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Is the plan to replace Obamacare really about freedom?

Speaker of the House Paul Ryan speaking at a Thursday news conference
REUTERS/Aaron P. Bernstein
Speaker of the House Paul Ryan speaking at a Thursday news conference about Congressional efforts to repeal and replace Obamacare.

By now, you’ve surely read and heard about the highly anticipated Congressional Budget Office “scoring” of the Trump-Ryan-Republican health care bill, or as they prefer to call it, the American Health Care Act.

(A small snotty aside here, just on the name of the thing: The previous health care overhaul, signed into law by then-President Obama, was officially named, “The Patient Protection and Affordable Care Act.” Republicans refused to ever call it that, and you have to admit, it is a mouthful of mush. Republicans dubbed the law “Obamacare” and proceeded to try to use it to discredit Obama by generally adding adjectives like “failing” and “disastrous” and a scheme that they soon announced was “imploding,” even as they did everything they could to sabotage and vilify it. So under the rule of turnabout is fair play, Democrats can call the new Republican bill anything they want, and I doubt very many of them are in the mood to call it the American Health Care Act.

Trump, who endorses the bill without reservation even though it breaks the clear promise he made to sign into law a new program that would provide health insurance to everyone at government expense, has asked that the law not be dubbed TrumpCare because, you know, he’s not the kind of guy who wants to stick his name on everything.)

Anyway, the CBO analysis projects that under the GOP proposal, the share of Americans who lack health insurance will almost immediately increase from 9.5 to 11.4 percent as soon as the new law takes effect, then shoot up within a year to 15 percent and continue rising to 18.6 percent over the next several years. (Here’s a fever chart of that CBO projection, courtesy of Vox.)

Personally, I believe that reducing the share of uninsured Americans was a worthy goal. Although there are many more ways to measure the quality of a health care system than just the share of the population with insurance, I think it’s a pretty big and important measure. I agree with Trump’s former position, in which he agreed with Bernie Sanders, that the goal should be coverage for all.

But it’s not the only way to measure such things. There’s also the quality of the care, and the cost of it. According to the CBO, the new TrumpRyanCare law will reduce costs — compared to the current trendlines — so much that the Republicans can afford to include in the bill a large tax cut to the rich (the reversal of the tax that was imposed under ObamaCare, to offset the cost of expanding health care) and still save money, on net, compared to projections of what ObamaCare would have cost over the next 10 years.

In fact, and although liberals may not attach as much importance to this than conservatives do, the CBO says that the implementation of TrumpRyanCare will reduce the deficit by about $337 billion over the next 10 years. (To be clear, that’s not to say that the national debt will come down, but that, if the CBO projection is correct, it will not go up as much as it otherwise would have. If you care about such things – and I actually do care about bending the curve of the debt-to-GDP ratio – deficits matter.)

If you were to ask which is a higher priority, to bend the debt curve or to reduce the ranks of the uninsured, I believe you would have a pretty good start on a question that would separate liberals and conservatives. Although if I was to let a little snottiness slip out, many conservatives are not real debt hawks when it comes to tax cuts or military spending, only when it comes to social spending.

But here’s the other thing – and here I’m bending over backward to understand the basics of the left-right dichotomy in modern America – conservatives think the key spectrum runs from more government to more freedom. Yet to liberal eyes, conservative “freedom” often equates with lower benefits to the needy tied to lower taxes on the rich. There, I’ve said it.

But heck, almost everyone cares about some kind of individual-freedom-versus-government-tyranny equation, don’t we? The Koch Brothers (whose motives are not pure), and the Tea Party and their allies in the House Freedom Caucus tend to attach a great deal of emphasis to this constant belief that if the government makes you do something, that’s the opposite of “freedom.” But you can call just about anything you favor a form of “freedom.” One of the famous “Four Freedoms” that Franklin D. Roosevelt outlined in 1941 was “Freedom from Want.”

Of course, it’s all an oversimplification. The government does a lot of things that secure our collective freedom. And “freedom,” if Janis Joplin had it right, is “just another word for nothing left to lose.” (I’m not sure Joplin was talking about health insurance.)

Which, amazingly enough, gets me to the strange point I started out toward a few paragraphs back: One of the things some freedom-loving conservatives hate most about Obamacare is the health care “mandate,” which requires those who don’t want to pay for health insurance to buy it anyway, or pay a fee (or a “tax” or a “penalty”).

Even though choosing to live without health insurance strikes me as a really bad choice, and even though my dyed-in-the-wool liberal soul is not truly offended by the health care “mandate,” if I try to understand the whole government-versus-freedom mindset, the mandate is a pretty strong example of taking away an individual’s cherished (and unwise) freedom-to-be-uninsured.

And in fact, the fact (okay it’s really a “projection”) in the CBO assessment that set me off on this whole strange rant was that: If the CBO is projecting correctly, the reason the uninsured rate will immediately shoot from the current 9.5 percent of Americans up to 15 percent if TrumpRyanCare is enacted is that the CBO believes that millions of Americans, if they don’t have a mandate to either get health insurance or pay a penalty, will just pay nothing and do what the Ayn Randers might call “self-insure,” which means they will choose to not have insurance and hope they don’t get sick or injured.

(Aside to my kids, if you are reading your dad today: Do not even think about doing this.)

So, does that mean it’s really about freedom? And, to the degree that it is, does that give you any more understanding of why to someone who analyzes everything through the “freedom” prism sees Obamacare as a step down the path toward “nanny-state tyranny” and TrumpRyanCare as a step back toward freedom?

Sometimes, when I see the pro and con sides arguing about this and other issues that one side sees as solidarity and helping the less-fortunate and the other side sees as meddling-creeping-government-tyranny, I wonder a little about – to paraphrase the philosopher Rodney King, “can’t we all just get along?

At least right now, we can’t seem to.

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Comments (125)

How can we require car

How can we require car insurance?

Agreed

That was my thought as well - if we aren't willing to mandate health care insurance, why are we willing to mandate car insurance (at least in MN). I would be happy to not have to pay car insurance, and I do what I can to minimize that cost, but I also understand the reality that I simply don't have the financial resources to pay for car repairs if I get into an accident. And if the accident isn't my fault, that stings even worse.

because

financial institutions will not put themselves at risk of default when you buy a car or a house....there is no equal to that leverage for health insurance.

No Loan On My Car

And yet I am required to have insurance.

Well

My cars are all paid for! One could make the case that health insurance provides the back drop that makes sure you can keep working to pay the home and car off?
The kickers is, hospitals have to take care of you at the emergency room, they in turn back bill to the county i.e. the tax payer, in short why should I as a taxpayer pay your health care if you don't want to buy your own plan.

I believe the only insurance

I believe the only insurance required is liability - i.e. coverage for the other driver if you're at fault.

The analogous position would be consenting to receive no care, even emergency care, if you don't have health insurance.

Car insurance is NOT to protect YOU.

It is protect OTHERS from the damage you do if/when you have an accident.

The only one hurt when you do not have health insurance is you (and your family).

Not exactly true

Because those who show up in emergency rooms receive at least some care even if they can't pay, that cost is ultimately passed on to us. And with high deductibles, even individuals with insurance sometimes don't pay.

https://insight.kellogg.northwestern.edu/article/who-bears-the-cost-of-t...

Granted, when you look at total $s of unpaid bills, many are calculated at the ridiculous "chargemaster" rate.

We do require car ....

insurance so we can "accept" 60,000 automobile deaths per year. That fact that we "accept" that many deaths is cars per year is purely outrageous. The driver is a number on an actuarial table somewhere. The parallel is that we seem to be about to "accept" all kinds of death per year to avoid the collective social cost for health insurance. Yet we claim we are civilized!

It's not a health-care

It's not a health-care plan--it's really a federal tax-cut plan.

It does not address patient-care quality. It does not address improving outcomes. It does not guarantee access or the mythical "keep your doctor".

It does not cut costs, because in the end, the overall medical costs will continue to rise, and even rise faster simply because of the back-door ways patient care will have to be paid for. Once again, primary care will be shoveled onto the emergency room and state and local taxpayers and the people who are insured will be the payers.

The fatal statistic for the American health care model is this: health-care spending is about $9500 per capita--and with approximately half of the people not of working age or not working, the health-care spending burden of each working person is $19,000.

It doesn't work out without higher inputs (taxes) from wealthy and corporations.

This current Trumpdontcare debacle (or shall we say hand-washing) is the current simplistic, uncaring response.

Better answers still needed.

The true death panel is your wallet.

Hey Neal

You could have stopped at your first sentence.

Don't tell me how to build a watch, just tell me the time, as my old boss used to say.

Well, then, just read the

Well, then, just read the first line.

That's freedom !

MAGA

No....

I like that "trumpdon'tcare" handle

Really

Was ACA actually a tax and cost increase plan then? :-)

No, the ACA was an attempt to

No, the ACA was an attempt to partially rationalize how health-care was paid for--it put it into an insurance form that followed the traditional and preferred payment path that the health-care system has been structured. It decreased all of the back-door payments that made up for those people who did not have insurance. Also, by bringing the uninsured into the system, it decreased the load on emergency rooms and reduced hospital admissions by having chronic conditions addressed before they became critical. And it disallowed refusal because of pre-existing conditions, allowed adult children onto policies, extended mental health and addiction services, and limited policy cost differential.

So no, the primary goal was not to raise costs and taxes. In fact, total health-care expenditure rose at the slowest rate and extended the life of the Medicare trust fund.

Say goodby to all that.

Sorry, Frank. (It's 2:20 pm)

So so wrong

Neal-

Your comment "Also, by bringing the uninsured into the system, it decreased the load on emergency rooms" is so so wrong.

ER visits have skyrocketed and most ER's are hemorrhaging money. I know first hand, my wife is an ER doctor. Her ER had record patient populations last years.

Why? Because with unlimited access and no to most patients, ER are full of people who simply find it more convenient than going to the clinic. HIPPA prevents the hospitals from re-routing them to a clinic, so every one gets seen no matter what their needs / conditions are. In rooms that are equipped and staff for far more serious issues, at costs that far exceed clinic costs. And with Medicare/Medicaid only reimbursing a fraction of the expense, ER are suffering big time.

Healthcare will never ever be fixed until we accept one thing - people have a personal responsibility to keep themselves healthy. Add to that concept that health starts at the lowest level with annual physicals and follow ups with primary care providers.

Until we do something to start enforcing some personal responsibility for living a more healthy lifestyle, we will never get health costs under control.

More convienient?

Why do you suppose that is? Could it be that the wait to get into their primary care facility is such that their illness would be exacerbated by the difference. Could it be that healthcare professionals (in the clinics at least) are some of the few entitled to "banker's hours" remaining in our 24-7 economy. Could it be that these "ER freeloaders" would prefer to fulfill their "personal responsibility" as wage earners and taxpayers and would find that difficult by taking unpaid time off (or being terminated from) gainful employment to ensure that clinic staff never works past 5? Perhaps you might indict your fellows, before you heap blame on the struggling.

Convenience or necessity ?

These data correlate with another new report issued by Health Policy Alternatives, which found that efforts by policymakers and health insurance plans to drive Medicaid patients out of emergency departments and into primary care are not working. More than half of providers listed by Medicaid managed care plans could not offer appointments to enrollees, despite a provision in the ACA boosting pay to primary care physicians treating Medicaid patients. The median wait times was 2 weeks but over one-quarter of providers had wait times of more than a month for an appointment.

"There is strong evidence that Medicaid access to primary care and specialty care is not timely, leaving Medicaid patients with few options other than the emergency department," said Orlee Panitch, MD, FACEP, chair of EMAF and emergency physician for MEPHealth in Germantown, Maryland. "In addition, states with punitive policies toward Medicaid patients in the ER may be discouraging low-income patients with serious medical conditions from seeking necessary care, which is dangerous and wrong. "

Also:

...About 90 percent of more than 2,000 respondents also say the severity of illness or injury among emergency patients has either increased (44 percent) or remained the same (42 percent).

http://newsroom.acep.org/2015-05-04-ER-Visits-Continue-to-Rise-Since-Imp...

Remember

I am luke warm on ACA and wish both sides would work together.

However even with it's benefits, ACA was one HUGE wealth transfer tax/ welfare program that was paid for by the the successful folks. If we were really out to just "rationalize" costs / payments, the funding stream would have been more flat. Instead it was set up to be VERY progressive.

As for the improvements, they could have been implemented without the large tax penalty.

Well

The Trump/Ryan care plan solves that problem: Just gives the rich a tax break and kicks them other folks to the curb, and restorers the emergency room at tax payers expense hole.
. .

Yes

Yes it is too bad that none of the Democratic Politicians are willing to enter the negotiation to find something better than ACA and ACHA... Trump and Ryan will probably need to give into the hard core Conservatives to get it passed.

"Successful Ones"

I was successful in being born into a working class family that gave me a solid upbringing, in part due to union negotiated wages and benefits. Some were even more successful than me, in that they were born into the country club set, and admitted into prestigious universities via being "legacies".

Would that I were more ambitious, I, too, would have been born into a more successful family.

Trumpcare

This plan is simply first and last a tax cut for the already-too-wealthy. There is no way to pay for healthcare for all except to tax those who are sucking the economy dry for their own aggrandizement.

Sure there is

You saw in another comment that health care costs $9000 per person in the US. It costs $6000 per person (or less) in most other industrial countries and they have better outcomes. We could have the health care of Japan or Switzerland and save $3000 per person for a total of $1 Trillion in savings.

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expendit...

Freedom vs. security

I think it's important to expand the context here, a bit. Freedom doesn't exist in a vacuum. It exists in many contexts where it expands and contracts in perfectly uncontroversial ways. Contracts are typically an exchange between freedom and security. An insurance contract is an exchange where I give up the freedom to do what I please with the money I pay in premium in exchange for security that insurance offers.

It's startling to see that Republicans, despite their business orientation, have such an unsure grasp of the principles underlying insurance. Speaker Ryan the other day, seemed to say that he didn't understand why expenses of sick people should be paid by healthy people. Well there isn't much else health insurance does besides that. And the fact is, there is little reason at all to think that the health insurance companies of America are managed exclusively either by Democrats or liberals.

"..despite their business orientation.."

What business orientation? Its a myth that Republicans are business oriented in the sense that they make good business people. They are business oriented in the sense that they bend over backward to do what big business wants. But when you look at the true believers in Conservatism and their dedication to market forces you see a lot of failure, the current CEO of Sears is an excellent example, he's structured the company in such a way as to pit departments against each other thinking that competition will make them all profitable, but the reality is that its lead to a lot of infighting, with departments undercutting other departments. The company and its value are in decline.

Of a more obvious example is the man in the White House, four times bankrupt and a string of failed businesses behind him, Trumps only business success has been selling his brand, basically a huckster.

No, Conservatives have no more business sense than anyone else, probably less. Business people end up supporting Republicans because they think they'll get a tax cut and maybe not have to follows the rules that everyone else has to follow.

Three Points

First, “freedom” is one of those things that depends entirely on whose ox is being gored. The very people in Congress who shout the loudest about “freedom” are the ones who have just approved a bill allowing employers the “freedom” to require employees to undergo genetic testing. Externalities matter. A person who is free to forego health insurance is likely at some point to need health care. What happens then? Does he become a free rider, using emergency care he doesn’t pay for? Rely on charity care that diverts resources from those who had the foresight to buy insurance?

Second, the individual mandate—something about which this single-payer fan is not crazy—is essential to the whole system. Enrolling everyone is the only way to spread the risk of people with pre-existing conditions, or older, potentially less healthy people. If preserving the role of private insurers was the goal, a mandate is the only way they will be able to provide the broad coverage people seem to like, without sustaining too much of a financial hit.

Third, Kris Kristofferson was the one who wrote the lyrics about freedom being “just another word for nothing left to lose.” Janis’s version of the song is the definitive one, but credit should go where credit is due.

Freedom

I was going to correct the Janis Joplin reference as well and note that Kris Kristofferson actually wrote the phrase in the song Me and Bobby McGee. But RB beat me to it. He must be a real hep cat.

So here's another take: Isn't mandatory pay-in to Medicare the same concept as mandatory pay-in for health insurance for all, whether you call it Obamacare or something else? Oh, yes, I forgot, Medicare is something that the Ayn Randers would eliminate as well as Social Security.

Me too!

And actually I prefer Kristofferson's version.
He didn't write it or sing it as blues.
Used to sing it back when I was a sixties folkie.

suffocating medicaid

The CBO score sounds wonderful for the budget conscious deficit-focused folks...until you realize that Medicaid contributions from the feds--the only branch being "scored" by the CBO--will diminish considerably so that "states can be creative and come up with better ideas" on how to get more out of less.

Those already screwing the poor by not offering medicaid via the ACA won't be as affected as the states that did decide providing health care to millions of their residents was a better alternative than spiting Obama.

BTW, you have got to admire the chutzpah of the GOP is phasing these cuts in so they don't fully land until 2020, when the first rates get set after the next Presidential election.

Rationale

Assuming you think healthcare should be paid for via the federal taxes and government. Why?

I personally think the States should take over welfare, medicaid, etc and get the Feds out of that short term business. I would have the Feds maintain control of medicare and SS because the long term aspect of them.

As for delayed implementation, that reminds me of the ACA roll out and Obama's delays.

No surprise on this comment

What do you think that southern states will do for welfare and Medicaid for minorities? Zero x zero. Reminds me of the die in the streets cheer from republicans in 2011

Really

Do you have that little faith in the people who live in the South?

The reality is that people will move to States where there are better jobs, better educations, better safety nets, etc. And if they don't, then they must be satisfied with where they live today.

Just sending them money to enable their current life styles is not a good way to promote change and improvement. It just enables them to continue those lifestyles for generation after generation.

Now that is what seems cruel to me.

Why is health insurance so different?

Why is it that some Americans happily pay for home and car insurance, even though they may never need it, but can't stomach the idea of having to buy health insurance? They accept that insurance is a pool that you pay into, in hopes that it's there if you ever need it. They even accept it as a requirement imposed by others, whether its the state (for car insurance) or your mortgage company for home insurance. Seems like common sense.

Because

auto and homeowners cost a fraction of what health insurance does thanks our enormously high cost and profitable health care sector. you are right though, you can't own a car or a home without insuring it, unless you pay cash.

Actually

You can't register a car without having liability coverage and no-fault, no matter how you pay for it. You can own it, but you can't operate it.

Companies that finance auto loans require collision coverage. It is not a state requirement.

good point

both true

American Health Care Act: Alternate Names

The ACA was dubbed Obamacare to discredit it. But I always equated Obamacare with Obama Cares. So I think it is appropriate to identify the American Health Care Act as Donald Doesn't Care. As Neal said above, this is not a health care plan--it is a federal tax-cut plan that does NOTHING to help those lower income folks who voted for Trump in droves. How many lives will be lost before these willfully ignorant voters realize they have be conned? The cold, hard facts are that Donald Does NOT Care About Them! Nor do the Republicans who are so blinded by power and ideology that they have become incapable of independent moral judgment.

Freedom from Want

From Wikipedia "Freedom from Want: The right to an adequate standard of living is recognized as a human right in international human rights instruments and is understood to establish a minimum entitlement to food, clothing and housing at an adequate level. The right to food and the right to housing have been further defined in human rights instruments."

Usually a set of societal behavioral expectations come with rights. Especially if society is going to tax some citizens at much higher amounts in order to provide others with that food, clothing, housing and now healthcare.

I mean we require that citizens pay those higher taxes, it is their responsibility as part of our society... With this in mind, what is the responsibility of those who receive the gifts from society? I mean they are not earning these items... They are purely gifts from the generosity of their fellow citizens.

Our society spend trillions of dollars per year on these gifts and on our public education system. What should we expect in return from the recipients?

I ask because ACA was a very large tax / cost increase that funded in essence a "health insurance welfare" system that has no work requirements. Now that certainly did provide many citizens with the freedom to have health insurance while other citizens were forced to pay a large portion of their bills. In essence one group of citizens were freed from a burden and it was placed on the shoulders of another for better or worse.

Regarding what

Regarding what "non-productive" elements of our economy deserve is not a new question

(quote)

Many modern readers of “Life Unworthy of Life” will actually resonate with the arguments that are described in it. If they did not know of its place in the history of the mass extermination of hundreds of thousands of disabled people of all ages, they would embrace the book with only a few reservations. Change the title, take out a few of the more racially provocative remarks, and the book could perhaps serve as the guiding document for Britain’s “Liverpool Care Pathway” which bears uncanny, even frightening, similarities with the arguments and eventual trajectory of Binding and Hoche’s book.

As of this writing, allegations that Britain’s medical system is actually encouraging doctors to put ‘dying’ people of all ages onto the LCP through the use of financial incentives. True, this trajectory may not end in a holocaust as apparent as what happened under the Nazis, but the similarities of the trajectory is undeniable. There are others, such as the fact that academics and ‘mere conversation’ preceded any actual implementation of any programs. In the 1930s, most of the doctors and medical professionals implementing the T4 program were not Nazis; presumably, none of the medical professionals implementing LCP are Nazis, either. Nonetheless, one of the main strategies for ‘humanely’ killing someone whose life has been deemed ‘unworthy of living’ is exactly the same: starvation, dehydration, and sedation… and over-sedation.

http://lifeunworthyoflife.com/foreword-to-die-freigabe-der-vernichtung-l...

(end quote)

Life unworthy of life--it's an older book.

Unworthy vs Natural Consequences

It seems that people on the Left like to make that leap...

I do not deem to judge people "unworthy of life", I am asking at what point are free adults in our society responsible for the choices they make in life and the consequences that follow?

Or is it the expectation that the hard working successful people have responsibilities in our society, including that they must keep paying extra to continually clean up after the other citizens?

Do Liberals expect anything from the unsuccessful people in our society in exchange for all the gifts?

I see

How you combined the words "hard working" and "successful." A lot of unexamined factual and moral assumptions packed into your sentence there.

Yes

You are correct: with free K-12 education, free libraries, educational assistance, etc. I do think most people can be successful if they work hard, make good decisions and strive to continuously learn.

One of my co-workers who came from Ethiopia at 19 unable to speak English, wonders why so many people fail to take advantage of the programs that helped him become a degreed mechanical engineer. How would you answer him?

I'd answer him in any number of ways.

It depends why he was asking. But that is on the far periphery of the moral and pragmatic questions about a society's obligation to afford primary goods and how a society fulfills that obligation. The terms "hard working" and "successful" need a lot more scrutiny before you can use them as criteria in such a discussion. As just one example, you use "successful" to refer to someone who has acquired a lot of money. At best, this is morally irrelevant.

Successful

I don't think someone needs to acquire a lot of money to be successful. As you said there are many aspects to it... Some may include:
- Maintain a healthy long term Marriage
- Raise children to be mature / independent
- Learn knowledge and skills
- Work and pay one's bill
- Give to charity and/or volunteer

I use successful /unsuccessful because rich /poor seems inaccurate to me. And ACA raised costs for more than just the wealthy. It hit people with a medical fsa, increased the costs of medical devices and more.

Throughout this thread

And in hundreds of MinnPost comments, you use the term "successful" synonymously with having wealth or a high income.

In a society in which economic and political structures are deeply corrupt, having wealth or a high income has other implications. Many do well by doing good, but some do very, very well by doing very, very injurious things to society. And many, many more, by choice or the coercion of the market, do reasonably well or at least OK by playing a small role in the service of the latter.

Yes

I agree that there are self centered unscrupulous and/or free loading people at all economic levels. Do you disagree? Or do you think they are only in the wealthy successful group?

Please remember that I support eliminating fraud, waste and criminal activities at all economic levels. (ie poor, middle class and rich)

Of course there are unscrupulous people

at all economic levels, but you are missing the point completely. The point is that because of the corruption of our political and economic systems, in the most important ways, there is a strong inverse correlation between what is morally grounded and benefits society, and what accrues wealth. For this and many other analytically strong reasons, the simplistic assumption that people "deserve" the income or wealth that comes their way, and the consequent opposition to social insurance and redistribution, are far, far more dubious than you take them to be.

Disagree

Sorry, there may be some reasons that some people are wealthier than they should be.

However that does not prevent others from learning and escaping poverty. That is on them.

Answer

Not everyone has the aptitude to be a mechanical engineer, whether they work hard or not. He's lucky that he does. He's also lucky that mechanical engineering happens to be in demand at this moment in history, had he been born prior the industrial revolution, his skills wouldn't have been particularly marketable. Its all chance John, all of it. Not just a "huge portion", not a small fraction. Everything in your life that's good or bad is simply the luck of the draw. Pretending that those with good fortune are somehow superior, or deserving of greater rewards, is foolishness. You asked what responsibility those whom fortune has not smiled upon bear to society? None, the whole purpose of civilzation should be evening out the cold hand of chance. If not, what purpose does it serve? We certainly don't need to be aggregated into a civil society if our plan is to let those who lose the game fall off into oblivion. Anarchy would be far more efficient at that.

Fatalism

Sorry I have a hard time with fatalism:
1. The acceptance of all things and events as inevitable; submission to fate:
2. Philosophy. the doctrine that all events are subject to fate or inevitable predetermination.

I believe in people and their ability to learn, improve and escape their fate.

Who's fatalistic?

I don't recall making the argument that recognizing the reality of the situation should cause one to cease striving to take advantage of any opportunities chance provides. Rather, recognizing the reality should provide the impetus to craft public policy that mitigates rather than exacerbates the inequalities created by the whims of fate. You aim to rail against that which is unassailable, to further your desired moral ends, regardless of the harm it will cause, and in spite of the fact that it won't really work for most people. That may not be fatalistic, but it is willfully harmful.

Really

Sorry. This sounds pretty fatalistic.

"Everything in your life that's good or bad is simply the luck of the draw. "

I simply believe differently.
- We choose our spouses and if we will fight for our marriage
- We choose if we will listen and study in school.
- We choose if we spend spare time at the library or in front of a video game
- We choose our clothing, behaviors, speech patterns, beliefs, etc
- etc

Now if you have Parents and Peers who behave and believe in a certain manner, it will be harder to do differently. But it is a choice that we can make, we are not predestined to failure.

I do love when

You make my point unintentionally.
To begin, chance is present in, and controlling, each of the examples you cite. You might take for granted the present level of civilization in which you exist, but it doesn't mean that it just happens.
1. You choose your spouse from amongst the limited options presented you. You haven't met and inspected the 4 billion or so available candidates. Beyond that, you have no control over accident, illness, and crimes that would make "fighting for your marriage" a non-option. Similarly, you haven't any real control over a spouse who simply chooses to end the relationship, whether you object or not.
2. Chance determined whether you were born and raised in a place and time in which schooling was available. Chance determined whether the genetics imparted to you by your parents included those for learning disabilities that would make that schooling more difficult.
3. Like number 2, chance determined your access to a library, I can tell you my small town had none.
4. Again, one chooses from that which is available. Its rather unlikely that in the abscense of any outside influence, I would become a Russian speaking Buddhist by growing up in rural WI. It was rather likely that I grew up a Lutheran speaking English peppered with Scandanavian colloquialisms.

Now to the point you made for me. What changes any of these examples? Who creates the public school system, who builds the library, who can bring new ideas and learning from afar to broaden the experience and opportunity of an isolated, homogenous group? Public policy, enacted through government action. Recognition of the disadvantages posed to some by the random circumstance of their birth, causing not fatalism, but proactive response. The opposite of what you and yours suggest, and indeed plan to enact.

Consistently

As I consistently say, we are all lucky to be born in modern America, where there are free schools, public libraries, a welfare system, peace, rule of law, physical mobility, etc. A place where options and choices abound.

I am fine with training programs (ie teach to fish). Not so fine with continually growing the number of people in need. (ie buying ever more fish) So back to my question, what do expect from all the recipients of this nations generosity?

teach a person to fish

You must not fish John. It will cost that person money they don't have unless they are provided with a fishing pole, reel and fishing line, lures and bait, a place to fish, a way to get there, and a license to fish. None of that is free. Somebody's got to pay for it.

Options and choices don't abound for free. A person has to get to the places where there are options, first they need to know where all those choices are. They don't put out signs that say 'choices are here and you can have options too!' Look at a paper? Maybe they have 25 openings there, maybe. Well then, there must only be 25 people who need work!?

Take a person in rural America where the people looking outnumber the options and the choices they are looking for. You will say that they should just pick up and move to a place where those things are. And where is that? How do they get there? Where will they live? How will they get transportation from where they have to live to a place where they 'might' find work? They have no idea! Like fishing, all those things cost money. What kind of jobs will a rural person be trained for before getting to a place where jobs might be? There isn't much in the way of farming in the city. So if they do get there where jobs might be, how will they get the training? They've most like have been asking their relatives to pay their way. If they will? Especially if the Nation's generosity is removed because some people think this Nation has been too generous already?

Please

Please remember that we spend 1+ Trillion dollars per year on fishing equipment. (ie HHS /Education) Not sure how we get more people to fish more effectively quicker for their good and that of us tax payers?

As I'VE consistently said

Nothing. Generosity does not depend on end result. When it does, it ceases being generous and instead becomes a capitalistic transaction. The generoisty of which you speak is there to mitigate the chance derived inequalities of our capitalistic society, not to reinforce them. There isn't enough water for everyone to fish, barring some population decimating catastrophe, unless your plan is to let the "natural consequences" of which you speak to become that method of population reduction (which would be reprehensible), we're gonna be handing out fish forever. Such is the cost of capitialism in our society.

Generous

I think a person can be generous and charitable.

I don't think supporting high taxes on Peter so money can be taken from him, and then later given to Paul is being generous.

If it is do you have $100 I can have to give away to a needy person? I feel like being generous. :-)

Sure

I pay it out in taxes, then same as most (barring those who use whatever means necessary to skirt their tab). In that manner I can be assured that ALL who need assistance have a reasonable chance to get it (as opposed to someone's idea of worthy), and that the amounts received will be more than the pittance collected from a wildly fragmented donor base. Why would I give my money to something that won't solve a problem? To make myself feel good? Taxes, and the programs they support, are the cost of the civilization you say you are so lucky to be a part of, they've accomplished more toward eliminating poverty than charity has in the last what, 10000 years?

Maybe

I figure everybody in the 15% and lower tax brackets are just paying their own share of the country's burden. It isn't until people get into 25% and above brackets where they are paying the tax burden for themselves and others.

John--we all know a few

John--we all know a few people that are extraordinary in one way or another. At the very least, your co-worker from Ethiopia showed extraordinary drive and persistence to come to a new, strange and potentially unfriendly place and make a new life.

However, unlike Garrison Kiellor told you, not all children are above average. Expectations that the exceptional should be the average is just not realistic.

Sorry

Alem is capable, but he is no genius... He was just driven to improve his life and took advantage of all the programs that were available to a young Black student like himself.

Extraordinary in one way or

Extraordinary in one way or another.

Determination and drive can be extraordinary, being a genius at making widgets is another way of being extraordinary.

People are all different, John. A few people are great at many things, some are great at a couple of things, the great, great majority are average in every way and worse in some.

Your casual judgements of people and their lives show a lack of that understanding.

Extraordinary in any respect is not average.

Seems you make

the false assumption that all folks have the capacity to be reasonable rational responsible thinkers, and act on that thought. Our success or failure is not a perfect platform to compare to another, What is that saying "Never criticize a man until you've walked a mile in his moccasins."
Actually I think liberals expect more out of society (successful and unsuccessful people) than conservatives. Gifts?

Please elaborate

What do you expect from the unsuccessful folks who receive a large investment from the tax payers?

.....they must keep paying

.....they must keep paying extra to continually clean up after the other citizens...

Are you talking about the EPA ? Cleaning up after our fine corporate citizens ?

Or perhaps you're talking about the Pentagon, and the politicians wars of choice ?

Magnitude

Please note that welfare, healthcare, pensions, etc pretty much dwarf everything else.

http://www.usgovernmentspending.com/year2017_r

John, is social security

John, is social security welfare ? Is medicare welfare ? Are unemployment benefits welfare ? Are worker pensions welfare ?

Perhaps in the broadest sense.

But I suspect you are referring to that given to ungrateful people ?

Dig out that amount and we can have a discussion.

SS and Medicare

No, SS and Medicare are for the most part forced insurance /savings accounts.

Though often Liberals ask that the Rich pay more in while not increasing their future benefit. If this occurs then they will become more welfare like.

I am talking about unearned gifts like welfare, medicaid, etc.

Except

the (largely off budget) military expenditure.

The common assumptions

in your comment, Mr Appelen, are that poverty just happens, it isn't a deliberate part of the way unchecked capitalism works. Furthermore, if a person can't afford things, it's because they've done something wrong -- usually the crime is defined as "being lazy", not working hard enough, not planning for the future, being irresponsible.
Another assumption is that the part of the community that IS hardworking, responsible, etc. is UNFAIRLY required to pay more in taxes that fund programs keeping people who can't pay -- children and their caretakers, the elderly, disabled people, those who had their pensions gambled away by IRRESPONSIBLE corporations, who had catastrophic illnesses before the Affordable Care Act -- sheltered, fed, and with necessary medications.
It seems to me eminently FAIR that if you are lucky enough to have a good income -- and yes, you ALSO worked hard and were responsible -- part of that income should go to those who have worked just as hard, or harder, than you and weren't so lucky. It's not a GIFT, it's what we owe each other as human beings, and it's there for you too, should you ever need it.

Sorry

I really don't think poverty just happens. I think some of it is bad luck and some of it is bad choices. My usual pet peeve is Single Parent Households and their relationship to the academic achievement gap and generational poverty.
http://www.familyfacts.org/charts/economic-well-being

I have friends who struggle some as a couple with kids and no college degrees, but overall they own a house, the kids do good in school and the family is generally okay. Not so for the single parent households, they really struggle. And unfortunately the number of single parent households has been growing since the war on poverty began.

So, I definitely think choices and actions lead to poverty. It does not just happen.

Oh, lets unpack this finally

So to parse this out, you don't like ALL single parent situations, or just CERTAIN single parent situations? Examples, should one whose spouse/partner is physically or verbally abusive be made to stay in the relationship? Should someone whose spouse/partner is deceased be pressured into another relationship just because? Should someone be forced to endure the infidelity of their spouse/partner simply to preserve a two-parent household? Should one endure the trials created by a drug or alcohol addicted spouse/partner? Should parents be made to "stay together for the kids" even if they've come to despise one another for any reason? Do any of these situations serve the best interests of anyone, especially any children involved. I'm gonna assume you said no, for most if not all of these, meaning your ire is reserved for a very small subset of single parent households. My guess is you hold to some notion that there are those out there of loose moral conviction, that are simply having kids for fun, or out of lack of concern. Fine, how many do you think that encompasses? Alternatively, perhaps you hold to the view that there are those having children purposely, to game the social systems in place to help the less fortunate? How many do you think that includes? Do you really think that dismantling our entire social safety net is warranted to address the fraction of folks who tick your box of outrage, at the cost of taking it away from all those who don't.

Do you assume

that women "selfishly" choose to be single parents? Or are such losers we can't get a man to marry us, or stay with us?
If so, you live in a different world, apparently with no interest in other peoples' lives, only judgement.
I chose to be a single parent rather than stay with an abusive man, who came from a well-to-do family and was a minister.
Of course that had long term effects on my and my children's economic situation. Suffering from chronic depression, I had not finished college when I got divorced. I got training and found a job with benefits. Because my ex-husband had wanted me to stay home, I hadn't worked for twelve years, losing those years of Social Security because this country, like many, doesn't recognize the economic value of the work women do in the family. Because women still earn only 80% of men's income, or less, my children and I didn't have as much money to live on. Their father resisted every expense beyond child support and felt himself injured by having to pay that.
I realize as I'm summarizing this -- the experience of many, many women -- that life is nothing like you think it is: make all the (few and easy) right choices, work hard, and all will be well!
I'm sorry for people like you who don't and maybe won't or can't think beyond the narrow limits of your experience. Because you and many others think you have the right to pronounce on lives you haven't lived. And you don't.

So

So you chose to marry the wrong man, have children, and wisely exit the situation.

Do you think this means that the other tax payers should be forced to pay more to help you carry your burdens? If society does this for you, what should society expect from you in return?

Please remember that I am all for charitable giving and do it often. What I question is the fairness and logic of government mandated wealth transfer.

And yours is one example, but the issue is much larger. And I assume you would agree that being a single Mother is hard work.
http://www.familyfacts.org/charts/145/almost-half-of-children-in-single-...

Wow

Congrats on the most tone-deaf, obtuse, and unabashedly mean spirited commentary I've seen in years. So let me get this straight, it's Ms. Hunter's marrying the "wrong guy" that's the real issue here, not the fact that she was victimized by a monster. For having the audacity to 1.Be abused 2. Escape the abuser before (?) major harm came to herself and her children she should be ostracized as a freeloader and burden on society unless she shacks up with the nearest available male, post haste. Apparently I was incorrect in assuming your answer to my previous post, as misogyny appears to be the root ideal in your societal worldview.
We OWE as a society a debt to all folks like these, particularly women, as society itself, as decades ( if not centuries) of paternalism and treatment of women as second class citizens bred the culture that allows behavior like that described to flourish. WE make the monsters. Of course we should foot the bill for the carnage wrought. Not to mention, what of the debt we owe folks like Ms Hunter for breaking the cycle of abuse? How much more damage might have been wrought in the future (by children conditioned to abuse) had she not had the courage to leave?

Monsters

So somehow society makes monsters? I guess I disagree since humans have been controlling and harming each for long before societies were formalized.

I think that society could help to reduce monstrous actions, but one of the important steps is to encourage people to live in healthy 2 parent homes. So we are back to the original questions.

Avoiding the question

So all single parent households are created the same? Mitigating circumstances be damned I guess. For all you push it as your uniting ideal, you sure seem loathe to defend it.

Unfortunately

I do not no what question I am avoiding. I agree that each household is different and sometimes there are mitigating circumstances. Unfortunately our welfare system has few filters... It just says that if you are poor, single and have children... We will send you checks.

That is why I like charity better, they do consider circumstances and require improvement effort in exchange for assistance.

Explain to us

What must the abuse victim, the widow, the spouse of the philanderer, the loved ones of the addict, do to "improve" in your eyes? Why must they "qualify" for someone's generosity? If that's the case, why bother with restitution for things like drunk driving deaths, murder and assault. SSI survivors benefits are out too. Apparently we're all responsible for everything, even when that which we cannot have any expectation of control over.

Question

How exactly did the tax payers become responsible for paying restitution when something unfortunate happens to a citizen?

Now I agree that SS survivors and disability benefits are "paid for" insurance benefits, hover the idea that the tax payers should bear the financial burden of everything that goes wrong seems like over reach.

How does it make sense that Peter should pay a higher tax rate because Paul got a woman pregnant and left her with 2 children to feed?

From what I understand Catholic charities works to ensure recipients are learning, working, no drugs/alcohol problems, etc. In other words they are learning to fish and can some day get off the programs. The bar seems pretty low and attainable.

Taxpayers=Citizens=Human Beings

The elements of that equation are in reverse order of importance. First, we're human beings, and many of us recognize that means we're sisters and brothers.
Second, we're fellow citizens in this interesting country -- all of us, regardless of color, race, religion, age, income, gender, sexual orientation and other things. The Preamble of our Constitution states our government's work; that is, our collective work as citizens.
Third, our business as taxpayers is to pay our share of doing our country's work.
That's how we taxpayers are responsible for helping pay what you call "restitution" when something unfortunate happens to a fellow citizen and human being.
We'll continue to disagree, I know.

Thank you, Matt Haas

for your understanding words re: single parents, abuse survivors, etc.
I haven't looked at this post in some time & had assumed MinnPost didn't print my response to John A. because it was so personal.
I had also intended to include in that response my awareness that many people carry even heavier burdens of poverty and other conditions than I did. (And my family are all doing well now.)
This blog post certainly did generate a heartfelt discussion! One of the best things we do as citizens and for ourselves, I think, is to engage in discussions like this. It clarifies my own ideas and beliefs when I articulate them with fellow readers, writers, and citizens.

There are uninsured, but no untreated

"Even though choosing to live without health insurance strikes me as a really bad choice, and even though my dyed-in-the-wool liberal soul is not truly offended by the health care “mandate,” if I try to understand the whole government-versus-freedom mindset, the mandate is a pretty strong example of taking away an individual’s cherished (and unwise) freedom-to-be-uninsured."

Hmmm...Insurance or no insurance, if you have an car accident and roll into my ER you will receive very expensive and state of the art care, ICU treatment and intubation with ventilator support if needed, very careful 24 hour attention by highly trained staff, rehabilitation and specialty consultations, all costing hundreds of thousands of dollars. There is no free lunch. Write that on your mirror. There is a freedom to be uninsured, and there is, apparently, a freedom to pass your costs onto fellow taxpayers. That limits their freedom, involuntarily and substantially.

How long?

Will you be treated until you recover, or just until your condition is stable?
Will you be billed for the services?
And TANSTAAFL to you too.

In the nature of the artilce - - more rambling thoughts...

Why do we not tax employer provided health care benefits as income? The liberals are always looking for ways to increase revenue.

Why are those who purchase health insurance through the exchanges not allowed a tax benefit for their premiums as those who receive health insurance through a company?

Why are we required to purchase only government approved health care plans and not purchase a plan that meets the individuals needs and provides choice?

I think Mitt Romney was somewhat/kinda right when he talked about the 47%. The Dems want to turn the 47% into the 55% and the GOP want to turn the 47% into the 43%. Government dependent VS self dependence. The government is to help those who are truly in need not to subsidize their special interest groups or buy votes.

"Why are we required . . ."

Two reasons:

1. Consumer protection. Insurers must meet certain minimum standards, so that policyholders will at least know they will be around to pay claims. No, not everyone is capable of doing their own market conduct exams. Apart from the obvious hucksters (remember the guys who used to advertise on utility poles?), there is often no way of telling who is going to scam you.

2. It kind of defeats the purpose of a mandate to require the purchase, and then say "but we don't care what you purchase." For that matter, if we're sticking with the old system, it seems foolish to give employers a tax break for providing medical coverage to employees without making sure that minimum standards for that coverage are met ("I'll pay for you to see my nephew. He got first aid merit badge when he was a Boy Scout!").

I have to chuckle when I see Britt Robson

say that delaying parts of the new bill shows chutzpah by GOP. That truly goes to show NOBODY (including politicians) read the bill... Delaying the worse parts of the ACA to try influencing CBO scoring and make a terrible piece of legislation appear tolerable, was the main objective of the Dems (ask Architect Jonathan Gruber).

To change the ACA it will take multiple phases. Obamacare was created through procedural vote, legislative law and executive orders, it will take months to undue this bill which covers 18% of our countries GDP. I will wait to see the final bill before I make a decision on whether it helps or hurts Americans and makes us more free or more dependent on Big Govt...

Multiple phases ?...Sen. Tom

Multiple phases ?

...Sen. Tom Cotton (R-AR) on Tuesday threw cold water on remarks from top Republicans that legislation the Congressional Budget Office gave a dreadful score to is just one of three phases in the process of repealing and replacing Obamacare.

"There is no three-phase process. There is no three-step plan. That is just political talk. It’s just politicians engaging in spin," Cotton told conservative radio host Hugh Hewitt....

What ?

They're not telling the truth ?