Rico,

I grew up near NYC and most of my family was born there, so we grew up learning the history of the place.  I’m assuming the book stops at the incorporation of Greater New York City, which was in 1898.  Before that, only Island of Manhattan was NYC.

ITW:

Seriously, you obviously know local history- the Shirt Waist fire story, and the Irish fire department battles- You’ll love “Gotham”. Bad news is it only goes up to 1898, with a promised second volume which hasn’t materialized yet. The developement of “public education” and welfare is fascinating.

PS: I’ll have to look up “Gotham”  Never heard of that book.

Ah, eat shit and die!  That better, Rico?

Now that I have that out of the way—just got an Enterprise pizza cutter and webcam to go with the corkscrew…  thinkgeek.com

Notice what keeps happening to health care companies, airlines, and cell-phone companies.  They keep merging and that old gov’t regulator, the Anti Trust Division hasn’t been stopping them.  Already the cable companies has a virtual monopoly, certainly an oligopoly.  You want high-speed internet? You can choose your cable company, Verizon’s FIOS, satellite, and maybe DSL.  DSL doesn’t work in my neighborhood—end of the line.  So it’s one of three, and they don’t really compete. Oligopolies don’t—they price based on game theory, not supply and demand.

So…if I’m stuck with a monopoly, I’d STILL rather have the government run it, pretending to be in the Public interest than a monopoly, duopoly, or oligopoly with their price fixing and NO interest in serving the public—but you STILL have no real alternatives.

There are 4 cell phone companies, and each is worse than the next.

You want an iPhone? There’s AT&T and….AT&T.  No unlocked phones, no alternative.  Now I’m not saying Apple has no right to do things the way they do—there are other phones, but imagine if Apple was the ONLY cell phone sold in the US….talk about a nightmare scenario!  Kinda like MS controlling all the business PCs—Window, Word, Excel, Internet Explorer, Power Point, Project.  You can’t use Linux, Word Perfect, 1-2-3, Firefox, etc.

My point being that a government monopoly IS better than a commercial monopoly, duopoly or limited oligopoly.  So I hold my nose and go for it.

ITW:

Our current system IS wildly inefficient!

And I think you’re spying on me. I use Lamisil and have a Klingon corkscrew!

Sounds like you’ve read “Gotham” by Burrows and Wallace. If you haven’t, do.

Your mention of fire and police allows me to agree that there is a need for government. Only the most rabid libertarian/anarchist would believe otherwise. Of course, your limits are far broader than mine, but still.

Right. Health care pricing is a mess, for the reasons I outlined. A true free market, undistorted by subsidies from whatever source, would help in my view. The problem, of course is that many people would still be priced out of the market for what is, sooner or later as you point out, an ESSENTIAL commodity. And that’s what has to be addressed.

The biggest problem I have with a Medicare type solution is that it’s operated by government bureaucrats, not by an entity which must keep consumers happy. If I don’t like Humana I can find another HMO, or opt out completely. No such luck with Obamacare or single payer. Then there’s that old, “Where in the Constitution does it say that…”

Look, it’s obvious we’re being way too civil with each other here and I’m afraid your truthdig confreres will start thinking you’re going soft. Let’s find a topic we can get ugly about and indulge in personal attacks so you can get your credibility back.

Rico, right church, wrong pew.  You’ve identified a key component of the problem.  Those utilizing the benefits and those paying for it aren’t the same people, therefore those charging for it do everything possible to game the system (Refer back to Rick Scott, that crook).  Certainly our current system is highly inefficient.

I’m not against profit. I’m all in favor of it. I LIKE it!  I think if you bring value you deserve to be compensated for it, whether it’s a new foot fungus med (like Lamisil) or a corkscrew that looks like a Klingon Bird of Prey. 

But not everything works best when it’s profit-based, for example police and fire-fighters.  Would YOU prefer to be arrested by a private cop or a public one?  For-profit fire-fighting is actually an ancient concept that was prevalent in New York City in the 19th century.  Companies would rush to a fire and shills would do things like put a barrel over a hydrant to hide it.  Companies would engage in fist-fights over who got to put out the fire—while the house burned down!  Compare THAT to those heroic men and women who died in the WTC trying to save people there!

So…is health care really a widget-based profit industry, particularly the insurance for it, or is it not?  Or is it a hybrid?

Health care is something sooner or later we all use unless we are phobic about doctors and die at home and aren’t found until the rot makes our corpse reek. Sooner or later we are all going to need it.

Yet I think you and I both agree that current pricing is badly skewed from what it should be, even when proper free market supply-and-demand analysis is applied.

Furthermore, we already have at least 3 workable systems of single-payer already in place:
1) The system the President, the Senate and the House have for life while they are deciding what you and I are allowed to have
2) Medicare
3) Medicaid.

As Candidate Obama, he proposed extending Medicaid to all Americans.  Medicare probably would work better but it’s actually a good, workable idea.  Of course the insurance companies hate it.  I’m sure doctors do, too.  But they hate the idea of being liable for malpractice, too, so I discount that.

Actually, the eye doctor tried to con me.  What turned me off was that the procedure he proposed directly contradicted what he had in his own brochure. He pushed the surgery HARD down-playing what were actually extreme risks. He should have said: You know, ITW, while I’d like the fee, you really are the kind of candidate who should not have corrective eye surgery. I’ll do it if you insist, but I don’t recommend it.

That’s the part he didn’t say.  Luckily, I’m suspicious enough and paranoid enough to back away.  My cousin did it anyway and now her night vision is ruined.

Plus, I would have had to wear glasses for 90% of what I do anyway, instead of 100% of the time.

(OK, that’s a little lie—I don’t wear glasses to sleep or shower )

ITW;

“There’s no way the US system can be considered “The Best” for all its citizens,”

That’s what I said. I agree wholeheartedly.

Anesthesiologists pay the highest malpractice insurance rates in the industry, so they have to recoup somehow. Sounds like your eye guy was at least up front with you. Isn’t that good practice?

The reason health care costs are so high is because consumers are insulated from the true cost of care by insurance coverage or government subsidy (Medicaid and Medicare). The most egregious example I can think of is the Scooter Store ad: “You can get one for free!” the ad tells Uncle Benny. “Medicare and your insurance will pay for it all!”

I went to the ER last summer with severe dehydration. Three liters of saline and a completely unnecessary chest x-ray later, I was out. Cost- $1300. Cost to me $150. If I knew I would have to pay the entire bill, I would have gone home, drunk some Gatorade and shaken it off. Uncle Benny and I are being insulated from the true cost of health care. Rather than negotiate with me and Benny over the price of saline and Scooters, they negotiate with the insurance companies and Uncle Sugar. Sweetheart deals all around. And therein lies a tale.

When the price of something goes down, it becomes scarcer. Do you remember the Nixon gas price freeze in the early 70s? Lines around the block trying to buy an ever dwindling supply of cheap gas. Producers weren’t making gasoline because they weren’t allowed to recoup their cost. (We can argue about the evil concept of “profit” another day.) So in an effort to make gas affordable to everyone, it made it unavailable to anyone.

The reason hip replacements and organ transplants and Scooter Chairs are free and unavailable in Cuba is because Cuba is just not wealthy enough to subsidize the total cost and is unwilling to allow the incentives that free markets would provide. People are lined up around the block waiting for free care that isn’t available.

And here’s where insurance comes in to completely fuck things up. If we could buy “gasoline insurance” and file a reimbursement claim every time we filled up, we’d all be driving Hummers and Exxon would be making outrageous profits- all subsidized by private insurance or “Energycare”.

That’s what’s happening with health care, except those without insurance have to pay the true cost, if they can afford it. Or they buy Priuses and ride their bikes a lot, to use the gas analogy. The problem is, that if you mandate universal coverage, SOMEBODY has to pay the premiums for those who can’t afford them and that somebody is the taxpayer.

And universal coverage will NOT make health care cheaper overall. Just the opposite, it will make it more expensive since EVERY consumer now is further insulated from its true cost, and health care providers can charge whatever they want knowing they will be reimbursed by Aetna or Uncle Sugar. Aetna raises premiums, or denies coverage, and Uncle Sugar raises taxes or borrows from China. And the cycle continues.

The solution is reuniting consumers with the true cost of health care. Prices will fall dramatically and therefore be more affordable to more people without having to resort to insurance. How to do that is well above my paygrade. Also, there’s the debate about whether health care is a “right” that has to be guaranteed or not. Touchy subject.

Rico,
Do YOU really want go there?  In infant mortality Cuba is tied with the USA at something like 41st.  There’s no way the US system can be considered “The Best” for all its citizens, only for those who get Cadillac health plans like C-level executives and Senators and Congresspersons—and Supreme Court Justices.

Plus, many practices don’t join plans so they can charge insane amounts—Anesthesiologists are the latest to milk this bandwagaon.  I had an endoscopy done a while back.  The doctor gets a few hundred $$ for this—but I got a bill from the gas passer for $1,000!  Only a small portion of that, a few hundred as well, is covered by our plan, a good one.  But the anesthesiology group sees a way to really SQUEEZE the patient, so they do.  This is good medical practice?

Look at all the ophthalmologists eager to do corrective eye surgery.  HUGE profit margin. I had one clown tell me he was going to use a procedure that his own brochure said wasn’t the right one!  Plus he told me I had 3 risk factors….I got the hell out of there.  This is good medical practice?

As long as doctors make far more money pushing procedures than providing appropriate medical care we will NEVER solve our problems.

Pat:

Except that the “for profit” part is what makes the US the best (NOT the fairest, nor most universally accessible, nor cheapest!) health care system in the world.

Cuba has free medical care and no medicine or clean sheets, tons of doctors and no Nobel winners, lots of clinics and no research hospitals.

If you’re really sick, where would you go?

As long as we have a for profit healthcare system, we all lose, many will suffer the bottom line.

This has to be done state by state (like Canada), For the Fed to force it down the different states citizens throats invites revolution or cessation from the union.

I think it unwise for the Federal government to get in a pissing contest with the states over this. 

We’ll see where it goes.

Gee Rico, now they REALLY are gonna make you unwelcome at the Young Republicans! Not to mention the Tea Party!:)

Reason? Common sense?  I’d say at this point not many Dems have much at all and no GOPers (in the Senate atleast) have any.

Yeah,common sense.  Do unnecessary surgery on a guy that leaves him a cripple and AFTER you pay him boo-koo bucks to pay for his lifetime care you go to prison.

But if a Canadian-Method hernia repair is indicated, and you warn the patient they fail 15% of the time, and it fails, you haven’t failed as a doctor and shouldn’t be liable. It was the correct treatment.

Common sense! Radical idea!

ITW:

“even NON-slave states were forced to help recover escaped slaves!” That damned Commerce clause again! (Just kidding.)

Look, I’m not going to dispute the many cases of abuse that many of our laws have been put to. I’ll concede every point you make on that score. But I am not advocating tort “elimination”, or caps on real health cost reimbursement for malpractice- just a little common sense in the “pain and suffering” category.

As for the South in the 60s- I’m a Yankee and in 1966 went off to Virginia for college. I was young and idealistic and did all the anti-war protest stuff- even tried to get arrested during the May Day protests following Kent State. Then I joined the Air Force and went over to the dark side. I must admit, I never felt like an outsider, altyhough I clearly was.

But I digress.

Thanks, Rico.

I remember the coffee suit. The woman was an idiot putting a scalding cup of coffee between her legs (!) but the rest stops were putting out coffee at insanely hot temps—close to 200 deg.  You couldn’t even touch the cups for 15 minutes!

But “tort reform” has used the exceptional cases to justify throwing out the baby with the bath water. Remember the proposed $250,000 liability max?  If you had health insurance and got really sick, like with some long-term cancer, if the insurance company saw it was going to cost them, say $500,000 to pay for your treatment, they could just flat-out refuse and then, in the law suit say “Hey! We’ll just pay the $250K max” and they’ve saved $250k—and you are probably now dead or bankrupt because of it.

You simplify the justifications of the 10th Amendment.  Remember: with the Fugitive Slave Act, even NON-slave states were forced to help recover escaped slaves! “Dred Scott” confirmed it (Scott’s owner actually freed him after—he agreed to be the plaintiff in a test case)  Plus, the 10th was the justification behind Plessy v. Fergusson, the Jim Crow laws and the use of fire hoses and dogs on peaceful protesters in the early 60’s.  I remember when the thought of going to the South was as scary as going to Hitler’s Germany. “Outsiders” (Americans) were being murdered there along with local residents who just wanted their rights under the Constitution.

Thanks! Hannukkah was lovely.  And a Merry Christmas to you and yours.

ITW:

I’m no constitutional scholar, needless to say. The 10th wasn’t used to “justify” slavery, it merely was used to say the feds had no business telling the states what to do, and until the 13th through 15th amendments were passed, slavery WAS consitutional, and evil. It’s still evil, but no longer constitutional.

” ECONOMIC activities involving ANY form of commerce are directly under the control of Congress and the Executive Branch.”

We’ll just have to disagree on the intended scope of that clause.

As for a health care fix, I just don’t know what’s the best course. Maybe a constitutional amendment?

I think you overstate the baleful effect of tort reform. For every malpractice suit that gets filed I can scald you with a hot cup of McDonalds coffee.

Happy Hanukkah by the way.

Rico,

You actually make sense and present a defensible argument. Wrong but arguable. However, I don’t see anything in the Constitution that prevents the fed govt enacting safety regulations.  Were that true, the entire FDA would be “Unconstitutional”, which, to my mind, is absurd.

I find both Kagan and Sotamayor to be Conservative Democrats, and are about as ideologically biased as John Paul Stevens.  While she was extremely Conservative, I found Sandra Day O’Connor USUALLY to be one of the least biased Justices during her tenure and I quite admired her even when I disagreed with her decisions.

The 10th Amendment is as over-utilized as the 9th Amendment is UNDER-utilized.  Why is that? Why is the question of what the implicit “rights” of states are SO much greater than the implicit rights of citizens?  Under the 9th Amendment the FISA, the MCA, and the Patriot Act are all clearly Unconstitutional.  Why is the 10th so much more important than the 9th?

Historically, what has it been used for? Well, the most obvious was to justify slavery, then to justify the Jim Crow laws, violations of voting privileges and even violations of Bill of Rights guarantees.  Curiously, NOW the 10th is being cited to allow the use of medical marijuana.  I think this is absurd.  I think ANY drug should be available for therapeutic use, unless its use is banned—for medical reasons. 

Plus the Commerce Clause, combined with the clause against interstate tariffs (honored more in the breach than in the implementation—examples would be cigarette smuggling from NC to NY), clearly indicates that ECONOMIC activities involving ANY form of commerce are directly under the control of Congress and the Executive Branch.

“...To regulate Commerce with foreign Nations, and among the several States, and with the Indian tribes;”

Rico, it’s a mistake to say the Commerce Clause is a “liberal” touchstone. It has been used numerous times by Republicans to overpower states’ rights in these matters, particularly when a state may not want an environmentally destructive action and the GOP PTB in Washington do.

But our HC system is a wreck.  Who hasn’t seen $25 aspirin tablets and $3k/night rooms, rooms you have to share?  Hospitals continue to get caught cheating on Medicare/Medicaid re-imbursements—the Gov. Elect of Florida, Rick Scott, was COO or CEO of HCA when THEY got caught cheating on them.  H barely got out of being charged by pretending ignorance.

But why doesn’t the GOP want to fix it?  What’s their only solution? Do away with malpractice lawsuits.  So if the bugger doesn’t do the surgery but bills you for it, and you get sicker as a result, tough shit (happened to my dad).  Or if the bugger does unnecessary bypass surgery on you (like Moon for Tenet HC in California) and even KILLS you (as he did a few people) then you have no recourse.

The new system will suck too. But that’s the result of Republican and DINO pressures on what got into the bill.

ITW:

I just read Cain’s post. I’m not piling on.

ITW:

“What’s the difference between being forced to buy auto insurance and being forced to buy health insurance,”

Except that you’re not forced to buy auto insurance, unless you want to own and drive a car. And the requirement does not originate at the federal level. It was New York City which adopted fire and safety codes in response to the Triangle Shirtwaist tragedy, not the feds. And as well they should have; it was well within their purview and responsibility to do so. Besides, can you imagine Congress in 1911 trying to enact a national fire safety code?

And, there is no “unless” with the health insurance mandate. It’s like saying, you must buy car insurance whether you drive or not. Would YOU put up with that, especially if it came from Washington? There is no “opt out” and worse, the mandate DOES originate at the federal level.

The battle flags are the Tenth Amendment on the conservative side, and the Commerce Clause on the liberal side. One side says “Leave me alone,” the other says, “We can do anything.” Nobody denies New York City’s right and obligation to enact fire codes. On the other hand, lots of people would holler if those very same codes originated in Congress, NOT because the regulations are a bad idea per se, but because of where they originate- the Constitution does not give Congress that authority, it gives that authority “to the states and to the people.”

We can agree all day long about how to run an inclusive, comprehensive health care system, but we will disagree as long as there is a “constitutional” issue attached to the debate.

I agree that conservatives are often as guilty as liberals of finding Constitutional justifications or Constitutional silences to promote ideological points of view. As for the Supremes, I think Sotomayor and Kagan are at least as ideological as Thomas and Roberts, don’t you?

Cain, you just parrot the GOP line.  So…government regulation preventing dumping excrement in with chicken or beef is a bad government intrusion?  Preventing a snake oil salesman from selling alcohol and cocaine as a cure-all is a bad government intrusion?
Preventing fire doors from being locked is a bad government intrusion?

On what planet?

In our society, where, unless you live in a major city with subways and buses, cars are how you make your living.  You can’t have a car without buying private insurance frequently barely regulated.  A choice between buying car insurance and not getting to a job is a Hobson’s Choice—no choice at all.

You refuse to see them as the same because you’ve clearly decided this health care bill is a “socialist” measure and the difference between it and car insurance is…it’s President Obama’s bill, EVEN THOUGH THE GOPers WHO OPPOSED IT PROPOSED A SIMILAR BILL A FEW YEARS EARLIER!

BTW, I think it’s El Stinko as well. I’ve become convinced that a single payer system, basically an expansion of Medicare to all citizens, is the only workable health system.

ITW,

There are two major differences between being required to buy auto insurance and being required to buy health insurance.

1. The auto insurance requirement is a state requirement not a federal one.  States have their own Constitution that dictate what is allowable under state law.

2.  Buying auto insurance is only required if you chose to drive on state owned highways, this is similar to not being allowed to carry a gun onto a plane, while you have the right to carry a firearm you forfeit that right when you choose to get onto a plane.

With the health insurance mandate you have no choice, save moving to a different country.  you must buy this product.  At the heart of the American dream is your right as an individual to make your own decisions.  Each time the government passes a new regulation more of that dream is taken away.

Rico,
I’m sick and tired of judges claiming things are “Unconstitutional” on bizarre and weak grounds.  As the anti-abortionists say “Show me the right to privacy in the Constitution” (I can), I say show me where the Constitution says you cannot be forced to buy insurance.

If that were the case then the laws of NY and NJ that considers driving a vehicle without insurance to be a misdemeanor, subject to up to a year in jail, is just as Unconstitutional.  Yet those laws have stood the test of decisions and time for well over half a century.

What’s the difference between being forced to by auto insurance and being forced to buy health insurance, other than it was Democrats who passed the latter and a Bush-appointed GOP judge who over-ruled it?

I’m tired of seeing us, in America, returning to the conditions that led to the Triangle Shirt Waist fire, where, without government regulations (that you hate), fire doors were locked by the owners and about 150 women died unnecessarily.  A similar event happened in more recent memory at a chicken processing plant in Hamlet, NC (An ugly town if there ever was one, having been through it a number of times).

Somehow, every government-imposed regulation is “Unconstitutional” even if it makes perfect sense and bars clearly criminal behavior like these business owners over 70 years apart.

We’ve been told it’s “Unconstitutional” to prevent corporations, even FOREIGN corporations, from buying millions of dollars in campaign ads to influence our elections, our choice over who will rule US!

A study was done a couple of years ago with terribly depressing results.  In case after case after case, if it was a politically charged issue, Democratic judges ruled for the Democratic position and Republican judges ruled for the Republican position.  In the most important case of our lives, 5 Republican Supreme Court Justices sided with a Republican candidate who had won less votes—and all of them were biased.  When Clarence Thomas voted to make George W. Bush the next President, his wife was already working for Bush vetting candidates.  Sandra Day O’Connor had been overheard at a party saying she couldn’t STAND the idea of Albert Gore as President. Both Scalia and Rehnquist had children active in the GOP at the time.  Nobody recused themselves.  Thomas, at a minimum, should have, clearly having a conflict of interest.

But it didn’t happen.

Better than that? Better than what?  George W. Bush put up biased judges deliberately—and the demo-weenies let him when Cheney threatened (illegally) to bypass the Senate rules and force an up-or-down vote.

What does it take to convince you that the so-called “Conservatives” ain’t?

ITW:

“Neo-fascist”? Come on now. You’re better than that.

The way this giveaway to the insurance companies and big pharma was finagled with no input from those who wanted a voice for one-payer or a chance to buy into Medicare sets my teeth on edge.

Whaddayagonnado, Obysmal? Put people in jail or just let ‘em languish until dead? Including kids?

Putz.

This is the reason Bush placed as many neo-fascist judges as he could on Federal benches with life-time appointments, all the way up to Roberts and Alito:

So that they could undo every piece of legislation Democrats got passed on some super-shaky grounds of being “UnConstitutional”.

“Constitutional” and “Inconceivable”..................
“I do not-a think that word means what you think it means.” Inigo Montoya

bmeisen, 

In some convoluted way that makes sense.

Have no healthcare, get sick and die.

Run a stoplight aand die.

The end result is the same and preventable.

I have to say that I actually agree with the Republican view on this.  I don’t see how the government can force individuals to purchase a product from a private company, for no reason other than one is alive.  There is something that feels very wrong about it to me.  With how cozy Republicans are with big business, I am surprised they are opposed to this part of the plan, seems like they should love it.  Maybe they do, perhaps they just want to seem to fight it to appease the libertarian portion of their base.   

A single payer system would be best, no doubt in my mind.  The US system is burdensome and stifling to business, and leaves too many people out in the cold.  Both cruel and expensive, there has to be a better way than forcing people to purchase insurance, even if there are subsidies for it.

bmeisen:

Are you serious?

If health insurance is a product then so are traffic lights. If the government cannot compel me to buy health insurance then it cannot compel me to stop at red lights.