought it was well understood.

And just because medicine seems "special" does not exempt it from the laws of economics. So, if you enact socialistic control, at best, you would achieve what the free market does. more likely, you will do worse. there is no way socialism can outperform a free market in terms of achieving the maximum satisfaction for all individuals.

No, free markets are not eprfect. They simply provide better tools for adjusting to changing desires than any other system. And that tool is the price system. Socialism has nothing to compare.

Maybe we're stupid...
I don't know why we spend more and get less in education. Maybe Americans are dumb. But we're talking about healthcare.

It sounds like you must think we have a great education system, though. After all, if we spend more and get less with healthcare, and you think that is a superior system, then our educational system must also be superior? No?

Misread
Sorry. You did say an MRI is not needed for life saving. Which makes your argument even less sensible. I thought you were saying "MRIs won't have a wait because they are lifesaving." Instead you are saying "You won't die if you don't get an MRI, so who cares if you have to wait."

EAsy to say to someone else. Not so nice if it applies to you too.

Yes, MRIs are not needed for lifesaving treatment.

However, last year, when I was told I may have MS, I was glad to get an MRI four days later to rule that out, rather than having the NHS say I needed to wait a month or three.

Yes, it wasn't "essential", but when you are worried you have a degenerative disease, ti is nice to be able to find out whether you do or not, and not have to wait.

Actually, this points out the problem of socialist thinkers. They apply their ideas to everyone else, but always picture themselves as a commisar immune to the consequences. Or do you rally want to have to wait for medical care?

I think you imagine someone as SPECIAL as you woulnd't wait with the peons. Yeah, think again.

And while you wait 6 months for a pacemaker under HillaryCare, tell me how much you love it.

Lastly
And finally, socialized medicine in the US owuld be much worse.

In the past, in every other country, they had the US as a release valve. The rich and those who saved up could go to the US for care, relieving pressure on the limited resources.

Once the US goes socialist, that will be no more. No place else to turn. And we will see the true rationing required for socialized medicine.

Yes
Point by point gets old. But let me try again.

"Yes, brain drain was used in the 50's, you are correct. I was actually thinking of the 80's revival in terms of medical research, with which I am more familiar due to age if nothing else. My error there. However, once again, why did british doctors of the 80's come to the US? Why so many doctors from EVERYWHERE? Not just the "bad" regimes you argue, but everywhere on earth."

ME: Whatever. I don't have any evidence to decide upon, so let's drop this one.

"And, an MRI is not a procedure used only for life threatening conditions. I have ahd 4 in the past year and I am hardly dying. Sick, but nowhere near death. So, I think you are quite wrong on that."

ME: I specifically said "Also, not every MRI is needed for life-saving treatment." I said the same thing you just said. So, I think you are quite wrong on that.

"In addition, the fact that care is not denied, but costs too much, is a silly argument. It costs what it costs."

ME: I don't think I'm suggesting that care intrinsically costs too much. Costs can vary depending on method of delivery. At some point, yeah, it costs what it costs. But is maximizing shareholder wealth part of that cost? Maybe, maybe not.

"So, your argument isn't that people are being denied care and dying in the US, but that they have to pay for their services and that is just worng. In other words, doctors should be enslaved and forced to work for below market wages. Or the taxpayers should be robbed to pay for care for other people. Those are the two true meanings of universal health care."

ME: That's a lot of assumptions there. I never said it didn't have to be paid for. The question is how do you pay for it? It's interesting you think of universal health care as "robbing". You would think that we didn't live in a society, and that the health of the average American wasn't important to the success of the enterprise as a whole. Why would someone even bother fighting for a country without any sense of the public good? Why not just sit on your porch with a shotgun and wait until you are actually attacked?

[I'm skipping some of your economics points because it would just get too long.]

"Assuming the goal of economics is to maximize the satisfaction achieved by individuals, then socialism cannot achieve what a private market can."

ME: That's a big assumption, and it's not clear that it is correct. Sure, it's one theory, but then we probably wouldn't have a lot of things that are "public" goods. You know, like Yosemite National Park. Reducing the economy to the maximization of individual satisfaction is risky (and maybe unworkable, considering the research amassed in behavioral economics showing that people don't always do what makes them happy).

"Read vonMises Socialism. This argument is now 80+ years old. And I thought it was well understood."

ME: It's just one view among many.

"And just because medicine seems "special" does not exempt it from the laws of economics. So, if you enact socialistic control, at best, you would achieve what the free market does. more likely, you will do worse. there is no way socialism can outperform a free market in terms of achieving the maximum satisfaction for all individuals."

ME: This is important. As I have said repeatedly now, the available evidence points STRONGLY to the opposite conclusion. Nobody here has even taken a stab at refuting it. Rather, all I hear is wishes about how the world would work, rather than facts about how it DOES work.


Mencken
One more thing. I've been in East Germany and Hungary both before and after communism. My family in both countries are doing much better now (ask me about communist toilet paper). So yes I do hate socialism because I experienced it, and for the life of me I cannot understand why any American would support a system of government that seeks to control its people. Please explain to me why, like I said earlier I want to understand.

Geez
"Sorry. You did say an MRI is not needed for life saving. Which makes your argument even less sensible. I thought you were saying "MRIs won't have a wait because they are lifesaving." Instead you are saying "You won't die if you don't get an MRI, so who cares if you have to wait."

You are STILL COMPLETELY WRONG. I said that "not every" MRI is needed for live-saving, meaning that SOME ARE.

DevilsPaintbrush
You're already controlled by the government. Might as well get better healthcare out of the deal.

Sad but true
I know it, thanks to FDR and his big government ilk and spineless republicans. That's why I'm a wacky libertarian.

Someday when we have socialized medicine and you see what a boondoggle it becomes I'll be right there to say I told you so.

It's been fun but I gotta go.

Mencken
I think the most essential point to address is this:
If you think medicine is special and thus not governed by the same economic rules as other endeavors, why? What makes medicine different and exempt from the laws of economics?

It is essential for life? So is clothing, food, shelter. So is water. Shoud Dasani be socialized? McDonalds?

It is too expensive? Look at the profit margins on Starbuck's coffee. the oil industry would die of envy looking at those profit margins. (Actually margins are very slim in the oil industry, but I saw the comparison of profit margins, oil about 10-20 cents/gallon. Starbucks somewhere around 30 dollars/gallon)

In addition, the idea of a "public good" does not invalidate the idea that economics should maximize satisfaction. Or are you saying a "public good" is one which provides no one with any satisfaction?

If you advocate some public good, the resources still come from somewhere and are not available for other sues. You would argue the public good is more valuable than the alternatives, but that is still an economic argument.

Or do you argue the purpose of economics is to reduce human contentment and satisfaction?

Do you work to suffer and to use your earnings to make yourself less content? No? then you admit my rpemise by your actions, even if you deny them for political reasons.

Typos
Sorry for the recurrent typos. Should try to type more slowly, but I am used to typing at a faster pace and can't manage to slow myself down now that I can no longer maintain accuracy at that speed.

In short
I think if we want a strong country, we need to support the public realm in addition to the private realm. The predominant thought for the last few decades has been to maximize the private at the expense of the public. This is evident in our crappy looking suburbs and crappy looking cities (except for older ones like Boston), and our crappy services and crumbling infrastructure. Maybe you think different, e.g. maximize individual satisfaction and the rest will work out. That is not a crazy idea. I just think the evidence now shows that the public realm requires conscious cultivation. But you don't have to listen to me. We can vote on it. At least for now. If more Americans want something, it must be the greatest good, right? Well, more and more Americans are coming around to the idea that our health care system sucks and more privatization is not the way to fix it. We'll see what happens.

Skunk in the cabbage patch
Cain wrote these two statements at the beginning and end of the article. I think they are key to his suggestion. They are: "Namely, the U.S. should eliminate the deductibility discrimination between employers and employees for health insurance premiums." AND "With a simple change in the current tax code to eliminate discriminatory deductibility for health insurance and eventually health care costs, free market dynamics can solve another problem that Clinton, Obama, Edwards and Romney want to make worse."
What is the discrimination, Mr. Cain? You'll pardon me if I take a big swing at it and miss. Me thinks you want to end employer paid health insurance premiums that are tax free to the employee. You want the employee to pay the premium and deduct the cost. That amounts to a rather large tax increase on those who have this benefit.
That's what I think you are really making a stink about, Mr. Cain. I don't like that!

More money, less bang
Do Americans pay more and get less from their health care bucks than similar countries?

A Google on some of the words quoted in "study" comments here led to:

http://www.cmwf.org/usr_doc/Schoen_natscorecard_chartpack_955.ppt

Slide number 58 shows two charts of money input to health care.

You can see a stripped version of the worst of the charts at:

http://www.cmwf.org/usr_doc/site_docs/annualreports/2006/msg_pres06.htm

For those who don't download .ppt files, slide 58 shows under the odd title, "Efficiency", graphs of several OECD nations' average spending and total percent of GDP spent for health care. The numbers for all the nations are clustered close together at the left end of the line charts in 1980. They all go up, with the US splitting from the others and going up much more, through 2004.

What the charts say: Apparently, either the US system changed in 1980 and beyond, or the others all changed, or both. Or maybe before 1980, the US was below the others and the lines simply crossed in 1980, giving someone an opportunity to create a clever graph. Or maybe the US was above the others before 1980 and simply did good in 1980. Whatever. Neither graph is on a log scale, as would certainly be appropriate for the spending graph, if not the %-of-GDP graph. I learned long ago that when someone feeds me a non-log graph for a log function they are either, (A) trying to fool me or (B) innumerate. But, let's cut 'em some slack here. They really did the sort of in-depth research that's necessary to run a non-market based, centrally controlled system.

BTW, one can intuit where the study producers are coming from. They have lots of race-based charts. And many of their metrics of "desired outcomes" are for universal access ... as opposed to, for instance, innovation pipeline diameter.


One very frustrating thing is that this study often alluded to big disparities among states - without showing them! This is reminiscent of the education studies that show how the US educational system is so bad relative to other nations - until you break out the states and find out that a US state is just fine if the state is "close to Canada". Or is Iowa. But not Mississippi.


So what are "desired outcomes"?

If the desirable outcomes are defined by those on one side of the debate, then there will be no surprise what system yields desirable outcomes. For instance, an oft-used desired outcome for health care systems is life span. Huh? Yeah, life span is easily measured, but are you excited about the differences between industrialized nations? Move to Japan and life longer? I don't think so. Would not a far better measure of outcome success be whether consumers of health care themselves think the outcome is better? Unfortunately, such a measure is rather hard to draw a bead on, isn't it? You could, for instance, say that if people are spending a higher percentage of their money on something, then that something is a big success - a desired outcome!

Apparently, no one has ever figured out a good way to measure whether people are satisfied with a socialist system. Heck, in non-socialist systems, no one has figured it out all that well. Don't believe that? Try pricing a new product. Without a dart board.


So, Mencken, posters here can be excused for ignoring this study's foregone conclusions. But, those on the market-oriented side of the debate should certainly get a clue from the study and put out their own "study" in which they define the inputs and desired outputs. People without fixed beliefs might then at least compare objectives.

Market-oriented people could, for instance, try to show that a market oriented system is best in a world where the "health care" of 1980 would be as unacceptable today as today's "health care" should be in 2030.


In the US there are states trying various wrinkles. One can't help but be hopeful that the facts will sort themselves out. People can still vote with their feet in the States.
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