Is the plan to replace Obamacare really about freedom?

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.

Comments (125)

  1. Submitted by Carol Flynn on 03/14/2017 - 10:53 am.

    How can we require car insurance?

    • Submitted by Don Oberg-Hauser on 03/14/2017 - 12:25 pm.

      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.

    • Submitted by Tim Smith on 03/14/2017 - 01:37 pm.

      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.

      • Submitted by Frank Phelan on 03/14/2017 - 08:54 pm.

        No Loan On My Car

        And yet I am required to have insurance.

      • Submitted by Dennis Wagner on 03/15/2017 - 10:11 am.

        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.

    • Submitted by Harris Goldstein on 03/14/2017 - 09:02 pm.

      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.

    • Submitted by Gerald Abrahamson on 03/15/2017 - 10:34 am.

      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).

    • Submitted by Joe Musich on 03/15/2017 - 08:35 pm.

      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!

  2. Submitted by Neal Rovick on 03/14/2017 - 12:06 pm.

    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.

    • Submitted by Frank Phelan on 03/14/2017 - 12:16 pm.

      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.

    • Submitted by John Appelen on 03/14/2017 - 12:49 pm.

      Really

      Was ACA actually a tax and cost increase plan then? 🙂

      • Submitted by Neal Rovick on 03/14/2017 - 02:19 pm.

        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)

        • Submitted by Tim Milner on 03/14/2017 - 06:10 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.

          • Submitted by Matt Haas on 03/15/2017 - 12:13 pm.

            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.

          • Submitted by Neal Rovick on 03/15/2017 - 01:27 pm.

            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-Implementation-of-Affordable-Care-Act

        • Submitted by John Appelen on 03/14/2017 - 07:10 pm.

          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.

          • Submitted by Dennis Wagner on 03/15/2017 - 10:18 am.

            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.
            . .

            • Submitted by John Appelen on 03/16/2017 - 03:47 pm.

              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.

          • Submitted by Frank Phelan on 03/15/2017 - 12:43 pm.

            “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.

  3. Submitted by John Clouse on 03/14/2017 - 12:10 pm.

    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.

  4. Submitted by Hiram Foster on 03/14/2017 - 12:17 pm.

    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.

    • Submitted by Henk Tobias on 03/14/2017 - 04:11 pm.

      “..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.

  5. Submitted by RB Holbrook on 03/14/2017 - 12:17 pm.

    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.

    • Submitted by Randall Bachman on 03/14/2017 - 03:33 pm.

      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.

      • Submitted by Paul Brandon on 03/14/2017 - 07:20 pm.

        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.

  6. Submitted by James Kelly on 03/14/2017 - 12:21 pm.

    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.

    • Submitted by Tim Smith on 03/14/2017 - 01:31 pm.

      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.

      • Submitted by RB Holbrook on 03/14/2017 - 01:59 pm.

        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.

  7. Submitted by Kolean Pitner on 03/14/2017 - 12:24 pm.

    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.

  8. Submitted by John Appelen on 03/14/2017 - 12:31 pm.

    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.

    • Submitted by Neal Rovick on 03/14/2017 - 03:31 pm.

      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-lebensunwerten-lebens-allowing-destruction-of-life-unworthy-of-life/48.htm

      (end quote)

      Life unworthy of life–it’s an older book.

      • Submitted by John Appelen on 03/14/2017 - 06:58 pm.

        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?

        • Submitted by chuck holtman on 03/15/2017 - 10:28 am.

          I see

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

          • Submitted by John Appelen on 03/15/2017 - 02:20 pm.

            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?

            • Submitted by chuck holtman on 03/15/2017 - 05:50 pm.

              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.

              • Submitted by John Appelen on 03/16/2017 - 10:33 pm.

                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.

                • Submitted by chuck holtman on 03/17/2017 - 11:40 am.

                  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.

                  • Submitted by John Appelen on 03/17/2017 - 03:52 pm.

                    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)

                    • Submitted by chuck holtman on 03/19/2017 - 10:00 am.

                      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.

                    • Submitted by John Appelen on 03/19/2017 - 09:56 pm.

                      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.

            • Submitted by Matt Haas on 03/15/2017 - 07:56 pm.

              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.

              • Submitted by John Appelen on 03/16/2017 - 10:42 pm.

                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.

                • Submitted by Matt Haas on 03/17/2017 - 10:58 am.

                  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.

                  • Submitted by John Appelen on 03/17/2017 - 03:59 pm.

                    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.

                    • Submitted by Matt Haas on 03/18/2017 - 11:38 am.

                      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.

                    • Submitted by John Appelen on 03/19/2017 - 07:50 am.

                      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?

                    • Submitted by Jon Lord on 03/19/2017 - 10:12 am.

                      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?

                    • Submitted by John Appelen on 03/19/2017 - 10:11 pm.

                      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?

                    • Submitted by Matt Haas on 03/19/2017 - 01:31 pm.

                      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.

                    • Submitted by John Appelen on 03/19/2017 - 09:44 pm.

                      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. 🙂

                    • Submitted by Matt Haas on 03/20/2017 - 09:16 am.

                      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?

                    • Submitted by John Appelen on 03/20/2017 - 01:57 pm.

                      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.

            • Submitted by Neal Rovick on 03/15/2017 - 09:17 pm.

              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.

              • Submitted by John Appelen on 03/16/2017 - 03:43 pm.

                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.

                • Submitted by Neal Rovick on 03/16/2017 - 07:48 pm.

                  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.

        • Submitted by Dennis Wagner on 03/15/2017 - 10:31 am.

          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?

          • Submitted by John Appelen on 03/15/2017 - 02:22 pm.

            Please elaborate

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

        • Submitted by Neal Rovick on 03/15/2017 - 01:34 pm.

          …..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 ?

          • Submitted by John Appelen on 03/15/2017 - 02:28 pm.

            Magnitude

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

            http://www.usgovernmentspending.com/year2017_r

            • Submitted by Neal Rovick on 03/15/2017 - 04:25 pm.

              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.

              • Submitted by John Appelen on 03/15/2017 - 08:45 pm.

                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.

            • Submitted by Paul Brandon on 03/15/2017 - 07:53 pm.

              Except

              the (largely off budget) military expenditure.

    • Submitted by Helen Hunter on 03/15/2017 - 04:23 am.

      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.

      • Submitted by John Appelen on 03/15/2017 - 03:46 pm.

        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.

        • Submitted by Matt Haas on 03/15/2017 - 08:12 pm.

          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.

        • Submitted by Helen Hunter on 03/15/2017 - 09:25 pm.

          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.

          • Submitted by John Appelen on 03/16/2017 - 10:19 am.

            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-mother-homes-live-with-never-married-mothers

            • Submitted by Matt Haas on 03/16/2017 - 12:43 pm.

              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?

              • Submitted by John Appelen on 03/16/2017 - 03:39 pm.

                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.

                • Submitted by Matt Haas on 03/16/2017 - 04:07 pm.

                  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.

                  • Submitted by John Appelen on 03/20/2017 - 10:46 am.

                    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.

                    • Submitted by Matt Haas on 03/20/2017 - 12:13 pm.

                      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.

                    • Submitted by John Appelen on 03/20/2017 - 02:11 pm.

                      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.

                    • Submitted by Helen Hunter on 03/21/2017 - 10:01 pm.

                      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.

                    • Submitted by Helen Hunter on 03/21/2017 - 10:26 pm.

                      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.

  9. Submitted by Dean Knudson on 03/14/2017 - 01:07 pm.

    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.

    • Submitted by Paul Brandon on 03/14/2017 - 07:24 pm.

      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.

  10. Submitted by Ron Gotzman on 03/14/2017 - 01:55 pm.

    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.

    • Submitted by RB Holbrook on 03/14/2017 - 05:31 pm.

      “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!”).

  11. Submitted by joe smith on 03/14/2017 - 02:04 pm.

    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…

    • Submitted by Neal Rovick on 03/14/2017 - 04:15 pm.

      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 ?

    • Submitted by Paul Brandon on 03/14/2017 - 07:27 pm.

      Who was it

      who hid the Unaffordable Health Care (Freedom to Die) bill in the basement, and rushed it through before it could be properly vetted?

  12. Submitted by James Hamilton on 03/14/2017 - 02:31 pm.

    Too many on the right confuse freedom with freedom from taxation. Which has a certain irony when one considers that the American Revolution was not about taxation but in large part about taxation without representation. There’s a not subtle difference between the two.

    While I’m not an advocate of single payer health care coverage, I see it as almost inevitable in the U.S. once “Republicare” is enacted and, as it seems determined to do, sends us back to the intolerable situation that existed before Obamacare.

    Although I was in my early teens when Medicare was enacted, I have vivid memories of the images which served as a catalyst for its passage, typically elderly men and women in rural America lacking any means of obtaining medical care that didn’t rely on the kindness of strangers, e.g., charity hospitals and doctors willing to forgo their usual fees. There were too few of either to accomplish much then and there will be once again soon enough.

    Premiums and deductibles for the 5% of us who purchase health insurance in the individual market are completely out of control, for many reasons. Those reasons include Sen.Rand Paul’s skill in slipping an amendment into 2013 legislation, reducing the government subsidy to insurers hard hit by the newly insured with serious and seriously neglected medical issues, ludicrous price increases for old, generic drugs which cost pennies to manufacture, just as ludicrous pricing for new drugs which provide only marginally more benefit (if any) than older drugs, permitting insurers to separately rate groups and individuals, and an array of other factors. With respect to the separate rating of groups and individuals, it seems to me that the goal should be to ensure that an insurer covers its operating costs and profit margin on its business as a whole and not by examining each narrow sector. (If I’m wrong, which is certainly a possibility, I invite an economist to correct me.)

    What I consider the most likely form of single-payer health insurance is the German system, about which readers can learn more below. It strikes me as a reasonable balance between the two extremes in our current social structure. Everyone gets medical care, based on income-dependent premiums, and those who prefer private coverage are free to purchase it. Everyone, however, must participate in one or the other.

    http://www.germanyhis.com/

    I do not expect to be around to see if my prediction is accurate. I wish those who will be well in their futures.

  13. Submitted by Curt Carlson on 03/14/2017 - 03:06 pm.

    Ayn Rand’s ‘freedom’

    The ‘freedom’ (or, alternatively, ‘liberty’) that Ayn Rand and those who love to quote her (in spite of their universal aversion to her advocacy of reason and atheism) advocate is the freedom to live a solitary, disconnected, non-social life. It is the freedom to deny the concept or reality of a social contract, a denial of the biological and historical fact of social interdependence, the freedom to deny any responsibility to fellow members of the nation or human race while accruing all the benefits.

    I wouldn’t mind it so much, maybe, if they had the intellectual integrity to admit it (and maybe go live in caves somewhere out of my sight and hearing). But the posturing of a Paul Ryan trying to justify his machinations as being in the better interests of anyone but himself and his campaign donors is disgusting.

  14. Submitted by Jon Kingstad on 03/14/2017 - 03:06 pm.

    Not about Freedom; About Injustice

    I’ve never been to India but I’ve heard from friends who’ve been there that they have a service, like our garbage service, which rides around and just picks up the bodies of the dead in the streets. Part of the argument for the ACA was dealing with our “free rider” problem that allows uninsured people to “externalize” the inevitable cost of health-care- at the emergency room- to the rest of us who pay through our taxes and or own health care costs. But underlying that is the assumption that we, as a society, don’t turn away people when they are in an “emergency” – a potentially life and death or crisis situation, to suffer and die in the street like the poor of India.

    Underlying that point is a matter of social and political justice. People have a “right” to decent health care even if they cannot afford it. What I mean by “right” is not like a common law right but a social obligation-something that we owe to each other and ourselves to live in a decent, just and moral society. The debate about health care finance and “markets” obscures the moral and I think main issue about what the “right”, i.e. just thing to do is.

    Eric Black’s comment about conservatives only being deficit hawks when it involves social spending is not really snotty. It’s the truth. I’ll never get tired of throwing back Dick Cheney’s comments about the deficit when he was pressing for more spending for the failed Iraq War: “deficits don’t matter.”

    Cutting social spending has always been the ened game for all of these tax cutting ideas, all of which have consistently failed for the past 37 years since Reagan proposed his “trickle down” tax cuts in the early 1980’s, On the front end, the rich GOP promises the tax cuts will increase tax revenues. When these fail to materialize as has happened for the last 37 years, the deficit goes up, so back to Plan B: more spending cuts- except for our bloated and wasteful national defense budget. Just another way of smuggling more tax cuts to the wealthiest, many of whom I understand, don’t want or need any more.

    Deficits do matter. But it’s not a choice between freedom and slavery or free markets and socialism. It’s about justice and creating a just society that achieves a better life for everyone, not just a wealthy few. That means health care for everyone even if means higher taxes and fewer aircraft carriers and jet bombers.

  15. Submitted by Connie Sullivan on 03/14/2017 - 03:32 pm.

    The freeloaders who will drop their health insurance when they can do so under Trumpcare (Ryancare, really) will depend on the rest of us to pay for their care when they do get sick or someone smashes their car or pickup and they reach the ER.

    That’s what’s being silenced in all the self-congratulatory Republican hype on the Ryan proposal. It’s freedom to be irresponsible in another way than it’s put in the usual Republican screeds about the 47%.

    Of course, we’ve all read the Ryan bill, right? We all know all the specifics of his plan? We all are experts in health care and in insurance realities, so we can discuss the ins and outs of a cap on insurance benefits for the sick or injured?

    And we all see that this Ryancare plan is the first Big Instance of Trump’s empty promises and lack of governing experience or skill being overtaken by Republicans in the Congress, right?

    Trump is simply going along because he doesn’t know what he’ talking about and can’t bother to take the time to find out about that complicated thing called health care or health insurance in this country.

    This is a guy who has gone bankrupt too many times to count and put the unpaid expenses on his lenders and bondholders: the quintessence of the irresponsible businessman. He thinks that’s the way everyone should behave: let the other guy pay.

    • Submitted by John Appelen on 03/14/2017 - 09:57 pm.

      Free Loaders

      Today we spend a HUGE AMOUNT of tax dollars on Medicaid and ACA subsidies each year.

      Is this a form of free loading in your opinion?

      How is better or worse than when people do not pay for health insurance?

      • Submitted by Bill Willy on 03/15/2017 - 04:11 pm.

        Where does it go?

        Where does all that money we spend wind up?

        I suspect I think it winds up someplace other than you seem to.

        None of my business of course, but, for example, you wouldn’t happen to own any health care industry-related stocks, shares in related mutual funds, etc., would you?

        No need to answer that (privacy respect, etc.), but if you do (like lots of other Americans, including our new Secretary of Health and Human Services), or don’t, it would be interesting to know what percentage of that HUGE AMOUNT you think winds up on health care-related businesses’ and their investor’s “bottom lines.”

        I mean, you make it sound like those HUGE AMOUNTS are going straight into the pockets, new cars, big screen TVs, and all variety of decandent paraphenalia and vacations of the takers who, in reality, are having a hard time affording their rent, their mortgage and day-to-day expenses of their family’s life in the minimal-as-possible wage world most Americans live in (thanks in large part to all those Heroic Job Creators we’ve given so many tax breaks to over the past couple of decades — so they would have the capital they needed to create all those great paying jobs they were GOING to create but, for some reason, haven’t quite gotten around to creating yet).

        I don’t know for sure, but, because of things like the following, I’d say there’s a MUCH better chance that all those deadbeats you seem so deeply disturbed by are much more of a conduit than a cause . . .

        “It only makes sense that Big Pharma would be associated with some big numbers. The size and reach of the major biopharmaceutical companies is pretty impressive (or scary, depending on your point of view). However, there are also some statistics for Big Pharma that aren’t all that large but are intriguing nonetheless. Here are a dozen Big Pharma numbers — small and large — that might surprise you.

        “1) $1.05 trillion . . . That’s the total revenue of the global pharmaceutical market. To put that number in perspective, it’s roughly one-quarter of what the U.S. federal government will spend in 2016.

        “2) $515 billion . . . Of the $1.05 trillion revenue for the global pharmaceutical market, nearly half of it — roughly $515 billion — comes from the U.S. and Canada. However, the two countries make up only around 7% of the total world population

        “3) 21% . . . This is the 2015 profit margin that Forbes estimated for the healthcare technology industry, making it by far the most profitable industry of all, with major and generic pharmaceutical companies leading the way . . .

        “4) 88% . . . The average stock return over the last 10 years for the 10 biggest pharmaceutical companies based on 2015 sales is 88% . . . ”

        http://www.fool.com/investing/2016/07/31/12-big-pharma-stats-that-will-blow-you-away.aspx

        And, of course, that’s just the El Pharma Grande piece of the American health care industry puzzle.

        And sure: They’re the leader in the truly rarified, Most Profitable Industry of All Club, but, according to Paul Ryan, Secretary Price and, one would presume, you, they NEED the tax breaks lodged in the Repeal and Replace plan and so do the people who invest their hard earned money in that particular sector (as well as all other sectors).

        And, of course, thanks to the Republican-sponsored and passed law of the mid-2000s, it is illegal for that HUGE AMOUNT-sucking beast, Medicare, to negotiate drug prices with ANY company in that sector.

        I’m (almost) sure you have an good moderate or centrist explanation why that particular law fits right in with the moderate centrist’s approach to efficiently financing America’s health care and why, in that particular case, competitive bidding with one of the Most Profitable of All businesses in America is a bad, counterproductive idea that would make it even tougher for those paying for all the freeloaders to get by.

        So, again. Where do you suppose those HUGE AMOUNTS of money all the takers are taking ultimately wind up?

        And even though we’ve been through this before (don’t make me haul out the data!) do you think the U.S. health care industry charging an average of $5,000+ per American more than people are being charged in any other country in the civilized world could POSSIBLY have anything to do with those HUGE AMOUNTS?

        If so, how come you never seem to be anywhere NEAR as upset with THOSE takers as you are the takers who, for all THEIR taking, never seem to have any money (as opposed to those you seem compelled to defend to the death who seem to wind up with just about ALL the money)?

        • Submitted by John Appelen on 03/16/2017 - 08:43 am.

          Price Fixing

          By the way, yes I have been invested in VGHCX for a long time and it’s performance hasn’t been terribly different from the SP500. My point is that healthcare is good business but they are not printing money by any means.

          It seems that you would like the government to engage in price controls, and I don’t think that is a good idea because of the high risk of unintended negative consequences for us consumers.

          Please remember that I am not against ACA or medicaid, I am just noting that they are welfare programs with no work reqts.

    • Submitted by joe smith on 03/14/2017 - 10:14 pm.

      Constance, who pays for the person who

      has a $850 dollar a month bronze health insurance plan (who pays $50, tax payers pay the other $800) when they get in a car crash and can’t pay the $10,000 deductible? If you are so worried about who pays for the folks who get in a car crash without insurance shouldn’t you be just as worried about the person with a plan they can’t afford and a deductible they can’t pay?? The tax payer picks up the bill for both!! Which is worse??

      • Submitted by Connie Sullivan on 03/16/2017 - 12:06 pm.

        When someone has no health insurance, or inadequate health care coverage (including huge deductibles), someone else pays for their health care expenses. Period.

        We’re all just talking about who pays what for a socially-humane benefit for our fellow Americans. Conservatives prefer that sick poor and elderly people quietly die in the streets so the wealthy don’t have to cough up anything for a social good. Liberals tend to think we’re all in this world together, and are willing to pitch in to help the next guy by paying something for his health care. Next teim, the liberal thinks, it could be me that need help.That’s what we’re debating.

        Before Obamacare, it was the taxpayers who paid, through hospitals. With Obamacare, more people were covered so hospitals took less of a “hit” when people came in sick or injured. People on Obamacare pay premiums and deductibles, so they do have skin in the game. They’re poor, though, to it’s not much skin.

        The only reason the U.S. doesn’t have universal single-payer health care is the lobbying of health insurance companies, wielding not only their long histories but their investors’ interests. Again: the common person loses what is considered a humane social benefit shared by all in order to benefit financially the super-wealthy.

    • Submitted by Paul Brandon on 03/15/2017 - 10:02 am.

      Bankruptcy

      I don’t believe that Trump, Donald has ever gone bankrupt -personally-.
      It’s usually some dummy company (a package he has sold to dummies) that goes bankrupt, letting him claim losses to to a tax code glitch without losing any of his own money. It’s called ‘being a great business man’.

      • Submitted by Bill Willy on 03/16/2017 - 12:51 pm.

        Sixth time’s a charm

        You’re right about the “personally” part (he’s never lost, even when he’s lost, “Big Time”) and dummies.

        And while the financial ins and outs are unfathomable (to me, anyway) the history of his six whopper bankruptcies is (sort of) interesting:

        http://www.politifact.com/truth-o-meter/statements/2015/sep/21/carly-fiorina/trumps-four-bankruptcies/

        Related side note: If he IS “involved with the Russians” and that’s the reason he won’t release tax returns, it’s likely those bankruptcies (along with his endless but always frustrated desire to build hotels in Russia) had a lot to do with it.

        As I was reading about “comrade Trump” last summer, the stories said no banks in American (or almost all of the world) would have anything to do with him because of those bankruptcies.

        And then one day some guy who (allegedly) “used to be” a member of the Russian mafia showed up at his office and said he knew some people who were interested in investing a substantial amount of money in his business and pretty soon there were two or three other guys with eastern European names and accents (and lots of money in some bank in Iceland) in town, shaking hands and smiling for the cameras.

        Lots of stories/articles about that around you may have seen. Here’s one from the Washington Post.

        http://www.washingtonpost.com/politics/inside-trumps-financial-ties-to-russia-and-his-unusual-flattery-of-vladimir-putin/2016/06/17/dbdcaac8-31a6-11e6-8ff7-7b6c1998b7a0_story.html

  16. Submitted by Dennis Wagner on 03/14/2017 - 08:53 pm.

    Some disagreement

    “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.”

    Conservatives: tend to take more of your rights and tend to leave you with more money (especially if you are already wealthy) (Machiavellian in nature)

    Liberals: give you more rights but take more of your money (democratic-socialist in nature)
    Example: Voting, GLBT, abortion, workers rights, immigrants, women, fresh air and water, consumer protection, etc.

    Would also say liberals tend to believe in the Preamble, republicans would prefer to ignore it.

  17. Submitted by Bill Willy on 03/14/2017 - 09:09 pm.

    Conservative ideology more lethal than terrorists

    Almost all of the reporting and discussion on this issue is revolving around ideas or euphemisms like the loss of health care insurance, loss of access to health care, Medicaid cutbacks, affordable or unaffordable for X number of people, etc..

    It seems to me words and phrases like “die,” “death” and “would be killed by,” need to be much more prominent in the reporting and discussion of this issue because THAT’s the Most Important Thing that will be happening if this approach to U.S. health care is allowed to be implemented.

    Not everyone who would lose coverage would die because of it, but quite a few would.

    US soldiers killed in Afghanistan and Iraq through 2014: 6,800

    Firearm deaths: 13,286 (2015)

    Opioid overdose deaths: 28,647 (2015)

    Traffic deaths: 38,300 (2015)

    People killed in America by extremist or terrorist attacks (including jihadist attacks) from 2005 to 2015: 71

    People killed in America by refugees since 1980: Zero

    “Repealing Obamacare will kill more than 43,000 people a year

    “The story is in the data: The biggest and most definitive study of what happens to death rates when Medicaid coverage is expanded, published in the New England Journal of Medicine, found that for every 455 people who gained coverage across several states, one life was saved per year. Applying that figure to even a conservative estimate of 20 million losing coverage in the event of an ACA repeal yields an estimate of 43,956 deaths annually.”

    http://my.chicagotribune.com/#section/-1/article/p2p-92401057/

    That’s the equivalent of 14 9/11 attacks per year!

    And here’s a Big Thing about that: The people concocting and promoting this approach to health care KNOW it.

    They’ve thought about, researched, discussed and planned for six years. And after all that thought, discussion and planning they’ve decided to go ahead and attempt to put their plan it into action even though they know it would cause the death of thousands of Americans every year if they succeed.

    “What is premeditated murder? . . . The term that is used to describe a murder that was planned in advance and was carried out willfully.”

    http://thelawdictionary.org/premeditated-murder/

    That may seem extreme — and it hasn’t happened yet — but think about it . . . Let’s say you and I and a couple other people came up with a plan that would “make us rich,” even though we knew some number of people would get killed if we carried it out.

    And let’s say we thought about it, met and discussed it, over and over again for three or four years and finally decided to go ahead with it.

    And 10 or 12 people wound up dying as a direct result.

    And we get caught, arrested, hauled into court and confronted with the evidence (somebody was wearing a wire!) that we had planned it for years and were fully aware that people would die but we did it anyway.

    What do you suppose would happen to us?

    Would the judge and jury set us free, shake our hands and send us back to our $170,000 a-year jobs with a recommendation for a promotion and pay raise?

    But . . .

    “Repealing Obamacare will kill more than 43,000 people a year”

    And people (everywhere) are considering this as if it may or may not make some kind of sense?

    Like cutting taxes (ANYone’s taxes, regardless of “wealth level”) and maybe saving $30 or $40 million a year in federal spending justifies the yearly sacrifice of thousands of our neighbors lives?

    Is pushing for or supporting that kind of thing what being “conservative” or “Republican” means these days?

    Is that the kind of thing that will keep or make America great?

    ________________________________________________

    Extremist/terrorist/jihadist killings: http://www.politifact.com/truth-o-meter/statements/2015/oct/05/viral-image/fact-checking-comparison-gun-deaths-and-terrorism-/

    Refugee killings: http://www.cnn.com/2017/01/29/us/refugee-terrorism-trnd/

    • Submitted by Helen Hunter on 03/15/2017 - 01:03 pm.

      Thank you, Bill Willy

      for stating the true priorities, and providing statistics. I didn’t know before how that 40,000+ statistic was arrived at.
      The genius of Obamacare was in figuring out how it could work financially and in putting together a system that got enough support from heathcare and medical people and the insurance companies to become law.
      Obama and his administration and some in Congress had the will to do that work because they wanted, both, more people covered by insurance AND to permanently restrain the spiralling costs of healthcare. In both, the ACA is a success.
      But we would never know that if our only source of information was the present administration and the present Congressional leadership : “a disaster”; “in a death spiral”; “imploding from within”; etc.
      Those are conscious lies to distract attention from their plan to premeditatively murder 43,956 Americans a year.
      Paul Ryan’s excitement over destroying our ability to pay for healthcare is repulsive.
      It is not CHOICE if you don’t have the means. The shops may be full of food but if you have no money, you can’t buy bread, or flour to make bread, or a kitchen to make it in.
      The donald-and-paul-don’t-care bill is a new “Let them eat cake.”

  18. Submitted by Joel Stegner on 03/15/2017 - 12:13 am.

    Freedom from fear

    Major illness is scary, nut major illness is a living nightmare that millions who cannot afford premiums or the dectuctibke before you get paid coverage. Having good insurance makes major illness more tolerable. That we are still debating whether or not to have universal coverage shows what a totally pathetic society it we remain nearly 245 years after our independence. Those who have the means to buy insurance but don’t are freeloaders. They should get no sympathy or charity from others.

  19. Submitted by Hiram Foster on 03/15/2017 - 05:50 am.

    Car insurance

    How can we require car insurance?

    There are at least two questions implied here. Can require people to buy car insurance? That is, do we have the ability, practically and legally to do it. I know of no legal impediment that says we can’t. Whether we can require people to buy insurance on the federal level is a different question because the US Constitution says things about the taxation power of the federal government which are not applicable to the state, and it’s the state that requires drivers to have insurance.

    The second question has to do with policy. Should the state require drivers to have insurance? I don’t know that this is a particularly controversial question. Driving cars is a dangerous thing to do, both for oneself and others. It seems to be good policy for those who do it, to be financially responsible.

    • Submitted by Paul Brandon on 03/15/2017 - 07:55 pm.

      Technically

      we don’t require people to buy auto insurance.
      They are perfectly free to not purchase insurance and not drive.

  20. Submitted by Max Hailperin on 03/15/2017 - 08:01 am.

    A true story about that lyric

    A year and a half ago, I was leading a class of first-year college students through a rhetoric exercise in which for each word or phrase on a list, they had to come up with an alternative with the same denotation but the opposite positive/negative emotional valence. It was going OK until we got to “freedom,” which stumped all the students. After waiting a decent period for them to think, I chimed in “nothing left to lose.” They all looked at me with that look that decades of experience has taught me means “we have no idea what you’re talking about, but that’s OK, don’t let it stop you.” So I offered by way of clarification, “you know — the song — freedom’s just another word for nothing left to lose.” More blank stares, maybe even blanker than the first ones. So I explicitly asked — and received confirmation — that they had no idea what song I was talking about. I announced my theory that they *must* have passively heard it playing sometime, somewhere in the background and just not paid enough attention to it to have formed a conscious memory, but *surely* if I were to play it now, they’d recognize it. So, being in a modern internet-equipped classroom, I quickly located a copy and played it — at which point 100% of the class told me that having now heard it, they were quite certain they had never before heard it. (They didn’t volunteer any opinion on whether this was a positive or negative thing.) So, the bottom line of this story is that all of us who make reference to this lyric, we are all dating ourselves.

    • Submitted by Paul Brandon on 03/15/2017 - 07:59 pm.

      I tried that in a class

      (of graduate students!) ten years ago — only one person recognized the song.

    • Submitted by RB Holbrook on 03/16/2017 - 09:25 am.

      I Have Learned

      Watch the old pop culture references in class. I didn’t expect millennials to know who Euell Gibbons was (relevant to a discussion about advertising), but I would have though Ed McMahon might have been recognized.

      BTW, and even further off topic, Janis did an acoustic demo version of “Me and Bobby McGee.” It’s well worth tracking down.

  21. Submitted by Jeffrey McIntyre on 03/15/2017 - 08:46 am.

    Trumpcare

    I’m retired, and on Medicare, so I don’t have a dog in this hunt (yet). I have read both the proposed bill, and as well the CBO report. The conservative spin on the bill is: access, freedom, choice, lower rates. Here is what I have gleaned so far, based on what I read: Rates will go up in 2018 and 2019…but may/will go down by 10% in 2026 (sounds like 10 steps backward, 1 forward). Insurance companies who today can charge older customers as much as 3x vs. younger customers will be allowed to up that to 5x…that would be a 66% increase. (not exactly “lower rates”). Folks will be able to put more money away in an HSA…if they can afford it after paying higher premiums. There are two more phases of this bill that will be absolutely terrific; but no one can say, just yet, what specifically they will cover (other than rumblings about buying across state lines…which in itself makes healthcare even more complex). As someone said the other day, I have access to the local Rolls Royce dealer, but having access doesn’t put one in my garage. How our GOP members in the House can endorse this is beyond me. BTW, I retired at age 59; but was able to keep my company supplied health insurance (on my nickel), it was $475 @ month. By 2014 is was $950 a month, HD with $3500 deductible…a Platinum Plan on the exchange was $550, same Dr., same deductible, same carrier (BCBS). But Obamacare is a disaster.

    • Submitted by Neal Rovick on 03/15/2017 - 01:44 pm.

      The reason why premiums are expected to go down in the next decade is that the number of people who need care will drop out of the system entirely and their health-care needs will go unmet or somehow transfer to somewhere else.

      It’s not that insurance for all gets cheaper–it’s that the insured pool is cleared of the higher-cost patients who need a lot of care and can’t afford insurance. Therefore, the average cost of insurance is less for those who remain in the pool.

  22. Submitted by joe smith on 03/15/2017 - 09:21 am.

    Constance, I am happy to see you concerned

    about the tax payers having to pay for the uninsured person in an accident. Do you have the same concern for.tax payer when a person on a bronze Obamacare plan that the tax payer subsidizes $800 of the $850 monthly premium can’t pay the $10,000 deductible?? We the tax payer carry that freight also. Does that bother you? Having a healthcare card and paying for healthcare in 2017 are 2 totally different things. Let’s try to fix that.

    • Submitted by Connie Sullivan on 03/17/2017 - 09:52 am.

      Somebody else always pays for you, Joe.

      If you aren’t a wealthy man capable of paying every dollar of your health care running possibly into the millions each year, somebody else will pick up your bill if you refuse to pay for health insurance or choose some inadequate coverage that leaves many thousands of dollars of care unpaid.

      I’m lucky enough to have good health insurance, based on the wonderfully-efficient Medicare that Paul Ryan intends to cut and amplified by an employer’s plan for its retirees (I pay the whole premium). So what I pay subsidizes you, if you have to use medical care and can’t or won’t pay for all of it: it’s in the premium rate I pay. as well as in the taxes I pay to Hennepin County (or Ramsey County, etc.) where there are public hospitals and medical staff.

      Please don’t think there’s some free lunch in all this. Only if we let people die for lack of care is there no medical expense that someone has to pay for.

      I’m a liberal who believes that if I can, I will help pay for you to get proper health care, preventive and emergency. You can thank me–and the other liberals like me–later.

  23. Submitted by Ray Schoch on 03/15/2017 - 01:47 pm.

    My 2¢

    I’ll add my thanks to those of Helen Hunter for Bill Willy’s commentary. It raises questions that neither Paul Ryan, Donald Trump, nor our more “conservative” commenters want to deal with. They don’t want to deal with those questions because in answering them, they’d either have to disavow the right wing’s governing philosophy (i.e., government is bad, always), or admit that they’re not bothered by the prospect of many thousands of their fellow-citizens dying prematurely because they can’t afford health care—in the richest society on the planet. It’s morally indefensible, in every major religion, to say, in effect, “I’m OK with you dying because I, being a better and more affluent person, can afford health care that you can’t pay for.”

    While not the only problem, one of the major problems with American health care, and the ridiculous system we’ve allowed to grow up around it, is that, in this country, it has been infected by a virus called “capitalism,” which has allowed health care to be privatized, in large measure, following a corporate model that requires every provider of health care-related goods and services to make a profit.

    We’re the only industrialized nation on the planet that operates that way, and the numbers, in terms of infant mortality, lifespan, death rates (especially when segregated by income), disease rates, and other commonly-used methods of measuring a society’s physical health show that our way is absolutely and positively NOT the best, most effective way to provide health care if better health and longer, more productive lives are the goal.

    In other industrialized societies, health care, though not necessarily regarded as a “right,” is nonetheless regarded as a legitimate function of government — a public service — provided by the government, or, if provided by private entities, incorporating numerous very detailed protections for consumers along with subsidies for the costs, and it is available to everyone, either without cost, or with small, manageable co-pays that are usually reimbursed.

    Trumpcare is decidedly not health care. It’s a scheme for lowering the tax rates on the very wealthy, with health care side effects that even a casual perusal of the law will show to be deadly for many Americans. That Congressman Ryan seems so enthused about it is simply a reflection of his ability to incorporate the selfishness that forms the basis for much of right-wing ideology into what ought to be, instead, a reflection of community and shared enterprise. Instead of pride, he ought to be ashamed.

    • Submitted by Paul Brandon on 03/15/2017 - 08:02 pm.

      Maybe it’s because

      other industrialized countries have realized that healthier populations are more productive, pay more taxes, and require less government spending.

  24. Submitted by Ilya Gutman on 03/15/2017 - 07:17 pm.

    I tried…

    I tried to stay away from this one but… Mr. Willy said that conservative ideology is more lethal than terrorists and Ms. Hunter and Mr. Schoch praised him for that. First, Washington Post’s Factchecker, which most commenters here hold in high esteem, gave Sen. Sanders’ statement about 36,000 people dying four Pinocchios so I would guess that a statement about 43,000 people dying would not be more truthful. On the other hand, it is possible to say that, considering that more than 38,000 people died in car accidents, the Congress has been killing at least that number every year by not banning all cars and trucks from the roads…

    • Submitted by Bill Willy on 03/16/2017 - 03:10 pm.

      Okay . . . How about this one?

      “The best studies on health insurance and mortality suggest 24,000 extra deaths per year if 20 million people lose their health insurance.”

      http://www.vox.com/policy-and-politics/2017/3/14/14921962/ahca-mortality-gun-homicides

      Whatever the exact number of thousands, the point is a whole lot more Americans will die if Obamacare is repealed and replaced with the plan now under consideration by Republicans in Congress and the people promoting and supporting it are fully aware of that.

      And so are you.

      An increase of 24,000 is the equivalent of eight September 11th terrorist attacks per year.

      An increase of “just” 10,000 would be the equivalent of more than three September 11th terrorist attacks per year.

      An increase of “a mere” 3,000 deaths would be the equivalent of one September 11th terrorist attack per year.

      Just ONE September 11th attack was enough to catapult the United States into two wars that have lasted 15 years (Afghanistan) and 13 years (Iraq) and cost American taxpayers a minimum of six trillion dollars ($75,000 per household and those household’s descendants in tax payments due).

      But now the same Congress that voted for those military actions and expenditures is contemplating a law that kill more Americans (every year!) than the attack that prompted them to do that.

      Are you saying you’re okay with that?

      Are you saying you think the benefits in the Republican plan make that a fair or reasonable trade-off?

      And, as far as those Pinocchios go, what number of increased deaths do you consider acceptable or worth whatever Republican health care plan virtues you perceive?

      As far as Congress “banning vehicles” goes, that’s a “fake-equivalent.”

      An accurate comparison would be Congress removing all laws and regulations that mandate vehicle makers install seat belts, air bags and other life-saving mechanisms, along with repealing all laws related to speed limits and driving under the influence of alcohol.

      Doing those things would increase the number of vehicle deaths substantially, but it would allow vehicle manufacturers to increase profits and give citizens the freedom to drive as fast and drunk as they wanted to without fear of government-imposed consequences.

      Would you be okay with that too?

      • Submitted by Ilya Gutman on 03/16/2017 - 06:56 pm.

        Let’s not inflame this more than necessary

        I don’t think 24,000 number is any more correct than 36,000 or 43,000. Again, you are acting on possibilities without having full knowledge. Sure, all those numbers make good PR, just like one Democrat’s saying that Republicans want everyone to die… All I am saying is that we have to withhold inflammatory statements like yours until we have full picture, rather than partisan rhetoric. I can come up with many Democratic policies that, in my mind, kill or harm people, but I just don’t think it is helpful to do it in such manner.

        And no, my equivalency is not false even though it is not precise either. If something (anything) kills people and it is possible to remove that something to stop the killing, then it is possible to say that NOT removing it is an equivalent of murder. So removing safety regulations will lead to more deaths but NOT banning driving still leads to thousands of deaths…

        And finally, I do not want anyone to die but having a health insurance on paper only, with no means to pay for deductible, does not help so it is hard to say how many lives Obamacare saved…

        • Submitted by Jon Lord on 03/18/2017 - 03:44 pm.

          Ilya

          No Democrat said republican’s want everyone to die. You know that. (but did you hear the one about what one Republican said about ‘meals on wheels?) That said everyone will die eventually. What a civilized country should want is that all it’s citizens live as long as they can in as good health as possible. The only ‘reason’ there is to allow people to drop off the insurance roles because they can’t afford it is that many of them will die sooner. In that way they will be less of a burden on the wealthy. IF there is any way for a wealthy person to notice that burden in the first place. It’s not a real number to them since it honestly doesn’t affect their bottom line in any noticeable way. Most of them don’t pay much in taxes anyway, but it’s in their minds that it does affect their bank accounts or stocks negatively. But it’s just pennies lost to a thousand dollars in income, would you notice that? Why would a person care? Other than ‘it’s the principle of it’? To me the idea that it does affect them is a red herring. Trumpcare attests to that since it hurts everyone ‘but’ the wealthy as it stands. It would be just pennies off the top for the wealthy helping to fund a decent health care system! That Trumpcare (I know! He doesn’t want his name associated with it!) might not yet be the ‘full picture’ doesn’t mean it’s going to change any after their due consideration. If it doesn’t change then it’s the full picture as it now stands and it fails.

          Remember…most states, especially southern states and or states with Republican Governors didn’t accept the ACA in the first place. Those people who never had Obamacare because of it are counted as though they were a part of the failure of Obamacare when it was those states that did the damage.

          And driving? There’s no ‘equivalency’ to be made there between allowing bad driving to denying an ill person health care.

          • Submitted by Ilya Gutman on 03/19/2017 - 10:28 am.

            Inflamatory statements are not helpful

            Actually one did: http://www.politico.com/story/2009/09/grayson-gop-wants-you-to-die-027726. And Mr. Willy did clearly implied this in his post, too, saying that conservative ideology will kill more people than terrorists. And then Ms. Hunter also alludes to Republicans’ being happy to kill people… And actually even you say that the wealthy don’t want to lose pennies just not to allow people to have health insurance (despite those wealthy giving more to charities than anyone in the world). Obamacare is not sustainable the way it is designed and we all know how and why it passed (“people are stupid” and “let’s pass it and then see how it works”). Huge deductibles are not affordable for the poor who are supposed to benefit and insurance companies can’t stay in the market if they are losing money. Now, I am not against an idea of providing health care to all people (I am against an idea of proving money to people who make the wrong choices) but the plan must work. If a law provides insurance to all on paper but in reality it doesn’t give people access to healthcare, I would prefer a law which provides insurance to fewer people if it actually works. And people in the states that didn’t accept ACA could still access it through federal website.

            All I was trying to do is to encourage people to learn (and accept) all facts before making statements and stop inflaming the conversation.

  25. Submitted by Dennis Wagner on 03/15/2017 - 09:00 pm.

    Thanks Ray (Nice post)

    “morally indefensible” can we also call that Humanity?
    We all know we are going to die, the issue is can we try to pull the politics out of the equation and try to make this entire health care debate a little more humane? We also know we can’t save everybody, but can we have a rational discussion on the “guard rails”.

  26. Submitted by beryl john-knudson on 03/16/2017 - 08:49 am.

    And so it goes…

    some strange responses as Trumpism minds compare car insurance and body insurance? The human factor appears to be irrelevant…

    … and comes at a time also when the morning blog yesterday announces Noseworthy from Mayo gives a ‘noteworthy’ comment that private insurance with more lucrative returns will be the preferred guide and Medicare, and other public funded programs will go to the end of the line as order of treatment?

    A Saudi prince gets preference over a retired American worker I assume?

    So much for totalitarian symptoms entering our heath care systems like smaller hospitals, clinics become followers in a sick process of selective care…so what other health care systems around the state, the nation will soon follow?

    Health care; a bottom line bonanza and Mayo’s body repair shop comes of age?

  27. Submitted by Kenneth Kjer on 03/16/2017 - 09:23 am.

    Simple solution

    The government pays back the 2.7 trillion dollars it owes medicare and then include everyone in Medicare. Done Deal, Medicare has worked for Seniors for years and there are multiple choices of insurance plans to fit ones budget from 0 dollars per month up to 500 dollars a month.

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