CDZ A New and Improved Constitution for the USA

[Derideo_Te]

For the experiment I chose:

1. A moral and just people will grant the federal government authority to require that every man, woman, and child in America will have access to adequate healthcare.

Let's start by getting rid of the fallacies about the Federal healthcare programs.

Setting the record straight on Medicare s overhead costs Physicians for a National Health Program

The traditional Medicare program allocates only 1 percent of total spending to overhead compared with 6 percent when the privatized portion of Medicare, known as Medicare Advantage, is included, according to a study in the June 2013 issue of the Journal of Health Politics, Policy and Law.

The 1 percent figure includes all types of non-medical spending by the Centers for Medicare and Medicaid Services plus other federal agencies, such as the IRS, that support the Medicare program, and is based on data contained in the latest report of the Medicare trustees. The 6 percent figure, on the other hand, is based on data contained in the latest National Health Expenditure Accounts (NHEA) report.

The journal article, written by Minneapolis-based researcher Kip Sullivan, finds that the gap between the two measures has been growing over the last two decades as enrollment in private Medicare plans has risen.

“The high administrative costs of the privatized portion of Medicare are no surprise,” says Sullivan. “What’s surprising is that the high administrative costs of the Medicare private insurance companies haven’t provoked a debate about whether spending more money on insurance industry overhead is a good use of scarce tax revenues.”​

These points are well summarized with appropriate credible citations in this article.

Medicare Is More Efficient Than Private Insurance 8211 Health Affairs Blog

Medicare Has Controlled Costs Better Than Private Insurance​

• • According to CMS, for common benefits, Medicare spending rose by an average of 4.3 percent each year between 1997 and 2009, while private insurance premiums grew at a rate of 6.5 percent per year. (See Table 13)
  • According to a calculation by the National Academy for Social Insurance, if spending on Medicare rose at the same rate as private insurance premiums during that period, Medicare would have cost an additional $114 billion (or 31.7 percent).
  • The CBO explicitly stated that its data on relative cost growth should not be used to make the argument that Goodman and Saving make, writing that the relatively low growth rate of all health care expenditures other than Medicare and Medicaid “should not be interpreted as meaning that Medicare or Medicaid is less able to control spending than private insurers.” Goodman and Saving mistakenly suggest that the growth rate of private insurance is the same as the growth rate of all health care expenditures other than Medicare and Medicaid; however, as CBO points out, the growth rate of all health care expenditures other than Medicare and Medicaid includes not just spending by private insurers, but also government programs and out-of-pocket costs paid by the uninsured.
  • The CBO has predicted that the rising cost of private insurance will continue to outstrip Medicare for the next 30 years.The private insurance equivalent of Medicare would cost almost 40 percent more in 2022 for a typical 65-year old.

Medicare Has Lower Administrative Costs Than Private Plans.​

• • According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue.
  • Insurance industry-funded studies exclude private plans’ marketing costs and profits from their calculation of administrative costs. Even so, Medicare’s overhead is dramatically lower.
  • Medicare administrative cost figures include the collection of Medicare taxes, fraud and abuse controls, and building costs.

So-called “competition” in the private health care market has driven costs up.​

• • In most local markets, providers have monopoly power. Consequently, private insurers lack the bargaining power to contain prices.
  • In most areas, two or three dominant insurers dominate the regional market, limit competition and make it extremely difficult if not impossible for new insurers to enter the marketplace and stimulate price competition.
  • Medicare Advantage, which enrolls seniors in private health plans, has failed to deliver care more efficiently than traditional fee-for-service Medicare. Both the CBO and the Medicare Payment Advisory Commission (MedPAC), the commission which advises congress on Medicare’s finances, have calculated that Medicare Advantage plans covering the same care as traditional Medicare cost 12 percent more.
  • Karen Ignagni, who heads America’s Health Insurance Plans (AHIP), the insurance industry’s trade association, has admitted that private plans cannot bargain down provider costs and has asked Washington to intervene.

So the facts are clear and unequivocal when it comes to Medicare. It is not bloated, self serving or inefficient. It is way more cost effective than the private sector and has a much lower overhead.

Furthermore the ACA is nothing like Medicare which is essentially a single payer system that operates effectively for millions of senior citizens.

The ACA is merely a means to ensure that everyone has access to AFFORDABLE healthcare. In that respect it has made HMO's accountable for actually providing healthcare instead of just focusing on their shareholder profits for the Wall Street Casino bosses. Yes, there are aspects that need to be improved and the majority of this nation approve of the ACA the way it is or want it improved.

Compare the reality of Medicare and the ACA delivering cost effective healthcare to the endless anti-Obamacare fabrications that have no basis in reality. Compare it to the "free market" failure that preceded those programs which reulted in bankruptcies, needless pain and suffering of millions of hardworking Americans who could not afford healthcare for themselves and their families. Every attempt to address that dire need was stymied by the greed obsessed Wall Street Casino bosses and their bought and paid for puppet politicians. They obstructed the ACA and still seek to repeal it for their own profit at the expense of other's pain.

It is farcical to assume that healthcare will be provided at the "local level" when it wasn't happening before for the exact same reasons. The profit motive always trumps the mealymouthed "good intentions" of those who place their own money over and above what is best for America as a whole.

Instead what we have with Medicare and the ACA is a compromise. It is not the optimal way to deal with the problem but it allows the greedmongers to still pocket their profits while ensuring that millions are not left to suffer and die needlessly. This option is working whereas the other option provided in the OP's "experiment" has never worked and will never work for millions of hardworking Americans.

 

[Olde Europe]

Here is one heck of a fine article on the States' virtues (here: Louisiana), and their unsparing, uncompromising, and relentless fight for the best interests of the State's citizens and the community they wish to form: Louisiana's best in defence of, well, interests

 

[Foxfyre]

For these reasons and others, I oppose such large massive federal programs and believe there is every justification to trust the state and local governments and the people themselves to solve problems without federal interference and intervention that inevitably produce as much or more unintended negative consequences than what good those federal programs do.

Nicely written, and conclusively argued, but still Birtcher crap solidly based on surreality.

Your assumption that the Federal bureaucracy is invariably bloated, power-hungry, self-serving, and costly, whereas the State governments are invariably the lean and efficient epitome of virtue, and the genuine expression of the people's will, is without merit. The assumption that a Federally administered program is more costly, requires more bureaucracy, than 50 different State-administered programs on the same subject, is equally without merit.

Finally, your assumption, or hope, that communities will, on their own volition, make provisions for the unfortunate is demonstrably wrong, as we've been made to behold during the most recent years, and your own depiction of good government focussed on securing the property rights of the haves directly contradicts that very assumption of yours.

See, you presume to have read what I wrote but you still misrepresent and mischaracterize what I wrote. I said nothing even remotely like "state governments are invariably the lean and efficient epitome of virtue ." What is it that compels some to argue so dishonestly?

Please review the guidelines for the discussion and pick one of the two statements and see if you can write an argument for it without accusing, blame, personal insult, or ad hominem. I did that. I am laying odds that those who are not right of center will be unable to do so. That is the purpose of the experiment.

 

[Derideo_Te]

you still misrepresent and mischaracterize what I wrote

Ironic given the misrepresentation and mischaracterizing of the Federal government in your post.

 

[Olde Europe]

See, you presume to have read what I wrote but you still misrepresent and mischaracterize what I wrote.

I have read what you have written with great attention, and made explicit the unwritten assumption on which your whole argument has to rest in order to make any sense at all. Without State and local governments being that epitome of virtue, the transfer of powers to them from the Federal government doesn't even begin to make sense. If, in fact, you wish to denounce these assumptions, your argument is not only without foundation in reality, but also illogical, amounting to a mere venting of anti-Federal government venom with no substance at all.

 

[Statistikhengst]

Here is one heck of a fine article on the States' virtues (here: Louisiana), and their unsparing, uncompromising, and relentless fight for the best interests of the State's citizens and the community they wish to form: Louisiana's best in defence of, well, interests

The information provided at the link that you quote, if it is correct, is horrifying, simply horrifying. The USA may be in the process of losing the good part of two Southern states to the ocean. That is extremely bad news.

 

[Foxfyre]

For the experiment I chose:

1. A moral and just people will grant the federal government authority to require that every man, woman, and child in America will have access to adequate healthcare.

Let's start by getting rid of the fallacies about the Federal healthcare programs.

Setting the record straight on Medicare s overhead costs Physicians for a National Health Program

The traditional Medicare program allocates only 1 percent of total spending to overhead compared with 6 percent when the privatized portion of Medicare, known as Medicare Advantage, is included, according to a study in the June 2013 issue of the Journal of Health Politics, Policy and Law.

The 1 percent figure includes all types of non-medical spending by the Centers for Medicare and Medicaid Services plus other federal agencies, such as the IRS, that support the Medicare program, and is based on data contained in the latest report of the Medicare trustees. The 6 percent figure, on the other hand, is based on data contained in the latest National Health Expenditure Accounts (NHEA) report.

The journal article, written by Minneapolis-based researcher Kip Sullivan, finds that the gap between the two measures has been growing over the last two decades as enrollment in private Medicare plans has risen.

“The high administrative costs of the privatized portion of Medicare are no surprise,” says Sullivan. “What’s surprising is that the high administrative costs of the Medicare private insurance companies haven’t provoked a debate about whether spending more money on insurance industry overhead is a good use of scarce tax revenues.”​

These points are well summarized with appropriate credible citations in this article.

Medicare Is More Efficient Than Private Insurance 8211 Health Affairs Blog

Medicare Has Controlled Costs Better Than Private Insurance​

• • According to CMS, for common benefits, Medicare spending rose by an average of 4.3 percent each year between 1997 and 2009, while private insurance premiums grew at a rate of 6.5 percent per year. (See Table 13)
  • According to a calculation by the National Academy for Social Insurance, if spending on Medicare rose at the same rate as private insurance premiums during that period, Medicare would have cost an additional $114 billion (or 31.7 percent).
  • The CBO explicitly stated that its data on relative cost growth should not be used to make the argument that Goodman and Saving make, writing that the relatively low growth rate of all health care expenditures other than Medicare and Medicaid “should not be interpreted as meaning that Medicare or Medicaid is less able to control spending than private insurers.” Goodman and Saving mistakenly suggest that the growth rate of private insurance is the same as the growth rate of all health care expenditures other than Medicare and Medicaid; however, as CBO points out, the growth rate of all health care expenditures other than Medicare and Medicaid includes not just spending by private insurers, but also government programs and out-of-pocket costs paid by the uninsured.
  • The CBO has predicted that the rising cost of private insurance will continue to outstrip Medicare for the next 30 years.The private insurance equivalent of Medicare would cost almost 40 percent more in 2022 for a typical 65-year old.

Medicare Has Lower Administrative Costs Than Private Plans.​

• • According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue.
  • Insurance industry-funded studies exclude private plans’ marketing costs and profits from their calculation of administrative costs. Even so, Medicare’s overhead is dramatically lower.
  • Medicare administrative cost figures include the collection of Medicare taxes, fraud and abuse controls, and building costs.

So-called “competition” in the private health care market has driven costs up.​

• • In most local markets, providers have monopoly power. Consequently, private insurers lack the bargaining power to contain prices.
  • In most areas, two or three dominant insurers dominate the regional market, limit competition and make it extremely difficult if not impossible for new insurers to enter the marketplace and stimulate price competition.
  • Medicare Advantage, which enrolls seniors in private health plans, has failed to deliver care more efficiently than traditional fee-for-service Medicare. Both the CBO and the Medicare Payment Advisory Commission (MedPAC), the commission which advises congress on Medicare’s finances, have calculated that Medicare Advantage plans covering the same care as traditional Medicare cost 12 percent more.
  • Karen Ignagni, who heads America’s Health Insurance Plans (AHIP), the insurance industry’s trade association, has admitted that private plans cannot bargain down provider costs and has asked Washington to intervene.

So the facts are clear and unequivocal when it comes to Medicare. It is not bloated, self serving or inefficient. It is way more cost effective than the private sector and has a much lower overhead.

Furthermore the ACA is nothing like Medicare which is essentially a single payer system that operates effectively for millions of senior citizens.

The ACA is merely a means to ensure that everyone has access to AFFORDABLE healthcare. In that respect it has made HMO's accountable for actually providing healthcare instead of just focusing on their shareholder profits for the Wall Street Casino bosses. Yes, there are aspects that need to be improved and the majority of this nation approve of the ACA the way it is or want it improved.

Compare the reality of Medicare and the ACA delivering cost effective healthcare to the endless anti-Obamacare fabrications that have no basis in reality. Compare it to the "free market" failure that preceded those programs which reulted in bankruptcies, needless pain and suffering of millions of hardworking Americans who could not afford healthcare for themselves and their families. Every attempt to address that dire need was stymied by the greed obsessed Wall Street Casino bosses and their bought and paid for puppet politicians. They obstructed the ACA and still seek to repeal it for their own profit at the expense of other's pain.

It is farcical to assume that healthcare will be provided at the "local level" when it wasn't happening before for the exact same reasons. The profit motive always trumps the mealymouthed "good intentions" of those who place their own money over and above what is best for America as a whole.

Instead what we have with Medicare and the ACA is a compromise. It is not the optimal way to deal with the problem but it allows the greedmongers to still pocket their profits while ensuring that millions are not left to suffer and die needlessly. This option is working whereas the other option provided in the OP's "experiment" has never worked and will never work for millions of hardworking Americans.

I give DT props for rising to the challenge of the experiment. This indeed is a comprehensive argument and he stayed within the guidelines, but I will not agree that the other option I argued 'has never worked'. I am confident that I can defend my argument that the federal government has worsened conditions it intended to address when Medicare and Medicaid went into effect back in the 1960's and, while many have benefitted from the programs, there is no evidence that such benefits could not have been provided more efficiently effectively, and affordably at the local level and/or the private sector and without the massive unintended negative consequences we have and are facing.

Medicare alone is projected to produce $117 TRILLION in deficits over the next 75 years--that averages out to roughly 1.3 trillion in costs each and every year to the shrinking pool of taxpayers compared to those receiving government subsidies--and this will be extremely exacerbated by the ACA that adds millions more people to the public dole. An excellent comprehensive discussion of this can be found here:
Medicare s Rising Costs and the Urgent Need for Reform

Doing the math, 1.3 trillion averages out to about $4,000 for every man, woman, and child in the USA. And the massive bureaucracy will swallow up a huge chunk of that leaving much less to actually deliver healthcare to those who need it. Given the ability of the private sector to deliver us fuel and cars and electronics and housing and food and clothing at prices people can afford to pay, does anybody really believe the states and/or private sector would not have delivered insurance and healthcare services more economically, efficiently, and effectively than the federal government has been able to do?

There is no virtue in offering medical care to people via transferring a massive and unsustainable debt to those same people's children and grandchildren, most especially when the medical care provided costs more than it would have had the free market been allowed to work.

Fifty separate little laboratories, each working on the problem almost certainly would have produced better solutions and results, and because each would have been doing so within budget and without running up massive deficits and without feeding an enormous bureaucracy that currently is spending $10,000 each and every year for each and every man, woman, and child living in America and is doing that by expanding an $18+ trillion national debt that is growing by billions each and every day.

 

[Foxfyre]

See, you presume to have read what I wrote but you still misrepresent and mischaracterize what I wrote.

I have read what you have written with great attention, and made explicit the unwritten assumption on which your whole argument has to rest in order to make any sense at all. Without State and local governments being that epitome of virtue, the transfer of powers to them from the Federal government doesn't even begin to make sense. If, in fact, you wish to denounce these assumptions, your argument is not only without foundation in reality, but also illogical, amounting to a mere venting of anti-Federal government venom with no substance at all.

Please read the guidelines and try again. So far you are making my wager look really really good for me.

 

[Olde Europe]

Please read the guidelines and try again. So far you are making my wager look really really good for me.

Why would you (or anyone) assume that we would be interested in your "guidelines", or your wager, for that matter? I, for one, am quite comfortable pointing out your divorce from reality in order to demonstrate that you have nothing amounting to an argument. I happily welcome your assistance to that endeavor.

 

[Foxfyre]

Please read the guidelines and try again. So far you are making my wager look really really good for me.

Why would you (or anyone) assume that we would be interested in your "guidelines", or your wager, for that matter? I, for one, am quite comfortable pointing out your divorce from reality in order to demonstrate that you have nothing amounting to an argument. I happily welcome your assistance to that endeavor.

Well thanks anyway for making my point that most progressives seem unable to argue a point of view without using straw men, non sequitur, personal insults, and ad hominem. If I had to pick one single trait of progressivism to dispute it, it would be the fact that most people who embrace that ideology cannot articulate an objective rationale for their point of view. The most common M.O. is to use massive cuts and pastes and/or to denigrate anybody who disagrees with them.

The people who forged the original Constitution did not have that problem so much even though their debates became quite heated at times. If the American people are to have a reasoned and productive discussion on how to improve the clauses in the original Constitution that have produced disputes and are seen as ambiguous by some and/or add whatever amendments are needed to correct the excesses and overreach of government, we have to be able to do that by concentrating on concepts rather than accusing or insulting each other.

 

[Derideo_Te]

Going to break down each of Foxfyre 's points and deal with them separately.

but I will not agree that the other option I argued 'has never worked'. I am confident that I can defend my argument that the federal government has worsened conditions it intended to address when Medicare and Medicaid went into effect back in the 1960's and, while many have benefitted from the programs, there is no evidence that such benefits could not have been provided more efficiently effectively, and affordably at the local level and/or the private sector and without the massive unintended negative consequences we have and are facing.

If you can "defend my argument that the federal government has worsened conditions" then please go ahead and do so. Address the specific problem that was the reason for enacting Medicare in the first place. Namely private health insurers refused to insure those over 65 because it was too costly. Please address exactly how the private sector would have provided coverage "efficiently effectively, and affordably" for the elderly. And yes, don't forget to list those "massive unintended negative consequences we have and are facing".

Medicare alone is projected to produce $117 TRILLION in deficits over the next 75 years--that averages out to roughly 1.3 trillion in costs each and every year to the shrinking pool of taxpayers compared to those receiving government subsidies--and this will be extremely exacerbated by the ACA that adds millions more people to the public dole. An excellent comprehensive discussion of this can be found here:
Medicare s Rising Costs and the Urgent Need for Reform

Taken purely on face value without questioning the underlying false assumptions behind the Heritage article let's directly address the "solutions" that they recommend instead;

A Better Policy. To solve Medicare’s cost problem, Congress and the Administration should embark on both short-term and long-term reforms. In the near term, Congress and the President should: enact a modest and temporary Part A premium to cover the cash deficits in the Federal Hospital Insurance (HI) Trust Fund; gradually raise beneficiaries’ Part B and D premiums by 10 percent over the next five years; expand “means testing” provisions of current law; require an estimated 9 percent of the Medicare population to pay a larger share of their Medicare costs; and add a 10 percent copayment to Medicare home health care—which currently has no co-payment at all, despite its rapid growth.

For the long term, Congress and the President should adopt a defined-contribution (“premium support”) system of financing. Modeled after the best features of Medicare Part D and the Federal Employees Health Benefits Program (FEHBP), such a model would inject intense competition into the program that would align incentives of beneficiaries and patients and plans and providers, root out costly inefficiencies and waste, and slow the growth in Medicare spending—which would benefit both enrollees and the taxpayers.​

Heritage is suggesting that the elderly who are in poor health and on fixed incomes must be made to pay between $336 to $576 a month (out of an average SS check of only $1,305) for home health care.

Monthly Statistical Snapshot November 2014
Elder Care Cost Compare Home Care Nursing Homes Assisted Living

Please note the 2nd paragraph from Heritage is a description of their plan as enacted as the ACA only they want to force retired senior citizens to purchase Obamacare instead of having Medicare. Do the math and what do you discover? Instead of a modest tax to pay for Medicare we will be forced to subsidize the ACA for millions of senior citizens instead. Isn't that the direct opposite of what you are advocating?

Doing the math, 1.3 trillion averages out to about $4,000 for every man, woman, and child in the USA. And the massive bureaucracy will swallow up a huge chunk of that leaving much less to actually deliver healthcare to those who need it. Given the ability of the private sector to deliver us fuel and cars and electronics and housing and food and clothing at prices people can afford to pay, does anybody really believe the private sector would not have delivered insurance and healthcare services more economically than government has been able to do?

The math is fallacious because it is assuming a "shrinking pool of taxpayers" while claiming that the pool will be enlarged. The reality is that the bulk of the baby boomer retirees are not going to be around for the next 75 years. In fact they will probably be checking out in the next 2 to 3 decades. So the burden is not as onerous as is being predicted by Heritage. As far as the ability of the private sector to provide "off the shelf" healthcare like it does with electronics that is comparing apples and oranges. Healthcare is labor intensive while machines can make cars and electronics. Anything that is labor intensive will always cost more. The private sector cannot change that reality.

There is no virtue in offering medical care to people via transferring a massive and unsustainable debt to those same people's children and grandchildren, most especially when the medical care provided costs more than it would have had the free market been allowed to work.

The Heritage "solution" will actually transfer an even greater burden of debt to our children and grandchildren since they are proposing a much more costly alternative.

Fifty separate little laboratories, each working on the problem almost certainly would have produced better solutions and results, and because each would have been doing so within budget and without running up massive deficits and without feeding an enormous bureaucracy that currently is spending $10,000 each and every year for each and every man, woman, and child living in America and is doing that by expanding an $18+ trillion national debt that is growing by billions each and every day.

So working with the state laboratories that did implement their individual solutions there was Oregon and Massachussetts to choose from. Oregon was using a single payer model and that was unacceptable so the Heritage Plan that became Romneycare was adopted for the ACA.

The current National Debt and budget deficit is outside of the parameters of the experiment. Yes, it is a problem but it needs to be addressed as a separate topic IMO. Suffice to say that there is more than one way to deal with that problem and the historical method used in the past has always worked and should be used again to bring this nation back into fiscal balance.

 

[Foxfyre]

Going to break down each of Foxfyre 's points and deal with them separately.

but I will not agree that the other option I argued 'has never worked'. I am confident that I can defend my argument that the federal government has worsened conditions it intended to address when Medicare and Medicaid went into effect back in the 1960's and, while many have benefitted from the programs, there is no evidence that such benefits could not have been provided more efficiently effectively, and affordably at the local level and/or the private sector and without the massive unintended negative consequences we have and are facing.

If you can "defend my argument that the federal government has worsened conditions" then please go ahead and do so. Address the specific problem that was the reason for enacting Medicare in the first place. Namely private health insurers refused to insure those over 65 because it was too costly. Please address exactly how the private sector would have provided coverage "efficiently effectively, and affordably" for the elderly. And yes, don't forget to list those "massive unintended negative consequences we have and are facing".

Medicare alone is projected to produce $117 TRILLION in deficits over the next 75 years--that averages out to roughly 1.3 trillion in costs each and every year to the shrinking pool of taxpayers compared to those receiving government subsidies--and this will be extremely exacerbated by the ACA that adds millions more people to the public dole. An excellent comprehensive discussion of this can be found here:
Medicare s Rising Costs and the Urgent Need for Reform

Taken purely on face value without questioning the underlying false assumptions behind the Heritage article let's directly address the "solutions" that they recommend instead;

A Better Policy. To solve Medicare’s cost problem, Congress and the Administration should embark on both short-term and long-term reforms. In the near term, Congress and the President should: enact a modest and temporary Part A premium to cover the cash deficits in the Federal Hospital Insurance (HI) Trust Fund; gradually raise beneficiaries’ Part B and D premiums by 10 percent over the next five years; expand “means testing” provisions of current law; require an estimated 9 percent of the Medicare population to pay a larger share of their Medicare costs; and add a 10 percent copayment to Medicare home health care—which currently has no co-payment at all, despite its rapid growth.

For the long term, Congress and the President should adopt a defined-contribution (“premium support”) system of financing. Modeled after the best features of Medicare Part D and the Federal Employees Health Benefits Program (FEHBP), such a model would inject intense competition into the program that would align incentives of beneficiaries and patients and plans and providers, root out costly inefficiencies and waste, and slow the growth in Medicare spending—which would benefit both enrollees and the taxpayers.​

Heritage is suggesting that the elderly who are in poor health and on fixed incomes must be made to pay between $336 to $576 a month (out of an average SS check of only $1,305) for home health care.

Monthly Statistical Snapshot November 2014
Elder Care Cost Compare Home Care Nursing Homes Assisted Living

Please note the 2nd paragraph from Heritage is a description of their plan as enacted as the ACA only they want to force retired senior citizens to purchase Obamacare instead of having Medicare. Do the math and what do you discover? Instead of a modest tax to pay for Medicare we will be forced to subsidize the ACA for millions of senior citizens instead. Isn't that the direct opposite of what you are advocating?

Doing the math, 1.3 trillion averages out to about $4,000 for every man, woman, and child in the USA. And the massive bureaucracy will swallow up a huge chunk of that leaving much less to actually deliver healthcare to those who need it. Given the ability of the private sector to deliver us fuel and cars and electronics and housing and food and clothing at prices people can afford to pay, does anybody really believe the private sector would not have delivered insurance and healthcare services more economically than government has been able to do?

The math is fallacious because it is assuming a "shrinking pool of taxpayers" while claiming that the pool will be enlarged. The reality is that the bulk of the baby boomer retirees are not going to be around for the next 75 years. In fact they will probably be checking out in the next 2 to 3 decades. So the burden is not as onerous as is being predicted by Heritage. As far as the ability of the private sector to provide "off the shelf" healthcare like it does with electronics that is comparing apples and oranges. Healthcare is labor intensive while machines can make cars and electronics. Anything that is labor intensive will always cost more. The private sector cannot change that reality.

There is no virtue in offering medical care to people via transferring a massive and unsustainable debt to those same people's children and grandchildren, most especially when the medical care provided costs more than it would have had the free market been allowed to work.

The Heritage "solution" will actually transfer an even greater burden of debt to our children and grandchildren since they are proposing a much more costly alternative.

Fifty separate little laboratories, each working on the problem almost certainly would have produced better solutions and results, and because each would have been doing so within budget and without running up massive deficits and without feeding an enormous bureaucracy that currently is spending $10,000 each and every year for each and every man, woman, and child living in America and is doing that by expanding an $18+ trillion national debt that is growing by billions each and every day.

So working with the state laboratories that did implement their individual solutions there was Oregon and Massachussetts to choose from. Oregon was using a single payer model and that was unacceptable so the Heritage Plan that became Romneycare was adopted for the ACA.

The current National Debt and budget deficit is outside of the parameters of the experiment. Yes, it is a problem but it needs to be addressed as a separate topic IMO. Suffice to say that there is more than one way to deal with that problem and the historical method used in the past has always worked and should be used again to bring this nation back into fiscal balance.

Actually, when Medicare went into effect, roughly 65% of the elderly did have hospitalization insurance which was roughly the same percentage as the U.S. population as a whole. And we had hospitalization insurance in those days, usually with fairly large deductibles, so that a lengthy hospital stay or expensive operation would not bankrupt us. Healthcare was paid for out of pocket just as we pay for our home and auto maintenance and other necessities out of pocket. Insurance was intended to protect us from large expenses that few could afford and was not intended to be a prepayment for routine services as health insurance is now. And because insurance companies were run as businesses competing with other private businesses and healthcare providers had no choice but to provide products and services at prices people could afford, most healthcare was within the means of the average working American. Then, as it would be now, the free market was the best way to provide excellence, accessibility, and affordability to all.

That does not mean that no provisions were made for the truly helpless and needy among us.

You did not show how the Heritage article was flawed in any way. You simply stated that it was. I will accept that as your opinion. I offer my own opinion that I have not done any work to verify the facts and figures they offered, but they are consistent with other opinions I have read over the years when it comes to reforming an existing program. Did you do any work to dispute the facts and figures they offered?

I will contnue to believe that a free people will do a better job of providing for the basic needs of the people via local government and the free market than can any federal one-size-fits-all program that will invariably become more self serving than public service and will invariably take away at least some of our liberties, choices, options, and opportunities.

What virtue is there in effectively forcing people into a one-size-fits-all government program that may or may not be what they would choose for themselves and, in the process, eliminating many of the other options that were once open to them?

 

[Derideo_Te]

Going to break down each of Foxfyre 's points and deal with them separately.

but I will not agree that the other option I argued 'has never worked'. I am confident that I can defend my argument that the federal government has worsened conditions it intended to address when Medicare and Medicaid went into effect back in the 1960's and, while many have benefitted from the programs, there is no evidence that such benefits could not have been provided more efficiently effectively, and affordably at the local level and/or the private sector and without the massive unintended negative consequences we have and are facing.

If you can "defend my argument that the federal government has worsened conditions" then please go ahead and do so. Address the specific problem that was the reason for enacting Medicare in the first place. Namely private health insurers refused to insure those over 65 because it was too costly. Please address exactly how the private sector would have provided coverage "efficiently effectively, and affordably" for the elderly. And yes, don't forget to list those "massive unintended negative consequences we have and are facing".

Medicare alone is projected to produce $117 TRILLION in deficits over the next 75 years--that averages out to roughly 1.3 trillion in costs each and every year to the shrinking pool of taxpayers compared to those receiving government subsidies--and this will be extremely exacerbated by the ACA that adds millions more people to the public dole. An excellent comprehensive discussion of this can be found here:
Medicare s Rising Costs and the Urgent Need for Reform

Taken purely on face value without questioning the underlying false assumptions behind the Heritage article let's directly address the "solutions" that they recommend instead;

A Better Policy. To solve Medicare’s cost problem, Congress and the Administration should embark on both short-term and long-term reforms. In the near term, Congress and the President should: enact a modest and temporary Part A premium to cover the cash deficits in the Federal Hospital Insurance (HI) Trust Fund; gradually raise beneficiaries’ Part B and D premiums by 10 percent over the next five years; expand “means testing” provisions of current law; require an estimated 9 percent of the Medicare population to pay a larger share of their Medicare costs; and add a 10 percent copayment to Medicare home health care—which currently has no co-payment at all, despite its rapid growth.

For the long term, Congress and the President should adopt a defined-contribution (“premium support”) system of financing. Modeled after the best features of Medicare Part D and the Federal Employees Health Benefits Program (FEHBP), such a model would inject intense competition into the program that would align incentives of beneficiaries and patients and plans and providers, root out costly inefficiencies and waste, and slow the growth in Medicare spending—which would benefit both enrollees and the taxpayers.​

Heritage is suggesting that the elderly who are in poor health and on fixed incomes must be made to pay between $336 to $576 a month (out of an average SS check of only $1,305) for home health care.

Monthly Statistical Snapshot November 2014
Elder Care Cost Compare Home Care Nursing Homes Assisted Living

Please note the 2nd paragraph from Heritage is a description of their plan as enacted as the ACA only they want to force retired senior citizens to purchase Obamacare instead of having Medicare. Do the math and what do you discover? Instead of a modest tax to pay for Medicare we will be forced to subsidize the ACA for millions of senior citizens instead. Isn't that the direct opposite of what you are advocating?

Doing the math, 1.3 trillion averages out to about $4,000 for every man, woman, and child in the USA. And the massive bureaucracy will swallow up a huge chunk of that leaving much less to actually deliver healthcare to those who need it. Given the ability of the private sector to deliver us fuel and cars and electronics and housing and food and clothing at prices people can afford to pay, does anybody really believe the private sector would not have delivered insurance and healthcare services more economically than government has been able to do?

The math is fallacious because it is assuming a "shrinking pool of taxpayers" while claiming that the pool will be enlarged. The reality is that the bulk of the baby boomer retirees are not going to be around for the next 75 years. In fact they will probably be checking out in the next 2 to 3 decades. So the burden is not as onerous as is being predicted by Heritage. As far as the ability of the private sector to provide "off the shelf" healthcare like it does with electronics that is comparing apples and oranges. Healthcare is labor intensive while machines can make cars and electronics. Anything that is labor intensive will always cost more. The private sector cannot change that reality.

There is no virtue in offering medical care to people via transferring a massive and unsustainable debt to those same people's children and grandchildren, most especially when the medical care provided costs more than it would have had the free market been allowed to work.

The Heritage "solution" will actually transfer an even greater burden of debt to our children and grandchildren since they are proposing a much more costly alternative.

Fifty separate little laboratories, each working on the problem almost certainly would have produced better solutions and results, and because each would have been doing so within budget and without running up massive deficits and without feeding an enormous bureaucracy that currently is spending $10,000 each and every year for each and every man, woman, and child living in America and is doing that by expanding an $18+ trillion national debt that is growing by billions each and every day.

So working with the state laboratories that did implement their individual solutions there was Oregon and Massachussetts to choose from. Oregon was using a single payer model and that was unacceptable so the Heritage Plan that became Romneycare was adopted for the ACA.

The current National Debt and budget deficit is outside of the parameters of the experiment. Yes, it is a problem but it needs to be addressed as a separate topic IMO. Suffice to say that there is more than one way to deal with that problem and the historical method used in the past has always worked and should be used again to bring this nation back into fiscal balance.

Actually, when Medicare went into effect, roughly 65% of the elderly did have hospitalization insurance which was roughly the same percentage as the U.S. population as a whole. And we had hospitalization insurance in those days, usually with fairly large deductibles, so that a lengthy hospital stay or expensive operation would not bankrupt us. Healthcare was paid for out of pocket just as we pay for our home and auto maintenance and other necessities out of pocket. Insurance was intended to protect us from large expenses that few could afford and was not intended to be a prepayment for routine services as health insurance is now. And because insurance companies were run as businesses competing with other private businesses and healthcare providers had no choice but to provide products and services at prices people could afford, most healthcare was within the means of the average working American. Then, as it would be now, the free market was the best way to provide excellence, accessibility, and affordability to all.

That does not mean that no provisions were made for the truly helpless and needy among us.

You did not show how the Heritage article was flawed in any way. You simply stated that it was. I will accept that as your opinion. I offer my own opinion that I have not done any work to verify the facts and figures they offered, but they are consistent with other opinions I have read over the years when it comes to reforming an existing program. Did you do any work to dispute the facts and figures they offered?

I will contnue to believe that a free people will do a better job of providing for the basic needs of the people via local government and the free market than can any federal one-size-fits-all program that will invariably become more self serving than public service and will invariably take away at least some of our liberties, choices, options, and opportunities.

What virtue is there in effectively forcing people into a one-size-fits-all government program that may or may not be what they would choose for themselves and, in the process, eliminating many of the other options that were once open to them?

They were paying 3 times as much as everyone else. Little wonder over 1 in 3 retirees could not afford any healthcare at all. Enacting Medicare reduced the poverty rate by 50% and increased life expectancy by a couple of years.

 

[Foxfyre]

Going to break down each of Foxfyre 's points and deal with them separately.

but I will not agree that the other option I argued 'has never worked'. I am confident that I can defend my argument that the federal government has worsened conditions it intended to address when Medicare and Medicaid went into effect back in the 1960's and, while many have benefitted from the programs, there is no evidence that such benefits could not have been provided more efficiently effectively, and affordably at the local level and/or the private sector and without the massive unintended negative consequences we have and are facing.

If you can "defend my argument that the federal government has worsened conditions" then please go ahead and do so. Address the specific problem that was the reason for enacting Medicare in the first place. Namely private health insurers refused to insure those over 65 because it was too costly. Please address exactly how the private sector would have provided coverage "efficiently effectively, and affordably" for the elderly. And yes, don't forget to list those "massive unintended negative consequences we have and are facing".

Medicare alone is projected to produce $117 TRILLION in deficits over the next 75 years--that averages out to roughly 1.3 trillion in costs each and every year to the shrinking pool of taxpayers compared to those receiving government subsidies--and this will be extremely exacerbated by the ACA that adds millions more people to the public dole. An excellent comprehensive discussion of this can be found here:
Medicare s Rising Costs and the Urgent Need for Reform

Taken purely on face value without questioning the underlying false assumptions behind the Heritage article let's directly address the "solutions" that they recommend instead;

A Better Policy. To solve Medicare’s cost problem, Congress and the Administration should embark on both short-term and long-term reforms. In the near term, Congress and the President should: enact a modest and temporary Part A premium to cover the cash deficits in the Federal Hospital Insurance (HI) Trust Fund; gradually raise beneficiaries’ Part B and D premiums by 10 percent over the next five years; expand “means testing” provisions of current law; require an estimated 9 percent of the Medicare population to pay a larger share of their Medicare costs; and add a 10 percent copayment to Medicare home health care—which currently has no co-payment at all, despite its rapid growth.

For the long term, Congress and the President should adopt a defined-contribution (“premium support”) system of financing. Modeled after the best features of Medicare Part D and the Federal Employees Health Benefits Program (FEHBP), such a model would inject intense competition into the program that would align incentives of beneficiaries and patients and plans and providers, root out costly inefficiencies and waste, and slow the growth in Medicare spending—which would benefit both enrollees and the taxpayers.​

Heritage is suggesting that the elderly who are in poor health and on fixed incomes must be made to pay between $336 to $576 a month (out of an average SS check of only $1,305) for home health care.

Monthly Statistical Snapshot November 2014
Elder Care Cost Compare Home Care Nursing Homes Assisted Living

Please note the 2nd paragraph from Heritage is a description of their plan as enacted as the ACA only they want to force retired senior citizens to purchase Obamacare instead of having Medicare. Do the math and what do you discover? Instead of a modest tax to pay for Medicare we will be forced to subsidize the ACA for millions of senior citizens instead. Isn't that the direct opposite of what you are advocating?

Doing the math, 1.3 trillion averages out to about $4,000 for every man, woman, and child in the USA. And the massive bureaucracy will swallow up a huge chunk of that leaving much less to actually deliver healthcare to those who need it. Given the ability of the private sector to deliver us fuel and cars and electronics and housing and food and clothing at prices people can afford to pay, does anybody really believe the private sector would not have delivered insurance and healthcare services more economically than government has been able to do?

The math is fallacious because it is assuming a "shrinking pool of taxpayers" while claiming that the pool will be enlarged. The reality is that the bulk of the baby boomer retirees are not going to be around for the next 75 years. In fact they will probably be checking out in the next 2 to 3 decades. So the burden is not as onerous as is being predicted by Heritage. As far as the ability of the private sector to provide "off the shelf" healthcare like it does with electronics that is comparing apples and oranges. Healthcare is labor intensive while machines can make cars and electronics. Anything that is labor intensive will always cost more. The private sector cannot change that reality.

There is no virtue in offering medical care to people via transferring a massive and unsustainable debt to those same people's children and grandchildren, most especially when the medical care provided costs more than it would have had the free market been allowed to work.

The Heritage "solution" will actually transfer an even greater burden of debt to our children and grandchildren since they are proposing a much more costly alternative.

Fifty separate little laboratories, each working on the problem almost certainly would have produced better solutions and results, and because each would have been doing so within budget and without running up massive deficits and without feeding an enormous bureaucracy that currently is spending $10,000 each and every year for each and every man, woman, and child living in America and is doing that by expanding an $18+ trillion national debt that is growing by billions each and every day.

So working with the state laboratories that did implement their individual solutions there was Oregon and Massachussetts to choose from. Oregon was using a single payer model and that was unacceptable so the Heritage Plan that became Romneycare was adopted for the ACA.

The current National Debt and budget deficit is outside of the parameters of the experiment. Yes, it is a problem but it needs to be addressed as a separate topic IMO. Suffice to say that there is more than one way to deal with that problem and the historical method used in the past has always worked and should be used again to bring this nation back into fiscal balance.

Actually, when Medicare went into effect, roughly 65% of the elderly did have hospitalization insurance which was roughly the same percentage as the U.S. population as a whole. And we had hospitalization insurance in those days, usually with fairly large deductibles, so that a lengthy hospital stay or expensive operation would not bankrupt us. Healthcare was paid for out of pocket just as we pay for our home and auto maintenance and other necessities out of pocket. Insurance was intended to protect us from large expenses that few could afford and was not intended to be a prepayment for routine services as health insurance is now. And because insurance companies were run as businesses competing with other private businesses and healthcare providers had no choice but to provide products and services at prices people could afford, most healthcare was within the means of the average working American. Then, as it would be now, the free market was the best way to provide excellence, accessibility, and affordability to all.

That does not mean that no provisions were made for the truly helpless and needy among us.

You did not show how the Heritage article was flawed in any way. You simply stated that it was. I will accept that as your opinion. I offer my own opinion that I have not done any work to verify the facts and figures they offered, but they are consistent with other opinions I have read over the years when it comes to reforming an existing program. Did you do any work to dispute the facts and figures they offered?

I will contnue to believe that a free people will do a better job of providing for the basic needs of the people via local government and the free market than can any federal one-size-fits-all program that will invariably become more self serving than public service and will invariably take away at least some of our liberties, choices, options, and opportunities.

What virtue is there in effectively forcing people into a one-size-fits-all government program that may or may not be what they would choose for themselves and, in the process, eliminating many of the other options that were once open to them?

They were paying 3 times as much as everyone else. Little wonder over 1 in 3 retirees could not afford any healthcare at all. Enacting Medicare reduced the poverty rate by 50% and increased life expectancy by a couple of years.

And is running up a debt that will crash us if it isn't brought under control. You do not save money by simply charging less to one group while charging more to another group and borrowing whatever isn't covered by doing that.

There is zero evidence that the same good results would not have occurred or been made even better had the problems been left to local governments and the private sector to solve.

Just as black Americans were the group advancing the fastest, economically, in education, and in opportunity right up to the Great Society initiatives of the Johnson administration. And from that time on that advancement has slowed, stalled, sputtered out, and sometimes reversed. Coincidence? Or causation?

If we are to have a serous conversation, such must be looked at seriously and objectively. Good intentions do not necessarily result in commendable outcomes and, when they do not, we must stop defending them on the basis that the idea was noble.

 

[Derideo_Te]

There is zero evidence that the same good results would not have occurred or been made even better had the problems been left to local governments and the private sector to solve.

There are the facts as we have them and logical deductions.

What was the impetus for local governments to provide healthcare to the elderly? What would have motivated them to raise taxes at the local level to cover the medical expenses of senior citizens in their area? What would have happened if some local governments had refused to raise taxes and left their elderly in poverty? Would they have moved to where local governments were providing healthcare? What would have happened next after this influx of sick elderly people?

Obviously that was not a viable scenario unless 100% of all local governments did it simultaneously with the same level of benefits. Unrealistic to expect that to happen.

So now let's turn to the private sector. Their prime motive is profit for shareholders and the Wall Street Casino bosses. How are they going to make a profit on providing healthcare to impoverished elderly sick people who will cost them more than they can pay in premiums? They would have to be able to get every working American to join into their health plan but they would be facing stiff competition with other insurers to keep their prices low. So they cannot assume the overhead of covering the sick and impoverished and still be profitable at the same time. Ergo there is a greater incentive to not cover the sick and poor than there is to offer them coverage. Unrealistic to expect the private sector to do anything at all that will harm their bottom line profit margin.

So having logically eliminated both local governments and the private sector from providing "good results" what other alternatives are there that are even remotely viable to deal with this very real problem?

 

[Foxfyre]

There is zero evidence that the same good results would not have occurred or been made even better had the problems been left to local governments and the private sector to solve.

There are the facts as we have them and logical deductions.

What was the impetus for local governments to provide healthcare to the elderly? What would have motivated them to raise taxes at the local level to cover the medical expenses of senior citizens in their area? What would have happened if some local governments had refused to raise taxes and left their elderly in poverty? Would they have moved to where local governments were providing healthcare? What would have happened next after this influx of sick elderly people?

Obviously that was not a viable scenario unless 100% of all local governments did it simultaneously with the same level of benefits. Unrealistic to expect that to happen.

So now let's turn to the private sector. Their prime motive is profit for shareholders and the Wall Street Casino bosses. How are they going to make a profit on providing healthcare to impoverished elderly sick people who will cost them more than they can pay in premiums? They would have to be able to get every working American to join into their health plan but they would be facing stiff competition with other insurers to keep their prices low. So they cannot assume the overhead of covering the sick and impoverished and still be profitable at the same time. Ergo there is a greater incentive to not cover the sick and poor than there is to offer them coverage. Unrealistic to expect the private sector to do anything at all that will harm their bottom line profit margin.

So having logically eliminated both local governments and the private sector from providing "good results" what other alternatives are there that are even remotely viable to deal with this very real problem?

My observation of the federal government is that it exists to increase its own power, prestige, influence, and the personal wealth of those in it. The more power it can take away from the people, especially when that is in the guise of public service and appeasing and lulling the gullible with noble sounding titles on the programs, the better off those in government will be. It mostly doesn't care whether the programs it pushes on the people actually do any good and it mostly refuses to look at, much less accept responsibility for any harm that it does. For most of the powerful in big government, whether here or anywhere else in the the world, the important thing is to convince enough people that it is good so they can retain their power longer in order to increase their power, prestige, influence, and personal wealth. They do it by confiscating our resources or obligating our resources by running up the debt. They throw the people just enough bones to keep them complacent and quiet.

Is it less noble that the private sector looks to its own interest but does not do so by demanding our money but rather earns it by providing products and services that we need or want and are voluntarily willing to pay for? Is it somehow evil that people looking strictly to their own benefit provide us with better, more affordable, more useful products and services so that we will buy their product and service rather than their competitors?

Throughout human history, it has been mostly private enterprise that has identified and furnished what the market wanted. And it is accomplished by just about everybody selling their labor or running a business to put dinner on their own table. But in doing that they benefit and serve society as a whole.

There is of course a role for government in many things, but it is the more local government that is more likely to be responsive and tailored to the specific needs and culture of the immediate population it serves. A one-size fits all federal program cannot possibly hope to do that.

 

[Derideo_Te]

There is zero evidence that the same good results would not have occurred or been made even better had the problems been left to local governments and the private sector to solve.

There are the facts as we have them and logical deductions.

What was the impetus for local governments to provide healthcare to the elderly? What would have motivated them to raise taxes at the local level to cover the medical expenses of senior citizens in their area? What would have happened if some local governments had refused to raise taxes and left their elderly in poverty? Would they have moved to where local governments were providing healthcare? What would have happened next after this influx of sick elderly people?

Obviously that was not a viable scenario unless 100% of all local governments did it simultaneously with the same level of benefits. Unrealistic to expect that to happen.

So now let's turn to the private sector. Their prime motive is profit for shareholders and the Wall Street Casino bosses. How are they going to make a profit on providing healthcare to impoverished elderly sick people who will cost them more than they can pay in premiums? They would have to be able to get every working American to join into their health plan but they would be facing stiff competition with other insurers to keep their prices low. So they cannot assume the overhead of covering the sick and impoverished and still be profitable at the same time. Ergo there is a greater incentive to not cover the sick and poor than there is to offer them coverage. Unrealistic to expect the private sector to do anything at all that will harm their bottom line profit margin.

So having logically eliminated both local governments and the private sector from providing "good results" what other alternatives are there that are even remotely viable to deal with this very real problem?

My observation of the federal government is that it exists to increase its own power, prestige, influence, and the personal wealth of those in it. The more power it can take away from the people, especially when that is in the guise of public service and appeasing and lulling the gullible with noble sounding titles on the programs, the better off those in government will be. It mostly doesn't care whether the programs it pushes on the people actually do any good and it mostly refuses to look at, much less accept responsibility for any harm that it does. For most of the powerful in big government, whether here or anywhere else in the the world, the important thing is to convince enough people that it is good so they can retain their power longer in order to increase their power, prestige, influence, and personal wealth. They do it by confiscating our resources or obligating our resources by running up the debt. They throw the people just enough bones to keep them complacent and quiet.

Is it less noble that the private sector looks to its own interest but does not do so by demanding our money but rather earns it by providing products and services that we need or want and are voluntarily willing to pay for? Is it somehow evil that people looking strictly to their own benefit provide us with better, more affordable, more useful products and services so that we will buy their product and service rather than their competitors?

Throughout human history, it has been mostly private enterprise that has identified and furnished what the market wanted. And it is accomplished by just about everybody selling their labor or running a business to put dinner on their own table. But in doing that they benefit and serve society as a whole.

There is of course a role for government in many things, but it is the more local government that is more likely to be responsive and tailored to the specific needs and culture of the immediate population it serves. A one-size fits all federal program cannot possibly hope to do that.

Ignoring the repetitive bashing of the Federal government let's focus on this claim of yours instead?

"A one-size fits all federal program cannot possibly hope to do that"​

I am sure that you will agree that neither does a private sector one-size fits all program.However you were claiming that "local government" is "more likely to be responsive and tailored to the specific needs and culture of the immediate population it serves".

So what if one local government doesn't but another does? This isn't the private sector competing. Local governments don't get to change their location if they get better labor or tax rates elsewhere. Under your scenario the local government where I am may decide that it is in the best interests of it's tax base to provide everyone with full healthcare coverage with zero deductibles. This will attract corporations because they don't have to deal with that overhead and in turn that will attract smart employees and the tax base will grow and everyone will prosper.

On the other hand the local government in your area will flatly refuse to do anything at all for the least fortunate citizens. As a result of the endemic poverty crime will increase and those lucky enough to be able to afford to leave will flee the jurisdiction of your local government. Your property value will drop and your quality of life will deteriorate. Whatever property taxes are collected will be barely barely sufficient to keep on the street lights at night.

The 3rd alternative is where the Federal government ensures that everyone has healthcare coverage and then one local government won't suffer while another prospers because of the poor decision making skills of those in power at that local level.

Just as you can turn on the lights and taps anywhere in the nation and the power and water remain the same so it must be with healthcare. Would you hand over control of the air that you breathe to the private sector? Would you want to be looking for the lowest price of breathable air with the least pollutants?

Some things are universal. Healthcare is one of them.

 

[Foxfyre]

There is zero evidence that the same good results would not have occurred or been made even better had the problems been left to local governments and the private sector to solve.

There are the facts as we have them and logical deductions.

What was the impetus for local governments to provide healthcare to the elderly? What would have motivated them to raise taxes at the local level to cover the medical expenses of senior citizens in their area? What would have happened if some local governments had refused to raise taxes and left their elderly in poverty? Would they have moved to where local governments were providing healthcare? What would have happened next after this influx of sick elderly people?

Obviously that was not a viable scenario unless 100% of all local governments did it simultaneously with the same level of benefits. Unrealistic to expect that to happen.

So now let's turn to the private sector. Their prime motive is profit for shareholders and the Wall Street Casino bosses. How are they going to make a profit on providing healthcare to impoverished elderly sick people who will cost them more than they can pay in premiums? They would have to be able to get every working American to join into their health plan but they would be facing stiff competition with other insurers to keep their prices low. So they cannot assume the overhead of covering the sick and impoverished and still be profitable at the same time. Ergo there is a greater incentive to not cover the sick and poor than there is to offer them coverage. Unrealistic to expect the private sector to do anything at all that will harm their bottom line profit margin.

So having logically eliminated both local governments and the private sector from providing "good results" what other alternatives are there that are even remotely viable to deal with this very real problem?

My observation of the federal government is that it exists to increase its own power, prestige, influence, and the personal wealth of those in it. The more power it can take away from the people, especially when that is in the guise of public service and appeasing and lulling the gullible with noble sounding titles on the programs, the better off those in government will be. It mostly doesn't care whether the programs it pushes on the people actually do any good and it mostly refuses to look at, much less accept responsibility for any harm that it does. For most of the powerful in big government, whether here or anywhere else in the the world, the important thing is to convince enough people that it is good so they can retain their power longer in order to increase their power, prestige, influence, and personal wealth. They do it by confiscating our resources or obligating our resources by running up the debt. They throw the people just enough bones to keep them complacent and quiet.

Is it less noble that the private sector looks to its own interest but does not do so by demanding our money but rather earns it by providing products and services that we need or want and are voluntarily willing to pay for? Is it somehow evil that people looking strictly to their own benefit provide us with better, more affordable, more useful products and services so that we will buy their product and service rather than their competitors?

Throughout human history, it has been mostly private enterprise that has identified and furnished what the market wanted. And it is accomplished by just about everybody selling their labor or running a business to put dinner on their own table. But in doing that they benefit and serve society as a whole.

There is of course a role for government in many things, but it is the more local government that is more likely to be responsive and tailored to the specific needs and culture of the immediate population it serves. A one-size fits all federal program cannot possibly hope to do that.

Ignoring the repetitive bashing of the Federal government let's focus on this claim of yours instead?

"A one-size fits all federal program cannot possibly hope to do that"​

I am sure that you will agree that neither does a private sector one-size fits all program.However you were claiming that "local government" is "more likely to be responsive and tailored to the specific needs and culture of the immediate population it serves".

So what if one local government doesn't but another does? This isn't the private sector competing. Local governments don't get to change their location if they get better labor or tax rates elsewhere. Under your scenario the local government where I am may decide that it is in the best interests of it's tax base to provide everyone with full healthcare coverage with zero deductibles. This will attract corporations because they don't have to deal with that overhead and in turn that will attract smart employees and the tax base will grow and everyone will prosper.

On the other hand the local government in your area will flatly refuse to do anything at all for the least fortunate citizens. As a result of the endemic poverty crime will increase and those lucky enough to be able to afford to leave will flee the jurisdiction of your local government. Your property value will drop and your quality of life will deteriorate. Whatever property taxes are collected will be barely barely sufficient to keep on the street lights at night.

The 3rd alternative is where the Federal government ensures that everyone has healthcare coverage and then one local government won't suffer while another prospers because of the poor decision making skills of those in power at that local level.

Just as you can turn on the lights and taps anywhere in the nation and the power and water remain the same so it must be with healthcare. Would you hand over control of the air that you breathe to the private sector? Would you want to be looking for the lowest price of breathable air with the least pollutants?

Some things are universal. Healthcare is one of them.

NOTING that your opening sentence disqualified your post because it violates the specified guidelines.

I would indeed entrust the air quality affected by local activity to local officials to deal with. I would trust them to deal with it more appropriately than I would trust a one-size-fits-all oversized federal government agency.

But air cannot be confined to a single state so where one state's pollution crosses state lines, certainly the federal government would have to be involved as it would with shared water and other resources. It isn't reasonable that Colorado be allowed to dam and store all the water from the Rio Grande leaving New Mexico and then Texas high and dry. Louisiana should not have to suffer the consequences of Mississippi violating the fishing quotas and taking all the fish from the coastal waters leaving none for others. Certainly drilling processes in the gulf or other coastal waters that can affect all must be regulated.

And it has to be obvious how such things are vastly different than a product or service that is best provided by the local government and/or the private sector.

Surely it is obvious how resources that MUST BE shared are quite different from

 

[EdwardBaiamonte]

Let's spell out, in clear terms that we all understood, exactly what we can expect from government and then decide whether we want to be a part of that or not

Except that every single time I have asked you to do exactly that you have flatly refused.

Again, you're totally missing my point. I said "Let's" - implying a collaborative process. I'm arguing for the value in clearly defining the scope and powers of government even if that doesn't produce something I like. I could do an outline of what I'd like to see, and then you could complain about it, but that would be pointless. You want a totally different kind of government than I do. I get that. And our disagreements are just a microcosm of the political divide the entire nation is straddling. We need to address these issues seriously as a nation, and produce a binding referendum that we can all agree to. If it goes your way, libertarians can either decide to make the best of it, or leave. Likewise, if it goes my way, you might face a similar choice. More likely, it would be somewhere in between. But the hope is that it would at least be more clear, and that in the future we might spend less time with unproductive ideological disputes, and more on good government.

The obvious choice is a compromise which is what the Founding Fathers did originally. Now are you willing to compromise or must it be all one way or the other?

Of course our Founders knew that liberallism was based in very deadly ignorance so why would anyone compromise with it? Would you compromise with Hitler and kill only 3 million Jews?

 

[Derideo_Te]

There is zero evidence that the same good results would not have occurred or been made even better had the problems been left to local governments and the private sector to solve.

There are the facts as we have them and logical deductions.

What was the impetus for local governments to provide healthcare to the elderly? What would have motivated them to raise taxes at the local level to cover the medical expenses of senior citizens in their area? What would have happened if some local governments had refused to raise taxes and left their elderly in poverty? Would they have moved to where local governments were providing healthcare? What would have happened next after this influx of sick elderly people?

Obviously that was not a viable scenario unless 100% of all local governments did it simultaneously with the same level of benefits. Unrealistic to expect that to happen.

So now let's turn to the private sector. Their prime motive is profit for shareholders and the Wall Street Casino bosses. How are they going to make a profit on providing healthcare to impoverished elderly sick people who will cost them more than they can pay in premiums? They would have to be able to get every working American to join into their health plan but they would be facing stiff competition with other insurers to keep their prices low. So they cannot assume the overhead of covering the sick and impoverished and still be profitable at the same time. Ergo there is a greater incentive to not cover the sick and poor than there is to offer them coverage. Unrealistic to expect the private sector to do anything at all that will harm their bottom line profit margin.

So having logically eliminated both local governments and the private sector from providing "good results" what other alternatives are there that are even remotely viable to deal with this very real problem?

My observation of the federal government is that it exists to increase its own power, prestige, influence, and the personal wealth of those in it. The more power it can take away from the people, especially when that is in the guise of public service and appeasing and lulling the gullible with noble sounding titles on the programs, the better off those in government will be. It mostly doesn't care whether the programs it pushes on the people actually do any good and it mostly refuses to look at, much less accept responsibility for any harm that it does. For most of the powerful in big government, whether here or anywhere else in the the world, the important thing is to convince enough people that it is good so they can retain their power longer in order to increase their power, prestige, influence, and personal wealth. They do it by confiscating our resources or obligating our resources by running up the debt. They throw the people just enough bones to keep them complacent and quiet.

Is it less noble that the private sector looks to its own interest but does not do so by demanding our money but rather earns it by providing products and services that we need or want and are voluntarily willing to pay for? Is it somehow evil that people looking strictly to their own benefit provide us with better, more affordable, more useful products and services so that we will buy their product and service rather than their competitors?

Throughout human history, it has been mostly private enterprise that has identified and furnished what the market wanted. And it is accomplished by just about everybody selling their labor or running a business to put dinner on their own table. But in doing that they benefit and serve society as a whole.

There is of course a role for government in many things, but it is the more local government that is more likely to be responsive and tailored to the specific needs and culture of the immediate population it serves. A one-size fits all federal program cannot possibly hope to do that.

Ignoring the repetitive bashing of the Federal government let's focus on this claim of yours instead?

"A one-size fits all federal program cannot possibly hope to do that"​

I am sure that you will agree that neither does a private sector one-size fits all program.However you were claiming that "local government" is "more likely to be responsive and tailored to the specific needs and culture of the immediate population it serves".

So what if one local government doesn't but another does? This isn't the private sector competing. Local governments don't get to change their location if they get better labor or tax rates elsewhere. Under your scenario the local government where I am may decide that it is in the best interests of it's tax base to provide everyone with full healthcare coverage with zero deductibles. This will attract corporations because they don't have to deal with that overhead and in turn that will attract smart employees and the tax base will grow and everyone will prosper.

On the other hand the local government in your area will flatly refuse to do anything at all for the least fortunate citizens. As a result of the endemic poverty crime will increase and those lucky enough to be able to afford to leave will flee the jurisdiction of your local government. Your property value will drop and your quality of life will deteriorate. Whatever property taxes are collected will be barely barely sufficient to keep on the street lights at night.

The 3rd alternative is where the Federal government ensures that everyone has healthcare coverage and then one local government won't suffer while another prospers because of the poor decision making skills of those in power at that local level.

Just as you can turn on the lights and taps anywhere in the nation and the power and water remain the same so it must be with healthcare. Would you hand over control of the air that you breathe to the private sector? Would you want to be looking for the lowest price of breathable air with the least pollutants?

Some things are universal. Healthcare is one of them.

NOTING that your opening sentence disqualified your post because it violates the specified guidelines.

I would indeed entrust the air quality affected by local activity to local officials to deal with. I would trust them to deal with it more appropriately than I would trust a one-size-fits-all oversized federal government agency.

But air cannot be confined to a single state so where one state's pollution crosses state lines, certainly the federal government would have to be involved as it would with shared water and other resources. It isn't reasonable that Colorado be allowed to dam and store all the water from the Rio Grande leaving New Mexico and then Texas high and dry. Louisiana should not have to suffer the consequences of Mississippi violating the fishing quotas and taking all the fish from the coastal waters leaving none for others. Certainly drilling processes in the gulf or other coastal waters that can affect all must be regulated.

And it has to be obvious how such things are vastly different than a product or service that is best provided by the local government and/or the private sector.

Surely it is obvious how resources that MUST BE shared are quite different from

Explain exactly how healthcare is vastly different to other shared resources?

Is there a finite amount of healthcare for everyone? Yes or no? If there is an unlimited amount of healthcare then everyone would be able to obtain it as cheaply as water or electricity, right?

Or is healthcare more akin to gasoline? Yes or no? If yes then that means that it is a finite resource that everyone needs just like water and electricity, right?

The prices of finite resources are subject to the market availability, right? So when oil is abundant gas is cheap and vice versa.

What happens when you have a very limited resource that is expensive to obtain yet everyone wants it like gold? The price will also fluctuate depending upon demand but the scarcity of the resource will ensure that the price remains high.

Healthcare is limited because there is a great deal of training required and it employs a great deal of sophisticated technology and research into drugs.

So now that we have identified where healthcare fits into the resource/price spectrum to need to analyse the market for healthcare.

Who needs it and when do they need it? Starting with pregnancy, birth and childhood healthcare is essential if you want to reduce infant mortality and childhood diseases.

Young adults rarely need it unless they are unfortunate to have accidents or become ill.

As we approach middle age things start to go wrong and the need for healthcare increases.

Once we become senior citizens we are largely dependent upon healthcare in order to optimize our life expectancy.

So we have a relatively scarce and expensive resource that pretty much everyone is going to need at least once in their lifetimes and probably many times.

Your scenario claims that it is best provided by local government or the private sector. In practice that will lead to inequities as far as ensuring that everyone has equal access to healthcare. In essence the wealthy will always be able to afford it while the least fortunate will be left to suffer.

What is the practical way to ensure that everyone has equal access to this expensive and scarce resource?