(Un) Affordable Care Act - the Uncomfortable Truth

[flintlock]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

In the end I honestly believe that we will be forced to go to what right leaning advocates call a "socialist solution"

We won't do it out of ideology. We will do it out of necessity. The rest of the world is kicking our ass when it comes to health care costs. In a world where trade is global? We simply will not be able to afford this dysfunctional trainwreck.

So I say this to anyone who believes that an unencumbered "free market" can provide a better product at a better price: Quit making excuses and start putting forth reasonable and functional solutions. For FAR too long the right has done nothing more than provide a few talking points while protecting the status quo.

Time's short gentlemen better make a start soon.

Will

I have come to the same conclusion.

[flintlock]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

One thing that strikes me as odd is how we keep hearing medical costs are going up at least partly due to limited resources. But I can't understand if that is true why we see so much more medical advertising than we used to. TV, Radio, I get several local "magazines" every week loaded with ads for dentists, doctors, hospitals. You can't turn on the TV without seeing ads for drugs to help men have sex, control their cholesterol, etc. Why would a supposedly overworked medical field need to spend a fortune advertising? I don't buy it. I can often call my doctor and get in the same day. They call me "reminding" me I need to come back. My pharmacy calls me repeatedly asking if they want me to call the doctor to request a refill. Hardly the behavior of an overburdened system. No, this is the big corporate business model running healthcare. MBAs run medical practices and clinics. The Physicians hire them to show how they can work less and make even more money. I don't have a problem with working less, I think most of us work too much. Its wanting to have your cake and eat it too that is troubling.


I think a lot has more to do with how we shop and pay for medical care than any shortage. Sure, we pay a lot because so many don't have insurance or don't pay their bills. Its a lot of things. But the lack of any market forces to act on pricing is the root of the problem. Imagine if you had insurance to pay for food. Pay a monthly fee and get as much food as you "need", with a small co-pay. We'd all be eating a lot more and a lot better. I'm not sure what is the answer, but I can tell you that until there is more disclosure on pricing and some sort of true market in healthcare, we might as well go to single payer. Because what we have now is hardly working.

[Chomsky]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

It's took me about 100 posts to start recognizing it but by 200 I understood it to be a reality. Most ideas here have to scale a "Great Center Right Wall" lovingly built and guarded by a small number of regular posters out of a 50K+ membership.

So from that perspective, "Producers" generally refers only to entrepreneurs, business owners/managers, accredited investors and anyone else who needs a hard distinction between themselves and people whose productivity is based primarily on physical and (limited forms of) intellectual labor.

No one who works in government, academia, the arts, the 'soft' sciences or any other domain considered by said Producers as unimportant can be considered productive. Generally, any domain whose output the Producers deem frivolous or that cannot be directly traded on a marketplace in exchange for cash or similar consideration is excluded from the definition. With the exception of union members (who are most definitely not Producers!), I have yet to determine if employees and other non-owners can be considered productive. Initial research indicates entry by these cohorts into the ranks of Producers is decided on an "at will" basis.

Similarly, for a potential solution to be considered "pragmatic" it must make it over the Great Center Right Wall. Those ideas that fail to make it are categorized somewhere between "impractical" and "immoral". This calculation depends largely upon the perceived limits such ideas may place on the freedom of action of Producers. A secondary consideration is the idea's potential to assist those persons assigned to non-productive, surplus populations.

Any idea identified as "left" is immediately removed from further consideration. The mere identification is sufficient for disqualification and there is no requirement of proof. This is so because Producers generally conflate communism, Bolshevism, socialism, social democracy, liberalism and the Democratic Party with each other and make no meaningful distinction among them. Anyone who persists in posting ideas identified as "left" should expect to receive regular notes of opprobrium until such time as the activity ceases.

It is also important to note that no similar guidelines are applied to ideas rooted in center right and conservative ideologies. These are generally considered "common sense," "free market" or simply "truth" and as such rightly cannot be labeled ideological. Furthermore, while criticism of center right ideas is not prohibited as such, it must be balanced by at least one equivalent criticism of the Democratic Party leadership, civil rights activists, labor unions, intellectuals and other fellow travelers. Failure to do so consistently is considered a marker of leftism and will be noted as such.

I understand this "modest proposal" is a something of a chore, but you can keep it simple if you just close your mind to any idea, regardless of its potential for good, that the Producers identify as leftist.

+1000000000

[jpatter666]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

My fear is a single payer system will be far more expensive than European systems, and far less efficient.

We know that Federal government workers receive twice as much of the income pie than any private workers save top management. A U.S. single payer system would be such a bureaucratic mess it could set back medical progress decades. Would SIEU agree to reasonable wages a single payer system would demand? We would also lose more doctors for a while.

The current system we have is not the answer either. We must replace that too.

This is America. We are leaders in science, in creating new industries, in GNP. We should be able to come up with a health care system that has reasonable costs, covers everyone, and runs like clockwork.

The challenge is to come up with a framework of a system that works. What ideas does this group have that could accomplish this?

Someone suggested that the military run the health care system. I don't think they can legally do that.

How about this for starters?:

Hire military veterans to run the health care system, hospitals, be the nurses and doctors in the new system. This system could be far more efficient than the current one.

To prevent lower income citizens from going to emergency rooms create neighborhood clinics staffed by nurse practitioners. A doctor could be stationed at one of these clinics, but close enough to be at an adjoining clinic in 5 to 10 minutes if needed.

Have a special government program to take good care of, at reasonable cost, to those with preexisting conditions that were not caused by their bad behavior, and not penalize everyone else with higher rates to cover them. Those preexisting conditions would have to be beyond the control of the patient; they cannot be self inflicted. If someone drinks too much, smokes, engages in risky behavior, eats junk food to excess; they have to pay the rate that befits their reckless behavior.

What I am hoping for is a forcing of hospitals/doctors/pharmacies to publicly list their prices. How can price discovery happen if you can't find the prices?

[Mn_Mark]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

...and welcome to the other side of the debate -- those who think a completely unfettered Ayn Randian environment will create the perfect solution.

Did I say the free market creates the "perfect solution"? No, I specifically said it creates the best POSSIBLE solution. You're setting up a straw man.

I suppose we continually creep towards socialism because well-meaning people see that the way things are under a free market are not perfect (in their view). So they support a little "tweaking" to the free market.

Maybe they support a little government-supplied free health care for the really desperate people or for children. Or maybe just a few price controls here and there because something seems a little too expensive. Or some subsidies to encourage something that really seems like it ought to be encouraged. A little regulation here, a little more there.

But things still aren't perfect. More regulation is needed. And oh, by they way, if we're going to give free health care to this group here because they're so desperate, then we really should give it to that group there too.

And the years pass and the bureaucracy grows. "Let's force emergency rooms to provide care even if the person can't pay for it." "Let's add prescription drugs to the things we give away." More regulation of who can enter the field to provide services. Loads of special exceptions for cronies of the politicians and big donors. Etc etc.

More years pass and the system is becoming truly unworkable. "Well," they say, "the government better just take this over altogether. Clearly the 'free market' is just not working. Maybe if we get rid of the profit motive then things will be more affordable."

And you end up with something like Cuba, where there is Universal Free Health Care !!!! and operating rooms that look like something out of a horror movie and patients are expected to bring their own drugs.

And all because well-meaning people thought that awful "Randian", "unfettered" free market could be fixed with just a little tweak here and there.

*You* can have your 1944 health care. Please refuse all modern drugs, equipment and care -- and don't forget to turn off the A/C. And by the way -- in 1944 there were serious price controls; a war was raging, remember?

I'm not saying I want to live in 1944. I'm saying that government interference in the health care marketplace caused inflation-adjusted costs of medical care to go up to a level many multiples of the level in 1944. You've seen how a free market drives down costs and rewards the development of innovation, right? Surely we can agree on that? So by all rights, medical care should at the very least not be MORE expensive than in 1944. Surely not 14 or 50 times more expensive. Even with new machines, new techniques - we've had those in other, relatively free marketplaces like computers. Medicine is a very high technology field; it should be subject to the same improvements in efficiency and technology if it is not being made uncompetitive by government interference.

Why do I feel that some level of national plan is now required? Because I see contradictory forces at work.

1 ) It's stupid to tie health-care to having a job. Like I've tons of money to spend on medical issues when I'm out of work.
2 ) It's too tempting for people to shortcut basic medical care to save money. This often hurts children.
3 ) The bureaucracy is insane. My wife does a short emergency visit and we're getting nickel and dime requests for payment six months later.
4 ) The US spends far more on health care than any other nation -- the results for our money are appalling.
5 ) We cover seniors who have mostly finished their contributions to society and leave children with the most to contribute to rot -- why? Children can't vote

(1) Health care is tied to having a job because the government exempted health care benefits provided by an employer from taxation. Therefore the marketplace naturally moved to provide health care benefits as a way of giving employees more money without it being taxed. Another example of how government interference in the marketplace skews incentives.

(2) If the free market was allowed to drive the costs of basic medical care down to where they would be in a truly competitive system, it would be affordable for the average person, just as it is affordable to get a big screen TV, a cell phone, and to have someone cook you a hamburger at McDonalds.

(3) Yes, the bureaucracy is insane. Because of government regulation and interference.

(4) The U.S. is not spending more than any other nation because it has a few remnants of a free market system that they don't have. It is probably partly spending more because it is much richer than most nations on a per-capita basis and can afford to spend more. You notice that the rich from other countries come to places like the Mayo Clinic for treatment. They're not going down to their local Guatamalan clinic. People in the U.S. spend much more than people in most other counties in almost every category, because we can afford more. I bet we spend more on computers than people in most countries, too - and that doesn't mean there is something wrong with our computer industry that requires nationalization.

(5) We "cover" seniors because they paid their whole lives into SS and Medicare and were promised coverage in their old age in return. Children haven't paid anything into that system. That's why children are not covered in SS and Medicare - but are covered in Medicaid, so I don't really understand your complaint here. Anyway, in a free market system I would expect there to be VERY few people who could not afford basic medical care, just as there are VERY few people who can't afford a refrigerator or other basic services. And of those who can't afford it, how many are in that situation because other government programs like welfare protected them having to take serious care not to have children they can't afford?

There have always been poor people, everywhere and always. There always will be - by definition, there will always be people at the bottom of the income ladder. But it is the freest societies that provide the most opportunity and the most affordable basics. Rockefeller made kerosene affordable for even the poorest people, giving them the ability to have light in the evening. For those who truly are unable to take care of themselves, there is charity. And free, rich countries have the most donations to charity. There would be more than enough to cover the people who were truly unable to care for themselves. And we would eliminate the moral hazard problem that occurs with government handouts and causes generations of people dependent on government.

[Mn_Mark]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

Alright, what do we do with retirees? Most of them cannot afford a new car let alone a week long hospital stay. If you are saying "just let them die" then do it. Don't be shy. But don't pretend that a solid majority of them will be able to do so, that's a fantasy I can't swallow.

First of all, if we had not gone down the path of government interference, the system today should have been at least as affordable as it was when my grandfather had his surgery and 12-day stay in the hospital in 1944 for a total of $1,000 cost, adjusted for inflation. By all rights, health care should have become much better for the same price by now, just as technology in other relatively "unfettered" areas like electronics did. So the vast majority of retirees should have been able to save for their old age and be able to pay for their own medical care, or have bought insurance policies to cover it like we do now for assisted living care in our old age. I can only point to the way the free market has made goods and services better and more affordable in other areas, and suggest that it would have been the same in health care.

The problem is that well-meaning people built this government/private hybrid health care industry monster over the last 70 years and now if it were to be summarily ended, people who suffer who made plans for their future based on the assumption that the government would care for them. So we would need some kind of phased transition away from government interference and back towards a freer system where more health care providers have an incentive to compete for customers and provide better service at a lower cost.

[Mn_Mark]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

What I am hoping for is a forcing of hospitals/doctors/pharmacies to publicly list their prices. How can price discovery happen if you can't find the prices?

We wouldn't need to "force" them to publicly list their prices if we got rid of the current system. They would have to advertise their prices because it would be a free market in health care services and they would be competing for customers, who would be paying out of their own pockets and thus would be very careful to get good value for their money.

I don't know exactly how we got into the current situation where people buy a health coverage policy and then the policy pays for everything without the patient needing to see the bill ahead of time. I believe it is related to the government tax decision back in the 1940s that said that health benefits provided by an employer would not be taxed as income to the employee. So the marketplace was warped so that the incentive was for employers to provide health care coverage, and we went on from there.

Get the government out of it. Get tax consequences out of it. Find out how to get more doctors graduated from more medical programs. Get more medical colleges so that there is competition among them to provide a quality medical education at a very affordable price, rather than hundreds of thousands of dollars. Limit how much a jury can award in a malpractice suit, so that malpractice insurance is not so astronomically expensive. Make it less regulatorily onerous and expensive to develop drugs so there are more companies competing to produce drugs. Phase out the government safety net so that people are forced to take responsibility for their own health rather than assuming the government is there to pay for the medical care if they need it. Let the truly needy rely on private charity and private charitable hospitals. Bill Gates and Warren Buffet can then donate their billions to take care of the truly needy Americans instead of other people around the world.

[Mn_Mark]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

True, but if the government institutes price controls similar to medicare,

if the profit-driven insurance companies are driven out of the equation,

if people don't need to spend so much money on health insurance and medical bills,

if people don't need to ignore health problems because they can't afford to get treatment (ultimately costing the system more money in the long run),

I think three things would happen:

1. Adults would be healthier and children would grow up healthier, which would boost productivity.

2. People would have more disposable income, which would boost the economy.

3. Businesses wouldn't have to spend money on insurance for employees, which should lead to an increase in hiring.

I'm not good at crunching numbers, but it seems the increase in productivity should offset the increase in government expenditure (tax dollars) caused by single payer (or whatever you call it) healthcare.

This would take the economy into an upward spiral, as opposed to the sinking death spiral that the healthcare industry is causing now.

It has taken a long time for this libertarian to come to this way of thinking. If the I in FIRE hadn't been so greedy it wouldn't have come to this, but as the middle class is destroyed by FIRE, the current healthcare system is unsustainable except for the wealthiest.

In countries like Ecuador and Colombia, people pay around $50/month for their healthcare, with minimal fees for services.

If "profit-driven" insurance companies (are there any other kind? is there any kind of business of any sort that is not 'profit-driven'?) are eliminated, and the government takes over, you may pay less for insurance - but pay a lot more in taxes.

The government does not do anything more efficiently than the private sector. There are a few goods that can only be provided by the government, by the nature of society - protection of property rights, defense, maybe roads (because of right-of-way issues). Everything else is more efficiently provided by the private sector because the private sector has the profit incentive to find ways to produce their goods and services more cheaply, so they can make more money. The government has no incentive to be efficient. It can force people to buy its services, regardless of whether they need them or whether they are a good deal. In addition, the people running the government have no incentive to do what they do more efficiently. You know how government agencies always make sure they spend all of their budgets before the end of the fiscal year? That's because if they don't, they get less money the next year. The incentives for a government administrator are: (1) never, ever actually solve the problem your agency was created to solve - if you do, you're out of a job; (2) each year, find a reason that you need an even bigger budget, with even more new employees - that means that as the administrator you have more power and can command a bigger salary yourself.

In government, all the incentives are in the wrong direction - and that doesn't even count actual government malfeasance like bribery and handing taxpayer monies over to cronies in lucrative contracts, etc, etc etc.

Do not kid yourself that the government nationalizing an industry means that that industry is going to make things more affordable for the average citizen. The government will raise taxes or debase the currency in order to offer that illusion that they are saving you money on health care. There are no free lunches.

[vt]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

What is not being spoken about in the health industry is the earnings of physicians and requirements.

I doubt most understand the time spent and cost of a medical education. After a bachelors degree heavy on sciences, the budding physician has to be accepted in medical school. Then 4 years in medical school with costs up to $200K at the best medical schools on top of what was already spent on the bachelors program.

After medical school there in internship and residency for 3 years for primary care doctors and 5 or more for specialties. The pay is about $45K in large cities. The hours are very long; at least 80 hours a week. So they are at least in their early 30's or older before they can start a practice or be hired at a hospital.

The primary care physician can be paid an average of $189K and specialists $400K. Before you think this is a lot look at the hours worked too.

http://www.forbes.com/sites/jacquely...for-doctors-2/

http://health.universityofcalifornia.edu/2011/07/15/work-hours-vary-widely-by-physician-specialty/

Also consider malpractice insurance costs:

http://medicaleconomics.modernmedici...miums-continue

While I'm not a doctor or in a health care profession I personally know a dozen doctors, including 3 in residency. They are extremely dedicated, smart, and work very long hours (including a lot of paperwork).

While physicians make decent incomes they do so in shortened career cycles, and some work beyond retirement age.
They have a much shorter time period to raise kids, save for retirement, and their taxes are high because of incomes.
They may not have education debt paid off for many years after graduation.

They may be the 1% based on income, but they earn it. Many do not make it close to the 1% in wealth.

[aaron]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

What is not being spoken about in the health industry is the earnings of physicians and requirements.

I doubt most understand the time spent and cost of a medical education. After a bachelors degree heavy on sciences, the budding physician has to be accepted in medical school. Then 4 years in medical school with costs up to $200K at the best medical schools on top of what was already spent on the bachelors program.

After medical school there in internship and residency for 3 years for primary care doctors and 5 or more for specialties. The pay is about $45K in large cities. The hours are very long; at least 80 hours a week. So they are at least in their early 30's or older before they can start a practice or be hired at a hospital.

The primary care physician can be paid an average of $189K and specialists $400K. Before you think this is a lot look at the hours worked too.

http://www.forbes.com/sites/jacquely...for-doctors-2/

http://health.universityofcalifornia.edu/2011/07/15/work-hours-vary-widely-by-physician-specialty/

Also consider malpractice insurance costs:

http://medicaleconomics.modernmedici...miums-continue

While I'm not a doctor or in a health care profession I personally know a dozen doctors, including 3 in residency. They are extremely dedicated, smart, and work very long hours (including a lot of paperwork).

While physicians make decent incomes they do so in shortened career cycles, and some work beyond retirement age.
They have a much shorter time period to raise kids, save for retirement, and their taxes are high because of incomes.
They may not have education debt paid off for many years after graduation.

They may be the 1% based on income, but they earn it. Many do not make it close to the 1% in wealth.

Yeah, the physician earnings is a distraction. Doctors have always been paid well, but less than they are worth. That has not changed in 50 years.

[Mn_Mark]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

A glimpse at what we have to look forward to when Obamacare finishes off the existing health care market and we get "single payer" like the Left has wanted all along. Or when a Hugo Chavez Bill DeBlasio type gets elected President and appoints more DeBlasio types to the Supreme Court:

Doctors Say Venezuela's Health Care System In Collapse

MARACAY, Venezuela (AP) -- Evelina Gonzalez was supposed to undergo cancer surgery in July following chemotherapy but wound up shuttling from hospital to hospital in search of an available operating table. On the crest of her left breast, a mocha-colored tumor doubled in size and now bulges through her white spandex tank top.
Gonzalez is on a list of 31 breast cancer patients waiting to have tumors removed at one of Venezuela's biggest medical facilities, Maracay's Central Hospital. But like legions of the sick across the country, she's been neglected by a health care system doctors say is collapsing after years of deterioration.
Doctors at the hospital sent home 300 cancer patients last month when supply shortages and overtaxed equipment made it impossible for them to perform non-emergency surgeries.
Driving the crisis in health care are the same forces that have left Venezuelans scrambling to find toilet paper, milk and automobile parts. Economists blame government mismanagement and currency controls set by the late President Hugo Chavez for inflation pushing 50 percent annually. The government controls the dollars needed to buy medical supplies and has simply not made enough available.

...

Doctors not allied with the government say many patients began dying from easily treatable illnesses when Venezuela's downward economic slide accelerated after Chavez's death from cancer in March. Doctors say it's impossible to know how many have died, and the government doesn't keep such numbers, just as it hasn't published health statistics since 2010.


Almost everything needed to mend and heal is in critically short supply: needles, syringes and paraffin used in biopsies to diagnose cancer; drugs to treat it; operating room equipment; X-ray film and imaging paper; blood and the reagents needed so it can be used for transfusions.

...

The country's 1999 constitution guarantees free universal health care to Venezuelans, who sit on the world's largest proven oil reserves. President Nicolas Maduro's government insists it's complying. Yet of the country's 100 fully functioning public hospitals, nine in 10 have just 7 percent of the supplies they need, Natera said.

...

The woes are not restricted to the public system.
Venezuela's 400 private hospitals and clinics are overburdened and strapped for supplies, 95 percent of which must be imported, said Dr. Carlos Rosales, president of the association that represents them.
The private system has just 8,000 of the country's more than 50,000 hospital beds but treats 53 percent of the country's patients, including the 10 million public employees with health insurance. Rosales said insurers, many state-owned, are four to six months behind in payments and it is nearly impossible to meet payrolls and pay suppliers.
Worse, government price caps set in July for common procedures are impossible to meet, Rosales said. For example, dialysis treatment was set at 200 bolivars ($30 at the official exchange rate and less than $4 on the black market) for a procedure that costs 5,000 bolivars to administer.
"The health care crisis is an economic crisis. It is not a medical crisis," said Dr. Jose Luis Lopez, who oversees labs at the Municipal Blood Bank of Caracas.

...

Medical students quietly showed AP journalists around to avoid alerting government supporters, who bar reporters from recording images in public hospitals. Broken anesthesia machines and battered stainless-steel instrument tables, some held together with tape, filled one of five idled operating rooms. Foul odors and water from leaky pipes continue to seep into the rooms, doctors said.
In August, cancer patients protested at the eight-month mark since the hospital's two radiotherapy machines broke down. The machines remain out of order.
Half the public health system's doctors quit under Chavez, and half of those moved abroad, Natera said.

[Penguin]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

It's took me about 100 posts to start recognizing it but by 200 I understood it to be a reality. Most ideas here have to scale a "Great Center Right Wall" lovingly built and guarded by a small number of regular posters out of a 50K+ membership.

So from that perspective, "Producers" generally refers only to entrepreneurs, business owners/managers, accredited investors and anyone else who needs a hard distinction between themselves and people whose productivity is based primarily on physical and (limited forms of) intellectual labor.

I've seen the same thing. I remember after Romney's gaffe about the number of people who get a lot and contribute nothing there was an outcry about how correct he was. On another forum I admitted that I agreed wholeheartedly with Mr Romney about the country being overrun with parasites but that we differed entirely on who fit that definition. To my way of looking at things he epitomizes the group that has added almost nothing to our bottom line but gotten rich doing so. That type of capitalism is extractive and adds nothing to society's betterment.

It amazes me when I hear right leaning economists and politicos fantasize about returning to an age where we had "real" capitalism. But the time frame they mention most times was one in which we did practically everything wrong according to their world view. We busted up monopolies. We were fairly protectionist. We had finance on a very short leash. Our immigration laws were considered draconian. We had many large government run utilities. We had tax rates that encouraged actual production over investment. Labor, as a whole, had far more sway at the ballot box and at pay time. It is amazing.

And we had a middle class. A big one.

Of course I agree with them that government has stepped into the void left after reversing all of these "mistakes". What did they expect? I have said time and again that I believe that in this day and age no one should be granted a college degree without first passing a Thermodynamics class. A real one that starts at first principles. So many of our problems today stem from a gross misunderstanding of how the world really works. There are so many lessons that this subject has to give us. So many analogies that can help get a grasp of subject matter far afield from thermodynamics proper.

One of these is path dependence.

There are instances (many of them in fact) in which a system can be modeled and some fairly accurate predictions garnered where only the end points at equilibrium need be considered. You can start with a mixture at a certain equilibrium state and end with a different mixture at a different equilibrium state and make a damned good estimate of energy release, product composition and what not. But then there are other systems and processes for which this just plain won't work. Some products that just cannot be modeled accurately without taking into consideration what path the process went through to get to the end state. You take a different path? You get a different result.

There is a big lesson in my humble opinion for the US in all of this. We have forgotten our roots. We've discarded the lessons our predecessors learned the hard way. In some cases we've forgotten that administering the same formula to a different beginning state can radically alter the end result. In others we are repeating policy mistakes from decades earlier and expecting the system to produce different results. And pretend to be shocked when we get the utterly predictable and disastrous results we did the last time.

Will

[Woodsman]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

A glimpse at what we have to look forward to when Obamacare finishes off the existing health care market and we get "single payer" like the Left has wanted all along. Or when a Hugo Chavez Bill DeBlasio type gets elected President and appoints more DeBlasio types to the Supreme Court...

The United States of America is not Venezuela. The Democratic Party is not the United Socialist Party of Venezuela. Neither Obama nor Deblasio are Hugo Chavez. You conflate them and make no meaningful distinction among them. Is it because you really believe there is none? Is there some other reason?

[Mn_Mark]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

The United States of America is not Venezuela. The Democratic Party is not the United Socialist Party of Venezuela. Neither Obama nor Deblasio are Hugo Chavez. You conflate them and make no meaningful distinction among them. Is it because you really believe there is none? Is there some other reason?

I believe that supporters of the Democratic Party like you (I presume) and friends and family of mine that vote Democratic genuinely do not want to live in a Chavez-style socialist economy. (Maybe DeBlasio and those on the progressive left do.) I think what they want to do is live in a Scandinavian-style "social democracy" - i.e., ample amounts of socialism to provide all the "free" "entitlements" that they think people ought to have, but not to the tipping point where things go down the drain Cuba-, Venezuela-, or USSR-style. They think there's a nice broad gap between the "fettering" they want to see done to the free market, and the socialism of a Chavez.

I think they are mistaken in several ways. They think they can import a significant amount of Latin America's population without making the U.S. into Latin America. It's not 20 million illegal Norwegians and Danes and Germans who are trying to get citizenship here. They think they can take over the health care system, turn it into a "single payer" system (that terminology really irritates me - it's socialism, but they aren't honest enough to just own the terminology), a sort of "socialism with American characteristics", and that it will improve things instead of making them worse. And all along, as things get worse and worse, they will make two arguments: (1) we just need to raise taxes a little more, spend a little more money, tweak the system a little more, take away a little more freedom, compel a little more of the "right" kind of behavior, and we'll get this socialist system of ours to work better, and (2) if it's getting worse, it's the fault of the conservatives who are demoralizing people and preventing us from making those last few tweaks and that additional little bit of spending and that little bit less individual freedom that would make it all work.

[Mn_Mark]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

The United States of America is not Venezuela. The Democratic Party is not the United Socialist Party of Venezuela. Neither Obama nor Deblasio are Hugo Chavez. You conflate them and make no meaningful distinction among them. Is it because you really believe there is none? Is there some other reason?

One more thought on this.

The Democrats aren't the United Socialist Party of Venezuela yet. (Though it would be an interesting exercise to compare the policy prescriptions of a DeBlasio and Chavez.)

But I think this is what we have to look forward to: because the country's demography has been changed by the Democrats via immigration law changes and amnesties and lack of enforcement of immigration laws, the country is on track to become majority non-white in the next couple decades. (I think this change will begin to occur faster and faster as non-whites elect non-white politicians like Obama who throw the door open to even more non-whites, who pass even more liberal immigration laws, etc.) The non-whites vote for Leftist politicians. Even Asians - the hardest-working ethnic group - voted 75% for Obama. This means that the general trend of the electorate is becoming more and more leftwing as time passes.

Right-wing whites like myself will become disillusioned, seeing that the ballot box has effectively been stuffed by the opposition and that we are to be dispossessed and nothing can be done about it through the political system. So we stop voting. There's no point voting in a rigged election.

Thus the conservative portion of the white population (and the few non-white conservatives) will stop voting, exacerbating the Republican party's problem at winning elections in a leftward-moving America. So the Republicans will move leftward (towards the "center", which has shifted leftward) to remain competitive. At the same time, the growing electoral dominance of the Democratic party will allow it to move more extremely in a leftward direction, as the majority of its non-white and progressive-white supporters want it to do.

The Republicans will become the center-left party, the Democrats will become the extreme-left party, and right-wing people like me will not look at the political system as a viable means of protecting their interests. (In a winner-take-all system like the US, only two parties ever have a chance.)

So while the Democratic Party is not yet the United Socialist Party of Venezuela, it will be.