The New Moderate’s 2017 Vigilance List

Ron P;

One of the problems that PPACA had is also the problem the GOP will have replacing it.

While near everyone agreed that what we had was broken – just as they do now, there is not and probably can not be majority support for a single solution.

While this problem is more obvious with PPACA and healthcare, it is a general problem with government.

It is why the default must always be – to handle the problem without govenrment. There are many requirements to justify the use of force by government. One of those is majority – possibly even supermajority support.

Legislators tend to engage in log rolling and grease with pork to build support.

But in the real world you can not get 5 of 9 to screw the other 4, by putting together 3 who want one thing that the other 6 do not and 2 who want another that the other 7 do not – atleast not when you are going to end up using force against the other 4.

In voluntary arrangements, real compromise comes at our own expense.
If I compromise to get something I want – I gave up something I wanted to get something I wanted. In politics I agree to screw over someone else for what I want. It is not morally the same.

Anyway, The only truly moral means of handling healthcare is to get government out of it. That will not be perfect, but the imperfections will be the consequence of our own individual choices, and not imposed by force on others.

But that is not what we are going to see.

So one way or another the GOP has been suckered into doing exactly the same thing that Obama did – imposing some plan that at best will have plurality support against the wishes of most people.

The only hope the GOP has is to do better than PPACA.
The good news is that is not hard.
The bad news is it is still being done by politicians

First, the fact that the free market is the primary means of regulating conduct, does nto make it the only one. Nor does it mean there is no role for government.

Too many seem to think that libertarianism equals anarchy.

That government may have a role does not mean government has any role we choose.

Government is limited to those three domains I keep repeating.

In your hypothetical – if an insurance company promises something in return for your premiums, and it fails to deliver, that is breach of contract and it is legitimate for governemnt to enforce the contract.

Regardless, the plurality do not have the right to use force merely because the demand to.
Nor even because they see an outcome they do not like.

The use of force – and all government is force, requires justification.
Any action you can not morally take as an individual – you can not morally take as a group.

I try to avoid the word “greed” as it means different things to different people. ‘
If in your conduct you have not: initiated force or fraud, kept your agreements, and not actually harmed others, then your conduct is no one else’s business.
If you have profited – that is great, in fact it is great for all of us, because it is not possible to profit and conform to those constraints without benefiting others.

Free – atleast mildly free markets in China have raised the standard of living of 1.6B people from the bottom of the third world to the bottom of the first world since Mao’s death.

Mother Theresa has not done so much good. Every charity ever in existance and every social safety net program ever added together have not done so much good.

If morality is measured by the benefits to “the most vulnerable” no system in existance is more moral than free markets.

Most of the time when people talk about greed they are really talking about their own envy.

If the dark side of human nature is your concern – then your focus should be on govenrment. Free markets are subject to self regulation, and to those three legitimate constraints I keep noting. There is no real regulation of govenrment.
Quis custodiet ipsos custodes?

Please give me a real world example where gree results in negative impacts on broad segments of the population without bad actions that is not covered by the three constraints I keep repeating ?

There is none.

Which raises another issue – what constitutes actual harm.

Having less choices than you would prefer is not actual harm.
Having less desireable choices than you want is not actual harm.

We tend to confuse the freedom to do as we please with the ability to do so.

I am free to be a concert pianist. I do not have the natural ability to do so, and no one owes me those abilites. Further no one owes me the opportunity. Juliard is not bound to accept me – merely because I want in. If something you think is a right or freedom imposes a positive burden to act on others – then it is not a right.

Food, shelter, jobs – these are NOT rights. No one owes them to us.

With respect to your quasi hypothetical.

I do not care if you have had health insurance all your life, or 5 minutes.

If an insurance company contracted with you to provide you medical coverage, and it violated that contract then you are entitled to have govenrment compel them to live up to that contract.

We do not need regulations or a massive federal government for that.

You seem to think that absent a regulation, there exists no remedy for some problem.

I assert that you can not come up with an actual real world problem that is not already covered by the three principles I keep repeating.

The foundation of all morality is liberty.
There is no system of morality that does not start with free will.
Absent freedom morality does not exist.
Restricting freedom outside very narrow justifications is inherently immoral.

Finally, though this observation comes from economics, I think it has broader application.
Free people – even attempting to act “immorally” constrained by those criteria I have offered can not ultimately help but benefit others.

Actually no – the chinese are far worse at “controlling greed” than we are.

Though the “controlling greed” meme is nonsense.

Please PRECISELY define what greed is ?

I do not beleive that you can.

But more importantly,
define some actually harmful human conduct that does NOT fall under atleast one of the 3 areas I repeatedly identify as the legitimate role of government.

You may not initiate force or fraud against others – not to profit, not for any other reason.
You may not renege on your agreements with others – not to profit, not for any other reason.
If you actually harm others – you must fix it.

Tell me something that you can do that would be “greed” that would not be covered by one of those points, that government should prohibit ?

There is nothing.

Outside those limits – what you call greed is just “envy”.

And quite honestly GOOD, not bad.

It is either impossible or nearly impossible to profit unless you provide far greater value to others, UNLESS you violate one of those strictures.

I do not thing Ron’s hypothetical is all that powerful or difficult.

I think it is already well addressed. In fact it is not merely address by my libertarian minarchy, but even anarcho-capitalists can successfully address it.

The most fundimental problem with Ron’s hypothetical – the common fallacious argument against libertarians or even more generally limited govenrment conservatives, is the false presumption that the choice is between anarchy and unlimited government.

That is not the case.

While it is actually the case that Ron’s hypothetical can not occur broadly – even with ONLY free market self regulation – otherwise no one would buy insurance.
Even accepting that there is some window that insurance companies can find – where they provide some of the coverage they agreed to – enough that people continue to buy insurance, but still violate their agreement with others, government still has a legitimate role in enforcing agreements. ‘

Regardless, Ron’s hypothtical does not demonstrate the failure of free markets.

When Obama was elected, the democrats mandate was to restore prosperity.

At that he failed, and that is why the GOP now controls much of the country.

That BTW is ALSO the mandate they have – not repealing PPACA, not sealing the borders.
And ultimately that is what they will be judged on.

With respect to your hypothetical – it is not complete.
The simplified version is someone develops some serious problem and they do nto have insurance to pay for it.
And that is where you end.

In the real world something happens next.
I am presuming you think she dies – but you did not say that.
Probably because in the real world that is not what happens.

Lots of people die every year of non-treatable cancers.
We all die eventually.
A small number of people die from treatable cancers – but not because they do not have insurance. Most commonly because they are not detected until it is too late.
My mother was incredibly well insured and yet she died of colon cancer.
The doctors told us that she had it for atleast 10 years.
She had to have known something but did not get it checked.
Colon cancer is one of the most slow growing and treatable cancers there is,
and yet afluent well insured people die from it all the time.

The fact is that PPACA made ZERO change to any mortality trends.

AGAIN health insurance is about FINANCIAL security – not health.

People who seek care do not die from treatable diseases in this country merely because they do not have money.

They do however go bankrupt. According to Elizabeth Warren’s work (before she became a senator), about 1/3 of all bankruptcies in the US involve health care costs.
And the average amount discharged in bankruptcy is about 2500.
This is not a Trillion dollar problem – it is not even a Billion dollar problem.

So in your hypothetical – because government has ALREADY screwed things up,

You beleive it is entitled to screw them up even worse.

If you have a woman with breast cancer she is being treated at a hospital.
The ER/DR. Office aspects of your hypothetical are either small or false.

If you want doctors to start seeing patients with less resources – that is trivial.

Get rid of the medicare/medicaid rule that prohibits doctors from charging private patients less than medicare/medicaide.

The govenrment prohibits doctors from engaging in charity.
As a result – patients end up at the ER.

I keep trying to tell you – what we had immediately before PPACA was NOT a free market system. It was already a highly regulated thoroughly F’d up government distorted system.

BTW I have little problem with our tort system.
In fact I would make it EASIER for people to file tort claims.

Torts are a legitimate form of “regulation” – and one that businesses fear and respect – otherwise why the tremendous pressure for tort reform.

I would likely eliminate or reduce mass torts, and class action lawsuits.

Beyond that though I have no problem with punative damages, I have problems with significant pain and suffering damages.
And I am going to require plantiffs to demonstrate ACTUAL HARM.

Regardless, “if I ruled the world” – there would be no regulation, but there would be significantly more torts.

At the same time I do wish to re-iterate – as a matter of fact, not ideology,

that the PRIMARY regulating forces in a free market – are the market itself.

Government – our criminal, contract and tort laws are a critical backstop.
But they accomplish TWO things:
They are the means of constraining the few of us in society who are only constrained by law – primarily sociopaths.
In a system with no govenrment AND sociopaths, everyone quickly degenerates to force, and fraud and the wheels come off.

BUT it is not govenrment that constrains the conduct of most of us most of the time.
It is our relations and interactions with others.

The mess we have made of language is not my fault.
That is to a large extent driven by political ideology – particularly that of the left.

I will have zero difficultly obliterating most any argument from someone on the left – if they will agree to use language consistently.

They can define terms however they please – so long as those terms mean only one thing – in the context of government – if we are writing poetry or fiction you can play all the word games you want. Further they must no define terms such as to preclude there being words to describe those values they do not like.

Anyway, give me that and it will take very little time to run any left wing argument into massive self contradiction.

Progressivism only survives based on massive ambiguity in the meaning of words.

Regardless you are opening up another issue – and that is legal interpretation.

When Adam’s said that we are a nation of laws not men – that was not to diminish the importance nor control of men.

What it means is that we make public choices based on law that government scrupulously follows and that has one meaning.
If we do not like the meaning – we have a process to change the law.
But those imposing the law – police, lawyers, judges, impliment the law as it is written.
Not as they want it to be.

If the law is wrong, the law is wrong – still the courts must impose the law as it is.
It is the people and the legislatures responsibility to change the law when it is wrong – not the courts.

Trying to fix things by manglining the meaning of words, moves us from being a nation with some bad laws to a lawless nation.
A nation where our standard becomes the favor of the judge we appear before.
Not the law – a nation of men not law.

So as a society we should pay a couple of trillions of dollars a decade to solve a problem that is not even a billion a year ?

Yes, the woman who develops breast cancer without health insurance should go bankrupt.
People go bankrupt all the time. There are about 750,000 people who go bankrupt each year.
I know people who have gone bankrupt personally.

Going bankrupt is not dying. It is starting over. It means several years of bad credit.
It is not good. It is also not something that we should pay a couple of hundred billion a year to avoid.

Trump went bankrupt 6 times.

Sorry Ron but I understand completely.

Regardless, the solution to a broken system is not to use its existing problems as justification to break it further.

Prior to EMTLA hospitals were not required to accept you if you could not pay.
Catholic hospitals in particular lobbied hard for EMTLA because other hospitals – particularly government hospitals were dumping patients on them – because catholic hospitals on their own chose to accept anyone.

I approve of the choice of catholic hospitals to take whoever comes through the door.
I do not support imposing their charitible policies on everyone else by force.

Ultimately the number of catholic hospitals has declined anyway – because government increasingly makes charity harder and harder. Look at what PPACA attempted regarding Little Sisters of the Poor.

Anyway MY point is simple – you should be free to choose to provide care to anyone who enters your door. You are not free to force others to do the same.

Between EMTLA and Medicares rules requiring doctors to charge all other patients the same price the charge medicare we are driving the poor away from doctors and to ER’s,
Further we have taken what could be Doctors charging different patients based on their ability to afford, to medical care is either free – because someone else is paying or expensive – because you are paying yourself.

This is a STUPID model.

There are myriads of reasons you want free markets – you do not get these horrible unintended consequences in free markets.

So again your argument is because government has F’d something up, it gets to F it up more.

I want a really simple tax code – small government low flat rate applying to everyone.

If we drop corporate taxes to zero – there is no sane reason to tax corporations.
Then it does not matter whether a group is a 501(c)3 or whatever.

Regardless, in the event you actually support tax exemptions – which mostly I do not.
They can not come with requirements to alter your conduct.

Can government dictate to a church what it teaches, because it is tax exempt ?
Can it dictate to a college ?
Then it should not be able to dictate to a hospital.

But again as a practical matter corporate taxes should be zero – then the entire corporate tax code goes away.

The objective is to get government OUT of making choices for us.
Not to increase the reasons it can.

The percents I have heard were different – Medicare covers 95% of actual costs, and medicaide about 72%.,

but it does nto matter, the point is that medicare and medicaid force subsidies from the privates system – which drives prices UP.

And AGAIN I would note – this is still bad government programs that break the market and make things cost more for the rest of us.

How strong do you think popular support of medicare and medicaid would be if people understood that not only are they paying taxes to support them,
but they are paying higher insurance costs to subsidize them ?

The left seems overjoyed at the difficulty that republicans are having getting a plan together.
They think this is a march towards Single payer.

Vermont tried to make Single payer work, they had popular support. But even with a strong left government they could not make the numbers work

As you note – neither medicare nor medicaid pay their own way.
Single payer either means the quality of medical care must decline substantially,
or the cost of government provided medical care must increase substantially.

Not looking to quible over numbers – yours make my point better than mine.

Still pushing the without health insurance someone is going to die rot.

Lets assume you are correct – what are you prepared to give up to maybe extend one persons life a bit ?

Save the children tells me all the time that for .50/day I can save some child from starvation.
So can you add 70 years, or even 10 years to the life of your hypothetical woman – for $.50/day ?

Equally importantly – how can you excoriate others for not “saving” the woman with cancer when you have not given $.50/day to save some starving child elsewhere ?

The fact is everything we consume is paid for from everything we produce.
If you spend a Trillion saving a few people from cancer – or even a billion or a million,
there is something else you have lost.

In the end your not really changing whether this hypothetical woman lives or dies – you are just changing how the decision is made. Because ultimately someone is going to have to decide who lives or dies.

The choices are simple – you can let bureaucrats in washington decide.
It is my understanding that the actuarial value of a human life that HHS uses is about $125K.
If it costs more than $126K to extend someones life – HHS is not approving it.

But there is a big difference between HHS deciding and letting people decide for themselves.

When the government decides – it decides for everyone. It decides for people that could easily afford $125K to extend their own lives, and it decides for those who can not.

When we decide for ourselves – we get to factor all kinds of things in.

If I am 80 – do I want to burn through 100K or what might go to my kids in order to live another 3-6 months – and possibly in great pain ?

If I am your hypothetical women – I may not have $125K – but I might be able to come up with much of it. Regardless, I get to decide.

If I am the hospital – I get (or should get ) to decide am I willing to put 125K into this patient – and hope they can pay me back.

When choices are made by government – they MUST be made blind.
Most of us understand we do not get to say – we will save the white guy, but not the black one. But that also means we do not get to say – we will save the woman with a job and a child – but not the drug addict.

What those of you on the left do not understand is that ultimately choices are going to be made – they must be made. When government makes them for us – more people do not benefit, that is actually close to impossible, because there really are only so much resources we are going to spend on healthcare, all that happens is the majority of us are relieved/prevented from making choices for ourselves.

Ron P;

With respect to your scenario:

Lets not pretend that all humans are kind and fart butterflies.

Contra the left free markets without government tend to be very effective at punishing bad behavior. They do not do so perfectly.
But look arround – there is no arrangement that acheives perfection.

In a free market are some going to try to cheat or otherwise game the system ? Yes, and sometimes they are even going to get away with it.

About 1 in 30 people are sociopaths. Alot of those are attracted to roles of power in business. Though I would note – even more are attracted to government and politics.

Something we should always remember when we think of government as the answer to any of our problems.

“If men were angels, no government would be necessary. If angels were to govern men, neither external nor internal controls on government would be necessary.”
Madison.

The same crooks cheats liars and theives that the left fears in business – make up our government. We are not obligated to do business with anyone.
We get to make our own judgement over who to trust and who not to, and if we are wrong – we get screwed as a consequence of our own error.
We do not have a choice when the crooks, cheats, liars and theives are our government.

But with respect to your scenario:

Insurance is a bit more complex than some exchanges – but the core is still simple – value for value. If you buy insurance that does not cover you when you need it – word of that gets arround and insurance companies have to adapt. Just as when insurance companies write policies that take on too much risk for too little premium – investors get pissed and premiums or policies change.

If you want to know what free market insurance looks like – go to the cereal Aisle of your grocery store. Dozens of choices from the 3 big companies, and hundreds of choices from dozens of other companies.
Something for everyone. And no one makes their choices the same way.

People are going to make sub-optimal choices in health insurance, but that is still better than being forced to accept sub-optimal choices made by others.

The argument for free markets is not that they are perfect, or that there is no lying cheating stealing or fraud. It is that nothing else works better, and more importantly – our choices are our own – even if we make them less than perfectly.

One last point, government can not and should not protect you from making bad choices. But free market does NOt mean that lying, cheating and stealing are acceptable.

I tend to repeat 3 legitimate roles for government:

1). to punish the initiation of force or fraud by others – that is the basis for most criminal law. If there is no force or fraud involved it should not be a crime.
2). To compel people to keep their commitments – that is the basis for most civil law, contracts. It is not governments job to decide what constituties a ‘fair contract” only to enforce contracts that were freely entered.
3). To compel people to make whole those they actually harm – that is the basis for most tort law.

In the GOP’s list of policies is tort reform. This is a place I oppose republicans. It is not the role of government to limit how we conduct our lives – economic or otherwise in the hope of preventing harm. I oppose regulation.
It is the govenrments responsibility to assure that hose that actually harm us – make us whole.
I do not support regulation – I do support Torts.
I do not support the NLRB – at the same time I absolutely support the right of workers to negotiate – as voluntary groups or individuals. Again it is not governments business to decide what a contract should look like, only to enforce those that are freely agreed to.

Back to your initial example:
If an insurance company actually breaches its contract – there is a role for government in enforcing the contract.

I would note that for most of us – we can not sue our insurance company when they breach. Why ? Government.
If you buy insurance for your self and the insurance company breaches – you can sue them. If your insurance comes through your employer ERISA dictates that you do not own your insurance, and the insurance companies contract is with your employer not you, so you have to go through an independent messy system of adjudication, that frankly heavily favors insurance companies.

One of the good things to come out of PPACA and possibly the GOP plan is an increase in the people buying insurance for themselves. That buypasses ERISA and makes insurance breaches harder.

No, there are very very few examples of real tragedies CAUSED by free market health care.

Most of those produced by the left do not hold up under scrutiny.

The more famous one used in the anti Romney TV adds was ludicrously false.

The husband lost his job, and subsequently his health insurance and many years later – with many other intervening factors, his wife became ill.

Is there someone claiming that if you buy health insurance and pay a single premium that the insurance company owes you healthcare for life ?

The vast majority of these horror stories boil down to either actual breach of contract – which even minarchy handles with no difficulty,
or messes created by ERISA – individuals insured through company health insurance can not sue insurance companies as a result of ERISA.
Or are horrible misrepresentations of the actual facts.

Completely ignoring government.

Do you beleive your insurance company is not going to cover you if you develop a serious problem ?

If you do not – then why are you paying for insurance ?

As you are paying for your insurance, that means you really beleive you will be covered – enough to spend the money on insurance.

Even without any government at all, we do not pay for things we do not bleive we are going to receive.

Medical care is going to cost approximately the same amount whether there is a PPACA, or some republican plan.

One of the problems with any approach other than free markets is that there is no top down solution that actually expands medical care or actually decreases medical costs.

That is what free markets do – with everything.
That is NOT what governments do with anything.

Your argument about the trillions of costs associated with those with pre-existing conditions – is a red herring. The healthcare needs of people and the cost of those needs are not reduced by insurance, or subsidies or tax credits.
In fact all of the above tend to INCREASE costs.

That does not make insurance inherently bad. But lets not kid ourselfs into beleiving that there is any top down arrangement of anything ever anywhere that has ever reduced the cost of anything.

The only thing that has EVER reduces costs and/or increased value delivered is free markets.

Nor is this any secret. FDR’s NRA was a system o0f top down economic decision making that had very nearly failed on its own when the courts struck it down.
Nixon’s wage and price controls made inflation dramatically worse.

The economic calculation problem – is an economic debate over the viability of socialism that was resolved both in theory and in practice decades ago.

Please name a single socialist country anywhere int he world that is not impoverished ?
Chaves took one of the more wealthy south american countries and has destroyed it.

Even those vaunted european social demoncracies have growth rates about one percent lower than ours and standard of living atleast 20% or more below ours – despite the fact that thye were wealthier than the US not that long ago.

Socialism does not work. Socialism lite does nto work.

What is wrong with US healthcare today is that it is not only significantly socialized – it is actually socialized badly.

One of my fears with regard to PPACA was that the system it replaced was a disasterous quasi socialized mess and it was entirely possible that PPACA could actually outperfrom what it replaced.
But I should not have feared – never under estimate the ability fo government – particularly left government to make things worse.

I am not personally all that concerned about pre-existing conditions.
The lefts selling of PPACA was grossly dishonest. Their criticism of alternatives is no better.

I tire of this nonsense that PPACA saved X millions of lives or resulted in some other miracle.

There has been ZERO change in long term trends of life expectance.

As I have noted elsewhere Health insurance is PURELY about financial security.
There are really only a very small portion of the uninsured for whom that is a serious problem

There was almost nothing in PPACA that had anything to do with Health, and probably nothing in its replacement either.

There are only two significant questions being addressed:

If we are stuck with quasi socialized healthcare – who and how are we going to pay its high costs ? It is going to cost the same amount no matter what.

Are we going to pass some change with sufficiently free markets to actually lower the real costs ?

Unless we make changes that actually reduce the cost and/or increase the value of healthcare – and the only thing that has ever reduced the real costs of anything over the long run or increased the real value over the long run is free markets – then the entire fight is over who and how are we paying for health care.

Unless the republican plan significantly increases free market competition it will cost the same and PPACA. The debate will be over who pays.

I am also NOT that deeply concerned over this.
I think that the GOP has too strongly walked into the obvious democratic trap regarding Healthcare. Unless they incorporate significant free market processes – any GOP plan will cost the same or more.

Personally I think republicans shoudl leave PPACA alone.
It is in its death spiral. Let it fail on its own.
I think it will be easier to get the country to make a wiser choice when it is clear that neither PPACA nor any other top down solution is going to work.

Yes, the democrats end game is single payer.

But if the republicans are smart enough NOT to push forward on “obama care lite”,
failure is more likely to move us towards a free market system than single payer.

Single payer is medicaide for all. Few of us are going to be happy with that.

I beleive Reason contracted for a recent poll on healthcare.

Every single item of PPACA that is purportedly popular – that the GOP is desparately trying to figure out how to deliver was extremely unpopular when asked
“would you be willing to pay more to ….”

Free markets are like voting in a democracy except:
You vote with money. You can vote for many things and to different extents, but each of us only has so much money.

This is actually important – and it is better.
You can not know how important anything is to people – unless you can know what they will pay for it.

If you beleive in the principles of democracy – you should beleive in free markets more.

In a political system we at best get to vote yes/no.
In the market you get to vote how important something is to you.
In a political system you vote hypothtically on ideas not their costs.
In a market you vote for actual things and your vote is based on their real cost.

Markets reflect the true wishes of people and the strength of those wishes.

If we are going to discuss what we really should do – what will work best.

Then YES, I am advocating completely getting government out of healthcare.
And that would include ending medicaid.
Medicare is slightly more complex – because we have lied to people and told them that they were buying medicare from their payroll while they worked.

I get disgusted by this “truly needy” nonsense.

Most of you know I am a landlord. I have 5 units. All of my tenants are bottom or 4th quintile.

Sorry, these are not “truly needy” people.
I periodically go into my tenants apartments and they are better off than my parrents were in the 60’s – and my parents were 2nd quintile.

I have a hard time thinking of families many of whom have SUV’s with leather seats, multiple flat screens, smart phones for their kids, laptops and tablets, leather sofa’s …..
as Truly needy.

Frankly, I think that it is elitist and stuck up to go arround pretending that these people can not survive but for government assistance.
Most of my tenants are decent hard working people able to carry their own weight and not in need of the govenrment help some of them receive.
Those who are not – are not doing any better for the assistance they receive from government.
And in fact may be doing worse.

I think it is incredibly stupid for us to take large amounts of money for everyone, and then give it back to them.

You want to pretend those towards the bottom do not pay much taxes.
Where do you think the money I have to pay for taxes on my rental properties comes from ?
Not from me.

No one would invest in anything, it they had to pay taxes on it and were not receiving money from others.

How do you think the Waltons pay their taxes – from the money paid to them by the people who frequent Walmart.

Contra the left – the creation of wealth trickles up. The Walton’s got rich because they created about 20times as much wealth for others.
But taxes flow down.

And again what is it that you expect government to provide as an entitlement to people ?

Nothing you are describing about medicare says – people die.

In Canada and the UK – people do die, waiting for government care.

I beleive I have written about my parents deaths before – but again, as it explains the difference between US and european health care – and the cost difference.

My mother died of colon cancer – she spent the last year in an out fo the hospitial.
My father died of vascular dimensia – and he spent the last couple of years in and out of the hospital.

Both had medicare – and good suplimental coverage. While they were “affluent”, they received the same care that people with medicare and suplimental insurance do.

In the end they both died – that is what happens to all of us eventually.

During that last year – the “medical” care they received was maybe a little better than someone on medicaid. No one does major procedures on patients who are not going to live more than a year or two no matter what. They did not get hip replacements or bypasses, or …

But they did end up in the hospital frequently.
My mother ended up in the cancer wing several times. My father in the stroke wing.

These were impressive. They had two nurses – 24×7 shared with one other patient.
Someone was ALWAYS present.
The rooms were private and sumptuous – better than the Helmsley palace.
Terrazo floors wood paneled walls, an entertainment system, giant flat panel, and an alcove for the family – where we could converse privately, sleep, eat ….

That is why US healthcare is incredibly expensive.

A ford Focus and a Lamborghini Huracan will get you across manahattan in about the same amount of time. The outcome is the same.
But no one pretends that a focus is the same as a lamborghini just because the “outcome” is about the same.

The standard of living in the US is more than 20% higher than nearly all of europe, 30% higher than most of.

A higher standard of living means we have more wealth (that is literally what it means)
Many of us can afford the Huracan rather than the focus.

My parents did not live longer because of US medical care.
But their last year was better.

So back to your medicaid patients – and your woman with breast cancer and no health insurance.

No I do not think it is a crime that medical expenses bankrupt some people.
I do nto think government must provide medicaid patients hip replacements, or wood paneled suites when they are in the hospital. I do not have a problem with not paying for advance treatments or expensive treatments that MIGHT work better for people who can not afford healthcare.

But I do have a major problem with government deciding the same things for the rest of us.

That is what the right tends to mean by “death panels” and that is where we are headed with “universal”.

When government takes over – it MUST treat everyone equally. That is what we want.
There are critical moral reasons it can not do otherwise.

When that happens ALL of us are only going to get the equivalent of medicaid care.

We certainly do not want government deciding who gets the wood panneled suite and who gets the ward.

To address outcomes one last time.

The most critical factors related to a nations people acheiving a life expectancy in the upper 70’s are rooted in the state of the art of medical care in 1950.
That is when there were few if any private rooms and hospitals had wards with 20 people in them.

Alot has improved since then. The quality of care is far far better. Hospitals are alot more pleasant. But outcomes are not that different.

We can trivially afford “universal” healthcare that is the equal to what the US had in the 50’s.
That is cheap – and will produce nearly the same outcome.
India has it – and has a booming medical tourism business.
China has it.

Hong Kong provides that to absolutely everyone.
But you can pay extra for better – and almost everyone does.

And that is how free markets work.

They increase the value delivered and decrease the human cost to do so.

But VALUE is whatever we want and need. It is not some pseudo objective measure of outcome.

Having a wood panneled hospitical suite with an entertainment system and an alcove for family and ….
That IS a higher standard of living.

One other thing about free markets – usually in less than a generation – the standard of living of the affluent, becomes the standard of living of the rest of us.

That does not happen where government controls.