You ’08 – Health Care Debate

Next up, health care. This is far from a new issue, but it has come into focus this year with the quorum of democratic candidates pushing openly for various flavors of “universal” health insurance, and republicans staunchly against anything with the stench of government-run health care.

Like trade, there are a range of plans from our candidates here. As a start, I’d like to ask all of you — no matter where on the spectrum you are — two direct questions:

  • Do you believe that the goal should be to cover every American or are you willing to accept a system that allows some to be uninsured? The unemployed who can’t afford it? The very poor without employer insurance? Where do you draw the line on who should be left uninsured and why?
  • Whether you favor free-market insurance, government-run insurance, or a mix; how do you believe your preferred solution best serves the interests of the public?

87 Responses to “You ’08 – Health Care Debate”

  1. ymatt Says:

    I’ll answer my own questions here, if for no other reason that I’m guessing my opinions on this particular topic are probably fairly extreme:

    I believe the goal should be absolute, no-exceptions, 100% coverage of all Americans. To me, it is unacceptable that a modern nation should make their citizens gamble on their own health. Modern health care simply is not accessible if you are not insured, and making sure that all Americans will have their health cared for through their lives — not just immediate life-saving treatment — must be ensured as a total society, just as police, firefighting and other vital shared services are.

    As such, I favor universal, “free” government-run insurance. Certainly if individuals want to purchase additional, market-provided insurance, that is their prerogative. But I even believe that Clinton’s and Obama’s proposals do not go far enough, in that they still force poor individuals to choose to “buy” health coverage and many simply do not have enough income where they can make that choice. Of course offering this will require spreading a large tax burden across all citizens, in the same gradation as our taxes already are, but insurance is already a burden we’re having to pay for. But today it is a burden that is much more difficult for the poor to bear. That is not acceptable.

    Does America have some of the best health care technology and providers in the world due to our free-market system? Yes. But offering exceptionally good service to some individuals while losing “unprofitable” coverage for the poor is not acceptable. This is one of the few areas in which I do not believe the free market naturally optimizes toward the right goal.

  2. shcb Says:

    Once a society decides it no longer wants to see people die on the street because they are sick and can’t afford medical care the government will be involved in health care. We should be clear that we have universal health care now, no one is turned down for treatment in any hospital in this country. The problem is who pays for it; in the end all the people who are responsible enough to have insurance (usually through their employment) pay for those that aren’t so responsible through higher medical costs.

    In these discussions someone will bring up the statistic that 40 or 50 million Americans are without insurance. This is one of the most manipulated statistics out there; this is the number of people that are without insurance for even one day, usually because they are between jobs. The other large percentage of this statistic are young people, who forgo insurance premiums so they have more money for fun things. In reality there are between one and five million chronically uninsured, mostly due to preexisting conditions. I don’t have a problem creating a system to pay their medical expenses.

    The best solution to most of these problems seems to be Medical Savings Accounts. With an MSA a savings account is built up for an individual by that individual. Then a catastrophic insurance policy is purchased with a high deductable, usually 1 to 2 thousand dollars or higher, the higher the deductable the lower the monthly cost. Minor or routine visits to the doctor are paid out of the MSA account with a debit card. This keeps supply and demand in balance and greatly reduces insurance claims at the doctor’s office, lowering cost of the lowest level of medicine, but the most important part, preventative care. The poor would use this same system but the government would somehow pay their bill, haven’t quite worked that part out in my head yet, but we would somehow get them out of the emergency rooms for a runny nose. At some point most of the poor will transition out of their situation to being productive citizens, perhaps at that time some of their MSA contribution could be used to pay back society, just a thought.

    This is where the government comes in, since many people aren’t responsible enough to provide for their own MSA the government would need to withhold from their wages enough to build and maintain a minimum balance in the account, and of course they can contribute more if they wish. Now this money is the property of the individual, it can be left to your estate, money above the minimum can be used for emergencies, there is ownership involved, one of the hallmarks of America.

    To go along with MSAs we should do away with employer provided insurance. This should be an individual’s responsibility just like auto insurance. The system we use now is a remnant of price and wage control of WW II and is way out dated. Since we have provided ownership of your healthcare, it is only fair that you be allowed to spend it as you wish.

    Strict socialized medicine naturally provides poorer service at a higher cost, and basic care with additional insurance paid for by individuals like they do in Britain just gives you the worst of both worlds and you end up with a medical system that resembles our educational system.

  3. ymatt Says:

    shcb,

    Although you have an interesting idea, I don’t see how it adds coverage for anybody. You failed to directly answer my question about who should and shouldn’t be covered — but it seems your answer is that only those who are employed or have enough money should be covered.

    To address some specific points:

    We should be clear that we have universal health care now, no one is turned down for treatment in any hospital in this country.

    Perhaps theoretically true for life-saving care, which is far from meeting the challenge of taking care of our citizens. And even then, I believe there are many cases where the uninsured are pushed off from hospital to hospital, or treated poorly.

    In these discussions someone will bring up the statistic that 40 or 50 million Americans are without insurance. This is one of the most manipulated statistics out there; this is the number of people that are without insurance for even one day, usually because they are between jobs.

    And those people don’t matter? Even I, with an engineering degree, have been in a situation where I was “between jobs” for about 6 months. I opted to simply not have insurance during that period because I simply didn’t have the money at that time. This is my point: American citizens aren’t only worth taking care of when they have jobs. What about those who can’t find jobs? What about their children? What about the elderly without pensions? All of these people either have no coverage or may end up with poorer coverage just by virtue of not being able to pay enough.

    The best solution to most of these problems seems to be Medical Savings Accounts. With an MSA a savings account is built up for an individual by that individual. Then a catastrophic insurance policy is purchased with a high deductable, usually 1 to 2 thousand dollars or higher, the higher the deductable the lower the monthly cost.

    You are still pushing the cost burden onto those who can’t afford it because it is still essentially either a fixed cost per person, regardless of income, or more likely there will be gradations of better or worse coverage. Unacceptable.

    Strict socialized medicine naturally provides poorer service at a higher cost

    I agree with you. The problem is that the free market naturally focuses on services that are the most profitable, which means those who can pay more for it. It reminds me of a bit in The Onion about a libertarian reluctantly accepting help from a firefighter when his house was burning down. Some people (I know not you) believe that the free market would provide more effective firefighting service. They are probably right, but the point is that we need to have equal services available to all Americans because more often than not, fires are out of our control. The same is true of illness or injury, and we need to treat healthcare in the same way.

    I don’t know why you and others continue to point at the social systems in other countries as failures. The people I’ve talked to in Canada and elsewhere like their system, and I’ve seen it work. I’ve even had to use it myself. I don’t know what you’re so afraid of.

  4. knarlyknight Says:

    There are turning points in people’s lives. Someone who suffers due to being refused necessary medical services is a point that can turn that person, and their family and friends, against the “system.”

    If a society won’t care properly for its most vulnerable citizens, or even the temporarily uninsured, then those people will get the message that society does not think they matter. That will contribute to their having a “take whatever I can take” mentality, including crime, because why should they care about others if no-one cares about them?

    The fantastic medical treatment I’ve received since childhood in Canada – from reconstructive plastic surgery after a traffic accident crushed my face to all sorts of miscellaneous elective procedures, and even for what many will consider frivolous, all at no direct cost to me – has made a huge difference in my attitude. I am very grateful to this country and ever the more willing to give back to it so that others can experience the *care* that I have received.

    I recall a conversation I had with a local in Hawaii when I was a teenager, he was chronically coughing and couldn’t afford to get treatment which was a bizarre concept for me at the time, but what astounded me and what made the memory stick with me all these years is how angry he was that they would not help him with his health considering all the riches of America.

    For an outside observer, the American health care debate is simply pathetic.

  5. ymatt Says:

    Well said.

  6. shcb Says:

    Matt, everyone should be covered, is that possible? probably not but certainly most should. MSA’s would naturally cover you and I when we are between jobs because the insurance is ours not our employer’s. The buffer is already there to handle the deductable part for those few months we are between jobs and if you have more in your account than the minimum you can use that money to pay the catastrophic premium, this is a couple hundred a month I believe. The poor would have their premium paid by taxpayers as well as their office visits. They would be sent to doctors willing to work at a reduced rate, mostly medical students and interns I would think, the care would be substandard and the waits long just like any other socialized medicine. The people who choose not to be covered now would be covered because their MSA would be held at a minimum level by withholdings. So as to not be too much of a burden I would use the money being withheld for Medicare to pay these withholdings on young workers. One of the difficulties is how to transition new or young workers into the system, but that can be solved. So we have covered the vast majority of people. There will be a few at the margins, bums, illegal aliens, those that choose to live off the grid and such that we will have to take care of the old fashion way, treat them in the emergency room and send them on their way.

    There will always be better or worse care, even in your system, which you seem to be modeling after the Brits has a basic level paid by government and a higher level if you pay for extra insurance. There is nothing wrong with that, it is incentive to work harder. Someone is going to pay for every penny spent on healthcare in any system, I would just prefer the people who want to have control over their lives and are responsible enough, have the option to tailor their healthcare to fit their current lifestyle throughout their lives. Other than that our systems are not that different, I am willing to concede some will not be covered, but not many, and they will all still get care.

    One last thing, the Canadian system, bear in mind that it uses the US system as a safety net and is subsidized by the US system to a certain degree, especially in regards to pharmaceuticals. Using a more standalone system like Britain’s is probably a more appropriate comparison. You Canadians, don’t get your knickers in a bunch, you have always been good friends and trusted allies, we don’t mind helping a bit.

    Your, right, I’m not libertarian, although I agree with a lot of their concepts, they just aren’t very workable in a practical way. The reason I don’t like the single payer concept is that it destroys supply and demand and stifles the creative aspect of greed. (that last sentence was my Christmas gift to you liberals, have fun with it :-)

    Merry Christmas to all,

    Rick (aka shcb) and family

  7. ymatt Says:

    The poor would have their premium paid by taxpayers as well as their office visits. They would be sent to doctors willing to work at a reduced rate, mostly medical students and interns I would think, the care would be substandard and the waits long just like any other socialized medicine.

    This is so funny, I have trouble even bothering with the rest.

    One last thing, the Canadian system, bear in mind that it uses the US system as a safety net and is subsidized by the US system to a certain degree, especially in regards to pharmaceuticals.

    I’ll let knarly tear into that one, but I’ll just say “give me a break”.

    The reason I don’t like the single payer concept is that it destroys supply and demand and stifles the creative aspect of greed.

    I completely believe in the creative aspect of greed. But be careful in kneeling at the altar of the free market to solve all problems. Why don’t you believe in privatizing firefighting? After all, you could ensure basic firefighting to everyone at lower cost, and let those with good jobs pay for insurance coverage that would pay for more complete, rapid-response firefighting. Imagine the advanced firefighting technology that would be incentivized!

  8. knarlyknight Says:

    Thanks. But might have overstated the fantastic Canadian health system, some relatives had waits to start their cancer treatment – in a perfect world they would have been treated immediately. Also, we seem to be morphing into a sort of two tier system (those with money get premium consideratinos) but the base level is still good.

  9. knarlyknight Says:

    USA as a safety net for Canadian health care? That’s a new one to me, maybe NL knows the other side of that story.

    What I do know is that the plastic surgeon who did my face later moved to the USA to triple (?) his income and live in a warm climate; *some* Canadians (i.e those who live in $1,000,000 homes) sometimes get medical treatment at private centres abroad; and, our government plans are funded federally but administered by the provinces, in (most? all?) provinces there are provisions to be transported to another province (or to the US) if for a critical need a required treatment is not available in the province when a person living in that province needs it.

    Privatize firefighting? That’s being done in California, owners of multi million dollar homes in Malibu have firefighting contractors to stay and protect their houses while those around them burn. I got no problem with that, as long as it doesn’t take ANYTHING away from the public firefighting effort.

    Here’s another example, why not privatize the army!!! And then when these private “security” firms have experience controlling mobs in other countries for salaries triple what army grunts earn for the same work, the goons can come back to America and do the same work whenever the “executive” in the White House asks. Oh, wait, you’re doing that already, with predictable results. Do you think that Blackwater might be asked to assist in keeping order when mobs go to polling stations to vote for Ron Paul in the 2008 elections? ;-)

  10. knarlyknight Says:

    Merry Christmas

  11. shcb Says:

    Thanks for that Knarly, Matt I’ll just address your last remark since I promised my wife I would paint the bedroom this afternoon, I will get to some of the other points later if you want.

    The reason I don’t mind some things government does that could be privatized is simply convenience, I don’t want to stop every two miles at a toll booth like we did in China, I don’t want write a check to my fire protection company every month. Especially since fire protection is something most people never need, but is so essential if you do. Some things make sense to privatize and some don’t. In Colorado, and I assume other places, minor road maintenance is handled by government employees and major jobs are bid on by private contractors, that makes sense. We don’t want to go through a bid process for a pot hole, but private enterprise is more efficient on the large jobs.

    In my plan government still mandates everyone has coverage, that coverage is simply supplied by the private sector. The unique aspect is ownership. Think about it, with socialized medicine, sure you just go to the doctor, knowing your bill was paid by your taxes, but with mine you have the ability to pay a little extra when you are young, let that money grow, pay more while your kids are young because you have more people in your policy and later in life when you don’t need so much coverage use some of that money to help the kids with college. If god forbid you were killed in a traffic accident, your next of kin could have that money you saved to start their own MSA’s or use it for whatever. What do you get in either situation with socialized care?

    If all you want is basic care, in my system just don’t contribute more than the minimum. For the poor, we as taxpayers will always take care of them, we are compassionate, we just need to make it more cost effective than it is now.

    I would consider someone making $9.00 an hour working poor, if we used the Medicare portion of their taxes, I believe that is 3.6% with employee match, they would have $2000 built up in just 3 years, their deductable. So if we said the minimum level is $4000 they would be vested in 6 years. After that they could use that 3.6% minus their deductibles, plus interest however they want for the rest of their lives. And have full coverage and the choice to go to the best or worst doctors they want depending on their current situation. And we’re still talking about the guy making $9.00, what empowerment that is.

  12. shcb Says:

    By the way, the same would apply to the guy making $120k

  13. shcb Says:

    Canadian healthcare:

    When I say we subsidize the Canadian healthcare system or that we are the safety net I don’t mean we send billions of dollars north to prop up a failing system, the Canadian system is fine but it would not be as healthy as it is without even higher taxes on Canadians without the US. As you said, if there is something doctors don’t have up there they can send patients south, and we don’t mind, we get the money. But without the incentives of the free market we wouldn’t have those resources and neither would Canadians.

    The real subsidy is the pharmaceutical industry.

    I’ve written about this before but some of you may not have read it. Here is how the scam works; every country has a clause or law that allows them to ignore patent rights if there is an emergency of vital national importance. This is usually used in time of war but it can also be use in time of peace. Say country A has developed a vaccine for AIDs and country B needs it because 30 percent of the population is infected. But country A doesn’t want to sell it to B because B refuses to institute minimum wage legislation that would bring its citizens to the level of A. Wages at this level would decimate B’s economy. So B declares a humanitarian emergency and produces the vaccine itself.

    A company develops a new drug, the cost of manufacturing and distributing the drug is $.60 per dose, the cost of the drug with past, present and future R&D makes the market price $3.00. Canada the customer goes to the company and says it needs to control costs and doesn’t want to pay $3.00, it will only pay $1.50 or Canada the government will declare an emergency and allow a Canadian company to produce the drug and charge Canada the customer $1.20. The American company has no choice but to sell the drug at a loss or lose the sale completely so it passes on the loss to the larger American customer base at $3.25. Hence we are subsidizing the Canadians.

    This is why we can’t allow the lower priced drugs back into this country, that would cause a downward spiral that would end in either the Canadians respecting our patents (possibly destroying the Canadian health system) or R&D to diminish to a trickle. This is also why government and private sectors shouldn’t merge. In this case the US Government can’t pressure the Canadian government to force the Canadian company to abide by international patents because the Canadian company is the Canadian government.

  14. knarlyknight Says:

    Who in shcb’s household left the liquor cabinet unlocked? It’s okay shcb, I don’t think the Canadian health system is going to get destroyed as long as we continue to contribute to it and as long as public opinion here continues to reject further Americanizations of Cdn medical care. As for US drug patents, I haven’t folllowed the issue too closely of late but I recall that about 15 or 20 years ago our countries came to a relatively amicable agreement as to how much of the pill mark-ups are actually attributable to R&D and how much is attributable to pharmaceutical executive bonuses and stock options and other silly costs such as excessive advertising … apparently you have heard a different story perhaps from some representatives of the hard done by mega/multi corporate pharmaceutical lobby. Sad how the obscenely wealthy are always able to get their tales of woe and hardship into the media so that sods like you and me can empathize with their financial pain.

    In any event, I understand that Canada has a healthy medical R&D record, in both past and present advancements (or am I just a sucker like you for my government’s propaganda?)

  15. shcb Says:

    That’s about it, same story, different storyteller. Funny how you can make your country telling my country how to regulate a private company so the socialist mold fits sound so valiant. But in the long run they skirted international law you are so fond of and the pill cost $1.50 in Canada and $3.25 here, and I pay for your drugs.

    Oh, Jayson, this is what happens using your economic model of government and private industry partnership.

  16. knarlyknight Says:

    Canada is far from being a socialist state, well at least compared to international standards. $1.50 vs $3.25 ??? I don’t think that is accurate, are you exaggerating?

  17. shcb Says:

    It’s just an example but I think that is about the disparity I have heard, of course that is just for drugs that are still under patent. Generic and over the counter are comparable in price because anyone can make them. With some drugs the difference may be considerably greater. It’s really quite criminal. But the real danger to progress comes with people like John McCain wanting to open the American market to allowing Americans to purchase these cheap drugs from Canada. If that happens the millions or billions it takes for R&D dries up and medical science grinds to a halt, or we pay for it with taxes and let the least efficient aspect of our lives, government, do the development.

  18. knarlyknight Says:

    Let’s think about that last sentence a little. It’s not like the politicians are doing the health research when it is publically funded R&D, the scientists still do the work. So it’s not that inefficient. Now when the private sector funds the research, their activities will be focused strictly on what brings the biggest rate of return on their investments, hence you can expect tremendous viagra type advancments etc. and not necessarily new cures for tropical diseases in poor countries.

    You might be interested in this recent article (short) on R&D for medical research systems, the R&D discussed is to accelerate the Discovery & Development side of R&D to gain greater bang for the R&D buck. Despite your dogma shcb, I believe that talented groups of people working in cooperation with other groups in a supportive and motivating environment are more productive than a bunch of people in teams working competitively with each other for the almighty dollar. In the former you have many winners going forward, in the latter there are only a few winners and a lot of big losers dropping out of the game.

  19. knarlyknight Says:

    The Wow Factor:

    http://www.theglobeandmail.com/servlet/story/RTGAM.20071220.wnationbernstein26/BNStory/National/home

  20. knarlyknight Says:

    And some further detail on the same topic:

    We must rethink our view of productivity and competitiveness. Productivity today is not about lowering the unit costs of manufacturing picture-tube TVs, it’s about inventing better flat-screen technologies. Productivity today is not about lowering the unit production costs of bovine insulin; it’s about recombinant DNA technology to produce human insulin in bacteria.

    Productivity is about the invention and system-wide application of ideas and technologies that will speed up and improve health delivery.

    The process of discovery is, itself, transforming the nature of competition. In a resource-based economy, scarcity drives up price. In a knowledge economy, the opposite applies – for example, software’s value goes up the more it is shared.

    Unlike oil or capital equipment, knowledge isn’t used up, worn out or consumed. The more you use knowledge and new ideas, the more valuable they become.

    Often, ideas or intellectual properties generated in one company or one university acquire value only when combined with those from another company or university. Companies, universities and countries must therefore collaborate: Synergies and complementarities can only come by merging ideas, creating …

    From Bernstein’s May 2007 article, http://www.theglobeandmail.com/servlet/story/RTGAM.20070523.wcoresearch23/BNStory/National

  21. shcb Says:

    That’s encouraging, he has developed a network of small entities that are encouraged to share ideas and share the spoils of their efforts for the common good, in America we call that a corporation. I’m not saying government can’t do good work, that government is not needed or not useful, it is just not efficient. If we are spending too much time on Viagra and not enough on something else, it is appropriate for government to push the industry a little with grants or tax incentives.

    You notice while he is downplaying competitiveness, he is competing with the private sector. Even Schumpeter acknowledged that a monopoly can act as a non monopoly if it is in fear of losing that status. Your nationalized health care is in competition with our private sector, if we are nationalized, that level of competition will be lost, will it be the end of civilization as we know it? No, but progress will lose a step, a big step. What you regulate you get less of. I counted comments to this site for a couple weeks before Matt started deleting things, after his deletions comments dropped by 50%, they rose to something less than pre deletion levels, and then dropped steeply after he deleted your comment a week or two ago. Now some of that is just the normal ebb and flow but a graph shows a significant drop on those days immediately following deletions. This is the danger of government intrusion, sometimes it is required, but you have to be willing to take the downside.

  22. ethan-p Says:

    If that happens the millions or billions it takes for R&D dries up and medical science grinds to a halt, or we pay for it with taxes and let the least efficient aspect of our lives, government, do the development.

    SHCB, I agree with you in spirit…however, the fact of the matter is that in the US, our drug companies spending quite a bit of their development budget on marketing. The libertarian in me says that it’s great, because the high profits from erection-drugs can go directly into more important life-saving drugs. That same libertarian in me says that it’s great that I’ll at least be physically able to have sex when I’m 80 — as sexual health is important to general health.

    When I take my libertarian hat off, I’m disgusted that so much is spent on marketing these drugs, and that drug patents last so long before generics are available. I’m not sure how much of the difference in cost between Canadian and American drug sales are attributable to marketing, but I’m sure that it’s a big number. That industry is ripe for some better regulation.

    With regards to the greater conversation…I’m torn on the issue. While I do believe that our market-based system has produced some of the most amazing and beneficial procedures that the world has ever seen — our current medical system turns it’s proverbial back on quite a few Americans.

    Sure, people usually aren’t refused emergency care in America, but we have many poor people who use the ER as their primary care. This is the most costly care available, and these costs can be exacerbated by the fact that by the time an ambulatory illness makes it to the ER, complications may occur, further increasing costs.

    On the other hand, I work in the healthcare industry. My company often bails governments out of healthcare snafus. I don’t trust the government for too much these days – why would I want to put my health care into the hands of these fucktards? Are there any proposals for making government insurance accountable? Does anyone believe that the federal government can be more accountable than a private insurer? How?

    Any ideas on what universal healthcare will do to our marginal tax rates? This was a bit that Michael Moore conveniently glossed over in Sicko, which sort of bugged me. (“Nono, we’ve got money in France! Our taxes are fine!” …so — why not mention the marginal tax rate in France then?) I honestly don’t know exactly what it would do to my taxes, but I do believe that the bigger a government program, the less efficient it can be — and this is a huge program. Since it’s socialized, there is no bottom-line to protect.

    I’ve also got a friend who was waving the universal healthcare flag until she lived in the UK for a few years. She wound up in a UK hospital, and told me that she vastly prefers our system — acknowledging that lots of people lose out, but when care is available, it is vastly superior with less waiting (and no quotas).

    So, once again — I have no freaking idea where I stand. Our healthcare system is certainly not well, but I don’t know what the right solution is. Universal healthcare is a great idea, but I don’t trust our government to get it right any more than I trust them to get social security right (or wars on non-proper nouns for that matter). Perhaps we should start with some real regulation of drug and insurance companies. The way I see it, insurance companies have the best chance of successfully implementing/running universal healthcare plans, but that won’t work until we can make the current system fairer and more effective.

  23. shcb Says:

    I’m working today so I’ll make this short, and respond more tonight. I think the MSA approach I’ve outlined is a good start and a good compromise of government and private sector. There probably is no perfect system. Even in MSA’s I concede there will be a point on the economic ladder that we will have to provide care as a socialized system, I just don’t want that for everyone. There should be quite a lot on MSA’s out there if you want to read more about them and not just take my spin which is just a regurgitation of what I have heard on Rosen’s shows over the years. There have been test programs run for the last few years and no one I have heard that was involved with them has not liked it. They have been restricted to small business owners so far so it is a self selected group that is more responsible than the general population and has the most to gain from this type of program, so put whatever you hear about MSA’s through that filter.

  24. shcb Says:

    Ethan,

    There are tradeoffs in almost every aspect of life, even love at first sight. Drug companies spend quite a bit of their total budget on marketing. Any business has to make decisions on where best to spend their limited resources. This is of course the reason private enterprise is more efficient than government, they have more limited resources so they use them more wisely. In comparison to others some companies spend more on advertising, some more on labor, some more on travel etc. When I had my small machine shop I spent almost nothing on advertising because my business was derived entirely by word of mouth, no one is going to buy an automated manufacturing system from an add in the newspaper. My neighbors had a duct cleaning business, they spent every available penny on advertising because you only need to have your ducts cleaned every few years and so repeat customers weren’t enough. I’m not that fond of seeing ED commercials every five minutes, but if that is what it takes to fund more important projects so be it. I don’t mind that a bunch of vain bitches had a half dozen face lifts so doctors could develop techniques to restore some poor kids birth deformed face.

    It doesn’t matter what the difference between the advertising in Canada and the US is because the companies are loosing at the very least opportunity costs, so there is no reason to advertise there. Kind of like the convenience store owner that puts up the “only 5 students allowed at one time sign” he has made the decision that the loss of revenue from a few of his customers is outweighed by the loss from shoplifting.

    Our system isn’t broken, the vast majority of Americans are taken care of quite nicely by our current system. Can it be better, of course, but we shouldn’t throw out the baby with the bathwater. Everything can be improved, largely because advancements in other areas make improvements feasible where once they weren’t. My MSA plan for instance, not too many years ago it would have been a nightmare just to administer whether an individual is at his minimum or not, now in this information age an employer can check the level online even if the employee has more than one job. This will be more work for the employer, but he won’t have to deal with insurance policies any more so it should even out. I don’t even care if an employee/employer have the choice between an MSA and a traditional system as long as most people are covered.

    The poor will have to be paid for by taxpayers to get them out of the emergency rooms. We are now anyway since the taxpayers are for the most part the folks that have insurance, we either pay here or there. But it will be cheaper to pay at the doctor’s office than the emergency rooms. But it should be done in such a way that it is advantageous to the individual to get out of that program.

    We should be a world leader in this area, not a follower, we have a unique laboratory in that we have 50 states that are as varied as they are. There is no reason that we can’t show Canada and the rest of the world that this kind of system can work no matter what the level of socialism the populace is comfortable with by simply changing the percentages a bit. If the rugged individualists in Wyoming and Montana want to cap the taxpayer funded poor at the lowest 5%, and New York at 30% so be it. Same with Norway and Chile.

    As to your question of what universal health care will do to our tax rates, according to the World Health Organization the United States has the highest percentage of GDP spent on health care of the top 50 industrialized countries by a bunch. We spend 15.2% and the next closest, Germany spends 11.1%. I don’t know if those are apples to apples numbers, they came from the World Almanac. I doubt that would change much, we would simply be paying tax monies that we are now applying to premiums, I think what you would see is much less value in service and medical advances, less bang for your buck. And of course the rest of the world would suffer as well. Much as we spend the most on our military to protect at least in part most of the free world, we also provide the lion’s share of medical development. That is the cost of living in the most productive and generous nation on earth.

  25. kalmquist Says:

    shcb,

    As far as I can tell from searching the internet, the idea that Canada obtains lower drug prices by threatening to violate drug companys’ patent rights is a myth that was started by a press release from Dennis Hastert.

    Drug companies charge different prices to different customers. Two major factors that affect the price is the volume of the purchase and the willingness of the customer to forgo the purchase.

    The second factor explains why large drugstore chains in the United States don’t get large discounts. These drug stores have decided to carry every prescription drug sold in the United States, so when they negotiate prices with the drug companies they never tell the drug companies that the price is unacceptable and walk away from the table. This means that they have little leverage in negotiations.

    Managed care companies do better, because they will decide not to purchase a drug if the price is too high (depending, of course, on the availability of alternative treatments for whatever medical condition the drug addresses).

    Canada, like the managed care companies, is able to get better prices because it isn’t committed to buying every drug on the market. It probably does better than any of the managed care companies because it is purchasing in larger volume.

  26. J.A.Y.S.O.N. Says:

    I’m going to skip to the bottom here, responding to the comment about my economic model. I am still formulating my response about health care.

    shcb,

    You either didn’t read my platform, you didn’t understand it, or you’re willfully distorting it to win the lies.com election race. For the record there was never anything in my platform about government and private industry partnership. That was never said nor was it implied. My economic policy was largely based on trade and tariff adjustments that were geared toward providing an incentive for companies to move manufacturing back to the United States. The other component of tariff and trade reform was based on the idea of regulating foreign imports because of the subsidized industry in many of the countries we deal with, China for example. I never expressed nationalization of industry or subsidization of industry in my platform.

  27. enkidu Says:

    Merry Christmas, Happy Holidays to all.

    America’s healthcare system is broken. Insurance companies make millions upon billions from denying healthcare to all Americans. Nataline Sarkisyan, I am sorry that your heathcare ‘provider’ chose profits over care in denying you a chance at life, but you are just one of many many thousands or millions of needless deaths at the altar of profit.

    If elected, I would bend every effort to revolutionizing medicine while removing insurance companies, middle men and profit margins from healthcare. Our doctors would not wander the streets destitute (like many of our veterans do now – shameful). I do not want the Canadian system: we can do that model one better (or two).

    While my dear deluded colleague mr shcb would have you believe only a measly one million Americans are without healthcare, the number is closer to 45 million. That is 15% of our population. We are supposed to be the richest, most innovative, most generous country on the face of the planet yet we cannot provide healthcare for all? We can do better, and we will.

    I have an extensive career in medicine and heathcare issues are part of my every day life, yet when I see my business’ healthcare premiums rocketing 20 to 25% every year, year after year, something isn’t right. My reimbursements do not grow 25% a year (I wish). The system is rigged for greed instead of compassion. Profit instead of care. European nations find plenty of room for innovation in their universal healthcare programs, yet we are supposed to be scared that the drug and equipment manufacturers won’t make their products any better because we now provide healthcare to all? That is an expanding market, not a contracting one. The economics of scarcity are the economics of failure. We lack only human will and the need to innovate.

    HSAs are nice and transfer a bit of the administration costs to the end user, but simple preventative care and health maintenance would save nearly all the costs of providing universal care by reducing the emergency room care for problems that should have been resolved long before urgent/emergency care was needed.

    And one more fallacy I would like to correct from shcb: tmk only ‘General’ type hospitals handle everyone, many (most?) hospitals and health clinics routinely deny healthcare to anyone who can’t pay. With universal health insurance/care we would care for everyone. Perhaps you could have a universal system with a private for-profit system on top of it, but the specifics of a detailed heathcare revolution aren’t to be set forth in a stump speech.

    In closing, heathcare, (like energy and defense policy) is profoundly broken under the current regime of neocon kleptocracy. We can fix it together. We will fix it together. We can do better, much much better.

  28. shcb Says:

    J.A.Y.S.O.N. Says:
    December 20th, 2007 at 8:10 am

    In terms of our foreign relations based on trade we currently are losing our basis for competing as an equal on the world scale. In order to really compete with East Asian nationalism and trade blocks like the EU we have to adopt similar tactics and recreate a more nationalistic based economy

  29. shcb Says:

    Jayson,

    Sorry for the short response last night, I was busy and only had a few minutes. Since this is off topic for this thread why don’t we move this discussion to “you 08-trade debate” if you wish to talk about it further.

  30. shcb Says:

    Just few tidbits of the CPS report on the uninsured that was released in September 2005, this is the study that I believe everyone is quoting when they say there are so many uninsured in this country.

    1. This is one of only four major studies by the government on the uninsured.

    2. 45.8 million uninsured

    3. 63% are under 34 years old

    4. 57% are childless adults

    5. 46% are employed full time

    6. 27% have incomes above 300%, employer subsidized premiums would be 2% of their income

    7. Children and the elderly have the highest likelihood of being below 200% of the poverty level but represent the lowest percentage of the uninsured because of Medicaid and SCHIP

    The group that needs the most help is the young childless adults, they are the most likely to fall through the cracks of coverage. Government programs tend to be tailored to children and families. Young adults don’t have the responsibility of a family and are more likely to work for a smaller firm that may not offer insurance. While the uninsured are in higher concentrations in several groups they are also very diverse, spanning all racial, ethnic, and economic areas of the population. They are also for the most part transitory, eventially most of them get coverage. All these things play into the viability of my plan. Socialized medicine would stifle creativity and competition, my plan would foster it.

  31. ymatt Says:

    The group that needs the most help is the young childless adults, they are the most likely to fall through the cracks of coverage.

    Being the most likely to not be covered does not make you the most needy. Thanks for posting those statistic breakdowns, but lets look at their converse:

    37% are over 34 years old

    43% are children or adults with children

    54% are unemployed

    (I had trouble reading your last statistic there, so I can’t create the converse.)

    If you look at it that way, that’s still pretty shocking when you’re talking about percentages of 45.8 million.

  32. shcb Says:

    One of the points I was trying to make is that the most needy are being taken care of with current government programs (socialized healthcare) this group would still have to be taken care in a socialized system, I don’t see a viable private solution with the truly poor, and I can live with that.

    Those above about 500% of the poverty level are fairly well taken care of. But there is a group in the mid-lower end of the economic scale that are not. For many of this group it is a personal decision based on the knowledge that they will be taken care of if something really bad happens. I want to find a middle ground for these people, and give those in the upper incomes some choices as well.

    There is so much information in this report that it is hard to get your arms around the problem. There are also some problems with the numbers in a few places. For instance the number of people that were uninsured for 12 months were considerably higher than in other studies, folks that have studied this study attribute this to the number of people cited in the study being covered by government programs is considerably less than the number the government actually is covering. I assume that is due to extrapolation, but if that number is way off….

    Here is a pretty good overview.

    http://aspe.hhs.gov/health/reports/05/uninsured-cps/index.htm

  33. leftbehind Says:

    Every American should have at least essential health care, and really could under the present mix of private and government coverage, were the present system forced to expand appropriately and work properly. Before we dash off towards the lofty goal of turning the U.S. Government into a massive insurance company, we should at least try to reform and improve the system as it stands.

    In simple terms: I really want the government to provide adequate healthcare to as many poor people as possible (which is a lot more than are covered now, I’m sure) but I also want them to stay the hell away from my own healthcare, and see no reason those of us who can pay for our own insurance should divert valuable time and resources from the care of those less fortunate by demanding the same government sponsored coverage they need and we don’t. My boyfriend and I, between the two of us, make over $80,000 dollars a year. Giving either of us, or any American in the same financial shape or better, government funded healthcare helps not a single impoverished person one iota, and actually works against the poor when one considers how much time, money and resources would be spent on each of us instead of on the jobless mother or hungry child they should be spent on. And does anybody really believe that I wouldn’t end up paying more in taxes to cover my healthcare than I’m already paying my present insurance company, or that the coverage I would receive would be that much better than what I’m getting now? I’m willing to pay the extra cost so that the poor will be better served, but the idea I should ultimately pay more so that I will almost certainly get less is absurd. Take my money, help the needy, but please leave me out of it.

    It must be said that vast numbers of the poor people who fall through the cracks of the healthcare system are people who are supposed be covered by one government program or another, which is hardly good advertisement for universal government healthcare. Yes, the U.S. government should be able to provide efficient, adequate healthcare for all its citizens, but it should also be able to win a war in Iraq as well, so you’ll have to forgive my scepticism regarding the govenment’s effectiveness when it comes to massive projects like “universal” government-sponsored healthcare. Of course I’m wrong, since everything the U.S. Government did before the 2000 election was flawless, and the country is already scheduled to enter a new age of Perfection and Grace when the good guys regain the White House in ’08, but old attitudes die hard, even misanthropy at the very cusp of the Bright New Age. But I digress…

  34. knarlyknight Says:

    Lefty,
    Why don’t you simply apply the enormous budgetary surpluses of the last 7 years towards funding for universal private health care?

  35. shcb Says:

    Well, it would seem Matt has found his deletion key again. I guess it is improper to criticize liberalism as a whole now even when done in a civil manner. I doubt this will stay up very long as it seems it is probably improper to criticize Matt as well.

  36. ymatt Says:

    It’s perfectly acceptable to criticize me. It’s not acceptable to make pointlessly lame, inflammatory, and sweeping comments like the one I deleted. Find a new place to wank off about liberals.

  37. shcb Says:

    ok

  38. ymatt Says:

    You bring up a good point, leftbehind, that 100% government-run healthcare isn’t necessary to make sure that all Americans are covered. In fact I find it kind of weird that I’m on the side of the argument in favor of making a huge addition to the federal government that I would have to be subject to. Covering the poor is really just one aspect of what I think is broken about our current system though.

    It bothers me that depending who I happen to work for, my health will be covered to a greater or lesser extent. It bothers me that if I were to become afflicted with a long-term chronic illness, then an insurance company could very well decide that it doesn’t want me as a customer anymore and I would have difficulty getting covered because I would not longer be profitable. It bothers me that I could well spend much of my twilight years trying to navigate between government and private programs, trying to figure out the best way to pay for the menu of drugs I may well require. The whole thing to me just seems incredibly backward to me.

    I’m all in favor of competition and right now my employer provides me with a great plan that I am loathe to lose. Perhaps there’s a better way to provide coverage that keeps government bureaucracy out of the mix, but I contend that all of our citizens should have all of their health care needs taken care of, no matter who they work for (or even if they don’t work), what preexisting medical conditions they have, or anything else you can think of. I’ve seen too many people get screwed, not just in the big life-threatening kinds of ways, but in the more subtle ways where their standard of living was lowered because they happened to have the wrong plan at the wrong time, or their life decisions were altered because they weren’t able to take a different job because they couldn’t afford to switch medical plans.

  39. knarlyknight Says:

    Ymatt, it sounds like you might want to have government ensure there is adequate healthcare funding for all, but to stay out of the health care insurance business. Is there any reason why your government couldn’t pay the private plan premiums for poor to average wage earners directly, say up to the median premium level out of all US health care insurers, and let those people choose which of those plans they want to join?

  40. knarlyknight Says:

    shcb,
    “ok” ?!

    Didn’t take you for the roll-over and play dead type. Here’s a liberal site/story you might be interested in, it’s got just enough conspiracy cloak and dagger and liberal bashing jabs to keep you interested:
    http://www.opednews.com/articles/opedne_bill_dou_071225_the_media_hounds_unl.htm

  41. ymatt Says:

    knarly, you may have a point that we might be able to have a compromise with some government safety-netting, but I think I would add some significant regulation for the private insurance industry. For example:

    • - mandated minimum coverage levels (automatically government paid for low income workers or the unemployed or elderly) that include preventative care, health-maintenance care for the chronically ill, pre/post natal care, and care for the elderly
    • - each insurer must have published, fixed premiums for each level of coverage they provide, regardless of the customer
    • - no customer refusal for any insurer, for any reason, at any coverage level offered if the customer can pay for it (minimum care level of course is automatic)

    That might go a long way to fixing the serious problems and inequalities we have. I still believe that the big problem here is that health insurance companies naturally want to focus on the most profitable (healthy) patients, but a person’s health is in great part out of their control. Offering more expensive or less comprehensive car insurance to a poor driver makes sense — it doesn’t work for health care.

  42. leftbehind Says:

    Knarly – I think investment of any appropriate part of any existing budgetary surplus towards expanded government healthcare for the poor is a great idea, and a reasonable step provided that the money is directly targeted towards aiding the lower economic levels and not simply thrown at unnecessary healthcare subsidies for Americans who are able to pay for their own insurance. I will concede that the impoverished are not the only people that fall through the cracks of the healthcare system – but there’s a good argument that middle and upper class Americans could be far better served by tighter government regulation of the existing healthcare system than by a taxpayer-subsidized overhaul. Why not let the government focus taxpayer money on those who need it most, while simultaneously making the existing system more efficient for those above the poverty level through legislation, regulation, and vigilance? I would feel differently if nobody were getting adequate healthcare under the present system, but most people are. This indicates that, while the present system is far from perfect, it has enough going for it that it can be saved, or at least provide enough of a foundation for the next level of healthcare. Even if a totally taxpayer financed healthcare system ends up as the inevitable and desirable result of healthcare reform, I would feel a lot more comfortable with a step-by-step process that builds towards the final goal through an evolution of the American healthcare system, rather the scrapping of everything we now have in favor of any model which would be totally untested and untried in the U.S.

    Besides, in the real world, it’s going to be a lot easier to fix the old system than it could ever be to dump the present model for a totally taxpayer-financed healthcare system. “Free” government healthcare sounds great during an election, when there are no numbers on the table, but when it comes down to brass tacks and Joe Sixpack finds out how much the program will cost in extra taxes, you’ll scarcely find a politician who’ll stand up for the idea. Maybe you guys would be happy to pay for it, maybe I would, but the vast majority of Americans aren’t there yet by a longshot, and the Iron Will of Washington gets pretty darn bendy when the rank and file says “no dice.” Americans know what’s broken in the current system, and will enthusiastically back legislation which helps fix it. They’ve also proven that they’ll pay more in taxes to help the poor along. Their record on supporting a sweeping and expensive expansion of government of the sort you’d need for “universal” taxpayer-financed healthcare is not nearly as good.

  43. knarlyknight Says:

    Lefty, Ymatt – you get no argument here, what you say makes sense to me and I’ll be the first to say try to fix the system that’s there, the costs of ripping out existing systems and starting something new is usually silly. (I wasn’t a big fan of corporate restructuring in the late 80s and 90s; a lot of good teams canned and narrow minded bean counters took their places.) Private, public, or combination of both, makes no difference to me what you do there. I like the Canadian system, not because it is the best (doubt that it is) but because it works and with tinkering it is getting better and should continue to improve. Same goes for you guys, maybe it’s just that you are just starting from the opposite side.

    Lefty, when I suggested “applying your budget surpluses to healthcare” that was a wise ass remark in response to your silly “everything was perfect pre-2000 election” sarcasm. I hate to be the one to break it to you, but there is no budget surplus in the USA, your “conservative” president has run up enormously impressive deficits since the 2000 election. Too bad the other guy wasn’t crowned. If you’d like there are some good Canadian ex-finance ministers from former Liberal governments who might be willing to offer advice to your “Enormous Government” Republicans about managing government spending, but I’m sure you guys know best about that, after all there will always be the grand-kids to pay for the bombs you drop on foreign lands now.

    Any You’08 Candidates here want to comment on whether America should assist Iraq in setting up a national health care system or whether we should be encouraging them to open their doors for private health insurance companies? (Those would be the international companies, hehehe.) Ooops, they have been a non-functioning state for four years and it is probably still premature to think about medical care for Iraqis? Maybe the medical costs from American DU dust is something best saved for reparation judgements when the criminals finally make it to the Hague.

  44. ymatt Says:

    Yeah, I have a hard time worrying about Iraqi health insurance when gunshots and shrapnel are one of their major health risks. I suppose I’m all for providing military hospitals and triage, even after our guns leave the country.

  45. leftbehind Says:

    Knarly – a wise ass remark from a wise ass, which is why my statement by saying “any existing surplus,blah.blah,” is largely hypothetical, as is everything else about this conversation. In actuality, most surpluses in the American economy are hypothetical, projected and transitory. Given his chance, I’m pretty sure Kerry could have found something stupid to waste Clinton’s surplus on as handily as Bush did. It will be interesting to see whose ass the current Canadian surplus disappears up in the future, but such conjecture is way off topic, and will probably get me deleted from the thread. Thus I yield the floor to cooler heads, but will defend my “silly sarcasm” as a pre-emptive strike against the reflexive Bush-bash everything on this blog eventually becomes, and as a warranted attack on the idea, inherent to the current debate on “universal” healthcare, that if we can just get Bush and his crew out of the picture, one of the bozos currently running for President will actually have enough on the ball to give us all free healthcare.

  46. ymatt Says:

    I think after consideration, I’m going to abandon my government healthcare stance in favor of a strict regulatory/safety-net stance that I think can have the same results. Right now I still think the regulatory piece is missing from the proposed plans out there. I’ve had a number of conversations with Jayson outside this forum, and I’m coming around to his regulatory platform overall.

    I have flip-flopped and now I must commit ritual suicide, but this was an interesting and useful debate for me.

  47. knarlyknight Says:

    Lefty,
    Clinton’s surplus was in fact blown by big government republicans; your hypothesis that Gore would have done the same is a lame guess, and judging by Bush/Gore differences of opinion on just about everything it is a very bad guess.

    ymatt,
    Ritual suicide noted. I’ll follow, not because I’ve flip flopped but because I’m sick to death of this topic.

  48. J.A.Y.S.O.N. Says:

    Yeah. What ymatt said I said…

  49. leftbehind Says:

    Clinton’s surplus, as much as it existed, was blown by the first bunch of politicians that got a chance at it, which happened to be Republicans in this case. Had Democrats had the same opportunity, they would have blown it too, just on different stuff. The only reason you don’t realize this is because you’re a Canadian, and your experience with either American political party is secondhand. You’re also not taking time to research just how much debt this government typically runs under, no matter who is in charge. As your second, I think I might let you twist the dagger around a couple extra times before I decapitate you, just for these lapses alone.

  50. knarlyknight Says:

    Lefty,
    LOL, but how can you be so misinformed? I based my comments on what I recall, and the first response to a google search confirms my recollection: post WW2 US budget deficits grow, contrary to popular belief, more under Republican presidents, and the decrease under Clinton was remarkable.

    Get educated: http://www.cedarcomm.com/~stevelm1/usdebt.htm

    As far as how much debt the US government typically runs under, are you trying to suggest King George’s surplus to record deficits via tax cuts are typical? I’m certainly not giving a joker like you the honor of my decapitation, I would probably just end up with a bad haircut.

  51. leftbehind Says:

    Yes you would, because it’s too much fun to watch you twitch on the ground.

    The article you cite shows that both the Democratic and Republican parties nearly match each other by expanding the national debt by almost 10% each year, which is absurd. The Democratic Party has wasted, approximately, 1% less of my money per year than the Republicans have. Wow.

    I’m no fan of Bush or his deficit, but the modus operundi that got us into the current pickle is hardly unique to him. Ever since Clinton projected a $746 Billion surplus in 2000, even Clinton proposed massive spending against money that wasn’t really there yet (which is what projected means, down here in the lower 48, anyway – “not really there yet.”) Clinton’s 2000 budget totalled $1.84 Trillion, including an 11 percent increase in military spending to finanace “air operations” over Iraq, drawing on $746 Billion that wasn’t in the bank yet, and lergely wouldn’t be for the greater part of a decade. This is the same “projected” $746 Billion that Gore told us was going to pay for his pouring of Federal dollars down an unreformed Social Security System while simultaneously financing a prescription drug entitlement for every old person in the country – whether they needed it or not – all while proposing “tax credits” that were only different from Bush’s tax cuts in that they were used to pander to voters making less than $100,000 dollars yearly rather than the wealthy supporters Bush was pandering to at the time. Bush and Gore both ran on tax and spending plans that, according to Time Magazine, rivaled each other at an almost dead even $1.5 trillion dollars ran through over a ten year period, drawing on a Clinton Surplus that existed, in large part, only on paper. Both were counting on a surplus that wasn’t even there yet to cover extravagant tax cuts, credits and or refunds while promising extravagant expansions of certain government programs. At least in Canada, some of the candidates speak French, so they’re easier to tell apart.

  52. leftbehind Says:

    All of which has nothing to do with the Health Care debate at the heart of this thread. I apologize to Matt, and express my willingness to concede the floor to him at any point.

  53. ymatt Says:

    Well, I actually think this is a useful and interesting debate, and does end up being relevant since the size of the budget has a whole lot to do (or it should at least) with the government’s ability to provide large programs like health care.

    Also I happen to agree with you.

  54. leftbehind Says:

    Then I consider myself on the right track for a change!

  55. knarlyknight Says:

    Yes, you are on the right track. Just need a few clarifications, as you said:
    The article you cite shows that both the Democratic and Republican parties nearly match each other by expanding the national debt by almost 10% each year, which is absurd. The Democratic Party has wasted, approximately, 1% less of my money per year than the Republicans have. Wow.

    That description does not match the graphs, the graphs are better described in the paragraph that follows the one from which you lifted your “absurd” figures:

    If you look at the 59-year record of debt since the end of WWII, starting with Truman’s term, the difference between the two parties’ contributions to our national debt level change considerably. Since 1946, Democratic presidents increased the national debt an average of only 3.2% per year. The Republican presidents stay at an average increase of 9.7% per year. Republican Presidents out borrowed and spent Democratic presidents by a three to one ratio. Putting that in very real terms; for every dollar a Democratic president has raised the national debt in the past 59 years Republican presidents have raised the debt by $2.99.

    Let’s look at Wiki, as it is at least peer reveiwed, they show a more recent accounting by president:
    http://en.wikipedia.org/wiki/National_debt_by_U.S._presidential_terms

    It shows:

    Democrat Presidents from 1978-2005 Federal Debt increased 4%

    Republican Presidents from 1978 –2005 Federal Debt increased 36%

    Moving on, I’ll take at face value your comments about spending plans by Gore vs. Bush, (Clinton’s plans are irrelevant as he could not get a third term) and recap without the enormously biased words:

    Gore projected borrowing to fund existing Social Security System and a prescription drug entitlement for every old person in the country plus “tax credits” to Americans making less than $100,000 annually.

    Bush’s tax cuts were directed to the wealthy, and enormous expansions of certain government programs (CIA, Military, NSA eavesdropping on Americans?)

  56. leftbehind Says:

    So it’s okay to spend money that’s not there as long as your intentions are good?

  57. NorthernLite Says:

    SHCB,

    Your assertions regarding Canada’s universal healthcare system are so misguided that I am almost sure they were stolen from Rush Limbaugh, probably while he was high on some cheap prescription drugs imported from Canada.

    Subsidizing our system? Um, ok. Maybe you were referring to the couple in British Columbia that held septuplets and there were simply not enough open infant care beds available at the time to house them all in one hospital, so they were went to Seattle. A one in a trillion occurrence.

    As for our prescription drugs, a lot of the price difference was stemming from the fact that the American dollar was worth about $1.50 in Canada about two years ago. The Canadian dollar is now worth more than yours, at about $1.02 today. So when your money was worth 1.5x more than ours, of course buying drugs here is significantly cheaper! But now your dollar is worth less than ours (something I assume you’re not blaming Bush for) and prices and aligning more closely.

    As for the other major reason, and someone touched upon this already, it is this:

    American drug companies spent US$57.5 billion on promotional activities in 2004 (the latest year for which figures were available).

    By contrast, the industry spent only $31.5 billion on industrial pharmaceutical research and development in the same year.

    Almost 60 billion spent on advertising. A practice that is restricted in this country. That’s why our drugs will always be cheaper. This is not rocket science.

    Btw, I was away for the holidays… Merry Xmas and Happy New Year all.

  58. leftbehind Says:

    And it’s a good idea to finance sweeping expansions of government while simultaneously taking money out of the system in the form of tax cuts/credits/loopholes, as long as the people you’re “benefiting” are poor enough to make you look compassionate, and nobody notices that the money you’re counting on to actually finance everything doesn’t really exist, and may or may not exist in ten years?

  59. leftbehind Says:

    Also, I must ask you, Knarly, if you noticed a few things on the Wikipedia table: you cite:

    1) You cite the statistic that Democratic Presidents have increased the National Debt only 4.2% to the G.O.P.’s 36.6% since 1978. What you don’t say is that there have only been two Democratic Presidents since 1978, versus three Republicans, two of which served for 8 years apiece. It’s no defense of the G.O.P., who have run the debt way too much, especially under Bush, to note that the Democratic Party has not been in the White House with the Republicans have, and have thus not had the same chance to run up as debt numbers. I’m not calling the G.O.P. good money managers, I’m just saying they’ve had, collectively, two decades to borrow from abroad while the Dems have only had 11 years (as 1978 was a year into Jimmy Carter’s four year term.

    2) Also, while there is nothing wrong with the graph for what it is, it is not expansive enough to factor in the effect of the Congress on increases in the national debt. Republicans never controlled the House during the Reagan – how does this figure into the expansion of national debt during his tenure? Under Clinton, the Democrats only controlled the house and Senate for two out of eight years. What effect did this have? I must confess ignorance of the Canadian system of Government, but in the United States, both the House and Senate play important roles in government spending. A body we call the House of Representatives (I’ve referred to it previously here as simply “The House,”) has the power, for instance, to pass “appropriation bills,” which authorize Federal Spending. The President makes “appropriation requests” to the House, and cannot spend money without their approval. Since borrowing is a function of spending, the Congress must be a factor in the National Debt, although this is outside the scope of the Wiki Table we’re discussing.

    Did you also notice that, according to the Wikipedia table we’ve been discussing, the Democrats have, with half the time in the White house the G.O.P. have enjoyed, increased Federal spending to within 2.5 percentage points of the Republicans. Following your thinking regarding this information, that would mean that Democratic Presidents have spent nearly as much money
    in a decade that the Republicans have in twenty, yet have only managed to increase the Gross Domestic Product 1.7 percentage points more than the Republicans have.

  60. leftbehind Says:

    Twenty years, not twenty decades, as the typo in my last paragraph would indicate.

  61. knarlyknight Says:

    Hi Lefty,

    You asked, “So it is okay to spend money that is not there so long as your intentions are good?”

    Definitely, smartly spent government borrowing can be fantastic for a country.

    Government borrowing is good when it can be reasonably expected to show good overall real return. Investments in infrastructure are at the top of my list of justifications for government borrowing. Next would be applied scientific research and education. Another, depending on circumstances, may be health care. All these things can be expected to contribute to the productive capacity of a country.

    Government borrowing to engage in illegal, unnecessary wars, long term occupation of oil producing states, and borrowing to provide the very wealthy with enormous tax cuts, are at the bottom of my list for government borrowing. These items can be expected to generate overall negative real economic returns. They also contribute far less, in general, to the productive capacity of a country, in terms of things that benefit the people, than the items at the top of my list. They sap the long term potential strength of the economy. In contrast, the items at the top of my list can be expected to add to a country’s long term potential.

    You question the difference in length of terms of Republican vs. Democratic presidents since 1978 as being a factor in the growth rate differences. I doubt it, as I strongly suspect the % increases in national debt between Republicans and Democrats are calculated by simple averages of the change in debt during the years in power divided by the years in power. That would average out differences in the number of terms held. I do not care enough now to verify this myself; rarely does analysis these days provide anything more than that type of simplistic overview instead of the more accurate analysis that would considering the lower compound growth rates which might narrow the 36% vs. 4% to something more like approx. 20% to 3.5% .

    The effect of Congress on National Debt could be a huge debate, so I will instead refer you to Figure 3 in the first link I provided (it shows the effects on debt of different president, House and Senate party control) and the short section of that analysis titled:
    Isn’t Congress In Charge of Spending?
    http://www.cedarcomm.com/~stevelm1/usdebt.htm
    The analysis includes these conclusions:

    1. Since the Neo-Conservative movement has become the dominant force in the Republican Party the national debt has grown and continues to grow …
    2. Experience has shown that “trickle down tax cuts” only work to concentrate the nation’s wealth into fewer hands and never help to rebound the economy.
    4. The only time we have seen national debt reduction in the past 60 years was when Democrats were totally in charge of our government or when one party was in the White House and another ran Congress.
    5. In the past 60 years when Republicans were in control of the presidency and both Houses of Congress, government spending was never reduced. The last time a Republican Congress reduced the national debt was in 1947, under Truman’s leadership.
    6. The last time the debt was reduced was in 1961 during President Kennedy’s first year in office. It has been almost a half century, 46 years, since this nation has paid down any of its exponentially increasing debt.

    As for which party had the best GDP performance, that is too complicated to deal with here without making some gross errors, since GDP as a measurement tool here is tainted. One reason for that is that a government that borrows heavily and spends will show a direct and immediate increase in GDP which might not be sustainable; whereas another government that does not borrow will not have an immediate GDP boost, but it can still have direct positive influence on GDP that is sustainable.

    So to say a government is better if it dramatically boosts GDP during its term in office may be a mistake, as it is likely to be simply a reflection of how much it borrowed. When the borrowing stops then the negative effect on GDP kicks in, and that could be just as dramatic. Therefore a subsequent administration curbing too much borrowing might dampen GDP growth, making it look worse when in fact it is establishing stronger economic fundamentals for long term economic growth.

  62. knarlyknight Says:

    NL,
    This is hardly news, but it’s a good reminder of corporate priorities. It is often said that TV advertising leads people to badger their doctors for drugs that may be inappropriate or unnecessary, and many doctors accede to the demands of their ad-driven patients. Not to mention the doctors who are directly induced by drug company reps to overprescribe.

    Drug firms spend more on marketing than research
    TheStar.com – News –

    Drug firms spend more on marketing than research
    Study finds U.S. industry spends twice as much
    promoting products as it does on development
    January 03, 2008

    OTTAWA–Drug companies spend almost twice as much on marketing and promoting their products than on research and development, a new study says.

    In their analysis of data from two market research companies, Marc-André Gagnon and Joel Lexchin of York University found that American drug companies spent $57.5 billion on promotional activities in 2004.

    By comparison, spending on industrial pharmaceutical research and development in the United States was $31.5 billion in the same year, according to a report by the National Science Foundation.

    The types of marketing in the $57.5 billion figure, compiled using data from market research companies IMS and CAM, included free samples, direct-to-consumer drug advertising, meetings between company representatives and doctors to promote products, email promotions and direct mail, said the study.

    The findings, published this week in the journal Public Library of Science Medicine, confirm “the public image of a marketing-driven industry,” the study authors say.

    It’s not a surprising conclusion, says Steve Morgan, a University of British Columbia expert on pharmaceutical industry economics.

    “It’s been known for a long time that manufacturers of prescription drugs spend more money on marketing than they do on research and development,” says Morgan.

    The pharmaceutical industry has for decades promoted itself as innovative and driven by research. Critics, however, contend that drug companies have acted based on market-driven profiteering.

    The Canadian Press

  63. leftbehind Says:

    Knarly – The civics site you cribbed your last two posts from was a good one, but I don’t think it added as much to the present conversation as you think it did, which is partly my fault. I assumed, too early, that you understood what Matt and I were trying to say and were responding to just that. I then just plowed my way deeper and deeper into abstracts without explaining myself clearly.

    Let me backtrack to the point of the conversation where I lost you, and re-iterate in simpler terms:

    Mr Clinton, who was President of the United States a long, long time ago, told all the people that the United States would have a lot of money in ten years. Now, Mr. Clinton didn’t have this money in his pocket, or in a bank, or in a pencil box like the one you have at school. The money was a projection, which is like an idea that someone has about what might happen some day. It doesn’t mean that it’s going to happen for sure; it just means that, if things go as expected it might be there some day.

    Now, Mr. Clinton worked with people that other people called the Congress, which is a big group of people who help the President run the Government. Mr. Clinton was very excited about all the money he thought the U.S. might have some day, and about all the wonderful things that could be done with that money, like helping poor people and sending the Air Force in their sleek new bombers to fly over Iraq so that everyone would know that he was boss. Mr. Clinton knew the money wasn’t there yet, it was just a projection, but the people were so happy hearing about all the money and the help for the poor and the sleek new bombers, that Mr. Clinton came up with more and more wonderful things to tell them.

    Then the Congress asked Mr. Clinton, “This all sounds wonderful, but how are we going to pay for the help for the poor and the sleek, new bombers?”

    So he thought and thought, and finally said, “why we can pay for all of this with all that money we’ll have if things go the way we think think they will. We’ll pay for it with the projected surplus!” This made him, and a lot of other people very happy.

    Now, a President of the United State only gets to be President for eight years, and Mr. Clinton had already been President for eight years, and was ready to retire. His job would go to one of two men from the South. One was named Tennessee Al, and other was named Texas George.

    When someone runs for President, all the people come to him and ask what he will do for them. People came from all over the United States to ask this of both Tennessee Al and Texas George. People asked “What wonderful things will you do for me with all that projected money we’re going to have? Will you buy me drugs? Will you buy sleek new bombers?”

    So Tennessee Al and Texas George both sat down and wrote a long list of all the wonderful things they intended to do with all the money that was projected to come in within the next ten years, and when they were done, both Tennessee Al and Texas George had a long list of things each man wanted to do for all the people with the projected money.

    The problem was that the projected money wasn’t there yet. Neither Tennessee Al nor Texas George could use the projected money for all the wonderful things they told the people they would do with it. It simply wasn’t there.

    To pay for all the wonderful things each man, or candidate, had told all the people he would do if they chose him to be President, both Tennessee Al and Texas George would have to raise people’s taxes. Taxes are money that people like your parents pay to the Government so that the Government can do the wonderful things people like Tennessee Al and Texas George promise to do during elections. But taxes are yucky. Nobody likes to pay taxes. Nobody likes to give more money to the Government so the Government can keep its promises. Both Tennessee Al and Texas George were afraid that if they told the people they would have to pay more taxes because the projected money was not there, the people would be angry, and they would not get to be President.

    So the two figured out ways to lower taxes and make people happy. Texas George would give all his rich friends tax breaks, so they would not have to pay as money to the Government so the Government could keep its promises. Tennessee Al called the tax cuts he would give out “tax credits,” which he would give to people who used lightbulbs he liked, or who drove very small cars. By the time both men were done, each had saved his friends $1.5 Trillion in taxes. The people were happy. No matter who became President, the Government would collect $1.5 Trillion less of their money in taxes.

    This was not good, though. Without the projected money to pay for the drugs and sleek new jets, the Government would have to pay for those things with the people’s taxes. But now, there would be $1.5 Trillion less in taxes coming in, no matter who was elected President. Who would pay for the drugs and the sleek new jets if they cost too much? What if something happened that nobody could see coming, like if the Illuminati were to blow up buildings in New York? No matter who was President, the projected surplus would disappear before the money was even really there in the first place…

    ITEMS FOR STUDY AND DISCUSSION:

    1) Write a definition in your own words for “projected.” Explain, in your own words, the difference between “There” and “Not There.”

    2) Have you heard an adult use the term “counting your chickens before they hatch?” What does that mean? How does that apply to the story of Tennessee Al and Texas George?

    VOCABULARY
    Spell and Define the following on the page provided in your workbook

    1) Projection
    2) Projected
    3) Taxes
    4) There
    5) Not There Yet
    6) Tax Cut
    7) Tax Credit
    8) Trillion
    9) Same Outcome

  64. ymatt Says:

    Oh man. I think we need to phrase all arguments here in the form of an elementary school workbook from now on. That was hilarious.

  65. knarlyknight Says:

    So, what’s your point? That you are good at patronizing people, or that your understanding of the topic does not go beyond elementary school concepts? You used a lot of space but didn’t add anything to the discussion except sarcasm, which at least appears to have amused Ymom.

    It appears you do not fully appreciate the huge difference between the Al and the George tax proposals.

    In 2000, you elected a Republican who destroyed any chance of recouping tax revenues in future years (your so called “projection”). He did this by giving tax cutS to the wealthiest people – it is well known post “Reagonomics” that the government income multiplier effect from such a tax cut is low to Nil. That fact is even stated in the “civics site” I quoted that you say is good, i.e.: 2. Experience has shown that “trickle down tax cuts” only work to concentrate the nation’s wealth into fewer hands and never help to rebound the economy.” And that concentration of wealth is exactly what you got, 9/11 or no 9/11: a dramatic cut in tax revenues to the benefit of the wealthy, with no corresponding consumer spending boost to flow through and grow the economy to raise tax revenues in following years. Case closed, George’s policy and ensuing events led to enormous deficits as a matter of historical record.

    Had you elected the Democrat who promised “tax credits” for people earning under $100,000 annually, the income multiplier effect to government revenues would have been high, so the likelihood of those “projections” at least partially materializing would have been good, 9/11 or no 9/11. Case not closed, we will never know for sure how big the deficits (surplus?) would have been under Al. However, on comparing Al Gores economically/environmentally targeted tax cuts vs. King George’s looting of the treasury on behalf of his wealthy supporters, we can say with high confidence that the fiscal imbalance would be far less severe under Al.

    So, to borrow from your elementary logic, we have:

    Under George Bush – the historical fact of enormous deficits;

    under Al Gore – a debate about whether the fiscal situation would have been similar, or would have been much better.

    Therefore on the balance of probability, if the past could be repeated, you should go with Gore next time.

  66. knarlyknight Says:

    Testing 123

  67. ymatt Says:

    I don’t think we’ll argue with the statement that “if the past could be repeated, you should go with Gore”, but the point is that there isn’t a particularly good historical reason to believe that democrats are much more fiscally responsible than republicans. The fact is that both parties gain political mojo by spending money and not increasing taxes whenever they can get away with it, and historically they have done just that.

  68. leftbehind Says:

    Exactly.

  69. knarlyknight Says:

    Yes, ymatt, I agree with that too, and also, as I’ve recently learned from the civics and the wiki site we referenced is that traditionally

    the Dems have been more likely to tax and spend, wheras

    Republicans are more likely to borrow and spend.

  70. knarlyknight Says:

    ymatt, just for clarity, this discussion arose from comments about healthcare and deficits, with Lefty asserting in his last Dec 31 post that Kerry (sic?) would have blown the Clinton “surplus” just as Bush had done post 2000. I tried to explain, poorly, that there are huge differences in how Bush’s plan resulted in huge deficits compared to how Gore’s plan likely would have impacted tax revenues – over time – less than Bush’s and that overall Gore’s deficits would likely be smaller. (Originally I thought Gore might have retained the projected surplus as a real surplus, but have since reconsidered.)

    I took issue with the certainty with which Lefty stated that things would have been just as bad under the other partys president. The reason is that I believe that there are few things worse for government revenues over time than the big tax cuts for the ultra rich that Bush handed out in the early 2000’s.

    Anything less fiscally stupid than that would have probably had a better outcome. Like the Gore plan, whatever that was.

    So in the end we all agree that your political leaders, republican or democrat, both are poor in terms of fiscal responsibility. However, I also recognize that my agreement with that position seems to fly in the face of the conclusions by wiki and http://www.cedarcomm.com/~stevelm1/usdebt.htm, both of which show, in terms of debt increases, that the republican are the worse of the two evils.

  71. leftbehind Says:

    John Kerry may, in fact be sick, but last I checked, his name is spelled K-e-r-r-y, so we’re cool.

  72. knarlyknight Says:

    hi left, meant “(sic)” as in Kerry wasn’t running in 2000, I’m not sure what Kerry’s role in all that would have been. Good thing yMom told us not to fight about whether we should go with Gore next time, I have to get some sleep tonight for a change. By the way, thanks to your country for the interesting politics, (the Canadian stuff usually bores me to tears and our current Prime Minister, Steve Harper, is the first ever that I literally can NOT listen to for morethan 30 seconds without feeling a strong urge to barf.)

  73. ymatt Says:

    I’m so proud, I’ve never had a nickname that’s made from a hilarious misspelling that is also an irreverent reference to my behavior before!

    yMom ’08!

  74. leftbehind Says:

    Knarly – No, Kerry didn’t run for President in 2000. Once again, your perception of the obvious is staggering – but who said that Kerry ran in 2000? Nobody even brought up the 2000 election until you brought Gore up after I had made a comment regarding whether or not I thought John Kerry would be more fiscally responsible as a President than Bush has been, had he been elected in 2004. Is this conversation moving too fast? Do you need us to slow down, or start diagraming our paragraphs? There’s no shame in asking for clarification when a conversation becomes too complicated, or when your second-hand knowledge of American politics becomes an obstacle. Everyone here is your friend, and we’re here to help.

  75. leftbehind Says:

    ‘Cause that’s what America’s all about – helping the little guy.

  76. enkidu Says:

    or in your case lefty – a bear of very little brain

    under R presidents the deficit grew an average of 36.6%
    while under D presidents it grew an average of 4.2%
    do I need to diagram that for you?

  77. leftbehind Says:

    Uh oh…Mom’s home. Be it far beyond me to correct or contradict such an accomplished figure (a jet pilot and a healthcare insider, my my) but I think the rest of the class and I have already been through this. I really doubt you have anything substantial to add to the conversation.

  78. ymatt Says:

    Are you blaming me for deleting some post you didn’t actually submit? I’ve been out of town for a week, dude.

  79. leftbehind Says:

    If you’re talking to me, I wasn’t referring to you Matt (i.e. making reference to Knarly’s YMom thing. ) I was addressing Enkidu. One of the reasons I like him so much is because he reminds me of my mother. Have I ever mentioned that it was Mom who turned me against women?

  80. NorthernLite Says:

    So it’s settled then: Everyone agrees that the wealthiest nation on the planet should provide healthcare coverage for every one of its citizens. :)

    Next topic in the debate please.

  81. enkidu Says:

    hey I hear there is some sort of War someplace or other
    maybe we could talk about that

  82. ymatt Says:

    I don’t see the point in a war debate. I’ve been purposely picking topics where there is a broad swath of opinion represented in the original platforms, but I don’t see that for the topic of the Iraq war. I’m about as uninterested in you/us yelling at shcb as I am the opposite at this point.

  83. shcb Says:

    :)

  84. enkidu Says:

    yMom knows best

  85. leftbehind Says:

    Absolutely right…for once.

  86. enkidu Says:

    hey lefty, no one wants to hear about how your mother abused you
    or you abused your mother
    or whatever

    so please
    stfu
    and back in your cave

  87. shcb Says:

    I’m kind of interested, do tell!

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