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in 2009 there is no bigger issue

There are some assertions in this article below that deserve some response.  It is a good example of sloppy thinking and distinctions.   This kind of paint the arguments with random colors seems quite popular, but is quite dangerous in public policy.   Sound reasoning needs to be promoted, used, and demanded in this debate, for there is great risk using emotion or only special interests to define reform, as it is being done today.

See Editors comments below: 


Why Democrats Are Losing on Health Care

Thomas Frank,  WSJ, Sept 2, 2009

They won't debate the proper role of government.

What's dragging the Democrats down in the health-care debate isn't confusion about details.  On this the president and his supporters have proven themselves the ablest of technocrats, easily identifying each plan's particulars and its shortcomings, laying everything out on nice flow charts.

It is the big questions that are tripping them up.  Concerns about the size and role of government are what seem to leave reformers stammering and speechless in town-hall meetings.  The right wants to have a debate over fundamental principles; elected Democrats seem incapable of giving it to them.

And in the silence, some lousy ideas have flourished. If universal health insurance goes down to defeat again this year, Democrats will have to live with the shame not only of having failed to enact their No. 1 priority, but also of having been beaten by arguments that a novice debater would have no trouble putting down.

Consider the assertion, repeated often in different forms, that health insurance is a form of property, a matter of pure personal responsibility. Those who have insurance, the argument goes, have it because they've played by the rules. Sure, insurance is expensive, but being prudent people, they recognized that they needed it, and so they worked hard, chose good employers, and got insurance privately, the way you're supposed to.

Editor:  "Clearly healthcare is not a product but a service.  Is is a right, as some portray, want, and work towards?   Such thinking fogs the issues.  If a debate is to ever occur on the issues, then the concepts have to be well defined and used."   

Those who don't have what they need, on the other hand, should have thought of that before they chose a toxic life of fast food and fast morals. Healthiness is, in this sense, how the market tests your compliance with its rules, and the idea of having to bail out those who failed the test—why, the suggestion itself is offensive.  We have all heard some version of the concluding line, usually delivered in the key of fury: By what right do you ask me to pay for someone else's health care?

This image of sturdy loners carving their way through a tough world is an attractive one.  But there is no aspect of life where it makes less sense than health care.

To begin with, we already pay for other people's health care; that's how insurance works, with customers guarding collectively against risks that none of them can afford to face individually. Our health-care dollars are well mingled already, with some of us paying in more than we consume while others use our money to secure medical services for themselves alone.

Editor:  "to compare today's healthcare insurance option and industry to a free market version is quite fictional.  We do not pay for other's healthcare.  We should be paying for our healthcare and buying risk management in the form of insurance.  Why is this concept so difficult to realize and act upon?  Reasoning is not a tool in this discussion it seems.  I thought that healthcare reform was about solving a problem of coverage and cost.   Both can be fixed by using the free market as outlined and phased in, as detailed elsewhere in this website.  Anything else puts our society at great risk, and what is the motivation to do that?"

The only truly individualistic health-care choice—where you receive care that is unpolluted by anyone else's funds—is to forgo insurance altogether, paying out-of-pocket for health services as you need them. Of course, such a system would eventually become the opposite of the moral test imagined by our Calvinist friends, with the market slowly weeding its true believers out of the population.

Editor:  "insurance plays an important part of risk management in car usage, fire protection for homes, and others.   Why would it not be an option that a free market would gladly offer, and be more creative in doing so, if the many mandates and regulations were removed.  Again this kind of poetic thinking has little bearing to a meaningful discussion on the topic of enhancing healthcare for all, which requires a great increase in competition in insurance."

The idea that merit determines healthiness is almost as risible. To be sure, we should all eat right, brush our teeth, and cut down on sweets, but that will hardly help us if we're born with a condition that requires expensive treatment. Or if we eat cookie dough that's tainted with E. coli. Or if our industry dies and our employer shuts down. Or if our insurance company, looking out for its own health, finds some pretext to rescind our policy.

The righteous individualists among us might also consider that our current health-insurance system, which delivers them the medicine they think they've earned, is in fact massively subsidized by government, with Uncle Sam using the tax code to encourage employers to buy health insurance. And were it not for government programs like Medicare and Medicaid taking over the most expensive populations, the political scientist Jacob Hacker pointed out to me recently, the system of private insurance would probably have destroyed itself long ago. That image we cherish of our ruggedly self-reliant selves, in other words, is only possible thanks to Lyndon Johnson and the statist views of our New Dealer ancestors.

Editor:  "Such a characterization of individualists is quite inaccurate if not totally unfair.   It seems once again that the paint brush stroke was swung across the canvas, and we are left with a picture as a valid depiction.   Certainly the notion that individualists expect subsidies is quite erroneous and untrue, but this shallow thinking is again quite sloppy in its reasoning.   It might be true for some, but is not true for many I know.  The expectation of entitlement is contrary to what individualism is based upon.   It is journalistic poetry, but an unsound argument."

One reason government got involved is that our ancestors understood something that escapes those who brag so loudly about their prudence at today's town-hall meetings: That health care is not an individual commodity to be bought and enjoyed like other products. That the health of each of us depends on the health of the rest of us, as epidemics from the Middle Ages to this year's flu have demonstrated. Health care is "a public good," says the Chicago labor lawyer Tom Geoghegan. "You can't capture health care just for yourself. You have to share it with others in order to protect your own health."

Editor:  "I could not disagree more with this sentiment, for it is just that, an emotion.  Government got involved because of the "Great Society" concept of Johnson in the '60's.   It was about liberal thinking that we could amass a society that was devoid of markets doing the right thing, that that government was required to step in, as it has in public education with such great success, or with the Post Office, with the high cost of that service well analyzed.   This is based on the notion that government is required to fill the gaps that markets do not serve, which is simply not true, and the most devastating myth working today.  In so doing the cost and quality suffer, and the result is simply a penalty for all.  In the beginning and end healthcare is just like receiving mail, something has to deliver something you do not have.  If it has competitive forces and you have free choice then the market works.  Simple as that.  Anything else is just sloppy thinking."

Yes, Democrats can prove that America pays more for health care than other countries; yes, they have won the dispute that private health insurance is needlessly expensive. But what they've lost is the argument that we are a society.

Editor:  "what they are loosing is the concept of what kind of society we are.   It is about leading and solving while innovating, and doing good things certainly, but not by using centrist controls as is in each of the Bills thus far, but rather believing in the citizens of this society and repealing the restrictions on the healthcare market place that has caused the problem we are now seeing.  Some are trying to solve the problems with more mandates, handouts, and expensive policies.  Where is the big picture and the sense in all of that?  Not on page whatever in an Bill."