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seawaspYeah, that's me. Started as a regular Libertarian, but it appears that the usual Libertarian (American) talking either sounds like one of the worst radical Republicans, or simply a sour individualist anarchist.
To me, a proper Libertarian has the basic principle of "government is for internal order and external defense, and not for interference in personal lives or business unless force is already being initiated by other parties", and looks at these things through both a lens of practicality (what works in theory doesn't always work in practice) and a lens of "rational *LONG TERM* interest" (I emphasize "long-term" because it's often a forgotten principle); in addition, a rational Libertarian recognizes that they are part of a larger society, and that the benefits of this powerful and advanced civilization are based on the continuing coordinated work of literally millions upon millions of people who do not -- and WILL NOT -- share all of your views, and some of whom may have almost directly opposing views, and who STILL have to all work together as part of the society, if not as friends and family.
Similarly, they must recognize that the basic principles of the society include the fact that we don't let people die if we can help it, even if they do stupid stuff or get themselves in a predicament through laziness, and that the basic laws of humanity mean that some significant number of people are lazy, dishonest, or downright criminal... and won't necessarily get caught.
Putting all this together, a sensible Libertarian should arrive at the following conclusions:
1) Taxes, while morally reprehensible in the abstract -- amounting to giving the government a license to rob -- are one mechanism to assure payment for services that the government is legitimately expected to provide (internal order, external defense). Some form of nonvoluntary funding, at some level, is going to be inevitably necessary in a large society to avoid the consequences of the Prisoner's Dilemma/Free Rider problem.
2) It is in my best long-term interests to maximize the functionality of my society so long as it does not UNDULY cost me in some other area. The "Unduly" is a matter of judgment, of course, but it should be recognized that unless I am myself sufficient unto all things, and still wish to maintain my modern-life lifestyle, I need to accept that there will be -- and must be -- some cost to my rugged individualism in this.
3) Costs to save lives rise rather predictably with the seriousness of the condition from which the person is to be saved, and the extent of work needed to be done to abate the condition. Some acute serious conditions (drowning) can be addressed quickly and relatively cheaply, but in most cases not.
4) Since the society to which I belong values all lives at least to the extent of not allowing deaths to occur when preventable, and since those who cannot or will not pay will therefore be saved at society's expense, it is in my best long-term interest to take actions to minimize those costs -- and preferably all other medical costs, since reduction in medical costs will free up resources for uses other than just keeping people alive.
5) The best way of minimizing health costs is to treat conditions as soon as possible and prevent conditions whenever this is practical. This requires regular checkups and the ability of any citizen to get care for any condition as soon as it is noticed.
6) This is, by its nature, not a profitable business. Overall such care will cost more for any individual group providing it than can be recovered by ordinary means (free riders, the incapable, the broke, etc.)
7) As this is to benefit all of society, and will contribute by its very nature to internal order, the strength of the nation as a whole, and in the long term my overall prospects, this is therefore a legitimate function of government -- assuring all its citizens of access to the health care that they expect from the most advanced civilization on the planet.
From this, I obviously favor a universal health plan -- one whose operation is basically like New York State's Child Health Plus or better. In essence, anyone below a particular -- quite reasonable -- cutoff pays nothing, those above pay a graduated amount per month, up to a cap which is still quite affordable for the salary level at which it applies. No copay, no deductible, covers everything short of plastic surgery for cosmetic purposes (and I'm not entirely sure about that).
This would require a number of major overhauls to the current system; protect doctors from current malpractice costs (my father in law was paying something like $100,000 PER YEAR for such insurance... and as far as I know he was never actually sued, so that wasn't due to some terrible oopsies on his part), reduce expectations of perfection (doctors can err), set standard fees for known services (adjusted by regional costs -- the GSA already does this for other things), and of course that'd be the death of health insurance companies. To get it passed, you'd probably have to -- speaking perfectly bluntly -- bribe the companies. Pay large sums to all the major players, and guarantee pensions to all the long-term employees so that you didn't kill off a few hundred thousand careers just like that. Long-term cost on that part would be trivial.
It would also in the long run save us a lot of money. All arguments to the contrary, we have had one of the most costly healthcare ... setups, for "system" implies something unified, which ours was not... in the world. It is, in fact, the best -- when you can afford the best. It's also one of the WORST in the civilized world if you CAN'T afford to pay. And it's been steadily getting more expensive. Part of this comes from the "take care of everyone" interacting with "doctors charge as they want" and with "insurance companies need to make profits" and "we want perfect health care with our insurance" and "if the doctor makes a mistake, sue!"; combine them and you have a recipe for constantly increasing costs all around, each increasing the next and the next causing its neighbor to increase in turn.
Having lots and lots of people who are afraid to go to a doctor because they can't afford it means they don't go until they HAVE to... and by then it'll likely cost ten times as much. They'll be out of work for weeks instead of a day or two, which impacts the employer and his customers. If they can't pay, that's ten times the cost charged to society (because we won't let people die). You can't avoid these costs unless you either (A) make damn sure everyone's cared for, or (B) are willing to let anyone who can't afford it die or suffer. This is not the general way America looks at itself, so (A) is the only reasonable, rational, and acceptable alternative. In the long run, it's also a sensible, cost-effective choice... IF, and ONLY IF, you can get it enacted that way.
Compromising on it, however, will screw everyone -- in the long term, even the insurance companies and/or the people running them. Companies, however, live on the short term -- this quarter, this year, maybe five years... but not twenty, thirty, forty years. And that's the timeframe any of us should be looking at.
I'm running out of time on this; later I have to talk about other parts of my current philosophy, like why people are afraid to let their kids play outside when its safer today than it was when I was a kid...
To me, a proper Libertarian has the basic principle of "government is for internal order and external defense, and not for interference in personal lives or business unless force is already being initiated by other parties", and looks at these things through both a lens of practicality (what works in theory doesn't always work in practice) and a lens of "rational *LONG TERM* interest" (I emphasize "long-term" because it's often a forgotten principle); in addition, a rational Libertarian recognizes that they are part of a larger society, and that the benefits of this powerful and advanced civilization are based on the continuing coordinated work of literally millions upon millions of people who do not -- and WILL NOT -- share all of your views, and some of whom may have almost directly opposing views, and who STILL have to all work together as part of the society, if not as friends and family.
Similarly, they must recognize that the basic principles of the society include the fact that we don't let people die if we can help it, even if they do stupid stuff or get themselves in a predicament through laziness, and that the basic laws of humanity mean that some significant number of people are lazy, dishonest, or downright criminal... and won't necessarily get caught.
Putting all this together, a sensible Libertarian should arrive at the following conclusions:
1) Taxes, while morally reprehensible in the abstract -- amounting to giving the government a license to rob -- are one mechanism to assure payment for services that the government is legitimately expected to provide (internal order, external defense). Some form of nonvoluntary funding, at some level, is going to be inevitably necessary in a large society to avoid the consequences of the Prisoner's Dilemma/Free Rider problem.
2) It is in my best long-term interests to maximize the functionality of my society so long as it does not UNDULY cost me in some other area. The "Unduly" is a matter of judgment, of course, but it should be recognized that unless I am myself sufficient unto all things, and still wish to maintain my modern-life lifestyle, I need to accept that there will be -- and must be -- some cost to my rugged individualism in this.
3) Costs to save lives rise rather predictably with the seriousness of the condition from which the person is to be saved, and the extent of work needed to be done to abate the condition. Some acute serious conditions (drowning) can be addressed quickly and relatively cheaply, but in most cases not.
4) Since the society to which I belong values all lives at least to the extent of not allowing deaths to occur when preventable, and since those who cannot or will not pay will therefore be saved at society's expense, it is in my best long-term interest to take actions to minimize those costs -- and preferably all other medical costs, since reduction in medical costs will free up resources for uses other than just keeping people alive.
5) The best way of minimizing health costs is to treat conditions as soon as possible and prevent conditions whenever this is practical. This requires regular checkups and the ability of any citizen to get care for any condition as soon as it is noticed.
6) This is, by its nature, not a profitable business. Overall such care will cost more for any individual group providing it than can be recovered by ordinary means (free riders, the incapable, the broke, etc.)
7) As this is to benefit all of society, and will contribute by its very nature to internal order, the strength of the nation as a whole, and in the long term my overall prospects, this is therefore a legitimate function of government -- assuring all its citizens of access to the health care that they expect from the most advanced civilization on the planet.
From this, I obviously favor a universal health plan -- one whose operation is basically like New York State's Child Health Plus or better. In essence, anyone below a particular -- quite reasonable -- cutoff pays nothing, those above pay a graduated amount per month, up to a cap which is still quite affordable for the salary level at which it applies. No copay, no deductible, covers everything short of plastic surgery for cosmetic purposes (and I'm not entirely sure about that).
This would require a number of major overhauls to the current system; protect doctors from current malpractice costs (my father in law was paying something like $100,000 PER YEAR for such insurance... and as far as I know he was never actually sued, so that wasn't due to some terrible oopsies on his part), reduce expectations of perfection (doctors can err), set standard fees for known services (adjusted by regional costs -- the GSA already does this for other things), and of course that'd be the death of health insurance companies. To get it passed, you'd probably have to -- speaking perfectly bluntly -- bribe the companies. Pay large sums to all the major players, and guarantee pensions to all the long-term employees so that you didn't kill off a few hundred thousand careers just like that. Long-term cost on that part would be trivial.
It would also in the long run save us a lot of money. All arguments to the contrary, we have had one of the most costly healthcare ... setups, for "system" implies something unified, which ours was not... in the world. It is, in fact, the best -- when you can afford the best. It's also one of the WORST in the civilized world if you CAN'T afford to pay. And it's been steadily getting more expensive. Part of this comes from the "take care of everyone" interacting with "doctors charge as they want" and with "insurance companies need to make profits" and "we want perfect health care with our insurance" and "if the doctor makes a mistake, sue!"; combine them and you have a recipe for constantly increasing costs all around, each increasing the next and the next causing its neighbor to increase in turn.
Having lots and lots of people who are afraid to go to a doctor because they can't afford it means they don't go until they HAVE to... and by then it'll likely cost ten times as much. They'll be out of work for weeks instead of a day or two, which impacts the employer and his customers. If they can't pay, that's ten times the cost charged to society (because we won't let people die). You can't avoid these costs unless you either (A) make damn sure everyone's cared for, or (B) are willing to let anyone who can't afford it die or suffer. This is not the general way America looks at itself, so (A) is the only reasonable, rational, and acceptable alternative. In the long run, it's also a sensible, cost-effective choice... IF, and ONLY IF, you can get it enacted that way.
Compromising on it, however, will screw everyone -- in the long term, even the insurance companies and/or the people running them. Companies, however, live on the short term -- this quarter, this year, maybe five years... but not twenty, thirty, forty years. And that's the timeframe any of us should be looking at.
I'm running out of time on this; later I have to talk about other parts of my current philosophy, like why people are afraid to let their kids play outside when its safer today than it was when I was a kid...
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Libertarian COMMIE CONSERVATIVE LIBERAL from HELL!
Date: 2010-03-18 05:30 am (UTC)We are by (american standards) socialised, conservative, libatarian and repressed sheep (see debate on internet filtering)
The last public outcry (apart from Iraq War) was a universal ID card in the late 1980's, when a lot of people went out to the streets to protest it, the government backed away.
We go meh on liberties Americans would storm congress if they where taken away (guns, free speech), have onerous libel laws We have an that are used to smack down critisim against public figures, yet we have a social medical saftey net, social security payments for sick, carers, unemployed and war veterans.
Taxes. User pays do not work for what economist call public utility: goods and services that everyone (or a majority) benefits from but would unlike be funded in a pure market. Parks are the classic example. Taxes should be simple, equitable and efficient. Hardly any tax meets this goal
Everything has a cost. To fund public utility, and other social mechanism like wealth distribution (via benefits and services to diadavantaged, which occurs in most 1st world nations with America being a major exception), we take away the power of determination of allocation. That is why there is no true democracy in the world, a true democracy EVERYONE has a say on the spending and raising of government money.
In australia, we have a very good barely functional socialised medical system. Our problem is that the medicare levy and GST are federal taxes, and health is a state concern depended on federal funds. The federal government wants to grab the power to fund hospitals, rip administration from the states and give them to regional boards. Apart from being constitutional, it requres all the states to sacrifice tax income and surrender powers to the federal government.
The message that most aussies would give to our pollies is "Screw this up and we kill you worse than disco"
Isn't politics fun?
no subject
Date: 2010-03-18 05:30 am (UTC)Only a few months ago did someone win a case in tax court allowing them to deduct their SRS cost. The IRS was trying to claim that it was "cosmetic" plastic surgery.
And the IRS may still appeal it into federal court.
Likewise some years back a porn star had to fight the IRS about getting her breasts enhanced to something like GG or the like.
The court finally did rule it a legit business expense.
no subject
Date: 2010-03-18 10:30 am (UTC)(Ducks and runs.)
no subject
Date: 2010-03-18 03:55 pm (UTC)no subject
Date: 2010-03-18 11:39 am (UTC)Simply speaking, the more complex network of private coverage can't operate without a vast army of adjusters and accountants to track billing and administer policies... and the complexities of each plan further increase that staffing burden on insurers and health-care providers. Tobias Buckell made the illuminating observation that US hospitals have a wing for billing, whereas Canadian hospitals have a room. The difference doesn't come from higher productivity north of the border, but from having only one set of policy guidelines to follow and one receiver for billing statements.
-- Steve knows it's counterintuitive to have lean, efficient government outcompeting the bloated bureaucracies of private industry, but lots of things in the real world are counterintuitive.
no subject
Date: 2010-03-18 03:53 pm (UTC)No, it's not shocking to "efficient market" purists who actually take into account the factors. There are say a dozen different major insurance companies involved (there are more, but they also interconnect, but let's not get into that). Each of them is competing for -- honestly speaking -- the same business: insuring healthy people who rarely need care.
To make a profit, they have to somehow either (A) avoid insuring people who will be net losses (while not appearing to discriminate in an illegal fashion), (B)find a mechanism to charge more to people who need more care while appearing to be fair, (C)Make getting a payout so difficult that some significant number of people simply never get the money that they are in fact owed, and/or (D)charge enough money that the healthy pay for the sick and then a little bit.
They are also, however, constrained by various laws that DON'T allow them to actually treat it as a REAL BUSINESS. If you were actually running insurance as a business, you would charge each individual insurance premiums based on your exact and best assessment of his likelihood of getting ill -- including past history, pre-existing conditions, etc. In many ways they're not allowed to do that, which forces them to either cover things they wouldn't cover normally, or find very creative ways to pretend they're doing so.
This means that all of them are trying varying tricks to make their plans appear attractive to various groups while evading the need to pay out. If it was just ONE such company, they'd find some livable compromise, stick with it until the laws changed, etc., and then you'd have one set of forms, one set of claim approaches, etc. But with multiple competitors in multiple fragmented markets, you have vastly increased complexity.
The government handling it simplifies things both by becoming the single-payer, AND because government is not supposed to be a business, can ignore the income-outgo part of the equation. The payments from those able to afford it HELP defray the costs, but it's KNOWN that the overall program will require direct funding -- and this is calculated into the budget.
no subject
Date: 2010-03-18 12:38 pm (UTC)I'm thinking here of the doctor who refused to test Maenad of alt.callahans for problems until her cervical cancer was too advanced to treat, because "you're too young to get cancer".
Or the ER doctor who told another callahanian woman, "You're too young to have a stroke, it's just an anxiety attack" and sent her home with Valium, when she presented in the ER with single-hemisphere loss of function and feeling.
Or, for that matter, the OB who told my mother, "All pregnant women have low back pain, dear" and ignored the symptoms of a herniated disc for four months until after my brother was born. (Apparently the conversation the day after my brother's birth was along the lines of, "So, back pain all gone, right, dear?" "NO." "Oh.")
no subject
Date: 2010-03-18 03:44 pm (UTC)Suing the doctor isn't really what you want to do in the end analysis; you want (A) the doctor in question stopped from screwing up on someone else, if what they did was clearly not a matter of a typical human mistake that any doctor could be expected to do sometimes but was in fact a matter of malice, stubbornly wrong choice, or clear incompetence, and (B) as much restitution as can reasonably be done for whatever the mistake was.
no subject
Date: 2010-03-18 05:56 pm (UTC)no subject
Date: 2010-03-18 08:05 pm (UTC)What is interesting to note is that malpractice suits generally top out a lot lower in the UK (except where the litigant has been permanently injured and needs round-the-clock care, in which case the sky's the limit -- the courts award damages proportionate to the cost of looking after them for life), and medical malpractice insurance is an order of magnitude -- or two -- cheaper.
no subject
Date: 2010-03-18 08:09 pm (UTC)no subject
Date: 2010-03-18 04:25 pm (UTC)You would be surprised--or maybe not--at how many horror stories like that I've heard from other women who've had heart attacks and strokes. Women who had symptoms even more pronounced and severe than mine (which were classic chest pain radiating to arm, jaw and ear; nausea, breaking out in a cold sweat) were sent home from their ERs and told it was all in their heads, it was anxiety, or their gall bladder, or acid reflux. "You're too young to be here," or "you're the wrong sex" or some variation of the two.
no subject
Date: 2010-03-18 05:57 pm (UTC)no subject
Date: 2010-03-18 01:16 pm (UTC)I believe this, but based on what I read, there seems to be a strong belief in the states that if something happens to you it's your own damn fault and I shouldn't be paying to fix it (unless it happens to me, in which case I expect heaven and earth to be moved to make it all better).
Kind of like Mel Brooks definitions of comedy and tragedy.
no subject
Date: 2010-03-18 03:12 pm (UTC)no subject
Date: 2010-03-18 03:40 pm (UTC)No, my principle is the correct one. The one you give is the hypocritical position that the people I call "free riders" tend to take.
That said, ANOTHER part of my philosophy and attitudes DOES include "It's your fault jack, suck it up" but that's in a different context. I.e., people should take responsibility for living in a world that won't be perfect, and for doing their own stupid stuff, but in the case of health care, no MORAL person is going to just walk away from a man impaled on a fence even if he DID do it by trying to imitate Jackie Chan and failing, etc., and thus on the health care side it's clear that the society expects you keep people alive, even if they did it to themselves, even if the basic principle of a libertarian is "be responsible for yourself -- including taking responsibility for messing yourself up."
no subject
Date: 2010-03-18 04:54 pm (UTC)I do disagree that people must recognize this principle, because all evidence points otherwise.
no subject
Date: 2010-03-18 06:41 pm (UTC)All clearly stating REQUIREMENTS, not circumstances, not making any statements about whether anyone at all besides me holds that particular position.
no subject
Date: 2010-03-18 03:56 pm (UTC)I do disagree with this part: "... unless force is already being initiated by other parties"...
Legislation isn't an effective tool against force that's already being used. It's slow to implement, difficult to pass and prone to compromise, especially when the one using force is in a position of wealth and power, as often are.
For instance, in my state, all overtime work must be paid at a time-and-a-half rate, even if the employer and employee both agree to straight hourly wages. This recognizes the power imbalance that already exists between worker and boss, because such an agreement could easily be coerced in a dozen (not-so-)subtle ways.
As a third point, insurance companies could have the opportunity to offer supplemental care, which is how they do things in France and Canada--basic coverage via the gov't, with additional insurance for those who want to purchase it. That's a sensible way to reduce health care companies without shoving all their employees into bread lines at once.
no subject
Date: 2010-03-18 04:11 pm (UTC)If you disagree with "unless force...", then you're saying the government has no right to ever interfere with business or personal activities, period. Which means no healthcare plan for darn sure, no regulations of what businesses or people can do, etc.
That basic principle is what makes it permissible for a government to make laws against murder, among other things. Your personal right to do stuff stops at my personal border. If you're crossing that border -- initiating force in any of several ways -- you've crossed the line to where it is my, and society's, business.
no subject
Date: 2010-03-18 04:42 pm (UTC)no subject
Date: 2010-03-18 06:43 pm (UTC)Note that "force" includes "pressure". It doesn't have to involve bashing someone on the head.
The border
Date: 2010-03-31 04:14 am (UTC)no subject
Date: 2010-03-18 05:15 pm (UTC)I don't know about that. I don't see more hypochondria here in Canada with single-payer than seems to be reported in the US, though I don't have any authoritative sources showing it either way. (FYI, I'm currently employed by a firm providing triage services over the telephone under contract to the provincial government; I don't know if that makes me an informed source, or a biased one, or both.) It is certainly true that people who can't afford insurance badly underuse primary and preventative care, which leads to added burdens on the emergent care side and thus higher premiums.
-- Steve's wondering if the US would be better served by making family doctors (esp. pediatricians) and local clinics public services while leaving hospital care coverage to private providers, but politically that's even more a no-go than the current Obama compromise plan.
no subject
Date: 2010-03-18 06:36 pm (UTC)no subject
Date: 2010-03-18 06:44 pm (UTC)no subject
Date: 2010-03-18 10:27 pm (UTC)I have some thinking and consideration to do.
no subject
Date: 2010-03-18 11:16 pm (UTC)I'd simply add "lower costs of medical education". My brother is going to be in debt for a quarter of a mil or more. Just like malpractice insurance, it's a huge cost that (naturally) doctors don't want to pay off for the rest of their natural lives. That would help a lot.
Other than that, I raise a glass of scotch to you for "succinct, well-stated handle on 99.9% of the major issues."
The "government is for internal order and external defense, and not for interference in personal lives or business unless force is already being initiated by other parties" philosophy would take care of the minor issues.
no subject
Date: 2010-03-21 06:42 am (UTC)to be honest, i come by my conclusions about healthcare in a *very* similar way that you do. and i don't think i'm any sort of libertarian - i don't really agree with you/them on taxes, for instance. i call myself a "rational anarchist" in the Heinleinian way, to a large extent. [i just think that if we are to have, say, rule of law, we *pay* for it - one way or another - and in Real Reality, money is the cheapest form of payment. but that gets into weird metaphysical constructions, difficult for me to articulate even at the best of times; almost impossible on these fucking meds...]
i just don't UNDERSTAND people who run around screaming "bootstraps" as if were something the majority could do. for the most part, those opposed to reformed health care - and REALLY opposed to a single-payer system - were born to what they have. sure, they worked to keep it, or expand it... but they were born to people with the drive to give their kids what they had lacked. most of them didn't start from little [or less] and don't understand how much bigger the difference is - mathematically, the difference between 0 and 1 is infinitely greater than the difference between 1 and 2.
and i also don't understand how THEY don't understand - it's like vaccination. you WANT "the herd" to be well taken care of. the only way to ensure that YOU [generic you] are healthy is to make sure illness doesn't start. by insuring everyone has the means to stay well.
to be sure, i was born with several health issues, so i'm not the most neutral of people... but, until recently, i *worked* for what treatment i got - and had i had actual, consistent healthcare, i would NOT now being facing the rest of my life being one of almost total disability. what is *actually* disabling me is a defect that could - that SHOULD - have been correct when i was a CHILD, and then most of the rest of the problems wouldn't be there at all. and in that case, i'd have graduated from college a decade or more ago, and been working hard and paying taxes since.
to reap, one must plant. to have a strong body, it must be fed and tended. this is as true in a country as in an individual - and those screaming "bootstraps" are sounding [to me, at least] as unsane as those who would carefully tend a hand while cutting the other off...
also: wouldn't it make sense, in a way, for the people who are currently running the "insurance" companies [NOT the CEOs, i mean the people who are ACTUALLY WORKING] to be hired to run any new system? they already know at least the basics of what they SHOULD be doing, even if it's only because they were taught how to not do it. that may just be me :)
no subject
Date: 2010-03-22 04:32 pm (UTC)no subject
Date: 2010-03-23 12:00 am (UTC)no subject
Date: 2010-03-23 01:51 pm (UTC)I would think it'd be an active impediment.
no subject
Date: 2010-03-24 07:24 am (UTC)i guess i hadn't really thought about that aspect. i'll go do that....
thanks :)
no subject
Date: 2010-03-21 05:26 pm (UTC)For instance, up here in the People's Republic of Canuckistan, emergency dental--I just got a puck in the mouth and will require surgery, to use one type of accident--will usually be handled by the normal system, but run of the mill dental care; getting a cavity filled, cap for a broken tooth, and so on, isn't. So my employer has dental coverage, and for that I deal with the insurance company (and the brief exposure I had to that makes it quite clear I don't to ever deal with the current American system for more important matters).
Similary, I get extended drug coverage in case I need something beyond the scope of the government system, insurance for things like braces, and possible prosthetics, which may or may not be covered under the government system, and so on.
We do have insurance companies up this way, and they do make money. Just not the hand-over-fist amounts they do down there.
no subject
Date: 2010-03-22 12:20 am (UTC)no subject
Date: 2010-03-22 04:28 pm (UTC)no subject
Date: 2010-03-22 04:27 pm (UTC)