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Can a centrist health plan attract support in a Congress without a middle?

Colorado Gov. John Hickenlooper is a moderate Democrat. Ohio Gov. John Kasich is a moderate Republican. They are both pragmatists who believe that the challenges of governing in polarized America requires cooperation across party lines. The two have a growing friendship that they hope to use to produce and promote a bipartisan approach to improving the U.S. health care system (or at least the portion of it that is driven by federal money and federal government rules and regulations).

I can’t say I expect anything to come from this, but I wouldn’t mind being proven wrong.

The two governors made a joint appearance yesterday on “Face the Nation” and described their effort.

Start at center, reach left and right

The basic idea was that you start somewhere near the political/ideological center and you reach out to moderate lefty and moderate righty members of Congress and see if there’s a version of health care reform that could pass with moderate support from both parties and without the support of members of Congress who dwell on what might be called the flaming left (single-payer) or right (full repeal of the Affordable Care Act with no replacement).

Personally, in the long run, I favor single-payer. As I’ve mentioned before, many countries that have variations of single-payer spend much less on health care and get much better overall results than the U.S. system gets or ever has gotten. But, at the moment, while Bernie Sanders made single-payer a thinkable thought for the first time in America, it is politically impossible in the short- or medium-term, and a great many people need a short- or medium solution to their health insurance needs.

In their joint “Face the Nation” interview, Kasich and Hickenlooper were fairly short on how their centrist plan would work. Maybe there’s no such thing. But the basic concept seemed to be that a plan that would significantly increase the number of uninsured Americans cannot attract support from Democrats and a plan that significantly increases the government cost and the government role in the health care system cannot attract support from Republicans.

If you start out in the exact center of the current spectrum, can you move a bit left on some pieces and a bit right on others and build a centrist plan that could not only pass and avoid throwing tens of millions into the ranks of the uninsured, but burst the repeal-and pretend-to-replace Obamacare fever?

You can read a transcript of the Kasich-Hickenlooper segment, or watch the 12-minutes segment here. If you do, you might, like me, be concerned that there is no such centrist plan that would actually make things better and have a chance to pass.

Partisan separation

That, in significant part, is because there isn’t much of a middle in Congress any more. Almost every Republican is to the right of almost every Democrat and almost every Democrat is to the left of almost every Republican.

In theory, I like the idea of parties that actually stand for something, and run on that something and, if elected and in control, will legislate that something. In parliamentary systems, this kind of thing is easier to accomplish, in part because there is usually only one house that matters (like the House of Commons in Britain) and the leader of the majority in that house is also the prime minister (so no need to compromise across legislative and executive branches). The U.S. system, in that sense, is built for gridlock because you need agreement across two equally powerful legislative houses of Congress and the agreement of the separately elected president.

But in the past, in America, there was the possibility of an unofficial centrist caucus in the middle of Congress. Both major parties were sprawling coalitions. There were liberal Republicans and conservative Democrats and a large number of moderates in both parties who formed a significant moderate coalition, which was often able to block far left or far right ideas and which could, on some occasions, form the basis of a big partisan coalition to get something moderate and bipartisan done.

That’s over. The parties have sorted themselves almost perfectly into left and right, which makes centrist compromise much harder and less likely. To draw again on yesterday’s morning shows, Chuck Todd on “Meet the Press” made this point with impressive numbers, relying on the long term National Journal exercise of ranking members of the U.S. Congress, according to their voting records, along a left-right spectrum.

In 2002, an unofficial centrist caucus

As recently as 2002, 137 members of the U.S. House formed an unofficial centrist caucus. Specifically, when ranked on a left-right spectrum, about 149 Democrats were to the left of even the most moderate Republicans and 149 Republicans were right of the most moderate Democrats but 137 members formed a large bipartisan group, half Democrats and half Republicans, in the middle. No bill could pass without attracting significant support from moderates.

According to Todd’s presentation on yesterday’s "Meet the Press," that unofficial moderate caucus is down to just four members of the House, two from each party. That’s down from 137 in 2002.

Such rankings are, of course, not perfect and are often criticized. But if they reflect any reality it’s hard to imagine taking a set of policies that are agreeable to those four moderates and then making tweaks and compromises necessary to get that up to the 218 votes need to pass a bill out of the House.

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15 years

Hmmm… 137 “moderate” House members in 2002, 4 “moderate” House members in 2017. If there's anyone left who doubts that we live in a polarized political climate, those figures alone should disabuse them of that particular set of rose-colored glasses. If — a very big "if" — the resurrection of such a moderate coalition would mean that Congress could, once more, begin to earn its salaries and perks, it might be worth doing. In 15 years, however, I'll be 88, and probably won't remember my own name, so, speaking purely selfishly, if it's going to be done, I hope it's done sooner rather than later.

The "middle" invariably

The "middle" invariably involves retaining the current insurance model.

Yet it is that model that has moved our heathcare costs well above that of every other country and into the unaffordable range. Squeezing the same old inflating balloon of cost just shifts costs and impacts.

It is astounding to me that most people remain ignorant that the largest portion of cost difference from here to elsewhere in the world is due to the convoluted payment systems that use up about 30% of the money spent.

Simple math:

US spending $ 9000 per capita x 0.7 = $ 6300

Gee, that's right in the range of what the Swiss and Norwegians pay--our nearest cost-neighbors.

Send me the genius award right away.

Warren Buffett says

The US economy produces $59,000 per capita GDP every year.

What percent of GDP should health insurance for our own American people be?

You ask, "What percent of GDP

You ask, "What percent of GDP should health insurance for our own American people be ?"

Your conflation of 'health care" and 'health insurance" is the very point I'm making.

Two entirely different questions.

What percent of the US GDP should go to the process of paying for healthcare ?

Or, what percent of the US GDP should go the actual act of healthcare ?

Individuals mitigate risk with insurance.

Self-insuring implies some pretty deep pockets, like the US Treasury.

But I still would use the term "insurance", since not everyone will have a claim, and of those who do the claims can be at the extremes of catastrophic to manageable.

Fewer payers of claims (or one single payer) means more efficiency, fewer multi-millionaire salaries for CEOs and lawyers, and probably better ways of bargaining with PHARMA and other providers while catching fraud and abuse in billings.

The question: "How much of our 18-19 trillion economy can be allocated to health?" is simply per capita arithmetic, yet many will oppose treating everyone the same.

The idea of making it "competitive" is a joke. Mayo patients are not served the same way rural West Virginia (or Mississippi) patients, despite the cost difference. People are not free to shop for price.

We're at 17% of GDP now and we should be able to do it all better for 10%.

Why not? Conservative politics has not yet evolved to public health and civil rights. (MHO)

Obamacare is centrist

I just pointed out the obvious.

Conservatives weren't working and the new ones would have been even worse. Movement to single pay is already happening, but will be very slow, given how much wealth and power the investor class will lose.

Take away the requirements, keep the subsidies, financially punish those who go without insurance as an investment strategy and create opt in Meficare for those 55+. Make sure all children are covered with generous insurance, as the payoff from prevention is huge. And maybe you want to raise parent's ability to cover their children to age 30.

Do specific things to make our model work, including things like punishing pharmacy gouging. Remind people that making people do without insurance is cruel, but that wasting money on services without great outcomes is something we can no longer afford to do. There is a middle ground.

Some reason for optimism

I see some hopeful signs in Congress. The US House of Representatives has 43 member bipartisan caucus that calls themselves the "Problem Solvers". They're working on a compromise for fixing the ACA.

In the Senate, Republican Lamar Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee is partnering with co-chair Democrat Patty Murray to hold hearings on shoring up the ACA Exchanges. If their recommendations can survive the bomb-throwers on the left and right and get out of committee, they have a good chance of passing.

Trump and some of the ultraright conservatives would still prefer to see the ACA fail. However, they'll have 12 working days to pass a budget and raise the debt ceiling before the government shuts down, so they're likely to be pretty busy. Not to mention their aggressive time line on GOP-only tax reform. This may give the Problem Solvers and Alexander/Murray time to get something done.

Everyone at some time needs medical care

Sad that repubs don't care about us.
Everyone gets sick and everyone if they live long enough gets old, which means more medical care.
We all need affordable medical care.
This should be a bipartisan plan.
Sadly, repubs prefer tax cuts for their wealthy benefactors who don't need them, compared to helping us...the workers.

The center

In my view, a centerist health care plan looks very much like Obamacare. Indeed, instead of being in the center, I see Obamacare as being Republican, if not necessarily right wing.

Obamacare was the result of a series of compromises made by Democrats, with various health care industry interests who are normally represented by Republicans in Congress. Although Republicans in Congress participated in the negotiations for Obamacare, for strategic political reasons, they did not support the final legislation. I have never been particularly moved by that because I viewed the Republicans in Congress as agents for their principals, the health care industry, and the health care industry did sign off on the assorted deals.

Now what seems to be on the table is a reopening of those deals between Democrats and the health care industry. I don't think this is a good idea in itself, because it was the doing of the deal that was always the stumbling block, there is actually much agreement on health care policy, or at least on what the participants would accept. By reopening the deal, these new centrists are trying to revisit what was actually the most difficult, and substantive issues surrounding health care policy. The intellectual arrogance and hubris of these guys is in fact, quite astounding.

Moderation in the Pursuit of Centrism is No Vice

"Centrism" is not a good thing in itself. It is useful only if it manages to bring about some realistic, concrete results. It's like compromise: no one in political life sets out to be the compromiser, but it is a necessary skill if anything is to be accomplished. Similarly, crafting something that can be called centrist may be the only way of getting something done.

Will a bill that fixes the weak points of the ACA be sufficiently "centrist" to pass? Perhaps. Will it be the ideal solution? Of course not. The best we can hope for is legislation that does not abandon the successful parts of the ACA, or the parts of the law that make it work, while fixing its deficiencies. Scrapping the whole thing and starting all over again, with the single-payer purists squaring off against the "let him die!" extremists is going to accomplish nothing, and will certainly not address the very real health care issues in this country.

I applaud their efforts....

I applaud their efforts in saving healthcare. I also agree with the Governor of Ohio that all entitlements need reform as well.

Such reform of Obamacare needs to be built around the following understandings.

#1 - Obamacare has failed many Americans. (If it has not failed - why are we having this discussion?)

#2 - Obamacare was sold to the people with lies. (This is obvious)

#3 - Fixing failing Obamacare with more Obamacare is not a solution. The problem with Obamacare is not political - it is fundamental economics.

#4 -Entitlement history is important. When you decree healthcare as part of an entitlement program, increase the # of recipients in a "Huge" way to that already overburdened entitlement program, and then attempt to reform that entitlement and increase payments to that entitlement at a slower rate - you should not be attached as necessarily "cutting."

This is why entitlement reform -although badly needed - is rarely done. Democrats are attached with the "tax and spend" mantra and the GOP are attacked as "cutters."

Hopefully the congress can get something done because so many Americans are "victims" of failing Obamacare.

"this is obvious"

usually means 'I can't support it'.

Entitlement Reform?!? Let's Go!

Let's start where the waste is the worst, the entitlement program run by the Pentagon. Fluor, General Dynamics, Northrup Grumman, Lockheed Martin and many others are entitled to billions of tax payer dollars, and they're constantly busting budgets because the Pentagon is run by, well, drunken sailors or so you'd think. We just dropped over $12B on our 11th aircraft carrier, and the overruns were gross indeed. (And if you think another carrier makes us any safer form ISIS or other terrorists, you got another thing coming.)

There's one huge over priced entitlement you can reform, and canceling the next $12B ($13B? $14B?) carrier boondoggle will free up plenty of money for healthcare.

"Centrism" is not a good

"Centrism" is not a good thing in itself. It is useful only if it manages to bring about some realistic, concrete results.

My sense is that there isn't much of a center in health care policy. It's a matter of different ways to do it. Obamacare accepted a Republican market based approach. We signed on, if not exactly agreeing to, the Republican market mythologies. The odd thing about Republicans that while they place enormous faith in the notion of market as panacea, they possess remarkably little knowledge of what markets are and are capable of doing. For a business oriented party, this is surprising, but it perhaps helps us understand why most businesses fail.

In the area of health care policy, the Republican idea is that if market forces are given full reign, competition would drive down prices. That markets and/or the potential for competition drives down prices outside GOP world, is a difficult and often dubious proposition. After all, if prices always went down in free markets, the stock market would always decline. If competition always forced prices down, gas stations across the street from each other would be giving gas away for free, or they might even pay you to remove it from the premises. Clearly other factors are at work, and a number of specifically applicable to health care are what make Health insurance so different from other forms of insurance, and health insurance markets so complex and often, so anti intuitive.

Market Forces

"In the area of health care policy, the Republican idea is that if market forces are given full reign, competition would drive down prices." That's the official justification. It is definitely a flawed premise. Health care consumers don't do a lot of price-shopping ("Hey, doc, how much you want to take out my appendix?"). There is also no good metric for comparing either cost or quality in health care. What is a successful result? How much would we be willing to pay for a better result?

At the end of the day, Republicans may be honest enough to admit that it isn't really about competition or an efficient market. Letting market forces have full reign is considered a good thing in itself. Competition is a good thing, even if it doesn't happen, or even if it's illusory. In a truly free market, a failure is considered just another thing that happens, or even a good thing--Schumpeter's "creative destruction." A failure in health care should not be shrugged off as capitalism at work.

Price and Quality Shopping

Well, I don't know about you... But it seems to me that my Company and Blue Cross Blue Shield do a lot of price / quality shopping...

My company is big enough to be self insured, however they cost / benefit shop Health Insurance Mgmt firms to ensure the employees are satisfied with the costs and benefits.

And as we saw with the BCBS vs Children's Hospitals, BCBS was willing to go to the mat to negotiate a better deal.

Now of course when the government gets involved and insists that non-insured people can walk in, pay a few months in premiums and get major work done with no negative consequences... That will screw up the system.

This is the 3rd company I have worked for during my career, and each has taken good care of us... As I have said before... I think we have a household income problem, not a healthcare problem. Too many single Parent Households, too many low skill / low knowledge households, too many illegal workers, to many consumers buying cheap/ foreign goods, etc.

Apples and Oranges

"But it seems to me that my Company and Blue Cross Blue Shield do a lot of price / quality shopping.." Okay, a company large enough to self-insure and a large insurer do price-quality shopping. They have that option.

Individuals do not, as a practical matter, have that option.

However

However the vast majority of American citizens are covered by companies like mine or the public entities like Medicare / Medicaid.

Even my self employed rural friends had many more reasonable choices available to freely choose between before ACA.

The one friend appreciates that he can be insured with his minor pre-existing condition, how he may choose to drop it again if the costs keep escalating. And a couple of them who had always been insured have now chose to pay the penalty rather than the premium.

Yes, but . . .

"However the vast majority of American citizens are covered by companies like mine or the public entities like Medicare / Medicaid." That's very true, but the choice or negotiating power belongs to my employer, not me. When I did not have employer-provided coverage, I still had options, but for my situation (married, 3 children), the practical economics limited my choices dramatically.

Choices

As I noted somewhere here, most of my self unemployed friends had more cost effective choices before ACA than they do now.

The unfortunate reality is that healthcare is expensive for many reasons. For my spouse, 3 kids and myself the cost is about $25,000 / year, and we are all relatively healthy. I pick up about $6,000 in premiums and $3,000 in out of pocket expenses... Which means my company covers about $16,000...

So who should pay for our choice to have 3 children and incur all the expenses?

Other citizens or ourselves?

ACA and Medicaid clearly says that other citizens are responsible for paying the bills incurred through other people's choices, which makes no sense to me.

Choices

Taxpayers subsidize a lot of other people's choices:

Choose to live in automobile-dependent suburbs? I'm paying for your roads.

Choose to be a farmer, even when market forces would dictate otherwise? Some $25 billion in tax money goes to farmers every year.

Choose to have a tax-exempt church? Someone else is paying for the fire and police protection.

Etc.

Really

Now I agree that the government does many things for the public good. Provide roads for shipping product and personnel. Provide incentives to promote certain behaviors by farmers. Provide benefits for charitable institutions.

But subsidizing the healthcare bills for an individual is like providing them with food and a place to live...Our society has typically insisted that people strive to be self sufficient and a key part of this is ensuring an individual experiences the natural consequences of their choices.

1. If you are a high school drop out, single with 3 kids your life is going to be pretty rough...
2. If you work hard, get good grades, get married, continue learning and have a couple of kids you will likely do pretty well in the USA. (many of my in-laws are in this boat)

Please remember that this is not a bad thing... We as a society prosper when individuals and families pursue path number 2...

What you are recommending is that people in Path 2 continue to pay more and carry more of the burden for people on Path 1. I often compare it to if I charged Child 2 a wealth tax because she was making good choices so I could give Child 1 some extra money each month...

Paths

I believe in human dignity, and not disparaging people who, for whatever reason, are on less virtuous paths than I am.

Frankly, I fail to see why it's better to allow indirect subsidies of charitable institutions that may not be contributing to the greater good than to make sure poor children have adequate health care.

Because

Because it encourages people like me to give a lot of money to different charities who do help citizens in different ways. Do you ever wonder why Gates, Buffet, Zuckerberg, etc give to charities rather than to the government? Could it be that these brilliant people understand that charities are more effective and efficient than government?

As for disparaging people, I am not seeking to disparage them... I am seeking to help them.

Just giving irresponsible and/or immature people more money and services without conditions is not really helping them improve their lives. It really is just feeding and caring for them so they can continue to make mistakes. And unfortunately that often includes making more babies that they are poorly equipped to raise well. Who unfortunately continue the cycle of generational poverty.

Just as if I transferred money between my saver daughter and spender daughter each month... The spender would just keep spending and unfortunately the saver would likely learn to hide her money. :-)

Why Do Rich People Do Rich People Things?

"Do you ever wonder why Gates, Buffet, Zuckerberg, etc give to charities rather than to the government? Could it be that these brilliant people understand that charities are more effective and efficient than government?" Or could it be that private charities are more than happy to give the donor publicity? The government isn't going to give public acknowledgement of the names of large taxpayers. While I'm sure they have the best of motives. no one forced them to call it the "Bill and Melinda Gates Foundation."

If you would like to get up a petition to name the project in my neighborhood the "Mr. and Mrs. John Appelen Street Repaving Project," I will be the first to sign. ;-)

Choose to purchase anything

Choose to purchase anything shipped by truck? Dont like the idea of the fire department get to your burning house in a horse drawn engine? You're paying for your roads.

"Choose to have a stable food supply, even when weather, natural disaster and the market would dictate otherwise? You're paying for that security.

Choose to have a tax-exempt church? Someone else is paying for the fire and police protection. They are called "the congregation"; aka your neighbors.

My Choices

A lot of highway money is spent on residential byways that do nothing but facilitate urban sprawl. They have nothing to do with transporting goods. Whatever I get shipped by truck is probably not coming across the new Stillwater bridge. That is there solely for the convenience of residential commuters.

Federal farm subsidies are, to use the argot of conservatives, market distortions. Or do you thin k that, without Big Government stepping in, we would all starve to death because no one has enough sense to grow and sell food?

I'm paying for the police and fire protection of that tax exempt church, too. Or did I miss the part that says I don't have to pay if I don't go to that church?

Really

I am guessing the Stillwater bridge is also there for the 10 of thousands of metro families who own cabins in Wisconsin. We Minnesotans do love our cabins. Ironic enough, MP just had a post on this topic.

https://www.minnpost.com/earth-journal/2017/08/new-bridge-opens-over-st-...

No I think environmentalists like to encourage farmers to not plant on erodible spaces.I think the consumers like not having big swings in their food prices when a lot of farmers are wiped out by bad weather. Subsidized crop insurance seems to be one of the biggest benefits now days. And please remember that ~75% of the farm bill goes to food subsidy programs for needy folks and kids, not the farmers.

If you don't understand the benefits of religious structures within our communities, there is likely nothing we can do to convince you. My particular church is busy pretty much every day between church stuff, non-profit daycare, providing meeting space for many other organizations, etc.

"The Benefits of Religious Structures"

I understand perfectly. I don't understand why I should be subsidizing them over, say, health care for all children (even the ones of undeserving parents). We have an idea of what someone like, say, Jesus of Nazareth might think on this issue.

If the market is so wise, why do we need tax policies to encourage anyone to do anything?

I actually did not want to argue about specifics, so my apologies for continuing. The point I really wanted to make is that we all end up subsidizing a lot of choices made by other people, regardless of whether we approve of these choices or whether we see any direct benefit to ourselves from them. The desirability of those subsidies, as with much of political discourse, always comes down to whose ox is being gored.

Politicians Needed Something to Do

I would be happy to go to some kind of a flat tax with no exceptions. Unfortunately the politician, accountant, lawyer, tax the rich, help reduce my home cost, subsidize the low income, etc folks are against that.

Life was probably much simpler before the governments started collecting incomes taxes...

By the way, I am fine with our government caring for the old, young and truly disabled. Unfortunately ACA, Medicaid and Other Welfare programs cast a wider net than that. And Liberals want to keep growing the net, which has the potential for causing more problems for our country.

Insurance question

Am I thinking about this right?:

Current annual U.S. per capita spending $10K+ every man, woman child. Does this mean that an insurance entity for a two parent, three child family needs to get $50K from them or elsewhere to be able to have enough to cover those whose spending needs to be more? (Let's assume no co-pays etc insurance entity pays everything)

Or is it a lower amount since one or more of the family might cost nothing in a particular year? Is there some sort of probability factor at play here that I don't understand?

Very Good Question

For my family, health insurance and out of pocket costs about $5,000 / member / year, which is pretty well aligned the numbers in this source.

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Tren...

It seems that the old folks are who really drive up the average costs as one would expect.

However figuring what is in that "per capita cost" is pretty challenging.

Well...

The sad truth is that one could find the Obamacare magic silver bullet: one or two low cost, inconsequential changes and miraculously it WORKS! And the GOP leadership would say great! Let's repeal and replace anyway. It is not about healthcare, it is about not allowing the D's to be credited with another functioning and lasting social program. The unfunded mandate of Medicare Part D? The R's love it. It was their idea!!

Do we need a political center?

Obviously, MY answer is no.
Even with political polarization, what IS required is agreement that we need some sort of health plan. Then, we could have a plan (such as the ACA, nee Romneycare) that is equally acceptable/unacceptable to both extremes, if in different ways. Then both sides could hold their noses and pass it.
What would prevent passage of some compromise bill is one party not wanting ANY public health care support (identity left to the reader).

Before ACA

Before ACA we had a lot of public healthcare support.

Remember Medicare, Medicaid, Publicly Funded Medical Research, Social Security Disability, Publicly Funded Medical Universities, State Funded Healthcare programs, etc.... After ACA we have a lot more public healthcare support and regulations...

This is by no means the black and white topic that both sides want to make it into. It is simply a matter of balance...

Leave thy net profits? No way!

"We all know that the U.S. economy is colossal, right, but just how big? In fact, with a 2015 GDP of just under $18 trillion, the US economy represents more than 20% – or more than 1/5th – of the entire global economy. Although emerging economic superpowers like China are significant, their economy is still 70% smaller than the U.S. Even when you add up the total commerce from China, Japan, Germany, the UK, France, and Brazil (numbers 2-7 on the list), the U.S. economy is bigger than all of them combined!"

And the Number One, Most Profitable Industry IN that U.S. economy?

"Pharmaceutical manufacturing and sales, genetic testing, workplace drug testing, and all of the hospitals and medical services . . . "

http://bluewatercredit.com/ranking-biggest-industries-us-economy-surpris...

America's top 10 most profitable industries and their net profit margins (net profit equals the cash left over after ALL the bills have been paid):

1) Pharma: Generic: 30%

2) Investment managers: 29.1 percent

3) Tobacco: 27.2 percent

4) Pharma: major: 25.5 percent

5) Internet Software and Services: 25 percent

6) Biotechnology: 24.6 percent

7) Savings Banks: 24 percent

8) IT Services: 23 percent

9) Regional Banks: 23 percent

10) Major Banks: 22.9 percent

www.surepayroll.com/resources/blog/the-10-most-profitable-industries

For comparison, here's a sample of the net profit margins of some other less "glamorous," less profitable industries:

Food manufacturing: 11.4%

Telecommunications: 10.9%

Agriculture: 9.9%

Utilities: 8.9%

Engineering and Construction: 8.8%

Clothing Stores: 8%

Forrestry and Logging: 8%

Building Construction: 7.5%

Trade Contractors: 6%

Hardware Store: 4.5%

Food Beverage Store: 3%

http://research.financial-projections.com/IndustryStats-NetProfit.shtml

Of those, the most interesting, or relevant, to me is "Utilities."

9% net profit.

Utilities include water and electricity which are at least as, if not more important than health care because health care (along with just about every other industry) would be useless without them: Water in general; electricity in particular.

Yet, somehow, the Utilities industry is able to function to everyone's satisfaction (including shareholders) with a healthy 9% profit margin.

But even though it's lower on the Essential Priorities List than Utilities, the health care industry can't. According to the existing system's proponents and protectors, it NEEDS to be America's (and the world's) MOST PROFITABLE industry: It NEEDS those 23% to 30% net profit margins to "remain competitive," etc..

Or could it have more to do with America's health care industry being an industry that is completely controlled and "regulated" by the Private Sector where there are no Public Utilities Commissions or other Big Government Regulators standing in the way of "Market Forces" and the Private For-Profit "sub-industries" it consists of?

Anyone (Republican, Democrat, Whatever) who thinks or says "Obamacare" or any other "Government run health care program" (Medicare, Medicaid, MinnesotaCare, etc.) is responsible for the high cost of health care has been (and is still being) duped, snowed, hypnotized and economically raped BY the American Health Care Industry.

Who do we think it is that's paying for and providing that industry with those stupendous net profit margins? The Net Profit Fairy? Unless you work for that industry, or make enough dividends from it to cover the cost of your health care insurance, the answer to that question is YOU, me, us.

Paying that freight is one thing (because they currently have everyone in America by the you know whats) . . . But deFENDing it and voting for the people who do is another thing that's pretty much the same as slitting our own personal financial throats to the tune of handing over an extra $4,000 to $5,000 per year TO that industry.

But then, if you're a defender of those providing us with the current version of the American health care system -- "The Greatest Health Care System on Earth!" they say -- you must figure they need that yearly $4,000 to $5,000 more than you and your family does.

Good for you! You're a very generous person. By all means, keep giving it to them so they can remain the Most Profitable Industry in the largest economy on the planet. Keep sending them that cash and keep telling yourself and everyone else that "It's all Obamacare's and Big Government's fault!"

I'd rather have the extra $4,000 or $5,000 (AND better health care).

But, I guess, a lot of folks enjoy feeling "so right!" so much that it's worth at LEAST a few thousand bucks a year.

As they used to say, "Go figure."

Risk vs Reward

Now I don't totally disagree with you, however please remember that troublesome risk vs reward curve... People are very unwilling to invest in risky ventures unless there are some serious potential gains to be had on the other side.

A holding that I have had for ~20 years is the Vanguard Healthcare fund. Now it has been a solid performer, but the gains you claim are no where to be found. Now I am happy to keep investing in new medicines and technologies, however I do want a premium for doing so.

http://www.morningstar.com/funds/xnas/vghcx/quote.html

Maybe as I get older I will start investing more in utilities where the risks are low.

Apples, oranges and fruit salad

Corporate earnings and corporate return on investment are not the same thing.
A corporation may elect to return profits to share holders, or to officers in the form or salaries, or to reinvest in the corporation.
This holds for nonprofits as well.

However

Returning the profit to the shareholders would show up in the mutual fund earnings.

Reinvesting in the corporation would hopefully show up in the stock price. (ie mutual fund earnings)

The employee and manager compensation is an expense that is subtracted out earlier.

My point is simply that many people think these folks are printing money, when in reality they are competing in a pretty risky and cut throat industry that has to work within a lot of government regulations. And be prepared to handle some pretty huge judgments when things go wrong.

Heathcare - a bucket with a hole in it

Our current healthcare system is like trying to carry water with a bucket that has a big hole in the bottom. No matter how fast you run with it, too much leaks out.

The free market model for healthcare is a mirage. Even if you did ask "how much you want to take out my appendix", you can't really get an answer. You can go to an "in network" hospital, but the ER is subcontracted and not in network. You can be in an "in network" hospital and - at 2am - have a "out of network" hospitalist swing by (without your advance knowledge) and examine you. Your in-network surgeon can call in an out of network colleague for a consult. The hospitals, docs, insurers can always figure out a way to game the system.

Controlling these costs are like a giant game of whack-a-mole - but without a hammer. Even the Medicare Advantage plans, which were supposed to bring this private market expertise to bear for controlling costs and improving care, end up costing Medicare more money.

How does one define "Centrist?"

60% of the American people think its the government's responsibility to ensure that all Americans are insured. That sounds like the centrist position, so is that what this folks are proposing? The vast majority of Democrats believe this. 80% of Conservative to Moderate Democrats think the government should ensure that all Americans are insured. So should a Democrat go against nearly their entire constituency to support something else for the sake of being centrist? That wouldn't be centrist at all, would it?

Excellent thread folks

I very much appreciate this whole thread. As I wrote in the original piece, I'm skeptical there's a "centrist" plan that would be better than single payer. But the votes aren't there for the foreseeable future for single-payer or any major increase in the government's role. The best thing about the imaginary or theroetical centrist plan (which would presumably be a modifiction of the ACA) is that it might end the current constant discussion of repealing the ACA and, I would hope, it would not produce a major increase in the number of uninsured Americans.  

Just curious...

Why would the votes for an imaginary theoretical plan be more "likely" than votes for an actual functioning plan that 60% of Americans support?

The only reason the votes aren't there is because Democrats refuse to put MFA on the table and try to get it passed, so it's circular logic. No one can vote for MFA because it's not being put up for a vote... MFA can't pass because the votes aren't there to pass it. Meanwhile, a theoretical plan that doesn't exist is more likely to help people than anything else?

I just don't get it.

Maybe

Maybe looking more realistically at the Medicare For All challenges will help you understand.

https://www.bloomberg.com/view/articles/2017-06-07/why-not-try-medicare-...

Centrism

The CBO tells us that TrumpCare will cost 22 million Americans their health insurance. What is the centrists position from that? Are Democrats being asked to compromise and accept maybe only 10 million Americans losing health insurance in the interests of just going along? How much greater, exactly, does only 10 million Americans losing their health insurance make America?

Call it obstructionism. I know that a lot of wealthy Americans eager for tax cuts a loss of health insurance will pay for PR firms who will do exactly that. But I just don't see the point of going from the right to the wrong direction for no policy reason whatever.

No there there

Kasich and Hickenlooper don't have a plan. It's nice that they talk about wanting to make a plan, but until they actually have a plan there's not really much to talk about.

Good Intent

They have good intent and are communicating with each other. That is more than many citizens have now days. I am happy to talk about and promote that as you know...

Centrist extremism or just simple denial?

This fascination with the illusion of centrism has always puzzled me. Conservatives use it to wring concessions out of liberals and I think liberals cling to it because it's a comfort zone of sorts, wherein they can claim to have popular agendas without actually fighting for anything. At any rate it's irrational. The idea that the "center" of a dysfunctional two party system is a reservoir of wisdom and success is simply fatuous. Americans don't need something Congress can pass, they need universal and affordable health care.

Note: Here we have liberals claiming that a "centrist" solution, that doesn't solve the problem and in fact doesn't even exist, is MORE realistic than a system that solves the problem, exists, and is functioning in countries all over the world (i.e. single payer). Why would anyone who professes to be concerned about people who need health care relief more or less immediately conclude that no plan at all is better than an extremely successful plan? Why would any liberal rule out MFA as a matter of course in favor of centrist nothing?

Logic actually dictates that "centrism" cannot yield the best policies, therefore all centrism can do is advocate for failure. Even centrist don't claim that "centrist" policies are the best policies, they simply claim that they're the best policies they think they can produce. Look, if we make failure our objective, if failure is the "best" we can do... stick a fork in us; we're done.

Perhaps the worse feature of centrism aside from embracing failure, is that it distorts perceptions of reality. There's absolutely nothing "realistic" about the idea that improvements to our health care system can emerge from some kind of centrist philosophy, that's why our two centrist have everything but an actual plan of some kind to offer. However to the extent centrism dominates mentalities, it distorts reality, warps logic, stunts imagination, and promotes decay.

Under ordinary circumstances it would be obvious to any competent politician that any Party or candidate that makes failure a political objective is a lunatic. Centrism normalizes failure and mediocrity. If Democrats think they can capture votes with a promise to fail millions of Americans who need relief, they're simply being obtuse, that's not the way voters think.

As for "reality", the fact is that we would have had MFA decades ago had Democrats and liberals simply put it on the table as a policy objective. And we could have it in a matter of years now if Democrats put in the table as a policy objective. Democrats and liberals aren't keeping MFA off the table because it's not realistic, they're keeping off the table because: A) The Democratic Party and many "liberals" who support it are simply not liberal. B). MFA isn't compatible with the neoliberalism Democrats embraced in the 1980s, and C) Democrats are not really looking for solutions, they're seeking the comfort of the status quo and deluding themselves that suffering in the center is better than thriving to the left. So millions of Americans continue to suffer and die because failure is the best Democrats have to offer. And they wonder why they lose elections? They wonder how they can "connect" with voters? Duh?

In the short term we simply need subsidize premiums, but good luck with that when the Republicans with whom you want to compromise have filed a lawsuit claiming that those subsidies are illegal, and one court thus far has agreed with them. This idea that it's more realistic to stand around blindfolded swinging at a pinata that it would be to just put some food on the table is just weird.

It's long long long past time that American liberals and Democrats who can't imagine anything but incremental failure stop pretending they're experts on "reality" and political possibility. If "centrism" had produced decades of success, victory, and a Democratic Party firmly in control of the levers of government, maybe they'd have a point. Instead they've given us Donald Trump as a president and made the Republicans the most powerful political force in America. This is obvious but like a horse that keeps trying to run back into the burning barn Democrats keep seeking comfort in the illusion of centrism.

Bi Modal

The obsession of citizens on the Left and Right to reinforce their bubble views of the world via blogs, specialty news sources, etc definitely are shifting our country to a bi-modal distribution of citizens. It was easier when we all watched the same national news, thus supporting a normal distribution of views. That is why compromising was easier...

https://ies.ed.gov/ncee/pubs/20084026/images/fig4_2.gif

The challenge of course with you plan is that there is still half the population on the other side of the curve that disagree with you. Unless you are hoping the folks in that other modal see the light and change significantly.

Forgive me if someone has already pointed this out...

It's a long thread so I may have missed this but, isn't the very idea that a political "center" of the nation can only be located in the "middle" of our two political parties kind of absurd anyways? One thing we know for absolute sure is that neither party at the moment is doing a good job of representing the ordinary Americans that are struggling with health care, so isn't the very idea that a REAL political center can only be found in proximity to those two parties kind of fatuous?

This is the problem with political centrism, it can't possibly represent the reality that American's face beyond the beltway as it were. It's like watching a debate about the number of angels sitting on the head of a pin.

Reasoned compromise...

Isn't "functional centrism politics" simply reasoned compromise? Throw 100 engineers at a new medical device and differences of opinion are sure to result; but, the pressures of the work place force reasoned compromise to produce a desired result by a desired date. No different for an automobile, a complex building or a cooperative work of art like a movie.

That our political processes can't replicate this is further evidence that in no other area of endeavor have we found such a collective bunch of petty incompetents. If our elected officials were a poker hand we would simply ask for all new cards and hope for a better outcome.

No, Nancy Peloisi, your'e not worth the trouble. No, Chuck Grassley, you aren't what you once were now that you're 85. The list is 540 names long...

Personally

Personally, I think it us citizens that are causing the challenge. As noted elsewhere... The Left keeps reinforcing their bubble and the Right keeps reinforcing their bubble. And us boring CNN, NPR, BBC, etc watching folks keep shrinking as a percentage.

I enjoy the bias rating system results from All Sides. Usually folks like myself agree with the ratings, however my further Left and Right readers often question them...
https://www.allsides.com/bias/bias-ratings

You know what I mean... My die hard far Right Parents see Fox as centered and everything else as Left leaning. :-)

Centerism

Centerism is a call for a political solution for something that isn't necessarily a political problem. I am frequently told that there was an"it" during the last election that I as a political sort of person, did not get. I have spent considerable time over the last months pondering what that "it" might be. I have come up with a number of answers, many of which might have some element of truth. One of them is that politicians fail to perceive the basic nature of things. Just as a hammer perceives the entire world as a nail, people like me who are obsessed with politics, see all problems as political. As with many of the most dangerous ideas, there is an element of truth in that.

"It"

As one of the people who's been telling people like Hiram that they don't get: "It" since the election, I can say I'm encouraged by Mr. Foster's posts in this thread.

Indeed, the notion that we can solve a health care crises by trying to locate the center of a "political" spectrum contained within the boundaries of our two political parties is an attempt seek a political solution to a non-political problem. Such an approach is literally incoherent. If you want to solve a problem like health care, you don't search for the political "center" with some abstract theory of politics, you look at what's wrong with health care and devise solutions. You then put those solutions on the table and make them part of your political agenda. Reality dictates politics, politics don't dictate reality.

Democrats as a Party need to decide who they are, and let that identity inform their policy. I think Democrats need to decide to be a liberal Party, we already have a conservative Party, and obviously the Democratic plea: 'Vote for us, we're Republicans too" hasn't worked out for them or the nation. Liberals would long ago have put MFA, living wages, affordable tuition's, women's rights, and labor rights on the table as clear and durable liberal agendas. Instead they've turned all of these principles into negotiable vagaries to be compromised away. Jerry Brown now suggests that Democrats throw women under the bus and add abortion rights to the list of principles Democrats will abandon (as if they haven't already abandoned women).

Fix the Problem

"you look at what's wrong with health care and devise solutions"

Given that a lot of our country's healthcare issues are self inflicted, how would you change these types of personal behaviors:
- excessive weight
- lack of exercise
- excessive alcohol
- smoking
- drugs
- having babies too early / late in life
- having babies while addicted

All of these personal choices increase the likelihood of developing long term or having a baby with a long term chronic health condition.

Thoughts?

Yes...

Let's turn the health care system into a mechanism of punishment for those who don't make the lifestyle choices we think they should make. After all, what else could "health care" possibly be about?

Actually

Actually we would not be punishing anyone, we would be letting people bear the burden of the natural consequences that were caused by the choices they made.

Currently ACA and Medicaid "punish" all of us by taking money from our families and giving it to others so their natural consequence burden will be less.

Now there are many elderly, children and disabled people that really need this help. The question is should we be doing this for able bodied adults who have / are just making poor choices?

In my view it is usually a bad thing to save people from the natural consequences of their choices, it slows their learning process and supports their continuing to make mistakes.

Ask any Parent who keeps rushing in to protect / bail out their kid when they do something unwise...

Funny...

You guys are always about personal responsibility, but when it comes time to actually take responsibility for your own choices it's always a: "Witch Hunt!"

I am fine

I am fine with impeaching Trump and putting him in prison if the special prosecutor finds something of enough significance to warrant it. That would be an excellent example of letting a narcissistic "above the law" bully experience the natural consequences of his freely made choices and actions.

Good example !!!

Facts and Data

This is a fascinating link that explains the problems well.

https://www.cdc.gov/chronicdisease/overview/index.htm

"Eighty-six percent of the nation’s $2.7 trillion annual health care expenditures are for people with chronic and mental health conditions. These costs can be reduced."

And if we do not convince Americans to take better care of themselves, all we will be doing is pushing the costs around.

Costs can be reduced

However, the cost of care in the USA is higher for those same chronic conditions than it is in European countries.

We can reduce the extra $500 per person in adminstrative costs, the 85% premium we pay for hospital services and the higher prescription drug prices US citizens pay compared to the rest of the world.

http://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-wit...

Yes, prevention and healthy lifestyles should be encouraged (usually done by government health agencies) but the focus needs to be on reducing the cost of services provided. Americans are getting gouged for their health care.

Trade Offs

I do tend to make decisions complex... Did you ever read this piece regarding some of the tradeoffs?

https://www.bloomberg.com/view/articles/2017-06-07/why-not-try-medicare-...

Now I know that folks here do not like my first hand stories from people I have met, however I work with enough people from Europe and Canada who see good and bad in their systems.

As I often say, I am fine keeping and tweaking ACA. It is unfair how it is funded, however it may be necessary at this time.

Dan, What system do you support?

Maryland

The problems of the Medicare reimbursement rate can be solved. In fact, Maryland has taken a couple of critical steps to solving it. First, they have an "all-payer" model, where all third-party payers (Medicare, Medicaid, private insurance) pay the same rate for the same service. The rates are typically higher than Medicare/Medicaid, and lower than private insurance rates from before the reform. This has been combined with initial steps to move beyond a fee-for-service model by capping hospital revenue on a per capita basis.

It will

It will be interesting to watch...
https://nonprofitquarterly.org/2017/07/26/next-payer-healthcare-featurin...

Do you know if all hospitals and Doctors have to accept that one rate?

If they are accepting

If they are accepting third-party payments, yes. If the individual is paying out of pocket, then the provider is free to charge whatever rate they see fit.

To address these problems I

To address these problems I would provide for universal health care and universal gym memberships.

Really

How are "universal health care and gym memberships." going to promote Americans eating healthy and exercising?

Walking daily is excellent free exercise and yet our American bathroom scales keep begging for mercy. And if your healthcare is free and not tied to your personal life choices, that seems like a non-starter when it comes to encouraging people to stop unhealthy behaviors and start healthy behaviors.

As you know, my motivational number was $3,000 / year... I kept increasing in weight, triglycerides, cholesterol, etc until my company changed their policies to give healthy families a $250/month premium reduction. One year later I have lost 15 pounds and brought my blood numbers back near normal.

So how do we discourage bad choices and encourage good choices through the US health policy?

Not everyone lives in your

Not everyone lives in your world of company-provided health plans, regular working hours, and sufficient leisure to pursue recreational walking--and supermarkets full of nutritious food within walking or easy driving distance.

I don't have time this evening to enumerate all the ways in which your simplistic prescription for the nation's health problems reflect a lack of understanding of why people do what they do.

I hear a strong echo of Luke 18:11: "Lord, I thank thee that I am not as other men are..."

Even if everyone were a slender, non-smoking, non-drinking, non-drugging, regularly exercising paragon, people would still succumb to hereditary or environmental diseases and conditions that come out of nowhere (an acquaintance died of a post-surgical blood clot and others developed multiple sclerosis or frontal lobe epilepsy late in life) or suffer serious injuries.

Reality and Republican/Libertarian fantasyland: never the twain shall meet.

Yes

Yes, however you can not deny the fact that a lot of the cost is due to the choices us Americans make every day. How do you recommended motivating every American to make those healthier choices where they can?

And no, healthcare paid for by someone else is not going to do it.

https://www.cdc.gov/chronicdisease/overview/index.htm

By the way, I rarely take "time to exercise". Instead I just rarely stop moving as I am doing household chores etc.

"Or do you thin k that,

"Or do you thin k that, without Big Government stepping in, we would all starve to death because no one has enough sense to grow and sell food?"

No. I think that until we can control the climate, we have to provide a cushion so farmers do not go bankrupt because of floods, or drought, or insect plagues, or wind storms.

Unless you're in favor of forcing out small farmers in favor if agribusiness.

Everything you purchase, everything, has at some point travelled in a truck. Developers are required to build the roads that serve their developments. The people that buy their homes are required to pay for uokeep. If you dont like that, I suggest a move to an uninhabited island is in order.

"Unless . . ."

"Unless you're in favor of forcing out small farmers in favor if agribusiness." And here I thought conservatives didn't approve of the government picking winners.

I Think

I think my farming friends would be fine if government exited agri-business. That is if they would take their rules, regulations and money... Unfortunately that is unlikely given that the rules, regs and costs of meeting them seem to keep growing.

And

For every responsible farmer I will show you another who, given the chance, would plant from road shoulder to shoulder, have cows swimming in the creek and manure issues wafting over everything...

Really

Really, I think you need to meet more modern farmers.

And I am fine with enforcing the laws on the books, like a 16 foot grass buffer between fields and public water ways. Instead of straightening out those few irresponsible farmers who violate this common sense law, Dayton, Environmentalists and Pheasant Forever pass a new law to control even more of the farmers personal property.

Please remember that good farmers want to keep the soil and fertilizers right where they are in the field... Otherwise they lose yield and/or have to buy more fertilizer. However you are correct that there are some foolish farmers who need to be punished / taught.

Naive comment

Most of the subsidies go to large agribusiness and they're the ones lobbying to keep them in place.

The problem with John...

I'm not picking on John per se, it's just that in the context of this thread John's comments represent a Republican/libertarian/conservative mindset. That mindset in a nutshell is that illness and injury frequently result from bad individual choices. Those bad choices cost us all money, increase health care costs substantially, and a focus of any health care system has to include some kind of financial motivation or consequences for bad health care choices.

The problem is this is all garbage, it's not a health care discussion, it's a cultural critique based on ignorance and misperceptions.

The majority of illnesses and injuries are NOT in fact a product of bad individual choices so even you could improve those choices, it wouldn't have the dramatic affect on health care costs that Republicans suggest. For instance 90% of all cancer is simply a product of normal cell production that tends to go awry as bodies age. Likewise heart disease is largely hereditary, as is type 1 diabetes. While exercise is good thing for the most part, it's also a major source of personal injuries leading to joint repair and replacement operations, and a variety of injuries and complications. Yes, good diet and and exercise are generally good things, but they're no magic health care bullet of any kind. As often as not diet and exercise recommendations are products trendy marketing campaigns. When we talk about "health care" we're talking about medical treatment, availability of treatment, and the cost of treatment.

Looking at the data, you can find many countries that have better health care metrics, and provide their health care much more economically, but the primary factor driving those superior metrics is government control or regulation of the health care system, not financial motivation. Yes the US has higher rates of obesity and associated complications but no serious economic study or comparison of medical practice finds that these factors explain our comparatively poor health care cost, availability, or quality metrics. And no examination of those countries with lower obesity rates etc. finds that the lower rates are the result of some kind of motivational system built into their health care "markets". Yes, Japan has lower rates of obesity, but that's not because they have a health care system that somehow rewards or punishes them for not being overweight. Meanwhile if you look at the Brits you'll find that while they have a population that looks very similar to ours in terms of obesity, smoking etc. They still have far better health care metrics than we do.

Another huge problem with John's discussion of "health care" is that it makes several bizarre assumptions about human motivation. Primarily it assumes that greed and financial motivations are the only or at least the most powerful of human motivations. This assumption is driven perverse market ideology based defunct economic assumptions. Obviously people don't make lifestyle decisions, or even financial decisions, based on some kind of financial cost benefit analysis. Some people want to be health so they can see their children and grand children grow up, or continue active lifestyles. Some people try to reduce their blood glucose levels because they don't want to experience the nerve pain, blindness, or heart attacks that type II diabetes can inflict. This may come as big news to someone like John, but some people try to make better lifestyle choices because they don't want to die. Any attempt to motivate better lifestyle choices based primarily on financial pressures is absurd because it simply won't work. The idea that motivational schemes based on financial pressures will somehow produce significant health care "savings" is pure fantasy.

Then there's the fact that we already know what John's financially motivated lifestyle and health care regime looks like, and it's a failure. There is not shortage of information and information campaigns regarding diet and exercise in the US. For decades companies and private insurance companies have been offering a variety perks and savings and what we know is that it doesn't work. No company offers such programs can demonstrate over time that they actually have a healthier workforce. Sure, some companies can claim to have reduced health care expenses for some period of time, but eventually unless they simply start denying coverage their cost savings turn out to be minimal and temporary. the Mills Fleet Farm guy liked to make big claims about his "success" with such motivational programs but detailed analysis didn't support his claims in the end. The other problem with these schemes is that prior to Obamacare and it insurance requirements, conditions associated with lifestyle "choices" were simply used as excuses to deny coverage or payment.

Finally, the fact is that these lifestyle motivation schemes tend to end up being little more than expressions of dictatorial impulses. This is always kind of weird because those expressing such impulses always claim to want a government that leaves people alone, yet they're the first ones to jump on board the oppression train. The idea that a government should directly or indirectly pick and choose the kinds of diets, physical activity, and family planning decisions people make is an assault on the very notion of a free society. Yet here John is, willing and able to jump in and tell women when they should and shouldn't get pregnant and have babies. The problem with the lifestyle approach is that those who advocate it assume that they KNOW what kinds of lifestyle choices everyone should be making. They end up turning health care into a mechanism of oppression that rewards or punishes people who live according to someone else's "values".

The idea that we're somehow protecting people from consequences by providing health care is simply a perverse expression of dictatorial cruelty masquerading as patriarchal compassion. This has absolutely nothing to do with recognizing or solving problems with our health care system, or lack thereof.

Hopefully

Actually I said I was motivated by a large financial credit, however I left the question wide open. " How do you recommended motivating every American to make those healthier choices where they can?"

Health care to me is much more all inclusive, the best way to reduce the cost is to eliminate the need for care. Please note that I received a 33% reduction to my portion of the insurance premium by just ensuring that my spouse and I were managing our Glucose, Triglycerides, LDL Cholesterol and Blood Pressure. Apparently the actuaries disagree with you that these things do not make a huge difference.

Finally I have no real desire to tell anyone how to live their life. I just want to ensure that they bear the consequences of the choices they made. Currently Welfare, Medicaid, ACA, SS Disability and even Special Education transfer those consequences to the tax payers.

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

http://www.pbs.org/parents/education/learning-disabilities/basics/causes/

Definitely not a good way to encourage people to make better life choices.

Yeah

"Health care to me is much more all inclusive, the best way to reduce the cost is to eliminate the need for care. "

I'm sorry but therein lay your complete inability to understand the true nature of health care. The need or demand for health care cannot be eliminated, it can only be met with more or less success. You simply don't understand the origin of injury, illness, and disease. You can whine about taxes all you wan't, but sharing necessary social expenses is most equitable and efficient form of economic distribution yet devised by human beings. If you think no one else shares the financial "burden" of your existence, you're simply un-informed. And again, the idea that you're only responsibility as a human being, or citizen, is to reduce your own tax burden, may well be your perspective, but don't assume everyone else shares that perspective, or even that it's the best perspective anyone could have.

Not my Goal

"you're only responsibility as a human being, or citizen, is to reduce your own tax burden,"

My goal is to have policies that encourage people to make positive choices that are good for our country, since a rising river lifts all boats.

Unfortunately policies that arbitrarily tax people who study, learn, work, save, invest and make responsible choices at a much higher rate so that the money can be given to citizens who do not learn and/or make responsible choices makes little sense to me.

Now I am happy to support charities and governmental programs that help people to improve their lives. I am just not a fan of paying them to stay where they are at the expense of the tax payers. I have great faith that every non-disabled person can escape poverty if they truly want to make the effort to do so.

Unfortunately many on the Left seem to have very low expectations / hopes for those who struggle.