POLICY: The libertarian bickering conintues!

More bickering between Jon Cohn, me, and the sensible libertarians Arnold Kling & Clark Havinghurst over at Cato Unbound . It’s a follow up to the articles we all wrote, and now Kling replied to all three of us, we’ve all replied back, and he’s replied back too….all extremely good stuff!

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  1. SBD, I give you this paste from the Denmark article:
    “The vast majority of health care is financed from local (county and municipal) taxes – some 81 per cent of all public healthcare expenditure. Local taxes are levied proportionately on personal income and property. The average county and municipal tax rate for 2002 is 32.6 per cent2 the highest local tax rate in the OECD.”
    So, how do you think your local ratepayers will react to this kind of tax load? Hell, our local ratepayers fight tooth and nail when commissioners want to raise the property tax rate 1/2 cent. And as to the qualifications of my local government to be able to manage anything this important and this complicated, no way. There’s just not enough intellectual property available in the county. My county is governed by old guard cronies that have not gotten out of the early 20th century mentality yet. If you also look at the voting levels in local elections you’ll find about 15%. Hardly a voter participation that would hold elected officials accountable.
    I would agree with a system that sets federal policy and standards and is then administered by the states. If you break it up into too many small pieces, every different layer adds costs and complicates delivery. I think Americans should be able to move from state to state and expect about the same costs and plan. This would stop the divide and conquer tactics of industry.

  2. You misread what I wrote Peter. I said that the Federal Government should stay out of Healthcare. The Denmark system is run at the County level and not the Federal level. This allows less room for corruption and more control to areas that may need it.

  3. Posted by: Scott C
    “Although both of them had health care through their employers and an additional third private insurance, the uncovered medical bills are surmounting and rising into the tens of thousands of dollars. Again, these medical bills are not covered by any of their 3 insurance policies. How, I ask, is this possible? How is it that this great country has families working their whole lives, paying into a health care system that is supposed to take care of them should they need it someday, only to find out that someday comes when you least expect it, blanketed by an awful reality.”
    Sadly the reality of healthcare costs is not only an issue for the uninsured. I think the above realization about the reality of insurance is the reason no one in the heathcare industry wants transparency. I think many of the intentionally uninsured are just ahead of the curve and have more of an understanding of their final financial position, with or without insurance, if they do get really sick. I dropped my insurance last year, not because I could not afford it, but because I didn’t want to afford it. This was based on my only claims experience with BCBS of NC in the 7 years I had paid premiums to them. I decided I was not going to play this deceptive and dishonest game any longer based on the marketing of fear and buying a product that does not live up to it sales hype.
    SBD, you contradict yourself when you say government should stay out of healthcare then post a link to Denmark’s successful healthcare system, single pay, government run, tax supported. Just another example of the, “solution” that Americans will not open their eyes to because either they have a vested financial interest in the present system or they have a glossy eyed and unrealistic view of “The American Dream”.

  4. agree with you that the Federal Government shoud stay out of the Healthcare business, or any business for that matter. My reading of our Constitution seems to also agree with this contention. I believe that the best place for these matters to be addressed are at the local or county level. There are two reasons that lead me to this conclusion.
    The first reason has to do with politics. At least in principal, politicians at the local level are much more held accountable for their actions and they can get booted every four years because of it. When some sort of political scandal is exposed on the local level, everyone hears about it through the local newspaper, local tv news, and local radio talk shows. There is much less opportunity for Corporate interests to bribe and corrupt the system. I am not saying that all corruption is eliminated, only that there is less than on the Federal and State level.
    The second reason has to do with the current problems faced by local and county government. One of the biggest problems has only recently surfaced due to the recent Sarbane-Oxley regulations that now require local and county governments to disclose the costs of healthcare to the public. These liabilities have been reported to be in the Billions of dollars. Billions of dollars that would not have accrued if a healthcare system were to be setup on the local level.
    The biggest example of such a system is the healthcare system in Denmark. Although the numbers should be taken with a grain of salt, 93% of those polled were satisfied with their healthcare system. That is absolutely astounding don’t you think?
    From The U.S. Health Care System: Best in the World, or Just the Most Expensive? which is based on various information including the OECD Health Data 2000: A Comparative Analysis of Twenty-nine Countries (Paris: OECD, 2000), the infant mortality rate in the US was 7.2 and the life expectancy was 70.0. The Denmark system has an infant mortality rate of 5.2 and life expectancy of 69.4.
    If the information is accurate, then how can the US claim to have the best healthcare system when the final outcome is relatively the same. Compared to cost, the problem becomes more apparent. The per capita 1998 dollars spent on US Healthcare was 4,178 while in Denmark it was 2,133. The US spent almost double of the money that the Denmark system spent with relatively the same longterm outcomes.
    Maybe the source data is incorrect or something, what do you think of these results?

  5. 1/10 of a cent = billions of dollars
    A Positive Change for Change: My American Dream
    I am a thirty-four year old, single, white, middle-class, tax paying male who commutes 110 miles round-trip to my full-time, civil service job in another state. I also attend graduate school part-time in the evenings. Not that this matters, for I could be any average American living in this country. Government loves figures and statistics so group me into any category you seem fit.
    I live life the way I do, not only to pay the bills, but to enhance my self-worth as a human being, and to fulfill my obligation as a positive, integral part of society. One day I hope I can look back and say I had a good life, lived it to the fullest, provided love and security for my family, and spoke for those not having the ways or means to always do so. This is my American dream.
    On my commute home yesterday, I was listening to NPR and there was a discussion of Governor Swartzenegger’s proposal to provide health care that would cover all of the people of California. It was a back and forth thing like any good debate. Some guests were in support and some clearly objected. As I listened I soon realized that the one common element of all the parties in the discussion was the financial cost it would take to accomplish his goal. Although I am currently healthy and have a health care plan provided by my employer, I was able to relate to the many callers who were speaking on this issue. Almost all of them complained about the rising cost of their health care. Whether it was a small business owner or a single mother, it was the cost of their health care that was taking its toll on their them. Their health care? Since when did it become the norm that health care in this country should be viewed as a luxury? It’s not like we are voluntarily going out and buying a big screen television or a latte at our favorite coffee shop.
    As I said previously, I am currently healthy and have health insurance. For this reason I consider myself one of the very fortunate individuals in this country. So why complain? Well for beginners, my seventy-two year old step-father has been very ill for over a year now battling the affects of radiation damage he acquired after they removed his cancerous prostate. Yes, he is so called ‘cancer-free’ and won’t die of cancer, but what the medical field doesn’t tell you is that your quality of life will never be the same no matter what the doctors tell you. In addition to that he also lost his bladder, part of his intestine, and now has a colostomy and urine bag. He wasn’t a CEO of a blue-chip corporation, a highly touted defense lawyer, or a researcher discovering a new cancer fighting drug to be profited from in the pharmaceutical industry. He is a simple man who drove an oil delivery truck for the same company for almost 30 years. He had just begun to anticipate relaxing during his retirement. Instead, he had to give up his livelihood because of his illness and now my parents rely on my mother’s salary to keep up with the bills. He too had an American dream but I wonder if it turned out the way he had wished. I’m not looking for sympathy. My point is he is just an average American who chose his path in life and like many other millions of Americans he discovered how a health crisis can pull the rug right out from under your feet.
    As far as my mother, thankfully she’s currently healthy. She works for a children’s hospital and isn’t a pediatric M.D., a high level administrator, or even a nurse (she would be outstanding as one, given all she’s dealt with during my father’s illness). She is just a receptionist who has worked for the same company for over twenty-five years. Although both of them had health care through their employers and an additional third private insurance, the uncovered medical bills are surmounting and rising into the tens of thousands of dollars. Again, these medical bills are not covered by any of their 3 insurance policies. How, I ask, is this possible? How is it that this great country has families working their whole lives, paying into a health care system that is supposed to take care of them should they need it someday, only to find out that someday comes when you least expect it, blanketed by an awful reality. It’s kind of like buying any expensive product with a warranty that doesn’t cover the cost of fixing it when it breaks. Would you buy it? Well, sadly the majority of Americans don’t have a choice.
    I also have a 17 year old brother who himself has health issues. He was born with Spina Bifida and will need further operations in the near future to correct problems he now endures as he continues to grow through his teenage years. He is an amazingly strong young man for his age. I’ve seen him take care of his father in ways that would make any older brother proud. He is a senior in high school now set to graduate later this year, begin college, and discover what his American dream can be. I hope it treats him well.
    I am one of millions of Americans who are deeply upset at the direction our country is heading. I believe that all good things in this world come from hope, love, determination, and vision. So instead of pretending problems don’t exist and turn my head, I choose to exercise one of the great liberties all American citizens have – the power of their voice and the right to have it heard. In today’s age it is so easy to get smothered with all that is wrong in this world. I refuse to just take it all in and become part of an apathetic society not believing in the ‘system’ any longer. I hope my ideas can provide a positive change for the people of our country and get the needle of the American compass headed back in the right direction.
    My gasoline bills are the largest part of my monthly budget next to my mortgage. My gasoline budget usually ranges from ~ $250-$350 a month depending on the time of year and the cost of fuel at the time. As I fill up my gas tank in my gas guzzling SUV about twice a week I, like most assuredly all Americans, look for the lowest price at the pumps. Yes, I drive a SUV but it doesn’t bother me what people think because that is my choice as a consumer in America. Everyone always says how SUVs drive up the price of gas but you never hear anything said about the millions and millions of minivans and pickups in America that get comparable mileage, do you?
    Anyway, back to my point. During my search this morning I looked at the signs for regular gas ($2.379) as I always do and something made me pause. Why is the price of gasoline sold in fractions and not in whole numbers? For example, why is it priced at $2.379 a gallon and not $2.38 a gallon? Surely, I hope it’s not just a mind trick to make us think we aren’t spending the $2.38 a gallon. It is like something being sold at $19.99 instead of $20 bucks. Well, that’s only half the story.
    What I really want to know is: where is my change when I purchase say 1 gallon? At $2.379 a gallon I pay $2.38. As a matter of fact, with a pricing structure like that, it is a fraud on public consumers because we aren’t getting the volume of gas we are paying for. Again, where is my tenth of a penny change when I buy exactly 1 gallon? Not a big deal you say. Well, that means that for every 10 gallons I spend on gasoline I am owed 1 penny. When I buy 100 gallons that would equal a dime, etc. If I multiply that figure by the amount of gas I purchase per year, that isn’t just pennies anymore, is it? I drive ~25,000 miles a year and estimate that I buy around 1,300 gallons a year. So, where’s my $1.30 change? Actually, I’ve been driving for 17 years so make it an even $22.00. So where is it? Where is the change for everyone that buys gas in this country? Maybe it evaporated into the atmosphere like the gas fumes when I accidentally ‘top-off’ at the pump. That shouldn’t matter anyway because global warming is just a theory, right?
    With this in mind I propose something I like to call the “Positive Change for Change” idea (or the positive CFC). It is kind of a spin on the negative CFCs we always hear about. Since a tenth of a cent for every gallon sold somehow ‘evaporates’ and only adds to the profits of the corporations that sell the product, why not require that tenth of a cent to go towards a national health care fund? After all, this money is owed to the public consumers who purchase this product every time they buy gasoline. I’m sure consumers wouldn’t mind contributing if it went towards securing the health of the people in this country. After all, it is our money, isn’t it? This would mean that for every gallon of gasoline sold, 1/10 of a cent goes in the national health care fund. Think the lobbyists and corporations will object? Of course, but do they really have any ground to stand on once people become angry enough and politicians realize that Americans don’t like to be lied to? We all know what can happen when those scenarios play out in elections, don’t we?
    So, you say you don’t really care about 1/10 of a cent and it wouldn’t make a difference anyway? Still not convinced it could make a positive change? Well, look again. If we do the math based on the statistics provided by the United States Bureau of Transportation (see the following link http://www.bts.gov/publications/national_transportation_statistics/html/table_04_09.html), there were 243,023,000 registered vehicles in American in 2004. According to the same statistics, the average annual fuel consumption in 2004 was 715 gallons per vehicle. Given those figures, if a consumer bought 715 gallons per year, this would mean that every vehicle would contribute 71.5 cents to the national health care fund on average, per year. If we then multiple that 71.5 cents by the number of vehicles (~244 million in 2004), this would give us ~174 million dollars a year into this fund.
    Now, this surely wouldn’t fund a national health care plan but it’s a start, and over time it can surely help. For example, over ten years we could have ~1.74 billion dollars saved. Twenty years would result in ~3.5 billion and thirty years would result in over 5 billion dollars. Seems like a long term solution and too long to wait? Well, what else do we have to do but live our lives, buy gasoline to commute to our jobs, and wait until we retire from the workforce in say 30, 40, or even 50 years? Over that time we could be funding our own health care system and the most magnificent part about this idea is that it doesn’t cost tax payers any more than they are already paying at the pumps!
    I know that it will take billions and billions more to fix the health care system but if government were to act on this soon, over time we could be making significant investments toward the health and security of our own people. Laws should also ensure that these monies can only fund a national health care fund. Better yet, if our government never got around to working this type of a system out, additional legislation should require the money to default towards funding the social security system. Think of it, in 30 years we could have saved and funded over 5 billion dollars towards health care and social security. Most of all, these figures are based on 2004 statistics and I’m sure we are well over 244 million cars by now. In addition to the increase in vehicles on the road every year, money could earn interest in accounts as well. Wow, if we did this say 50 years ago we would have already funded ~8.5 billion dollars (not including interest) towards health care and social security, and maybe we wouldn’t be fighting over how to fix it now. Think of all of the American dreams we could have helped over that time period.
    Here’s another idea. What if taxpayers could donate to a health care fund on our yearly federal and state tax forms? There are currently all types of societies, funds, and organizations that we can donate to. They include; Olympics, wildlife, missing/exploited children, prostate and breast cancer research, WTC, etc. Also, one of the first things on our federal 1040 tax forms is a question as to whether or not we want $3 to go towards the presidential reelection campaign. I bet millions of people would choose a health care or social security fund over wildlife or the Olympics. Now I love my cat, but I never gave money to the wildlife fund.
    I am not an economist, a government official, or a world leader. I am an ordinary American citizen who worries about the cost of my health care now and for my future family. I am no different than any other American citizen in this country. I want a brighter, more secure future for the children I plan to have some day. If there’s one thing I’ve learned over my 34 years it’s the less money I have, the better I am at budgeting my money. Why doesn’t our government use this same principle? Maybe the leaders of our country need to realize that the spending habits of our governments are a direct reflection on the people who are deciding how to spend it. If politicians making these decisions had to worry about how to pay for their health care costs maybe we would all have excellent health care coverage.
    Government needs to realize that it is supposed to work for the people and not for the corporations. Listen, I understand how important our economy is and what it does for us but there is no justification for not investing in our people. We are all shareholders in everyone’s future. When did this country lose sight of this? We need to shift our thinking and start to hold our governments liable for the health and security of its people. I can’t see why legislators wouldn’t jump for an opportunity like this, the power and ability to make a significant positive change for the health and welfare of the people. On the other hand, I guess I do. I guess my idea would mean ~174 million dollars less a year in profits for the corporations that have been committing fraud against the American people for as long as gasoline was sold in 9/10 of a cent, and our government that continues to let it happen.
    Quality health care for American citizens is not a luxury. It is an essential human right that should be provided to everyone by our government. Realize that the strength of any home is only as good as the foundation it is built on. Our country is only as strong as the health of its citizens. This foundation needs to be healthy and strong in order to persist and stand tall. I know the constitution doesn’t state that government needs to provide health care to its citizens. But hey, our founding fathers got the whole right to bare arms thing down, didn’t they? Just try not to get shot because you and your family might go broke trying to save your life if you do. Better yet, buy additional private insurance to cover you, just in case. Now, if they only sold ‘American dream insurance’, I would buy that.
    As I reflect on all that my family has gone through I wonder about my American dream. I think about the millions of people who have stories just like me. I know I will continue to fulfill my obligations and responsibilities, not only as a human being, but as an American citizen as well. I only hope the people of our government will come around and do the same. I dedicate this post to my father George and to all Americans that continue to struggle with their rising health care costs, while living their American dream.
    Be sure to share your stories, dreams, and ideas at http://positivecfc.blogspot.com

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