Time to grow up

Friday, January 13, 2006
I know this will not make a lot of conservatives happy but it is time to grow up in terms of government programs.

I realize that entitlement programs need reform, in fact I supported Bush's calls to cut back on the growth of Social Security.

But I think conservatives are still living in a dream world where things like the prescription drug plan have no place.

Folks, the difference is not between a drug plan and some old lady making choices between food and medicine, it is between nationalized medicine and a drug plan.

There was the Reagan revolution and there was the Contract with America and government is not smaller. This is not just because the Republicans did not cut spending enough, it is because the people want and expect a certain amount of government involvement in our economy and in people's lives.

There is just not consensus to cut out all government programs.

I used to milk cows for a living and once when I was in the business I went to Washington DC with a group of farm wives. Lobbying I guess you could call it. I met a man there who told me he had spent his life fighting dairy programs and I thought "In a world full of famine and war and tyranny he chooses to spend his time fighting people who milk cows. What a strange man."

I still feel that way. My check from the milk processor which bought my milk included money taken out to pay for the program. We were docked to pay for the surplus as well.

And in return when Americans walk into a grocery store they do not have to wonder if clean drinkable milk will be there. I know people think that the market can take care of all that. But the market does not give a damn if milk is there or not. The point to the programs is to make sure it will be.

Now if you think people are upset by the price of gas, imagine an empty dairy case. Perhaps centralizing the industry in the hands of very few producers would make control of production more manageable, but only to a point. Old Bessy ain't got a spigot, you can't just turn her off and on.

{and yes shortages can happen, they were not unusual before government programs, they called them butter riots}

53 comments:

Doug said...

Mao had the ultimate plan for Cultural Revolution:

Incredible story of a woman tortured under Mao for half her life who now owns
Geomagic, which has "defined and dominated the high-tech field of digital shape sampling and processing, or DSSP"
Ping Fu: Entrepreneur of the Year

"Ping was forced to watch the Red Guard tie a kindergarten teacher to four horses. The Guard members--just teenagers themselves--then startled the horses.

Ping was forced to watch another teacher be dropped head-first down a dry well.
She watched the Red Guard scald her little sister with boiling water because one day Hong made too much noise as she played.
Another day, the Red Guard threw Hong into a river for the fun of watching her drown.
Ping jumped into the river and dragged her out. The enraged Guard members then beat the girls, and raped Ping.

Now that Ping was an adult, and condemned as an enemy of the people, what hope did she have for a quick death?
As the dark hours bled out, Ping considered her "crime." Five years earlier, in 1976, Chairman Mao had died and the Cultural Revolution had come to an abrupt end...

Doug said...

Is Bush's presciption drug plan even economically sustainable for 40 years?
What is the projected cost?

Medical savings accounts and non-government insurance are the way to go imo.
Health Care Costs Spiraled when the govt got involved.

Would Lipitor be a $12 Billion dollar a year product without government subsidies, or would people choose to EAT LESS FAT?

If not, is that other people's children's problem?

Doug said...

"There was the Reagan revolution and there was the Contract with America and government is not smaller...
...it is because the people want and expect a certain amount of government involvement in our economy and in people's lives
"
---
That is a given when a free lunch is on the table, but what has that got to do with whether it is good policy, or even SUSTAINABLE policy over time?
Rational analysis either trumps wants, or else society descends into the equality of equalized poverty.
Current Social Programs are unsustainable Ponzi schemes riding on bogus bookkeeping and runaway immigration.

Knucklehead said...

Terrye,

I know this will not make a lot of conservatives happy but it is time to grow up in terms of government programs.

I don't know that this is entirely a matter of "growing up". In general "conservatives" are the "grown ups" in the political mix.

I am not the least bit close to being a collectivist but one of the things that it has taken me a long time to begin to come to grips with is that "government" which, in our US system , is of the people, by the people, for the people.

The point of the our government is to give us what we want. Not what each of us wants individually but what we want as a "people". Or, rather, something that approximates as closely as possible what the majority wants.

Which is all to say that I cannot have it as I wish it. I must muddle through with what an imperfect system delivers to approximate what it is that the bulk of my fellow citizens (we the people) want.

There are, fortunately, a number of things within our system which work to mitigate the frustration which accompanies such a relentless denial of my personal wishes.

One of those is that it is a democratic system with freedom of association, speech, and religion. This allows me to exercise my admittedly infinitesimal influence to try and push or pull toward my personal preferences. I am free to put my back to the wheel or grab the tug rope to whatever degree I see fit. The larger the degree the more influence I will have. The smaller the degree the less influence I will exert and the more I should pay attention to just shutting my pie hole and quitting my bellyaching.

I realize that entitlement programs need reform, in fact I supported Bush's calls to cut back on the growth of social security.

I cringe (at least when my skin doesn't crawl) at the word "entitlement" used in this context. I seriously wish we could deep six that term and use the proper term - welfare - placed in the proper context. That context is easily and readily established:

We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.

Followed by a quick trip to any reputable dictionary, in this case Merriam-Webster Online:

Welfare -
1: the state of doing well especially in respect to good fortune, happiness, well-being, or prosperity
2 a: aid in the form of money or necessities for those in need
b: an agency or program through which such aid is distributed

The first definition fits quite well with the usage in the preamble and is completely consistent with the understanding and usage of the term at our constitutional epoch.

The second definition gives us the framework for what a thing like "welfare" would look like where the the rubber meets the road. Our government was set up to promote the general welfare. There is no doubt - at least in my mind - that we are a nation mature enough to recognize that there is "need" among us and wealthy enough to service, to adequated degrees, those needs.

The devil is, of course, always milling around the details so it is no mean feat to define, monitor, and adapt what we identify as "need" and who has need and define, implement, monitor, and adapt agencies and/or programs to service the "need".

Needs change over time and as individuals we tend to see them as very personal things. We each need to put our personal idea of "need" aside or, at the very least, recognize it within the context of "the people".

What irks me about "liberals" is not their relentless love for "welfare" programs but, rather, their never ending expansion of what they identify as "need" and their recalcitrance when it comes to monitoring agencies and programs so that we may adapt to changing need. In this sense "liberals" are intensely conservative. They fight change tooth and nail; more of the same is the only objective they seem to recognize.

But I think conservatives are still living in a dream world where things like the pescription drug plan have no place.

Certainly not all "conservatives". In my case, if "we the people" want a "prescription drug plan" paid out of the national treasury, then so be it. My "conservatism" comes into play here in that I would prefer that we conservatively define "need" and conservatively implement the agencies and programs to service the need. Add to that the "conservative" notion that we cannot have everything our hearts desire, so we almost certainly need to make some tradeoff - if we want some list of drugs delivered to some list of people and the cost borne by all of us, then all of us need to be prepared to give up something else to some degree.

So, for this conservative, my conservatism does not lie in a general opposition to "welfare" but in a desire to see the government's role in promoting the general welfare managed as conservatively as possible.

Folks, the difference is not between a drug plan and some old lady making choices between food and medicine, it is between nationalized medicine and a drug plan.

In this rare case, Terrye, I think you have oversimplified rather than identifying the essence of the matter with your customary efficiency.

I think we are refusing to look beyond the simplistic notion that "health care" should be "free" (or at least Joe and Joan Blow whould never see a bill for "health care") rather than examing the components of health care and trying to resolve the problems in some sensible manner.

Just to toss out an example of what I'm getting at, perhaps it is time to re-examine the notion of "regulated monopolies". Those are the beasties which brought us ubiquitous electrical and telephone service. We don't need them and the regulated monopolies became a hindrance over time, but perhaps it is time to look at some portion of health care plant as public infrastructure and develope and control it as a regulated monopoly.

We also need to examine where the costs lie and how those costs can legitimately be lowered as well as which "health care" goods and services are not appropriate for payment out of the general treasury (i.e, rationing). As an example, rather than simply expecting the full bill to be picked up by the treasury at the point of sale or service delivery, perhaps we need to look at investing in increasing the supply of product and services and reducing or absorbing the liability; i.e, reduce the cost of entry and persistence of medical goods services.

Oops, sorry, I've gone on way too long. In my defense I am convinced that we will not solve this "problem" within the context of our system - without doing irreparable damage to our system - unless we give a long, hard look at the R&D, supply-chain, and demand mechanisms at work. Putting in place, piecemeal, a Euro system will smother us. We are different and we need to go about it differently.

markg8 said...

Correct me if I'm wrong but farm price supports started in the 1930s. There was a big modification to the milk price supports in 1948.

The upshot of all this was a guaranteed living for dairy farmers over the years. In my biz I know a lot of dairy processors who also benefit from cheap predictable prices for their raw material.
One told me growing up in Minnesota in the 50s that everybody knew if you were a failure at everything else you could always buy some cows and go into the dairy biz to make a living. That abruptly changed in the early 1980s when Reagan tried to slash the dairy price support system in a way that would help the biggest most profitable producers and hurt the small less efficient or over extended dairy farmers.

In the early 70s Earl Butz as Nixon's head of Agriculture vastly expanded farm supports. As he put it "we're going to plant fencepost to fencepost" and using modern chemical farming feed the world.

The result of this is first world agribusiness has driven small third world farmers out of business.

It's very hard to get to wean farmers off the goverment tit. It's very hard to wean politicians like Hubert Humphrey and George W. Bush off the political benefits their largesse brings. We don't ever want to go back to the depression where farmers couldn't make a living. But we've got to get ADM, Cargill, Kraft and other big agribusinesses out of the taxpayers' pocket and off the backs of third world farmers.

All legislation should be periodically revisited. Any kind of government program is subject to abuse and there are always those who game the system and are willing to pay politicians to tilt the playimg field in their direction. That doesn't mean we arbitrarily throw the system out. But it also doesn't mean we distort the sector to benefit the big players. There's gotta be a balance.

David Thomson said...

“But the market does not give a damn if milk is there or not.”

Nothing could be further from the truth. The market is all about getting people what they want. Government pay outs to particular dairy farmers are not even slightly necessary. They actually increase the cost to everyone via higher taxes or increased costs at the grocery store.

“The result of this is first world agribusiness has driven small third world farmers out of business.”

Absolutely correct. Price supports in this country inevitably destroy the hope of the third world’s farmers. Markg8 even gets it right once in a while. Miracles do happen!

Knucklehead said...

DT,

There's a bit more to what has driven "small, third-world farmers out of business" than "first-world agribusiness".

In the first place, how much has "first-world agribusiness" really focused on developing agricultural products suited to third-world markets? Is it really a case of first-world agribusiness driving small, third-world farmers out of business or, rather, preventing small, third-world farms from growing into larger agribusinesses? Or how much of each?

Third-world (and "second-world" whatever that is) has undoubtedly suffered due to first-world methodologies such as "big business" practices (lower COGS) and distribution as well as first-world subsidies. But subsidies are clearly not the full story. The second and third worlds are hardly "subsidy free zones".

I'm too lazy to go look up and link to the reports but I have seen reports which make a convincing case that third-world agriculture has also been seriously damaged by first world generosity. Cyclic weather patterns create, for example, drought or flood which, for as long as agriculture has existed, plays havoc with farmers. Normally the conditions are temporary and agriculture recovers. In the third-world, however, such normally temporary conditions produce famines which the first-world reacts to with generosity; we send them large boats filled with sacks of gruel to alleviate the famine condition. The unexpected consequence of this is that farmers don't recover their production since food is near ports rather than out on the farms.

Another factor at play here is first-world protectivist policy for agricultural product further hindering the recovery of third-world agriculture. Genetically engineering crops to them more resistent to thrid-world conditions (drought, diseases, pestilence) should have, by now, gone a very long way toward helping to recover third-world agriculture but refusal to allow such crops into first-world markets has seriously hampered this recovery.

David Thomson said...

“I'm too lazy to go look up and link to the reports but I have seen reports which make a convincing case that third-world agriculture has also been seriously damaged by first world generosity.”

This has indeed contributed to the problem. In the long run, many of our donations often cause more harm than good. When we donate food or clothing---this means a third world farmer or clothes maker will loses a sale. And yes, one cannot overlook the problem of the corrupt third world leaders.

Americans pay significantly more for sugar products than much of the world. The sugar lobby is very powerful in Washington, DC. These higher prices are forcing candy makers to leave the country. A number of third world countries lose sales because of this corrupt arrangement.

I have always argued against both unthinking welfare to the poor---and the disgusting money given to the corporations. Both abuses must cease.

MeaninglessHotAir said...

Terrye,

Sorry, I hardly agree with anything you wrote there, which is unusual.

First, if M8 the Hateful One is on your side, that should get you worried.

Second, there isn't some huge gang of "conservatives" out here who hate government at all costs and want to turf out the little old ladies into the streets. By framing the issues that way you have already turned it into an "us vs. them" paradigm and made it clear who the bad guys are. That's not conducive to rational discussion. The question isn't who the bad guys are; the question has always been what is the best use of our limited resources, and how can we make the best use of them.

It's simplistic though tempting to paint the world as good guys vs. bad guys. I don't particularly like it when people on here start trying to paint the world as "evil Leftists", implying that getting rid of the "Left" is the only problem. Nor do I think it's useful when people start painting with the "conservative" bursh. It would make life a lot easier if all we had to do is put all the Republicans in ovens as M8 the Hateful One wishes to do.

The very word "conservative" is wrong, because in general it is the Democrats these days who adamantly oppose change, as we discussed yesterday.

What the best way is to make efficient use of our resources so that the general welfare is optimized is a very big and complicated question that takes lots of discussion. I can't possibly begin to do it justice right now, or even in a lifetime. But I'll have more to say later after work. Stay tuned.

markg8 said...

When American farmers with their combines, Roundup, price supports and export subsidies can produce corn or wheat at much cheaper prices than campesinos in Latin America or dirt farmers in Africa it's huge problem for the locals.

Back in the 90s I had a Mexican cheese mfr. as a customer who wasn't worried about the Buddys of the world coming to wipe out his biz under NAFTA, it was Kraft.

It's not just us, Euros are even worse. But there's gotta be away to balance all these interests. I'll stop hijacking the thread. Didn;t mean to morph it into a WTO discussion.

Skookumchuk said...

When American farmers with their combines, Roundup, price supports and export subsidies can produce corn or wheat at much cheaper prices than campesinos in Latin America or dirt farmers in Africa it's huge problem for the locals.

Yes, and the huge Brazilian soybean farmers are kicking small US producers all over the map. And there are plenty of Mexican agribusinesses - Bimbo, Herdez - that have made great inroads in the US market. This is much too complex to reduce to simple ideological statements.

flenser said...
This comment has been removed by a blog administrator.
Knucklehead said...

Take away the combines and roundup and price supports and export subsidies so they can all be campesinos or dirt farmers. Or, conversely, give all the campesinos and dirt farmers combines and roundup and price supports and export subsidies so they can be big agribusinesses.

Somehow I don't see either happening. The price supports, for all their flaws, seem to be pretty good at keeping an enormous variety of agricultural products on store shelves at (despite our constant kvetching) remarkably affordable prices. The export subsidies seem to do a pretty good job of ensuring that vast surpluses, should they arise, don't rot in fields or storage.

Yet another odd and imperfect system that seems to give us what we want and yet has some unintended consequences we don't like to think about. It would be a pretty safe bet, however, that campesinos and dirt farmers existed prior to such things as combines, roundup, price supports, and export subsidies and will continue to exist if those things were eliminated.

flenser said...

I'll stop hijacking the thread.

Who are you, and what you done with markg8?

terrye said...

When I milked cows they took a tax out to support the surplus which was mandated in order to ensure ample supplies for the much abused American taxpayer.

They also taxed me to support the dairy buyout. They also took my loan payment to FHA out of my milk check. There were a lot of months there when Uncle Sam made more money milking those cows than I did.

My point is a simple one.

They call it the Food Security Act not the Farmer Security Act for a reason.

You can not put milk in a grain bin and wait for the price to go up nor can you ship milk over long distances because it is perishable and very heavy. It has a short shelf life and it takes three years to grow a heifer from birth to production. Not a lot of flexibility there.

I have no problem with the reform of any programs and even getting rid of several, my problem is with people who act as if cheap food is in the Bill of Rights.

Back in the day when the market was the only thing controlling the price of milk farmers dumped milk to drive up prices. Consumers were outraged. They rioted. That is why there are such programs.

That is my point, when people talk about free lunches they have to realize that means them too. Once I got into a discussion about this with an economics professor. He called me a "welfare queen" because I had a dairy farm. I told him that I was tired of getting lectures on capitalism from people with tenure.

As for mark agreeing with me, well what can I say. It must be that stopped clock thing.

And as for the drug pescription thing, people can get rid of all that but if they actually have to provide for mom's meds and all her care they can forget sending the kids to college and a lot of other things they take for granted as well.

Nothing is free. And after I left the farm I went into health care and the costs have gone bezerk. There are people on social security living on less than $900 a month. BTW I know people who are getting this benefit and they do have to pay for it if they have the means. I know one couple that pays $500 a month for their Medicare. It is not just a giveaway.

terrye said...

David:

There is no way to import cheap milk from Thailand or anywhere else.

Unless it is Canada.

flenser said...

I concur with MHA. Except with the definition of "conservative". The political meanings of liberal and conservative are not the same as the dictionary ones.

"Liberals" are not especially open-minded, and being opposed to change does not make Chinese communists "conservatives".

How come we never had a discussion of economic policy before?

I should add that I also agree with terrye, to an extent. There is a role for government to play in ensuring that our food and water are safe. But it seems a stretch to go on to say that the gubmint should pay for peoples perscription drugs.

terrye said...

And btw, Cargill is not a third world farmer, they are however one of the leading producers of soybeans in the third world.

Without land reform and property rights increasing production of certain commodities in places like Brazil may not help the people you want it to help.

Hell, it worked out with oil, why not corn?

Doug said...

" By framing the issues that way you have already turned it into an "us vs. them" paradigm and made it clear who the bad guys are. That's not conducive to rational discussion"
MHA:
Well said.
OTOH, the Evil Leftists are Hell Bent on destroying this country!
;-)

terrye said...

MHA:

It was not my intention to put things in the context of good guys vs bad guys.

I think that attitude may have come about years ago when I farmed.

However, I have to say I have heard conservatives like Fred Barnes say that in the future small government is less likely not more likely. That does not mean there can not and should not be reform and common sense in the programs however.


Maybe people need to realize that there are real people effected by these programs and when they say that we should just get rid of them, that in turn has an impact on people's lives.

terrye said...

flenser:

Maybe conservative is not the word I want. After all I consider myself conservative in many ways.

I think it has to do with government intervention, when and where.

I farmed and so that makes me feel differently about it than I probably would otherwise and I worry about the wrong people getting control of the food source more than I used to.

Knucklehead said...

Terrye,

I have heard conservatives like Fred Barnes say that in the future small government is less likely not more likely.

Barnes isn't exactly making a risky prediction there. It seems abundantly clear that the majority of voters don't really want "small" government.

There's also the matter of whether such a thing is possible at this point in history. Personally I wouldn't mind seeing a Jefferson redux where the federal debt is paid off and taxes are placed upon goods and services - a fee based system. But what do I know.

Knucklehead said...

BTW, no matter what changes are made to various welfare programs, up to and including "elimination", it is a virtual certainty that transition mechanisms will be put in place. I don't think anyone, even those who advocate the elimination of programs, advocates tossing granny into the snow and then pelting her with her empty med bottles.

Eric Blair said...

Guys, Do you have any idea how much fraud and abuse costs the health-care industry? Some estimates are as high as $170 Billion a year.

I think the prescription plan is supposed to be like $400 billion across the life of the program.

As Mark said, things need to be revisited from time to time.

terrye said...

eric:

For sure.

Knucklehead said...

How does anyone calculate the cost of a program such as the prescription drug plan over the "life" of the program? These sorts of things live forever once they are born.

Here's a WaPo piece from Feb '05 that says it may cost $1.2 trillion over the first decade.

The Boomer Generation's retirement rat in the snake's belly will likely take 30 or more years to digest. Nobody has a clue what "health care" will look like, let alone cost, over that sort of timeframe.

Doug said...

"Maybe people need to realize that there are real people effected by these programs and when they say that we should just get rid of them, that in turn has an impact on people's lives. "
---
But we need to keep in mind that out of control govt expansion also impacts everyone's lives.
Todays bulging budgets will be impossible to pay when harder times inevitably come.

terrye said...

The costs of the medications are staggering. Perhaps there should be more and easier access to generic drugs, changes in patent laws.

I have a client who suffered a massive stroke in his fifties, he went through his insurance after he was forced to stay in a nursing home for some time. He lost his house and his savings and he is now on medicaid, he is 66 and he and his wife live in HUD housing on his social security, his wife is 64. The government pays for a great many of his meds, but he has to meet the "spenddown". That means he has to spend what money he has on doctors appointments or medications and only when he has spent down his social security to the point he has very little left will medicaid kick in. The wife gets no help at all. Recently she stopped buying her medication. They refuse to give her medicaid.

It is also true that there is a cut off on the pescription drug plan and people are paying as they have the means to pay. That is why there are so many different plans.

Is this fair? I don't know and I worry about the costs when the boomers retire.

But when people are spending hundreds of dollars month in and month out just on medicine it is hard to imagine a solution that is fair.

As for forcasting costs, that is true with a lot of things including the Iraq war.

flenser said...

Is it better for everyone to have the same quality of healthcare, even if it means low quality care, than for some people to have better quality care than others?

That seems to be the question this is moving towards. I don't think a third option is possible.

Knucklehead said...

Terrye,

The costs of the medications are staggering.

There is no doubt of this. "Something" has to be done but whatever that something is it has to address the components of "cost". Expecting the American taxpayer (a collection of people rapidly shrinking towards minority status) to simply "pay" without figuring out how to reduce costs strikes me as unfeasible over the long haul.

I haven't researched the PhRMA but page 3 of their "brochure", Why do prescription drugs cost so much? provides a useful list of some of the reasons. My guess is that this comes from the Pharm industry's perspective and surely there are other perspectives.

Reality is we have to find ways to deal with costs while, at the same time, recognizing not only "need", but "value". If we want drugs to come to market faster, and cheaper, we've got to address some of the factors that make them come to market slowly and expensively.

In part, this probably means surrendering some liability. This implies setting R&D and test standards that, when rigorously followed, absolve developers from liabilities such as we've seen recently with the athritis medications (I can't recall the names) and stuff like Viagra.

It seems harsh, but looking at the problem as one of individuals won't lead to its solution. The issues really have to be examined in a systemic sense. Why do people such as those you mentioned need these medications? What can be done to reduce that need? Why are the medications they need so expensive? What can be done to reduce that expense? What is the value of the medications to those who need them? What portion of that value can we legitimately expect the taxpayers to fund?

The example you gave us is a heartrending one. But it is just one of many and there is a nearly unfathomable level of complexity.

Living an "unhealthy" lifestyle has consequences. Oddly enough, so does living a healthy lifestyle. An overweight, fond of a few drinks, loves his beef and other tasty food, smoking man of 50 or 60+ may wind up needing bypass, blood thinners, and all sorts of health care and medicine. The clean living, athletic, runner of the same age may just as easily wind up needing a different, but no less expensive, set of health care and medicine - things like knee and hip replacements, arthritis medications, etc.

We abuse our bodies in different ways and we break them down. What responsibility do we, as a nation, have to each of us individually? Are we prepared to tell the lifelong athlete that he can have the $50K hip replacement but the lifelong beef-eater that he can't have the $50K heart surgery?

BTW, Terrye, this is not an attack on your ideas or examples. I personally think these issues are solvable to an adequate degree. I just do not believe for one second that we (the larger "we" that you and I or Yarbg or whatever) are looking at them in ways that will allow for a viable solution. We need a "compassionate" yet "conservative" approach to this stuff. We're apparently not ready to try and achieve that yet. Everyone is seeing either the "compassion" or the "conservatism" and not yet ready to look at some fundamental re-examination of the systems involved for the purpose of adapting them to meet a radically different world than the one we knew.

A mere 20 year agio the problems we are facing today were unfathomable. Health issues that killed people then are health issues that affect people's lifestyle and economic wellbeing today. The nature of the problem has changed so radically, so quickly, that we haven't yet even begun to understand how to think about it. All we see at this point are "problems" rather than "value" or "solutions".

Heck, I might live to be 120. And I don't take care of myself well. That's a staggering social issue.

MeaninglessHotAir said...

Unlike Knucklehead, I don't think these issues are solvable. There is never enough healthcare. Demand is infinite, particularly in the last tiny fraction of life.

Terrye, you say the cost of health care is staggering, but how does it compare to not having it at all, which is the case in Britain and Canada to a large extent. Here, we have things available which are very costly but which can extend your life. There, they simply die while waiting in the queue to get access to the health care. Which is fair, if fair makes any sense at all?

I think Flenser is right. There is a degree to which people will willingly die without getting health care provided they know that it's not accessible to those evil rich people either. A "We may be poor but at least we're all poor"--kind of mentality.

Then, as Knucklehead says, if government provides all health care, there's the issue of fairness. Why is it fair to subsidize the health care of people who haven't taken care of themselves? That issue will undoubtedly come up, and then there's the issue of why people should be allowed to not take care of themselves, because this is costing everybody else and society as a whole. So, we will have a new layer of bureaucracy like Human Services barging into our houses and monitoring us and taking away our "unhealthy" choices. What constitutes these choices, science being as poor as it is, will change in the political winds. So one year it will be verboten to read in bed and another year it will be verboten to run too many miles a day. It's a recipe for a complete nightmare.

At any rate, we're conflating two or three entirely different issues here, each one of which could occupy us for years.

Knucklehead said...

MHA,

There is never enough healthcare. Demand is infinite, particularly in the last tiny fraction of life.

This is exactly the nature of the problem we are facing. Some hard-nosed facing of reality (rationing), however, would solve this problem. Nobody wants to hear it, but at some point we have to understand that there is a point where what needs to be said is, "I understand how painful this is to you, Mrs. Smith, but no further expenditure of resources is called for."

Knucklehead said...

MHA,

Then, as Knucklehead says, if government provides all health care, there's the issue of fairness. Why is it fair to subsidize the health care of people who haven't taken care of themselves?

That's not quite what I said. Yes, not taking care of oneself - living an unhealthy lifestyle - incurs costs. So does living a healthy lifestyle. The precedures and medicines may be different but they are equally expensive.

It represents an interesting dilemma. Why is it more "fair" for taxpayers to bear costs to keep a "healthy lifestyle" person out and about and playing tennis and hiking and such for many years than to bear similar costs to keep an unhealthy lifestyle person gasping on the sofa looking at the TV for a few more years? Both might incur similar "health care" costs. The former will incur substantially higher social-security costs 'cause he's gonna live to be 140.

Quality of life? Who determines "quality" when the thing we're measuring is "life"?

Syl said...

I think Flenser is right. There is a degree to which people will willingly die without getting health care provided they know that it's not accessible to those evil rich people either. A "We may be poor but at least we're all poor"--kind of mentality.

I think this is crap.

Most Americans do not go around envying people that are richer than they are, wishing the worst for them. They just try to do the best they can for themselves.

Syl said...

Why is it fair to subsidize the health care of people who haven't taken care of themselves?

WTF does this mean anyway? Who decides what a healthy lifestyle is? It seems to change from year to year anyway, there are so many factors involved. It's more of a political issue than a health one and whatever the New York Times believes constitutes healthy living this year becomes the norm.

Until the next year.

What concerns me about some conservative thinking is that what they think is a healthy lifestyle has more do with conceptions of morality than health.

Knucklehead said...

Syl,

Well, in defense of those who make that connection, "immorality" can contribute to some serious health risks ;)

flenser said...

syl

Most Americans do not go around envying people that are richer than they are, wishing the worst for them.

This is largely correct, I think, but it misses the point. There is a powerful equalitarian movement in this country. The DLC, to say nothing of points left in the Democratic party, have called in the past for narionalized health care.

This is not based on envy, since the people involved are themselves reasonably well off. But it is based on a belief that everyone should be treated the same.

terrye said...

MHA:

My point was not that I wanted to see Canadian health care in America, my point is that there but for the grace of God go I.

In other words, stop complaining about having to subsidize some old lady's blood pressure medicine. And often times people do...right up until they or someone they love needs the help.

BTW, my mother became one of these people after years of suffering I would not wish on a serial killer.

She had RPI which renedered her blind. She had an aneurism which left her prone to seizures and unable to feed or dress herself without assistance. Live with that kind of cost and loss for years and you get a different perspective.

It is not all about envying the rich, sometimes it is just about desperation and fear.

terrye said...

flenser:

I don't really think that people want to be treated the same. Trust me I have worked in nursing homes, my mother died in one and the rich never have to see the inside of a place like that.

When you see costs go into the hundreds of thousands of dollars for long term care it is obvious that costs are prohibitive for most people.

Average people can not pay that, much less older people on fixed incomes and they can not afford private insurance either.

terrye said...

knucklehead:

Everybody gets old, it has nothing to do with lifestyle.

People get sick, it is a fact of life.

Specter said...

Hey check this out. Pretty interesting. Here. What is really interesting is the signature list at the bottom.....

flenser said...

terrye

The patients you are talking about may well not want to be treated the same, although you seem to be saying that you want it.

But to repeat, the people I'm describing are not the less well off, but the upper middle class members of the Democratic party. It's really not a matter of opinion whether they want nationalized health care; they do.

If we can ever agree on that point we might move on to whether or not that would be a good idea.

terrye said...

flenser:

I don't think we are even talking about the same people.

I am talking about a minimum of care for people with limited resources.

But I am concerned about the over all costs for people in general as well.

My own health insurance doubled this year.

Liability is a factor I am sure, but this is just not showing any signs of levelling off. I am sure the cost of health care has a lot to do with why Bush does not get better marks on the economy.

But I don't know the answer.

terrye said...

specter:

I saw that, maybe someone would like to check it out and sign us up?

Syl said...

spectre

I'm not so sure I agree with sweeping reforms.

More transparency, yes.

Maybe the public just doesn't understand that the vast majority of lobbyists are not corrupt and that lobbying is an important part of our democratic process.

Buddy Larsen said...

The Medical Savings Accounts should help--whatever you put in gets tax-abated, then you use it to pay for your own medical care--and presumably you'll join the doc to help cork costs. Coupled with a catatrophic care policy, it will be an answer IF and WHEN enough folks use it.

Buddy Larsen said...

Big Agribiz is an easy target--but it is strong because it's efficient, meaning it lowers the cost of living, fights inflation, helps poor people at the checkout counter, etcetera. Undeniable. But, as is seen in the WalMart beouhaha, it IS easy to hate many of the accompanying dislocating effects. But Mark's comment about getting Big Agro off people's backs is just French-Farmer rhetoric. The market rewards low-cost production, and this force-of-nature builds big agribiz as surely as God makes little green apples. Sad but true.

Buddy Larsen said...

that said, there may be an answer to the "onion problem" besides govt subsidy. The "onion problem" is that when onion prices are up, everyone plants onions, then next year onions are down, and the farmers can't replant.

Buddy Larsen said...

It's basically a communication problem, perhaps. maybe the net will help fix it, eventually.

Buddy Larsen said...

Agribiz knows how to hedge, knows how to use futures and other derivatives to smooth the fluctuations and create predictability. Small farmers are naturally way behind this curve--but maybe their kids won't be.

Buddy Larsen said...

"Efficiency" per se is certainly not the be-all and end-all of life--it has no place in romance--but to deliberately "de-efficiency" a market segment is merely dumb, markets are 'about' efficiency, and all that romance achieves in markets is, less capital to work with (and more, for the competition).

terrye said...

buddy:

I agree with a lot of what you say and young people are more efficient. I don't think most people want to farm like they used to.

What irritates me are the people who think that the market is a fine and dandy thing just so long as some farmer is losing his ass and the minute they have to pay more they demand that something be done, whatever that means.

Milk is in a category of its own because of what it takes to produce it and the fact that it can not be stored or held over.

You have to use it or dump it or dry it.

Buddy Larsen said...

Oh,lord, the complications of handling perishables are infinite. The troll's remark up above about dairying being the last place where no one can fail is just the most complete know-nothing city-snob rubbish I've heard in awhile. The efficiency demands on livestock businesses are tremendous--starting with the genetics of the herd.

Fail to optimize right there, and yer doomed--regardless of how well you can trick out maximum product sales per feed-dollar. regardless of how well you can trick out feed production per per water, tractor fuel, and labor costs, regardless of a hundred other cross-variables that are ALL critical--including how much 'build-in' your operation can achieve against weather vagaries.

But ya don't do much nightclubbing in your shiny sharkskin suit, so ya must be a dummy.