I've moved this discussion from the comments section for the September meeting. I've quoted all the relevant comments below.

Dru Whitledge:

Only the two views indicated above -- both of which I've heard bookoo before and consider sub-optimal on the cooperation side -- they rob Peter to pay Paul telling Peter be nice and willing to do that. Peter gets pissed. Status quo is Franklin robing both Peter and Paul -- sub-optimal to the competive side. Is there any intelligent discussion of finding an optimality -- which would also describe a sustainable and fair system with no bad guys in it -- of either kind.

Richard Berg:

Didn't understand your entire comment, Dru. I always think of "robbing Peter to pay Paul" as a pyramid scheme thing, but you seem to suggest that any form of insurance would result in robbing Peter to pay Paul - Peter would get pissed if Paul gets more claims paid than Peter does. Is that really what you mean to say?

Dru Whitledge:

I'm pretty sure re-reading my post that I didn't say anywhere "any form of insurance", but without being an accountant or even an actuarial -- Peter would likely be pissed if he percieves that he is predictably "net negative" for participating in "any form of insurance", while Paul would be proportionately less pissed if predicatably net positive. Given the option -- Peter will likely terminate his participation -- before voting Republican or Libertarian -- unless you prohibit termination.

Richard Berg:

So, the answer to my question seems to be, yes, you consider any form of insurance to be "robbing Peter to pay Paul". No need to be defensive if that's really what you think, just say so plainly. Of course, if that is your view, it falls, how shall I say this - somewhat outside the mainstream?

Orson:

Most people have health insurance or government coverage of some kind-and those who don't (or can't) ultimately get some kind of treatment at public expense. Insurance costs are higher because Medicare is underfunded and physicians have to shift underpaid costs to private sources.

May I reformulate Dru's challenge? If I read the verb to "rob" correctly, Dru is trying to get at a political dualism and social welfare-spending paradox. On the one hand, proposed reforms either increase explicit coercion (taxes, universal benefits, bureaucratic rationing), or smuggle them in under freer choice options (ie, the present system).

So the "opposites" aren't really opposite-the social welfare dillemma never really clarified--REAL alternatives never offered--is this right, Dru?

Richard Berg:

It is simply not true that "those who don't [have health insurance] ultimately get some kind of treatment at public expense". Emergency rooms are not free. If they were, we would all drop our insurance and use them instead. I'm curious, Orson. Do you also consider this country's long-standing universal police protection and military defense to require "explicit coercion (taxes) ..."?

Dru Whitledge:

Jeeze, Richard, you're smarter than that, aren't you, you must be ... or ... are you secretly ... an evil doer attempting to distort my words on behalf of the Health Insurance evil doers or big pharma or ... Al Queda?! Just read what I wrote. No need to impute anything -- nor extrapolate it to any unfounded conclusion (or agenda). It demeans you to do so. If you wish to argue a point do so honestly on the merits of what is argued, don't attempt to prevail by distorting what is argued.

The sustainable concept I argue ain't all that complicated -- Paul is entitled to consume only what Paul produces -- any more and he is consuming what someone else has produced (Peter). Peter may be compelled to contribute to Paul's consumption ONLY to create a "public good" to EQUALLY benefit Peter (including risk mitigation). Peter may also elect to charitably contribute to Paul up to a point. Taking any more is robbing Peter to pay Paul and pisses off Peter. Peter?s perception is important.

This is beginning to sound childish, Dru! Pretty soon you will be quoting Aesop's fables. I was under the impression that what the underlying reason for the discussion is whether or not we have an efficient health care system in the United States and if so, then how much would it cost in terms of medical care insurance and how that should be regulated, if at all.
One of your assumptions is that there are super-producers (such as the CEOs of Lehman Brothers, insurance company CEOs, etc.?) And then there are the good-for-nothing under-producers who merely wish to take advantage of the others.
I have only a single simple question for you: should our country continue to subsidize inefficient and arguably borderline dishonest health insurance and drug manufacturing companies, or should we maximize competition between them and a not-for-profit government supported insurance pool?

The health insurance reform issue is an ideal nail upon which to hang a discussion of libertarianism, which seems to be where Dru is coming from. There are of course no successful modern countries that have espoused libertarianism, but in health care we at least have a situation where one country, the USA, is far more libertarian than any other post-industrial country. And, how is that working out for us?

It sucks! We are ranked #37 in the world in health outcomes (World Health Organization, 2000, at http://www.photius.co..., but even that's not the whole story. We also spend far more than anyone else, and down at our #37 position, we spend many times as much as our competition. We have far more bureaucracy, longer average waiting times (go ahead, try to argue this point, I want you to), and worse choice than any other modern country.

Taking into account both the outcomes and the dollars spent, and depending on the dollar value given to health care outcomes, we probably have the worst health care system in the entire world. (Again, not the worst in terms of outcomes, where we're #37, but the worst in terms of outcomes per dollar spent).

This is the clearest example I can find on the world stage of libertarianism having a chance to prove itself. And, it has utterly failed. Libertarianism has been relegated to the fringes of popular consciousness for good reasons, and I hope it stays there.

The US ”sucks” - it has failed! says Richard. ”we probably have the worst health care system in the entire world,” n terms of cost-effectiveness, he says.

I’ll disagree: we actually do get what we pay for, ie, a better outcome for the money. But when we do actual apple--to-apple comparisons by parsing the most relevant details, in terms of human demands - despite readily identifiable (and remediable) obstacles in health care - we get (or at least can get) the best for our unique nation.

RICHARD TO ORSON [from event 13 Sept posted elsewhere]:
**”It is simply not true that ’those who don't [have health insurance] ultimately get some kind of treatment at public expense’. Emergency rooms are not free.”**

REPLY:
Of course there is no free lunch in health care: ERs are not "free." WE pay. Private insurers are paying for the underfunding of Medicare, for instance-by about 20-30%. This government cost-shifting makes private insurance more expensive. The relatively fewer uninsured, or not covered by government programs, do use LESS healthcare-40-60% less is the figure I've seen. (Thus, if they are included as Obama wants, cost will rise and access will fall.)

The social-welfare question health-care poses has quantitative and no-nquantitative aspects we need to consider. Numbers and culture-both.

REPLY TO RICHARD ABOVE:
US WHO's ranking is low mostly because of higher infant mortality (mostly immigrants and the docile poor), sedentary and obese lifestyles. Now, WHO's life expectancy stats are a great bludgeon, but when all you have is a hammer, everything looks like a nail-including the US. What's needed to fairly evaluate health care systems are apple-to-apple comparisons - not apples and oranges.

So-what are apple to apples? The US is a uniquely large and diverse nation, five times larger than our European peers. Among the very largest developed nations in the world, only Japan exceeds us in later-in-life life expectancy. Why? Genes and healthier lifestyle, probably. The US also has great numbers of immigrants (as much as 60% of the world's), with language barriers to health care access other nations like Japan don't face. For instance, millions of people eligible for Medicaid simply don't avail themselves of it. (SEE the health care chapter in "Cowboy Capitalism" by German journalist, Olaf Gersman.)

What happens when we control for the relevant variables (which WHO does not)? US white people's life expectancy is comparable to Northern Europeans. In fact, by middle age (40s and 50s) US life expectancy is world leading in life expectancy. How can this be true?

Anecdotally, don't the world’s wealthy beat a path to Cleveland and Mayo Clinics or med schools in the US? Not Germany? Not Italy or France or Japan? Maybe it's because 85% of all medical research is conducted in the US. (Think about it: with only a few exceptions, the US has owned the Nobel prize for medicine for many decades.) Quality does not come without costs.

Why? Intellectual capital plus the selfish profit motive. Kill the profit motive, as Megan McCardle at the Atlantic online has energetically argued (SEE Asymetrical Information), what becomes of this taken-for granted stream of medical progress? It dies. Thus, the death rate from heart attack shrank from 30% just over 15 years ago to 6% and falling!

The US has higher rates of cancer survival for the most common forms like prostate, colon, and breast cancer. We do much more preventive testing than the Eurosocialist states, and survive these diseases more by 9% up to 52% than they do. In general (and despite FDA bureaucracy), we get the better procedures, pills, and surgeries than they do.
(SEE Dr. Scott Atlas, Stanford University Medical School, Is US Health Care So Bad? [my title])

We have longer waiting times, sways Richard? (SOURCE please?) Not according to Dr. Atlas: ”Americans spend less time waiting for care than patients in Canada and the United Kingdom. Canadian and British patients wait about twice as long—sometimes more than a year—to see a specialist, have elective surgery such as hip replacements, or get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In Britain, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.”

Worse is what we American’s call ”customer satisfaction.” Writes Dr. Atlas, "More than 70 percent of German, Canadian, Australian, New Zealand, and British adults say their health system needs either 'fundamental change' or 'complete rebuilding.'" American's, even lower income people, are more satisfied with their health than elsewhere, including neighboring Canada, he says.

So-is there a health care cost crisis, as Obama cries? In the early 1960s, the average American spent 52% of income on food, housing, and health care. In recent years, that figure is about the same, 54%. But do we get more food, larger and more houses, better and more life-enhancing health care? Unequivocally YES.

In other words, YES, we do spend more on health care than other nations by a large amount. But we do get something out of it: we get longer, better lives, especially later in life. Sometimes, you get what you pay for.

None of the above denies that there aren't important changes needed. Republican sponsored tort reform, which raises costs from $2-300 billion per year, in every Congress they controlled since 1994 was defeated in the Senate, for example. (Tort reform in Texas started under George W. Bush looks like a real success.) Opening state regulated insurance - loaded with pricey, uneconomical mandates for special interests - to competition, as in auto insurance, would be the biggest and simplest immediate positive change. And insurance portability? YES, please.

But the plan Obamacare basically poses is really a fundamental practical political question for Americans: can bureaucrats ("I'm here from the government and I'm here to help you") provide for individual medical needs better than the people can for themselves? Or not? Factually, this is extremely unlikely, given the ongoing failures of government health care (eg, Indian Medical care Service, looming Medicare insolvency, Medicaid, even the VAs "cherry picked" service population). (SEE my friend in Sedalia, CO, Dr. Paul Hsieh's blog We Stand FIRM.)

Today, what we are witnessing in the pushback against Obama is the old-fashioned re-assertion of American Exceptionalism's individualist ethos, health care being only one of many Big Government's (eg, Cash for Clunkers? "Stimulus" that doesn't stimulate?) overreaches. Ad more so than last time (”Hillary Care”), which also foundered on Big Bureaucracy. It was as predictable (for over three decades, Americans self-identify as "conservative" to "liberal" by 2:1 ratios) as the sun rise. No one should die from rationed medical care because America is broke. Unless American individualism and initiative and reward based systems are now dead.

[CONTINUED]

I've lived in the Netherlands and studied in the UK. While these state health care systems served my easy young-and-healthy needs fine, when I travelled, I always encountered mimddle-aged people with strange chronic ailments I'd never seen in the US: people with gout, awaiting intestinal surgeries or prostheses - all kinds of odd stuff with people killing time (ie, many months), waiting for help that I had never seen in the US. This is undoubtably because of rationing of procedures and state spending when people actually need them - the inevitable fate of state-run inefficiency.

As my St. Andrews University (Scotland) educated prof said about all the docile English people unaccountably "queued up" in England: "Hmmm. They Make good slaves." But American's don't. Or, at least, we don't want to be treated like ones. (SEE Aussie political psyhologist John Ray's Socialized Medicine blog.) Nothing has changed in twenty years, despite the stout denial of American Exceptionalism by the left.

Orson:

I've lived in the Netherlands and studied in the UK. While these state health care systems served my easy young-and-healthy needs fine, when I travelled, I always encountered mimddle-aged people with strange chronic ailments I'd never seen in the US: people with gout, awaiting intestinal surgeries or prostheses - all kinds of odd stuff with people killing time (ie, many months), waiting for help that I had never seen in the US.

Then you've been hanging out in the wrong circles. I've seen these situations all around me, among co-workers when I've had minimum-wage jobs and with my neighbors in many of the crappy apartment complexes I've lived in. Those who haven't watched people slowly die while they knew it was happening, live very sheltered and privileged lives. There are neighborhoods right here in and around Denver that are like third world countries.

This is undoubtably because of rationing of procedures and state spending when people actually need them - the inevitable fate of state-run inefficiency.

We have rationing of procedures here, too. Insurance companies decide when people are too expensive to go on living. My friend Gene (no longer living) believed that the insurance company essentially murdered his aunt, because while being treated for ovarian cancer she was vibrant and physically active and not suffering any pain (I witnessed this myself). But once the insurance company found out that the cancer could not actually be cured and that they were paying to extend the life and quality of life of a woman in her 80s, they cut off the funding for her treatment. Gene told me that overnight his aunt was bedridden, unable to care for herself in the most basic ways, and in agony, and within days she was dead.

And if you don't have insurance, hospitals decide when you're too expensive to go on living.

People think that everyone can get medical care at public expense if they don't have health insurance, but that isn't true, at least not when it comes to the pricier ailments. People often die on waiting lists for medical care. When I had Hodgkin's Lymphoma, there was only one place in Denver where I could get treatment--at St. Joseph Hospital in the Caritas Clinic--and that was because it's a teaching hospital and they happened to have an opening at the time. That would have been a $50,000. medical treatment.

And I had visible tumors all over my neck for a year before I was able to get a diagnosis, because it took me that long to come up with the money to pay $20. to see someone at a clinic, and then another $20. for a second visit, and then to pay for tests even at a deeply discounted rate, to find out what was wrong with me. It was a long, slow process with many months between visits while I tried to scrape up the money to take another step forward. Over the course of that year, the tumors went from small itchy bumps on my throat, to big itchy, achy knots, to lumps so large that the biggest one was the size of a small chicken egg, and so painful that one I could feel in my upper back made it impossible to lift my right arm. I could not wear a seat belt in a car because of the tumors along my collarbones.

When I finally got a diagnosis and was then accepted into St. Joe's, they told me that if I had been diagnosed promptly I could have just had radiation, instead of going through the seven months of chemotherapy that were necessary because the tumors that could be seen and felt were just the beginning and they had spread throughout my body. So it's actually a whole lot cheaper for hospitals if medical problems can be caught early on instead of allowed to worsen.

Some time after I'd gone into remission, I read a newspaper story about a woman in her early twenties, younger than me, who lived in another state and was the single mother of a young son, and she was allowed to die of cancer because she didn't have health insurance. Though again, if you haven't seen this type of thing around you, you hang out with a pretty rich crowd. I'm sure it only made the news because the little boy was orphaned, and because all of the places that turned her down for treatment knew that would be the result.

(I think it was Utah and she may have been 22, but I can't be sure because chemo murks up your mind for a while, and it took years to get back the memory, concentration, and overall sharpness I had before.)

I hadn't realized how lucky I'd been until I read that story. And everyone who has medical treatment is lucky. But I don't think we should have to rely on luck.

A lot of the protesters against reform are elderly people on Medicare (who hypocritically don't want the rest of us to have "socialized medicine at taxpayer expense,") or people whose jobs give them coverage, being rallied together by representatives of the health insurance industry. When I see a lot of low-income uninsured people like me out on the streets protesting against reform I'll listen to their objections, because those are the people who have the most credibility on this issue, as far as I'm concerned. (Though I'd listen critically, realizing that the health insurance industry may not be above bribery.)

Why? Intellectual capital plus the selfish profit motive. Kill the profit motive, as Megan McCardle at the Atlantic online has energetically argued (SEE Asymetrical Information), what becomes of this taken-for granted stream of medical progress? It dies. Thus, the death rate from heart attack shrank from 30% just over 15 years ago to 6% and falling!

Not very scientific, Orson. This is...

a

What happens when we control for the relevant variables (which WHO does not)? US white people's life expectancy is comparable to Northern Europeans. In fact, by middle age (40s and 50s) US life expectancy is world leading in life expectancy. How can this be true?

Yeah Orson, I guess if you don't count everyone that doesn't have access to health care, the rest of us are doing OK. That's kind of the point, though. Those with insurance have access to some of the best medical care in the world. Those without don't have access to any health care. Yes, they can usually get treated in the ER, if they don't mind losing their home or being in debt for the rest of their lives.

I don't have any experience with health care systems outside the U.S., so I will just link to a couple of articles. These were written by a woman from California who is now living in Canada, so she has seen both systems first hand:

Mythbusting Canadian Health Care Part 1
Mythbusting Canadian Health Care Part 2

(edited to fix spelling error)

Jeanette, I'm not buying it. Why? Because if what you say about hospitals or insurance companies is true, you still have options; people still have the choice of buying better insurance and shopping around. And if that fail, one can seek contract enforcement through the courts. If what you say is true about your own experience, then you have a lawsuit you ought to see an attorney about!

Under bureaucratically managed "health care," who can you sue for non-performance or damages? It is against the law to sue the state. Bureaucrats will be insulated from lawsuits AND you will eventually have no other choice.

Now, perhaps this is news to you: Socrates is mortal: we all WILL die, sooner or later. There is no utopian option in life. Instead, we only have the engines of science and the culture of applied reason to improve quality of life and save lives. With the Obamacidal "Health Care," our country will moves down the food-chain of medical progress, as it becomes less available and less affordable.

The churlish and destructive attitude you manifest amounts to the slogan of the old British Socialist Labor Party trade-unionists: "I've Got Mine, Jack!" Meaning, "screw you!" who are not fortunate enough to suffer from a disease not already treatable by progress in the pipeline like mine. How sadly narrow minded and self-serving.

On to my updated brief: "Coverage Versus 'Health Care' by Bureaucrats-Slavery Versus Freedom!"

Last week, the House of Representatives passed a ”health care” bill that will give all but 12-16 million people ”coverage.” But not necessarily ”health care.” What’s the difference? It is important because mere "coverage" does not entail actual health care. It will mean disability and premature death, when bureaucrats decide on it, the because the people have sold out liberty for the illusion of security.

Consider the case of Linda Grayson of Vancouver, Canada, and how it illustrates America’s future. She was a divorced mother of two children, and in her early 20s. A congenital defect resulted in a disabling spinal condition with no way out because she was too young for surgery. Other’s were ahead of her on the waitlists.

She lost her job and went on welfare because she could not work from the chronic pain. Instead, she got morphine to which she got addicted. She couldn’t walk so she was given a walker. Nerve degradation resulted in losing control of bowels an bladder, so she was given diapers to wear. She couldn’t lift her small children with all her pain, and thus couldn’t be a functioning mother - there’s no compensation for that.

Denied surgery multiple times, after two and a half years, she found a doctor who would schedule her - another wait of six months. Finally, by her mid-20s, she got the surgery she needed, that she could have readily gotten in the US.

A KOA caller tonight from Denver lived 14 years under Australia’s socialized ”health care.” Hiis wife suffered an injury in an auto accident. She needed a pin put into her leg, and that took 15 months to schedule. Meanwhile, her leg ”healed” wrongly because of the wait. To this day she is can only walk hobbled in ways few American’s experience, because we enjoy options our money freely buys.

What happens when your money can’t but what you need in health care? People strategize to gain political ”pull,” just as Ayn Rand described in her prophetic 1957 novel of America’s future, ”Atlas Shrugged.” I know of friends in Toronto who send their children to private school where they can hobnob with the best doctors. Only that way, by becoming the best doctors ”friends,” can they ensure getting the health care they want. Otherwise, their money is no good to get thee best Canadian ”health care.” This is how ex-Prime Minister’s in Canada jump the common-man's "equitable" queue.

And forget about the best techniques, medicines, and standards of care filtering down to those without political connections. Bureaucrats are in charge of state medical spending. Because tax-payers refuse to elect those who would spend more, there is rationing just like every other socialized system of ”health care.” Because people cannot buy what they want and need, there is no competitive reward for innovating, for improving actual health care.

If Obamacidal ”Heath Care” is passed, the US will relinquish its leading place in medical research and improvement and world leading life-spans. Instead it will go off-shore, where the profits can be made. US economic growth will suffer, and our place in national wealth will slide, just as happened to Great Britain during the 1960s and ’70s.

What’s in the 2,000 page bill few Congressmen read, passed by anti-democratic Democrats? According to the Wall Street Journal, there will be 111 new bureaucracies erected to fill out the 3,000 ”Shalls” in the bill that are now merely governmental schemes to control, regulate, and tax your most intimate life. The ”Death Panels” are back, ensuring that the old will die faster and those judged ”redundant” won’t get any costly care bureaucrats of the state budget control. The Owellian term employed in Britain is ”NICE” - National Investigators Controlling Excellence. Your fate will be controlled by the faceless, heartless state.

There is no language in the Constitution permitting such a vast increase in state control, amounting to nationalizing (ie, theft) of 17% of our economy. Any claim to the contrary is sheer invention. (For example, the hyper-elastic "Commerce clause" - a NEW DEAL (TM) era invention - is interpreted to allow the fed to regulate economic activity, interstate or not - but there's nothing permitting them to mandate economic INactivity! ie, the Obamacide requirement to buy insurance or pay a penalty.) Political observers I follow say that there is a better than 50% chance that the Senate will pass a bill of similarly fascist scope and intrusiveness, reaching into everyone’s private lives. Naturally, this President says he will sign it.

Obamacidal ”health care” will kill the American Experiment, either with a bang or a whimper. You can go along to get along like the craven good slave of Euro-topia. Or you can join the New Resistance.

You can passively resist: ”Keep Your Laws Off My Body!” by refusing to pay or cooperate, using black market health care that will rise-up in place of the vast numbers of doctors that will abandon the system one way or another. Risk going to prison instead of becoming a slave to the state’s predictably horrible schemes.

You can silently refuse to cooperate. Become a refugee and move abroad: let the rubes pay for the mad-spending and currency inflation the Obama-Nazis have foisted upon our children. It won’t be the America I grew up in anymore, anyway!

Or you can join us, the angry mobs, shouting ”FUCK NO! and ”Death To Traitors!” This is how a True American Patriot honors his forebears. Government ought to fear a people armed and numerous! This was the vision of America’s revolutionaries, after all.

REBELLION! REVOLT! REVOLUTION! Tar and feather the bastards! Because this is how True Patriots honor their inheritance of angry, revolting mobs led by visionaries, who risked their lives, their fortunes and sacred honor to have their natural liberty to ”live free or die” sanctioned by a new, improved compact. And if some people must die to live in a new and freer America, so be it. The Founders survived much much worse. And as Jefferson advised, a little rebellion now and then is a good thing!