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Its over.Seventeen years ago, I was a health policy analyst for the Service Employees International Union and having the time of my life. President Clinton had been elected in November of 1992, and the union became deeply engaged in the fight to pass comprehensive health care reform legislation. In addition to writing countless reports, fact sheets and pieces of congressional testimony, I got to fly around the country speaking to union members about the bill and encouraging them to support it. We were working days, nights, and weekends. I felt like a warrior in a great and holy cause.In the summer of 1994, however, it all came crashing down. The Presidents bill was complex and difficult to explain. It was criticized by both liberals and conservatives within the Presidents own party. Support for the bill withered in the face of an advertising campaign led by the health insurance and small business lobbies. Eventually, the Democratic Congressional leadership ran for the hills, not even bringing the bill to a vote on the floor.I remember the last few days before it became clear that health care reform was dead. We were rushing around, trying to find something, anything that we could take to the floor that would pass. The idea that we could have worked this hard for two and a half years only to end up with nothing was just too painful to contemplate.Sound familiar?A few weeks ago someone asked me how I was feeling about the prospects for health care reform, given that the legislation had moved closer to passage than in any previous attempt. Im like those Boston Red Sox fans in 2004, I responded. Im not going to believe it until the final out.Well, it turned out to be 1986 not 2004. Again.Im joking because if I dont laugh, Ill cry. I work in health care. I know that health insurance makes a difference in peoples lives. It means that we catch cancer early, that people with hypertension avoid a heart attack, that diabetics hold on to their kidneys and toes, that people with depression get the treatment they need to face down soul-crushing sadness.My mother had an Uncle Bobby who was a driver for a small New England trucking company. He had 10 kids. He died in his early 40s from a heart attack. His kids grew up without a father and his wife was a widow at a terribly young age.If Bobby had been alive today, wed have the tools to help keep him alive. Weve got drugs to manage cholesterol and hypertension, health educators and nutritionists to help him develop new eating habits, and patient registries and alerts to track him if hes overdue for tests. Our patients have a cardiac death rate 30 percent below the statewide average. Health insurance and access to high quality health care makes a difference.Yes, yes, I know, the bills werent perfect. But they were better than a lot of people realize and probably the best that we were going to get in the year 2010. As Donald Rumsfeld might have said, you go to war with the Congress you have. With 30 million more people getting coverage, Im sure we would have saved more than a few Uncle Bobbies.Its possible that we may still be able to move the ball downfield. In the wake of the collapse of comprehensive reform in 1994, Congress passed the Health Insurance Portability and Privacy Act (HIPAA) in 1996 and the State Childrens Health Insurance Program (SCHIP) in 1997. The latter was the most significant expansion of public health insurance since Medicaid began in the 1960s.Painful as it is to say it, though, I dont expect that we will see much progress this year. The Obama Administration has clearly decided they need to focus more on job creation and financial reform in the run-up to the November elections. Without presidential leadership on health careand perhaps, to be fair, even with itmany members of Congress will not be willing to take any more tough votes on this issue.At times like this, I am inclined to recall words from the late Senator Edward Kennedy, who championed health care reform throughout his legislative career. They were words that he offered in the wake of another difficult defeat:

For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.

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Ironic that the actions of those who do not need health care, banks and brokers, were the reason health care will not make it this time. Unfortunately, job creation and financial reform is the right move because, even tho health care is right, legislation cannot be passed without credibility. Certainly we have to give Catholic bishops another zero here. They blocked it while they have had little to do with job creation. Perhaps as the country rebuilds we can get the climate right to help these forty million people whose lives will remain terrible because of the lack of health care. Perhaps we need to paraphrase Matthew 25 and state: "I needed health care and you did not provide it."

It was nice for congress to give unions a pass on the health insurance tax; and Ben Nelson made out well, as well as what's-her-name. And I loved the transparency of the process, (we're all equal but some are more equal than others) a transparency Obama thrilled us all with when he campaigned for the presidency.

Those of us without health care can't afford to sit around bemoaning what might have been. Some things you can do if you're in this boat:1. Do what you can to reduce risks from catastrophic illness. If you can't find family health insurance, explore coverage for as many people as you can. Raber and our son found an affordable policy, and that lowers our overall risk. I haven't been able to find affordable coverage. A lawyer friend suggested that we could probably reduce risk further if Raber and I got a civil divorce; he would not be responsible for unpaid bills if I died. However, we haven't got to that point yet.2. Tell your doctor you have no health care. Some doctors will charge you less for office visits. Ask for generics and meds that may be older but equally effective to treat illnesses. 3. Shop for the cheapest source of drugs. If you find a cheaper pharmacy, ask your current one to give you your prescriptions. You'll find they will sometimes match the cheaper price. We saved $50 a month on our kid's asthma meds this way.4. If at all possible keep your own health care account. Right now, health savings plans that allow you to sve with pre-tax $$ are not available without purchasing high deductible insurance--which I can't afford. But you can put money aside for unexpected routine services. 5. Try to get diagnostic testing through your health department every two or three years. It's better than nothing and free. Check in with your doctor and dentist at least once a year; they may drop you if you don't.6. Understand how whatever safety nets that haven't been gutted in these hard times work in your state work.7. Get flu shots to prevent serious illness and complications that might cause hospitalizations.8. Do what you can to stay healthy--eat better, walk more, etc.9. Accept that The System is not interested in helping you, but that you can try to help others in need. Be willing to visit the sick, lend someone a listening ear, and donate what you can to the desperate cases you know.It's not enough, not by a long shot, but if you're shut out of health care entirely, you haven't got a lot of choices.

BillWhat do banks and brokers have to do with it?The problem was with the fundamental dishonesty of the process. The president and the most hard core reformers want a single payer system, and their initial effort was clearly an attempt to do it incrementally. Going back to 2006 you can find Obama explaining this tactic. Instead of trying to convince people they were right they told them that they were just reforming the insurance system.In my opinion, the only two ways we will acheive universal coverage and lower costs is either through a nationalized system or by a combination of measures to promote free market competition in care and financing and an entitlement for the poor. This thing was the worst of both worlds.As for Matthew 25 - What you want it to say is "When I was sick, you used the police power of the state to force other people to pay for me." But it doesn't. Nothing stops anyone in this system from being charitable. Surprisingly, the man who tells us we are an uncharitable nation, the president, was not very charitable until he became a millionaire, and now he is talking about making it more difficult to be charitable by taxing charitable donations. Yes, we have the responsibilty to care for each other, but we don't have the right to force other people to.

"Yes, we have the responsibilty to care for each other, but we dont have the right to force other people to."Then how do you propose to pay for the "entitlement for the poor" you suggest above?

Well, I've contacted my Congressman and told him I want them to pass the Senate bill. If it really is over, I will be expressing my displeasure at the polls next election. Not much, but it is something I can do.

As people have noted, one of the principal issues is how to pay for healthcare. The Senate bill proposes a series of measures that seems to put the burden on the middle class, while the House bill taxes only the wealthy. In this respect,the Senate bill appears to be highly regressive, while the House bill is clearly progressive; yet the Administration endorses the Senate's approach to funding. This seems to me to be grossly unfair. This also seems to be just one more example of the Obama crowd favoring the rich at the expense of the public at large. But perhaps I am missing something. Could anyone here enlighten me?

"Ironic that the actions of those who do not need health care, banks and brokers, were the reason health care will not make it this time."And to those groups, we might add: our elected representatives in the Senate and the House, whose nationalized health care is perhaps the best of all.

Regarding House Bill vs Senate Bill, it seems like the only bill that could pass now is the Senate Bill. So, the choice today is Senate Bill or No Bill. Or is that wrong?

"But perhaps I am missing something. Could anyone here enlighten me?"Charles--At the risk of sounding smart-alecky, I think the missing link is that the majority of Americans (even the non-rich) simply think it's only fair that, as a general rule, people should pay for their own healthcare. They think that soaking the rich is un-American, immoraland darn mean.

Sean,Would people pay taxes if they were not forced? Goldman Sachs is giving out 16 million plus in bonuses because it is allowed. Yet Goldman and Co caused this Great Recession. They have a lot to do with people's anger and rebellion. Don't laws force people to do what they would not do? Certainly laws must be just. But they are backed up by force.

Granting Mark's argument for the sake of discussion, and I'm hardly sure it's the case -does that mean wer give up on the issue of health care as a right and that each looks out for himself is the working moral principle (what's Mt.25 got to do with it?)I do want to thank Peter for a view from the inside.Despite the political raguments here, his notion is clearly based in the common good -something we seem to be slipping more away from!Given all the big money anti-Obama spin out there -sometimes represented by some arguments presented here - I think we will see little change and Peter is right to be saddened by what goes on.

Check that. 16 Billion.

Mr. Nixon - excellent post. As someone who works in the behavioral health field since the late 1980's and a justice fanatic, this is very sad. Despite the objections of large companies (such as the one I am employed by), the goals of healthcare reform are necessary:- we will continue to see double digit medical cost increases impacting more and more; small businesses will stop providing insurance;- we have a crisis in healthcare management and delivery - the current procedure or fee for service model is dead; we must move to a community MD team approach that emphasizes wellness, health initiatives rather than treating only the most sick or dying- we need to address Medicare/Medicaid spending which only increases the national debt- we must address the 50 million and growing uninsured and include (in some way) the undocumented- we need to address Tort Reform- we need to address pharmacy spendWhether we do this incrementally or in bigger steps, it must be done.

"If Bills Fail, a Quandary for Insurers" suggests that health insurance companies may not be happy to see the reforms go down.http://www.nytimes.com/2010/01/22/health/policy/22insure.html?scp=3&sq=H...

Not passing insurance reform means:1> Insurance companies will continue to cover abortion2> everyone will be forced to pay greater health care costs3> unemployment will threaten the lives and health of people4> more people will be "trapped" in jobs, or on welfare.I cannot imagine why anyone wants these things.

Yes, we have the responsibilty to care for each other, but we dont have the right to force other people to.Sean,You are in disagreement with the Catholic Church, which sees health care as a human right. If health care is dependent on the charity of others, then to call it a right is meaningless. What are governments for if not to guarantee basic rights? Why do you think the US Council of Catholic Bishops is supporting health care reform (with, of course, some specific objections to the current legislation)? Do they misunderstand the Gospels? You are not preaching the Gospel of Jesus Christ. You are preaching the gospel of classical liberalism and laissez-faire capitalism. "Am I my brother's keeper? It's my money, and nobody has a right to tell me what to do with it. I am an individual, not part of a community."

I think the missing link is that the majority of Americans (even the non-rich) simply think its only fair that, as a general rule, people should pay for their own healthcare.Mark Proska, The majority of the American people approve of torture and approve of abortion (at least in some circumstances). See my message above to Sean. Why do you think the US Council of Catholic Bishops is supporting health care reform? Don't they understand the Gospel?

MarkAs one of those who would be taxed under the Senate bill I consider highly progressive taxation neither "mean"nor "immoral". In fact, I think that the notion of the rich wallowing in the pleasures of wealth while others suffer is exactly where the immorality lies!

Those who don't have children nonetheless pay taxes in support of schools.Those who don't drive nonetheless pay taxes for upkeep and construction of roads.Those who are against war nonetheless pay taxes for upkeep of the military and periodic bouts of out-of-control national testosterone.Those who are not religious nonetheless fund those who make tax deductible contributions to religious organizations.Those who don't own homes nonetheless pay taxes to fund those who deduct mortgage interest.See any pattern there? It's called being part of a greater society in which all pay their (alleged) fair share of the tax burden in support of what we as a people, through our elected legislators, determine to be part of the commonweal.Until healthcare for all is considered a basic right, I damned well don't want to be taxed to support schools, war and home mortgages. It's "un-American, immoraland darn mean" to force me to do so --- right Mark P?

Excellent, Jimmy Mac!I recently was coerced by the government to spend two days on jury duty. It's tyranny! I should never be forced to do anything I don't want to or pay taxes for anything I don't use myself. Wikipedia tells us, "In the United States at the end of 2001, 10% of the population owned 71% of the wealth and the top 1% owned 38%. On the other hand, the bottom 40% owned less than 1% of the nation's wealth."Why should the top 1%, who owe 38% of the nation's wealth, give up anything to provide health care to the bottom 40%, who own less than 1% of the nation's wealth? Listen to this loony nonsense from the Catechism of the Catholic Church:

2402 In the beginning God entrusted the earth and its resources to the common stewardship of mankind to take care of them, master them by labor, and enjoy their fruits. The goods of creation are destined for the whole human race. However, the earth is divided up among men to assure the security of their lives, endangered by poverty and threatened by violence. The appropriation of property is legitimate for guaranteeing the freedom and dignity of persons and for helping each of them to meet his basic needs and the needs of those in his charge. It should allow for a natural solidarity to develop between men.2403 The right to private property, acquired or received in a just way, does not do away with the original gift of the earth to the whole of mankind. The universal destination of goods remains primordial, even if the promotion of the common good requires respect for the right to private property and its exercise.2404 "In his use of things man should regard the external goods he legitimately owns not merely as exclusive to himself but common to others also, in the sense that they can benefit others as well as himself. The ownership of any property makes its holder a steward of Providence, with the task of making it fruitful and communicating its benefits to others, first of all his family.2405 Goods of productionmaterial or immaterialsuch as land, factories, practical or artistic skills, oblige their possessors to employ them in ways that will benefit the greatest number. Those who hold goods for use and consumption should use them with moderation, reserving the better part for guests, for the sick and the poor.2406 Political authority has the right and duty to regulate the legitimate exercise of the right to ownership for the sake of the common good.

CharlesYou are certainly free to pay extra taxes if you wish to do so. The rich already pay a disproportionate share of the tax burden, and the desire of many (mostly of the non-conservative persuasion) to see them pay more seems, to me, to be motivated more by envy of the rich than by compassion for the poor.Jimmy MacI never claimed that taxes, in general, were immoral. I do happen to think that certain taxes, for example the death tax, are immoral, but thats beside the point. DavidI support health care reform as well. Thats why I did not support this bill.

"The majority of the American people approve of torture and approve of abortion (at least in some circumstances). See my message above to Sean. Why do you think the US Council of Catholic Bishops is supporting health care reform?"Notre Dame settled this question for us - the USCCB has no place imposing its minority view on the majority under our Constitution.

Jean Raber's 9 points recall the Italian advertisement for Moore's "Sicko": "If you want to be healthy in America, make sure you don't get sick."

Amazingly there has always been a strong union of the 10% who are super wealthy with the Middle Class which is astronomically distant from them. It is an illusion of the Middle Class that the rich respect them in any way. Through control of the media the super rich drum up anger against the poor and the downtrodden. It is a Middle Class illusion that somehow makes their association with the rich in this way a real identification in which they fantasize being in the same stratosphere. I believe in capitalizm. But not in illusory behavior.

Notre Dame settled this question for us the USCCB has no place imposing its minority view on the majority under our Constitution.MAT,Interpreting what happened with Notre Dame in the most "conservative" way possible, school officials didn't heed the bishops' dictum that Catholic institutions should not honor pro-choice politicians. What that has to do with the bishops imposing their minority views on the majority under the Constitution is a mystery to me. And if Notre Dame defied the USCCB, does that mean all Catholics are now free to do so? Even the ones who denounced Notre Dame? I have argued in some detail that saying the government has no right levy taxes to pay for health care for those who cannot afford it themselves is not compatible with Catholic teaching. I actually agree that "the USCCB has no place imposing its minority view on the majority under our Constitution." However, that's not the issue here. The issue is whether it is compatible with Catholic social teaching to say, "Its our money, and the government has no right to take it to pay for somebody else's health care." It seems to me it is antithetical to Catholic social teaching.

"You are certainly free to pay extra taxes if you wish to do so. The rich already pay a disproportionate share of the tax burden, and the desire of many (mostly of the non-conservative persuasion) to see them pay more seems, to me, to be motivated more by envy of the rich than by compassion for the poor."Disproportionate share is an interesting idea. But I think it boils down to this. If 10 percent of the population owns 71 percent of the wealth, should the 10 percent pay 10 percent of the taxes or 71 percent of the taxes?

" If 10 percent of the population owns 71 percent of the wealth, should the 10 percent pay 10 percent of the taxes or 71 percent of the taxes?"Spot on. Unfortunately, the middle class will go on buttressing the 10% in some absurd hope that the rich will favor them.

The Federal Reserve does a study every three years on consumer finances. The most recent one in 2007 (before the economy tanked) shows the gap between rich and poor continued to widen in recent years and was the widest since the 1920s. http://www.federalreserve.gov/pubs/oss/oss2/2007/scf2007home.htmlSo the rich seem to be doing okay under our current policies.But no one answered Jean Raber's earlier question: for those who object to a government subsidized health plan, how, then, do we provide quality healthcare for those unable to pay for it?

Irene, I didn't ask how the U.S. would provide health care to those who've lost their benefits and can't afford to replace them. The answer has been clear for some months: It won't. Congress doesn't have the will to do it. The Church, which acknowledges health care as a right, and its separated brethren are making no moves to do it. And individuals in an economy may give lip-service to it, but are living in an economy in which wages are stagnant, new jobs are rare aren't eager to start on some new venture that will raise taxes. Service organizations might be able to wring out a one-time donation of a few hundred bucks doing a fish fry or something. But if you've got ALS, like one of our parishioners had this year, a few hundred bucks won't even pay for his widow to file for bankruptcy b/c she can't pay the debts he left behind.Instead of wasting a lot of energy worrying about it (only drives up your blood pressure!), take care of yourself, stay as healthy as you can, and ask Christ Jesus and all the saints to preserve you from diseases you can't afford to get.I'd also advise people to try, if at all possible, not to be female. Coverage for me under the same policy Raber and my son have would be more than their premiums combined. Women in child-bearing years will pay higher premiums against the high cost of pre- and post-natal care, and women in menopause run statistically higher risks of cancers and get more expensive diagnostics. (In Holland, BTW, health care costs for women is kept lower because the majority of Dutch kids are born at home.)

"Id also advise people to try, if at all possible, not to be female."Excellent advice! Unfortunately, half the population has trouble following it.

Ms Steinfels posted a link: If Bills Fail, a Quandary for Insurers suggests that health insurance companies may not be happy to see the reforms go down."And a quote from the article says:"But now, in the possible absence of forced change to their business, the insurers still face the daunting challenge of selling a product that is increasingly out of reach for more Americans as the cost of medical care and thus premiums continues to climb."Let's be perfectly clear here. The health care business in the United States is built around the idea that health care is a commodity like any other commodity. In general, providers, insurance companies, drug companies etc. are in the business of providing services to people who can pay for it. This is why the "miracle of the free market" will NEVER be able to fix the problem of the uninsured. For one reason or another, the uninsured can't pay, so they don't enter the market.The health care reform was a referendum on whether we should have the universal coverage that the free market will never provide on its own. It in turn became a referendum on the free market as such. This stupid sidetrack came from the Left as much as the Right. The main question was always (and only) "is health care a commodity or not?" Viewed in this way, the vast majority of the population benefits from the way the system works now. They may be dissatisfied, but it was always an uphill battle to convince most people that however bad they had it with their benefits, their service levels, or their jobs in the health care system, it would be better and not worse for they themselves if there was a reform of the system. From a purely business point of view I can tell you that the rest of the developed or aspiring to be developed world thinks that the US is deeply stupid to allow a situation where health care is such a drag on the economy in the way that it is. (They are also delighted; it makes us much less competitive). If we were serious about the problem, we could have looked at the problem in this way from the start. But as usual, we took the tack that we wanted certain parts to be fixed, changed, or punished, while other parts were held intact. In the end, as I think Mr. Nixon implies, we are not going to fix anything until our only recourse is to react to a catastrophe. We Americans always pride ourselves on being so innovative, but we are actually short sighted and we usually don't really move until someone hits us upside the head with a toaster.

My very point, Mark.I had surgery 10 years ago during which the doctor removed only what she needed to instead of doing a complete hysterectomy.Had I known I would lose my health insurance at my time of life, I would have insisted she do the hysterectomy or switched to a doc who would have done it. I would have thus eliminated the possibility of future female cancers.Too much information, I know, but the types of things those of us without health care do think about.

DavidI am not in disagreement with the Church, I am in disagreement as to how you do it. When I say you don't have the right, I don't mean that in the political sense but the Christian sense. Our Christian obligation to the poor does not come with the moral right to force others to use their property in ways that we wish. Politically, in a democracy, of course the majority has some right to force others to do things they wouldn't otherwise do. What I object to is pointing to scripture and saying - "Look, Jesus says I can take your property and give it to others, and if you disagree you are uncharitable."Irene,I think most people accept there is a place for government subsidization of health care - heck there already is. What most people don't want is a system where this is the model. So when you call your congressman, you have to accept that 2 other people are calling on the other side.There are many things that could be tried short of a government takeover, but they aren't being tried.Jean,I am sorry to hear about your health problems. Did you consider, however, that under a nationalized system, 10 years ago you might not have had the choice? That's one of the ways single payer systems keep costs down. Do a procedure now that forecloses the need for others later, even if the patient suffers inconvenience or non-deadly side effects. Use an older, cheaper, treatment that is safe but less convenient for the patient. The statisics on treatments in these systems demonstrate this. Fifteen percent of adult type 1 diabetics in the US have insulin pumps while in Britain it is less than 2 percent. In Canada and the UK hip and knee replacements are frequently decided based on the usefulness of the person's life. My 72 year old father-in-law probably wouldn't have gotten a hip replaced in the UK.I lived in a government run system most of my life, I can tell you that while military medicine was good and the physicians well trained. Treatments that were routine in the civilian world were unavailable to me and my family - we got treated, but it was usually by older cheaper methods until the new way became so ubiquitous it couldn't be avoided. Military kids with broken arms were wearing plaster casts for years after fiberglass casts were common on the outside. Even today, the most modern hearing aids etc. are not available.

Henri Nouwen writes that we have "more than enough health care": those of us who have health insurance, that is.Jean, here's another solution to your quandary, no more drastic than getting divorced: move to another country that provides universal health coverage!

"Surprisingly, the man who tells us we are an uncharitable nation, the president, was not very charitable until he became a millionaire, and now he is talking about making it more difficult to be charitable by taxing charitable donations."I like this concept that people would be more charitable if only they were given more incentives.

"Interpreting what happened with Notre Dame in the most conservative way possible, school officials didnt heed the bishops dictum that Catholic institutions should not honor pro-choice politicians. What that has to do with the bishops imposing their minority views on the majority under the Constitution is a mystery to me."Exactly. Notre Dame rejected the notion that there are positions incompatible with the CCC and USCCB in material respects which would preclude one from being honored given the pluralistic society. You yourself have defended the President's position on abortion as not being "extreme" under the theory that there are not insignificant percentages of Americans who hold the same position therefore it is mainstream regardless that it is wholly inimical to the USCCB's position. So if the President can hold a position so inimical to the USCCB's teachings on the dignity of life and receive lauds by Notre Dame, I personally got the message loud and clear. I will trade you capital punishment for health insurance and will purport to work for policies which may or may not lead to lack of health insurance being safe, legal, and rare, where rare is defined post-facto, depending on how I need to define it vis-a-vis an election year. Personally, I'm indifferent to all this. I was born in 1976 and the country where I was born adopted socialized medicine in 1978 and I lived under it until 1988. I thought it sucked but if the USCCB tells me I should support it, I personally will do whatever they tell me to - Epictetus taught me some time ago that I am going to die either way so might as well err on the side of the Church. That being said, after decades of liberals undermining the teaching authority of the Church on abortion in particular, I think it is absurd to defer to the USCCB on their support for health insurance. It would have been nice to know we were supposed to listen to the USCCB in November 2008 and we would have had the 6th and deciding vote to overturn Roe on the Court right now.

"...adopted socialized medicine..."By this, I did not mean to suggest that either of the bills under consideration in Congress would institute socialized medicine. I was speaking generally.

Mr. Nixon,I thoroughly enjoyed your opening post but I must disagree with your us of the CCC and USCCBs as blanked support for health care reform.Now I cannot speak for either Mr. Proska or Mr. Hannaway, but it seems a little disingenuous when you write "You are in disagreement with the Catholic Church, which sees health care as a human right." Now, as you are more than aware, the language in the document you link to (Pacem in Terris) is more coached than that and the discussion of rights to health care are framed by the duty to work, as a legitimate employment benefit, medical assistance be cheap or free, and finally BASIC healthcare being a inalienable right. Some could argue that the United State's government has fulfilled those rights by providing universal emergency room coverage.Secondly, you seem to lack your usual nuanced approach when you use the CCC and the USCCB documents like a hammer in those subsequent posts. It is ironic the the current Commonweal magazine has a lengthy article dealing with teaching the bishops (from a left wing perspective) but when the bishops are in agreement with the progressive wing of the church, they are used as a hammer. Now if the proposition that neither the CCC nor USCCB pronouncements, nor even encyclicals are infallible is to be maintained than it must be given that those documents do not completely and accurately portray the wealth of Catholic thought on any issue and to claim that Catholic social thought is monolithic is to narrow Catholicism down beyond the parameters of traditional liberal Catholicism.Now speaking as an outsider, a Canadian, I have nothing to gain or lose in the discussion in the American decision on health care reform. My interest is purely academic in the subject and I view the American discussion as a valuable way to improve our system here in Canada as we continually look to improve the health care system up here.It seems to me that conservative opposition to health care reform should not be rooted in reactionary fear, but should simply and politely state that the fundamental principles and direction of the proposed shift are contrary to good governance. To borrow a quote from Chesterton: "The Old Liberal would say "There ought to be a good Irish government in Ireland" but the modern Unionist doesn't say "There ought to be a good English government in Ireland" he says "There is a good English government in Ireland" which is absurd." (Heretics)Now the present system in the US leaves much to be desired and undoubtedly must change. Conservative opposition should be rooted in a critique of the direction of the proposed change. From what I have read (which is limited) I feel that the reform can and should be criticized for three distinct reasons:1) it will vastly expand the bureaucracy which tends to be less efficient than a truly open market (note the current system is not an truly open market)2) the issue of financing the costs will invariably fall on the middle class because the upper class have the means to move many assets overseas and avoid taxation. Unfortunate as it is, it is a fact that of that 71% of wealth controlled by the upper class, most of it is very liquid whereas the middle and low classes have much of their wealth tied up in housing, pensions etc. http://sociology.ucsc.edu/whorulesamerica/power/wealth.html3) and finally, like so many other social services, the system will not encourage a solution to the problem of poverty. Like so many social programs before, the sense of entitlement coupled with the faceless government charity does not motivate people to self-betterment. Back in my undergrad days I was a rather devout communist for a couple years until I started to realize that this rolling faceless bureaucracy perpetuated many problems it sets out to solve. As a teacher, making $40,000 I sometimes look at my neighbors who drive nicer cars than I do, have nicer homes than I do and think that if my wage were to drop $10,000 I might be better off because I would be the recipient of substantially more government assistance, tax breaks etc. This situation is simply wrong.

A discussion exercise This is a true story from the Boston Globe from last month, but I cant find it on the site anymore, so here is a summary.A Brazilian man is here in the US illegally. He came about a decade ago. He is in his 30s, is married, and has at least one child as I recall. After being here about two years he was diagnosed with a serious heart malady I dont recall the details but it is a degenerative disease. He has been treated for the last 7 or 8 years, at a cost exceeding $100,000 a year (at least in recent years). He has been unable to work for at least a couple of years because of his illness. All of his health care bills have been paid by the state.If he does not get a transplant he will die. The surgery and follow-up will cost $1.5 million or more. If he gets the transplant he will have about an even chance to make 50.Brazil has universal health care. The mans family here and in Brazil says that if he returns home he will die. In fact, a doctor who knows there system indicated he probably still wouldnt be alive in Brazil, and that while there is a heart transplant capability in the country, he would likely not qualify for treatment due to his prognosis.The story was mostly about how his illegal status was complicating his situation.Questions Which society has a better system from the Catholic perspective?Should he be sent back to his country that has universal care, and according to many experts is above average on a world standard?Does his right to health care include a right to get a transplant?

Adam -- I'm afraid you have Peter Nixon and David Nickol confused.

1. Which society has a better system from the Catholic perspective?Brazil2. Should he be sent back to his country that has universal care, and according to many experts is above average on a world standard?No.3. Does his right to health care include a right to get a transplant?Yes.

AdamAs to your point regarding regarding taxation you should keep in mind that we are not talking about a tax on assets(which might be moved overseas), but rather a tax on income (which I think you would agree is not quite so easily moved overseas). According to the CBO, for the top 5.0%, the average annual pre-tax income per household is $540,000. Their effective rate for all federal taxes is 29.2%. This includes all individual, social insurance,corporate and excise taxes paid these 5.8 million households.So perhaps there is some room to increase taxes on the upper classes without precipitating wholesale migration.

Sean said: I am sorry to hear about your health problems. Did you consider, however, that under a nationalized system, 10 years ago you might not have had the choice? Thats one of the ways single payer systems keep costs down. Do a procedure now that forecloses the need for others later, even if the patient suffers inconvenience or non-deadly side effects. Use an older, cheaper, treatment that is safe but less convenient for the patient. Jean replies: I'm sorry for personalizing this, but I think my situation illustrates how screwed up the system is. I don't know that I would have had a choice 10 years ago about the nature of my surgery. Once your doc tells the insurance company you can have something cheap, they're skeptical about second opinions for procedures that cost more. But at least it was a good American free enterprise telling me what I could have or not have and not the government. Whew!Now I need periodic endometrial biopsies, Pap smears and other tests for the "equipment" that was left after the surgery. I can't afford that, and the specialist told me not to bother to come back b/c there's no way she can monitor without the tests. I'm lucky in that I only have elevated risks of disease, not the actual disase itself (as far as I know). People who have been diagnosed with cancer and have no health insurance are often unable to get in to see an oncologist at all without health care or Medicaid.Moreover, I AM taking the cheaper and more inconvenient drugs b/c I cannot afford the other kind. I understand that in your view, forcing others to subsidize medical procedures is a slippery slope toward a dystopian police state where the cops come and force you to be charitable or haul your fanny to a Gulag run by the politically correct. I also understand that you are willing to live with casualties who slip through the cracks in the current system in order to prevent our lives being governed by elected representatives instead of the far more trustworthy captains of industry.Fine. But what you say doesn't make me feel particularly grateful to be dealing with the current system.OK, sorry for thread hogging, and I'll leave someone else the last word.

Adam,I hope I made it clear that I was taking aim at two statements, one by Sean Hannaway and the other by Mark Proska:

Sean: "Yes, we have the responsibilty to care for each other, but we dont have the right to force other people to."Mark Proska: "I think the missing link is that the majority of Americans (even the non-rich) simply think its only fair that, as a general rule, people should pay for their own healthcare." [I am assuming here that Mark is not merely reporting what he believes the position of the majority to be, but citing the alleged belief of the majority as his own position. Apologies if that is a mistaken assumption. -dn]

Whether or not one is in sympathy with the current legislation, I think it is fair to use the Catechism and the various Encyclicals linked to on the USCCB site to make the points that the Catholic Church (1) considers basic health care as a right and (2) considers it the right and the duty of government to tax people for the common good. The fact that the USCCB supports the current legislation (with some important reservations) indicates that they do not agree that it is wrong to "force" some people to pay healthcare costs for the poor. So I would never argue that people who don't support this legislation are somehow not good Catholics. But I feel very confident in saying that given the teachings of the Catholic Church on health care as a right, private property, and the rights and duties of government, it is seriously out of synch with Church teaching to maintain that the government has no right to impose taxes on people who can afford them to pay for health care for the poor. If Sean or Mark were arguing that this particular legislation is unfair because it places the burden on the wrong people, that would be one thing. But they seem to be arguing that each person has the duty to pay for his or her health care costs, and if they cannot do so, the money must come from charitable giving, not government taxation. That seems to me clearly in conflict with Catholic teaching, no matter how poorly conceived the current legislation may be. I see that Sean has modified (or clarified) his position somewhat, but that does not change my critique of the statement of his that I quoted. A few other quick comments . . . .it will vastly expand the bureaucracy which tends to be less efficient than a truly open market (note the current system is not an truly open market)Well, the administrative costs for Medicare are 0.6 percent. And in any case, if health care is a right, we do not leave it to the free market -- no matter how efficiently it may operate -- to guarantee rights.Some could argue that the United States government has fulfilled those rights by providing universal emergency room coverage.Having been in the emergency room a year ago after being struck by a car, and also having a nephew who is an emergency room doctor, I would say that the emergency room is the last place to get basic health care. Plus emergency room treatment is phenomenally expensive, and every time a person who cannot pay doctor bills uses the emergency room as a substitute for a conventional visit to a primary care physician, the burden falls directly on insurance companies and those who can afford to pay their own bills. This situation is simply wrong.I could not agree more that it is fundamentally unfair for working people to be taxed to provide a better lifestyle than they enjoy for people who don't work but live on government assistance. I don't know how often that really happens, but when it does happen, it is because the system is flawed, not because better-off people should not be taxed to help those less well off.

It's my clear visual resemblance to David that confuses people...;-)

Firstly I would like to point out to Mollie that I didn't confuse Peter Nixon and David Nichol, I did something much worse, I conflated them into a two headed beast, the frightful "Petid Nixol". I am terribly sorry for the mix up and my only excuse is focusing more on the issue than the people speaking. I humbly apologize to both heads of that mythic beast.And to Charles, I think you are right in a sense, but the effect will be much worse for the (upper) middle class than you anticipate because (as you noted) income is being taxed. A tax on wealth, on property, on capital gains would hit the wealthiest much more than a tax on income because traditional income doesn't constitute a large portion of the wealth of the elite. My father, a rather high up CRA (our IRS) has long worked on such cases and the assets and wealth of the wealthy are notoriously well hidden. Simply put, such a tax will hit the professional elite, such as doctors, but will not begin to dent the disparity of wealth. The impact on the economy will likewise be negative as it is the upper middle class who are not only the tax workhorse, but also the investing workhorse of the economy.And to David concerning health care as a basic right, I note that the passages in Pacem in Terris that refer to healthcare as a right simultaneously refer to:"food, housing, work, education and access to culture, transportation, basic health care, the freedom of communication and expression, and the protection of religious freedom" http://www.usccb.org/healthcare/vaticanquotesonhealthcare.shtmlWe must therefore recognize a distinction in the concept of rights (universal and inalienable, not based on nationality) and 'rights' (equal benefits pertaining to all in a society). We rely on the market to provide many people with the 'right' to work, education, transportation etc. I am not convinced that the market cannot be encouraged and provided a framework in which it can provide healthcare satisfying said 'rights'. I also think we disagree on a definition of 'basic' health care. The government provides emergency first aid, information on healthy living, (at least in Canada) tax incentives to eat healthy and live active lives etc. In Canada we also have the 'right' to such basic health care as abortions, safe-injection drug sites, sex change operations, cosmetic surgeries, tattoo removals, medicinal marijuana etc. In today's medical and technological framework we as a society have the technological and medical ability to prolong life almost perpetually and this is part of the discussion here in Canada as we decide what constitutes 'basic' health care services offered by the government as we look for ways to have the system survive the tide of baby-boomers retiring and requiring more medical aid while contributing less to the income of the government through taxation.

We rely on the market to provide many people with the right to work, education, transportation etc. I am not convinced that the market cannot be encouraged and provided a framework in which it can provide healthcare satisfying said rights.Adam,I think Catholic social teaching does not view the free market as the solution to problems like lack of health care. It would, of course, be wonderful if the market did make health care affordable for everyone, but is there anywhere on earth where that is now the case, or was in the past? Even the currently proposed bills don't achieve universal coverage. I think when the Church speaks of health care as a right, it means that everyone must have access to basic health care. It would not be enough to bring the price down so that a large percentage of people could afford it and a few could not. To be following Catholic social teaching, a way would have to be found for everyone to get basic coverage.

Mr. Marischuk --I think you raise an important question about the "right to" basic things including food, education, housing, health care, etc. But what does "right to" MEAN? Does it mean the same thing as "the right to ACCESS TO" these things? Or "the right to GOVERNMENT PROVISIONMENT of" these things?I have a right to own a dog. But that is not the same thing as a right to the government's providing me with a dog. I have a right to a house. But does that imply a right to the gvernment's providinh me with a house.I thnk that part of our disagreement involves these distinctions. You thnk that citizens do not have a right to the government's provision of health care to everyone. And I must say that I think Pacem in Terris is rather ambiguous about just what our "rights to" those things (including housing, ecucation, health care, etc.) are.

Sean --If the very rich own 71 per cent of the wealth of the USA, and our military budget goes to protecting 100 per cent of the wealth of this country, then the very rich benefit from 71 percent of the military's efforts. Doesn't this imply that the very rich are provided with 71 percent of the benefits of the military budget? In other words they benefit from vastly more protective military services, so, in justice, they should owe vastly more in taxes dedicated to the military? Extrapolate from this that other government services (e.g, the State Dept., scientific research expenditures, etc.) also benefit them more,then there is I think reason for them to pay proportionatey much more in taxes than the middle class do.

I don't know about rights, but I believe health care (that's health care, not health insurance) is a basic human need, right up there with food, water and shelter. People can and do die without these things. I have pretty secure health insurance (for the duration of my husband's life) but I would be happy to pay more taxes so other people could have the same. The NY Times today has an article about a battle between a local hospital consortium and United Healthcare (which has 1 million subscribers in NY) over reimbursement rates and admissions approvals. The insurer is seeking major concessions from the hospitals and is, at the same time, seeking a rate increase from subscribers. http://www.nytimes.com/2010/01/25/health/policy/25insure.html?ref=nyregion

Irene said: "The NY Times today has an article about a battle between a local hospital consortium and United Healthcare (which has 1 million subscribers in NY) over reimbursement rates and admissions approvals. The insurer is seeking major concessions from the hospitals and is, at the same time, seeking a rate increase from subscribers."Let's look at this in the context of the discussion above. Your last sentence could imply that the insurance company is trying to squeeze both the hospitals and the subscribers, with the implication that they are seeking a cost cut on one side and a premium increase on the other. The article doesn't say, however, that United Healthcare is going to get a cost cut from the hospital. It said that the insurer led off the negotiation with a cost cut while the hospital led off the negotiation with a large price increase. And even if the insurer got a cost cut, it still has maybe 120 or more hospitals in the system whose costs are going up as well.The "admissions approvals" is actually a request for notification of admission, not an approval of admission. This is so the insurance company can put case managers on the case. The hospital at several points in the article wants to imply that these case managers are accountants. They are actually doctors and nurses. They are not trying to dictate care. They are trying to make sure that the care falls into the best evidence based guidelines for care. Also, the managers deal with the patients as well as the doctors to make sure that the patients follow their medical instruction, take their medications, get adequate follow ups, etc. The hospital doesn't like the idea that their payment would be cut for non-compliance because the pay cut would actually force them to comply and they do not want to be monitored in this way. The hospital is always going to argue that the insurance company is not qualified to monitor standards of care. The hospital is never going to accept any downside consequences for quality of care.

Unagidon: But the article does say the insurer is seeking cuts from the hospitals and increases from the subscribers. It may be a negotiation tactic, but it is still trying to do both at the same time. And the Oklahoma hospital consortium struggling to meet the "notification" requirement says it "doesnt feel to us like cost control, it feels like a revenue stream enhancement to the insurance companies".

UnagidonYour answer to my questions (especially the first one) actually demonstrates why people like me are suspicious of the motivations behind health care reform. Is it about helping people or equalizing them? If what we end up with in 10 or 15 years is a system that is wonderfully equal but inferior, have we solved the problem or just covered it up?

AnnFirst, I am not sure whay you are asking me this, but I would just say this is a faulty economic argument. Take for example a man who owns a factory. It employs 500 people. It is worth $500 million. Tax money that goes to protect it, provide transportation infrastructore etc. doen't just benefit the owner. If the place burns down, the owner is probably the person least affected in terms of day-to-day existence. The workers, suppliers, service providers, transporters of goods, creditors and on and on and on all have an interest in the factory that tax money helps satisfy.Moreover, not all tax provided services bear a relationship to wealth at all - in fact most don't. Since we are talking about health care, if Bill Gates pays $50million a year in txes and under a nationalized system $2million goes for the health care system, is he getting $2million in benefit?JeanAs for "living with casualties" - I would turn to you and ask, are you willing to live with the casualties that would occur under a nationalized universal system? I am not willing to live with casualties at all in the sense that I think they are inevitable. Like you, I want to see everyone covered, but I would like to see it in a high quality system.

Sean said: "Your answer to my questions (especially the first one) actually demonstrates why people like me are suspicious of the motivations behind health care reform. Is it about helping people or equalizing them? If what we end up with in 10 or 15 years is a system that is wonderfully equal but inferior, have we solved the problem or just covered it up?"And you'd have a right to be suspicious if there was a necessary relationship between Brazil's universal care and Brazil's quality of care. But there isn't and the proof is that I am sure you would rather get your heart transplant in France or Germany than Brazil (to name three countries with universal systems). It seems that some people believe that since the quality of American health care is high and was produced under the current system, it follows that if we depart from the current system the quality of health care will decline. We can talk about what kind of a theory of capitalism we would have to have for this to be true. But it strikes me (as a businessman) American capitalism seems tough, innovative, and robust until someone wants to change the current business environment. Then it turns into a tiny little hothouse flower shivering in the sun.

This is an excellent discussion with too many well-made points for me to agree with individually. Just a couple of comments:* If the majority of American voters wanted health care reform, it would have been done by now. The most important question is, 'Why is reform so unpopular?' My hypothesis is that voters are afraid. They are afraid of the state of the economy, they are afraid that if they do lose their jobs they wont be be able to find others, they are afraid because their wealth and savings were halved or worse in the recent recession. So many things that formerly were taken for granted are now uncertain. We live in a time of paralyzing fear. And so, faced with losing one more thing that they want to be able to take for granted (doctor visits and prescription fills with cheap copays, and affordable treatment for catastrophic health problems), voters are clinging tenaciously to the status quo. Just my reading of the psychology of the moment.Btw, if I am right about this - that fear is the overriding emotion right now - then a path is being laid for a demagogue to ascend to power. That is what we got in 1980 - an amiable demagogue. Someone who will say, 'I will make your fears go away.'* I do agree with Unagidon that the market by itself will never provide affordable health care for the poor, just as it doesn't provide affordable decent housing for the poor. If the market fails that sector and the government doesn't step in, we're left with what Jean described: suffering, begging and some private almsgiving that isn't nearly comprehensive enough.Folks who have read my comments here know that I am in favor of markets and don't have a high opinion of the efficiency or efficacy of government programs. But I recognize that the government is the last resort for basic human needs, and I believe that is where we are with health care.(btw, Jean, don't worry about hogging threads. Post more!)

If what we end up with in 10 or 15 years is a system that is wonderfully equal but inferior, have we solved the problem or just covered it up?Sean,It depends on what you mean by "inferior." Suppose we are talking about food, where the rich are eating filet mignon and caviar and drinking expensive wine, and the poor are undernourished. If it were possible to even things out a bit so that the poor could afford decent, basic nutrition, and the rich had fewer luxuries, would that be objectionable? Suppose it is necessary to provide everyone with health care to put a limit on extremely expensive care in order to pay for basic care for people who now must go to the ER if they want to see a doctor. Would that be a wonderfully equal but inferior system?

My hypothesis is that voters are afraid. Jim,I think you are correct. The question is whether or not they should be. I think Obama and the Democratic Party have failed to make the case that they should not be, and the Republicans have very effectively intensified people's natural fears (death panels! deficits! government takeover! socialism!). So both major parties are to blame, but of course the Democrats have merely failed to do what is good, whereas the Republicans have done is evil. Speaking objectively, of course.

"I think you are correct. The question is whether or not they should be [afraid]. I think Obama and the Democratic Party have failed to make the case that they should not be, and the Republicans have very effectively intensified peoples natural fears (death panels! deficits! government takeover! socialism!). "If people are afraid, I'd think the thing to do would be to demonstrate that they needn't be afraid. One of the commenters (it may have been Patrick Molloy - apologies if I'm misattributing) has suggested a couple of times that, rather than spring a vast new program on the entire country at once, we "proof-of-concept" it by running a much smaller scale test pilot program. Pick a representative sample of counties from around the country and show us how mandatory insurance would work, how insurance exchanges would work, and so on. If it works as well as it's purported to, we can ramp up from there.

I agree with you David, about your filet mignon analogy, and like your sly joke about objectivity.In order to prepare the public for this sort of thing, someone needs to explain the matter in terms people can readily understand, for example that the public should consider this as a matter of practical Christianity and not a matter of politics.Once the need to universal health coverage is adequately explained, and is settled in the minds of most Americans, two key issues stand out as needing to be explained:1 - The American public does not want to pay for abortions2 A national health insurance plan needs to cover everyone living here and that includes the indocumentados.No one party can simply breeze into this sort of reform without the proper preparation. Democrats have tried this before and failed. In fact the only Democrat who really tried to explain the need for national health insurance was President Truman. Granted he did not succeed, but at least he made the honest effort to explain the matter. Since then, Democrats have simply tried to ram this through any time they had the chance and each time, they have irritated the public to the point where they get temporarily voted out of office. Frankly, that seems likely to happen again.

Irene said: "But the article does say the insurer is seeking cuts from the hospitals and increases from the subscribers. It may be a negotiation tactic, but it is still trying to do both at the same time. And the Oklahoma hospital consortium struggling to meet the notification requirement says it doesnt feel to us like cost control, it feels like a revenue stream enhancement to the insurance companies."Please see what I wrote about his on the new thread.Of course the Oklahoma hospital consortium would say that. They want to make it sound like the notification thing is some sort of "gotcha". But unless the hospitals have really rotten billing and notification systems that would generate these all the time, how could this end up being something as major as a "revenue stream" for a payer. Could it be just as likely that they don't like the idea that they would now have to comply with their own contracts?

"Like you, I want to see everyone covered, but I would like to see it in a high quality system."Does not sound honorable to me, Sean. Unless looking out for #1 is our motivation for life. So what happens to the concept of the Body of Christ? So if others are hurting they should stay in pain because otherwise they will give me pain. What is wrong for the rest of us to put up with some lack of quality which to others amounts to great care. Seems very materialistic and non-Christian to me. You can choose to prefer not to lose quality of service while helping others. Just understand that it is not Christian.

I read where if a House-Senate compromise version of the proposed Congressional-Obama plan were actually made law, then fully 95 percent of Americans would be covered; the 95 percent noted in the article came from Nancy Pelosi or her office.Keeping in mind the 30 million Americans (and probably 10 million indocumentados) without medical coverage was one reason Democrats initially took up health care reform, and that there are about 300 million Americans; the upshot is that before any health care reform was considered, some 10 percent of Americans did not have coverage. And so if Congress enacts some version of the current reform plans (House and Senate) and spends the money as called for (a great sum of money it seems); some 5 percent of Americans (15 million people) will still not have coverage, and none of the indocumentados will be covered.Hmm.

CBO and JCT estimate that the direct spending and revenue effects of enacting the Patient Protection and Affordable Care Act incorporating the managers amendment would yield a net reduction in federal deficits of $132 billion over the 2010-2019 period. Decreasing the budget by $132 billion does not seem to me like spending "a great sum of money". Or am I misunderstanding this quote from the CBO Director's Blog?

Sean --Sorry to have misdirected my post to you. Thanks for replying anyway.Let me just say to your point that the richest rich have mainly what Keynes called "human goods subject to gravity" as opposed to other goods that can't be measured accurately. (Leave it to a first-rate genius to think up such a beautifully simple distinction :-) It seems to me that the goods you mentioned which are shared by the manufacturer and his employee are not in the subject-to-gravity category and so are not germane to my point. My point attempted to show by means of a measurable goods that the richer you are the more benefits you get from government by way of protection of your assets.When thinking about fair taxes you might bear in mind Leona Helmsley's infamous remark, "Only the little people pay taxes".

David,Unfortunately that's not what we're talking about. The cause of our health care financing problems is not the equivalent of filet treatments. We aren't in trouble because people are getting luxury care.The reality is that what is an inferior system is subjective to a great extent. Any choice will have trade offs. For example, I will admit that the French have what seems to be a very responsive and relatively inexpensive primary care system. They also have a system that does not use diagnostic tests at nearly the level of the US system - one of the things that makes it more expensive. However, French survival rates for most forms of cancer are far lower than in the US. So while your chance of getting cheap quick and universal primary care is better there, so is your chance of dying from cancer.We have a system that nearly 90% coverage and more than 80% of people have some level of satisfaction with the quality. So, I think that a system in which there is 100% covergae but most people aren't satisfied is inferior unless you think that acceessability is the sole criteria for judging the quality of the system.

AnnI don't know about human goods subject to gravity, but I do understand that the value of something is based on the what someone is willing to pay for it, or in that case of taxes the point to which someone is willing to put up with it.The problem with your view is that most of this wealth is not tied up in anything consumable, but in things tha themselves produce wealth. This mentality that is not about fairness, but based in resentment is ultimately destructive. There will get to be a point at which either the productive assets go elsewhere or when the owner finds it simply not worth the effort and risk to use them because so much of the return is eaten up by taxes.As for Leona - aside from being a nasty person, she apparently was an economic moron, and of course a a criminal. The reality is that "little people' pay relatively few taxes. This may be appropriate, but it shouldn't be an excuse for confiscatory taxation.

I just want to say I found Peter's introduction excellent but disagree with Jim that the comentary is execellent as well -a Scrooge like approach that says it's awful to pick a man's pocket to to help others.Bah humbug to that!

Are there no prisons? Are there no workhouses?

"Are there no prisons? Are there no workhouses?"Workhouses? There aren't even any jobs!

Oh please, Bob. Stop with the Scrooge nonsense.For years I have been listening to the left use this tired condemnation of the other side's generosity. What we need is effec tive answers to problems. Not answers that make us feel good and leave the people you say you want to help worse off.Spend some time in a public housing project or a welfare office. These are monuments to the idea that really smart people with enough tax money can solve any problem. Foolish non-Scrooge-like ideas like rent control provided cheap housing to the wealthy and condemned thousands of poor and middle class people to dilapidated housing or forced them to leave urban centers all together.I just happen to think that a system that places as much of the decision making authority about value and expenditures in the hands of the people actually using a system tends in the long run to be more beneficial than one that places almost all decision making in the hands of the government.In fact, as maybe Mark is pointing out - Scrooge is the liberal assuming that the state takes care of the problem - the charitable subscribers are the conservatives in the story.

"For years I have been listening to the left use this tired condemnation of the other sides generosity. What we need is effec tive answers to problems. Not answers that make us feel good and leave the people you say you want to help worse off."Sean, just because the Left always says this doesn't necessarily mean that it isn't true..."Spend some time in a public housing project or a welfare office. These are monuments to the idea that really smart people with enough tax money can solve any problem. Foolish non-Scrooge-like ideas like rent control provided cheap housing to the wealthy and condemned thousands of poor and middle class people to dilapidated housing or forced them to leave urban centers all together."They are monuments to failed experiments. But teh government experiments were in reaction to market failures. How come private sector entrepreneurs are allowed to fail as a matter of principle without it being a failure of capitalism, but if a government program fails, it proves that government can't solve a problem?"I just happen to think that a system that places as much of the decision making authority about value and expenditures in the hands of the people actually using a system tends in the long run to be more beneficial than one that places almost all decision making in the hands of the government."Here is the crux of the issue. You are not defining the poor as the users of the system. You are defining the tax payers (or the private sector). The poor have no power in the market, except through their votes. The market may attempt to create solutions for these problems (and fail) or government may attempt to produce solutions (and also fail). But there are several things for sure. First, political power is not opposed to economic power. Political power and economic power are simply two kinds of power in a society, but different people have different levels of access to them. People use the power they have. Second, any solution will be a mix of government and private power. The people whose power is mostly economic will try to control the thing economically and the people whose power is mostly political will try to control the thing politically. This isn't some kind of nascent socialism. It's democratic capitalism. Or to put it in purely market terms; the government CAN'T intervene unless there's already a market vacuum of some sort. This is why we are talking so much about health care, where the market has failed, and not cheeseburgers, where the market has not.

UnagidonHas the market failed? Or was there never a real market to begin with? Most critics (including the president) trace the underlying problem with our system to the use of employer provided health financing and specifically the provision of health care as a non-taxable form of income. It wasn't a free market failure, but government regulation that resulted in the problem. This all happened at the same time that most of the rest of the world was moving toward socialist models. That isn't the only model.

Sean, I'm in the private sector and what I am seeing in health care is a market. The regulation in it is irrelevant. For a market to exist, there has to be a buyer and a seller. I don't care if the seller is the employer or the member. Makes no difference at all. There is no impediment that I am aware of in terms of regulations that prevent anyone whatsover from buying their own personal insurance policy in the United States. It's just that for many people, these policies would be far more than they could ever possibly afford. That is a market problem, not a regulatory problem. If we took away all regulations at every level, we would still have buyers and sellers and I would still only be selling people who were buyers (i.e. who had the money in their hand). And there would be a lot of people out there (at least 30 million) whose empty hands would not be holding insurance policies.

Bob Nunz is still smarting because I made him work that half-day last 12/25 :-)

Unagidon--I think you are missing something fundamental that Sean is pointing out. It makes all the difference when the purchaser (employer) is not the end user (employee). The discipline of the market is not present when the employee's pocketbook is not (directly) impacted by the amount healthcare he uses. He has little incentive to be efficient when he does not directly bear the full cost his healthcare decisions. The employer can be as efficient as it wants, but this will have limited overall effect, since it has little control over the healthcare decisions of its employees.Although there is no law against an individual purchasing healthcare insurance, it would not make sense for him to do so if his employer is already paying for his coverage. In addition, the employer has a tax incentive for purchasing healthcare insurance, the individual doesn't. The market is simply reacting to the incentives provided by the tax code. Grant the same tax incentive to the individual, and the market will snap call.

Mark, it is truly a pity that this thread is almost dead, because what you (and Sean) said is very important and poorly understood and needs to be examined at length.My responses to Sean were against the idea that I think he seems to hold that there is a free market on one side and government regulation on the other side and that cases where the market is not performing adequately are the cause of regulation. There are theories out the on the right and on the left that business does not like regulation. This is simply not true in fact. Business doesn't like regulations that it doesn't like. They might be "anti-regulation" as a default position when trying to mobilize people that don't know any better, but in fact business people know that while regulations have costs, no regulations has costs too. It's just that in the market, sometimes the benefits of regulation are not enjoyed by the people who have to pay for them. You are half correct when you say incentives incent. What really happens is that good incentives, and only good incentives, incent. And the fact is, revising the tax code would not create good incentives for consumers to buy insurance, nor would some magical group of capitalists spring up suddenly to sell it.Contrary to what Sean thinks, businesses first provided insurance benefits on their own as a way of increasing "compensation" in the context of wage controls during World War 2. I suppose one could argue that without wage controls businesses simply would have increased salaries. But aside from the fact that one cannot run a wartime economy without regulations, capping salaries helped control inflation, which is something that the economy needs to avoid during a war. In short, business wanted the regulatory caps and then in their capitalist style they looked for ways to get around them when it suited their individual competitive needs. The reason that this became so widespread was because in a wartime economy it is very easy for things to spread very widely very quickly.Since health benefits were part of the overall package, if business (in general) had decided to cut them and operate like they did on a pre-war basis, they would have had to make up the cut in salary, don't you think? The economy took off from the war and after the war. They was no labor glut. However, it happened that health benefits were a rather cheap thing to offer. So it became standard and business loved it. The reason that business doesn't love it any more and the reason that they are unable to simply stop giving these benefits and have the worker/consumer take care of them himself is that the underlying costs of medical care are increasing far faster than wages are in general and far faster than business can control. When you talk about incentives and individuals, you are giving very poor marks to how American business acts with what are, in fact, the same incentives. American health insurance from the business person's point of view is all about individual incentives. Those rising co-pays and out of pockets that you have been seeing this last decade or two are precisely from business constructing those utilization incentives that you claims don't exist now because employees get their insurance handed to them by someone else. You must be very wealthy indeed if changes in your insurance plans have not directly impacted your pocketbook relative to the amount of health care you use.The consumer doesn't understand what is going on; I will grant you that. They think that the insurance companies are raising rates on one hand and ripping off doctors on the other (and this when they are not simply denying benefits altogether). But insurance companies (and this is true about any kind of insurance whatsoever) simply is a vehicle for distributing risk and passing on the underlying costs. It's just that the underlying costs are out of control.If there was a way to "incent" the individual any more than we do now to be prudent with their benefits, between us insurance companies and American business we would have figured it out already and we would be ramming down the worker's throat.Business would love to get out of the insurance benefits game and they would love to pass 100 percent of the thing off to the consumer. But consumers would not be able by themselves to pay for insurance. Why? Because at least with businesses there is some semblance of risk pools. A company with sick workers pays higher premiums than a company with healthy workers. There is at least some redistribution of risk within the company. But if you take that away, than only well people will be able to afford insurance, even if you reduce the tax burden to zero. As underlying medical costs keep going up, you are not talking about some free market consumer adapting by being prudent. You are talking about people choosing between medical care and, say, food. If we were to say that business would then have to increase salaries to cover the general COLA of medical care, then business is simply back providing insurance benefits indirectly, without the business expertise (and discipline) that they can use to influence utilization.This is how it really works.

Unagidon--Well, since you already know how it really works, there may not be much that I can add to the discussion ;-) Nevertheless, I will follow up on one thing you said that I agree with, and lament. Big business often does not mind regulation, and in far too many cases actually courts it, to prevent others from entering their market. On the other hand, I've yet to meet a small businessman who has anything but disdain for government red tape.

I'm sure you could add to the discussion. I'm talking as an executive in the business and am always willing to listen to other people's insights.Small business people don't like red tape in theory. But a lot of it benefits them too.

"But consumers would not be able by themselves to pay for insurance. Why? Because at least with businesses there is some semblance of risk pools. A company with sick workers pays higher premiums than a company with healthy workers. There is at least some redistribution of risk within the company. But if you take that away, than only well people will be able to afford insurance, even if you reduce the tax burden to zero. "I've wondered for some time if there wasn't a way to simply take the currently-uninsured and configure them (somehow) into risk pools. Would that be possible? Practical?

As a follow-up to my previous question: aren't there examples of non-employer risk pooling out there? E.g. the Knights of Columbus, the Lutheran Brotherhood?

There are lots of risk pools as you have described. But the question I would ask as a private sector insurer is "whose risk pool"? We could concoct a risk pool of the 30 million uninsured that would probably have a lower cost per person than most people would be able to get on their own, but this doesn't address the problem that many many people simply could not afford to pay for it anyway. Health care costs have risen and are rising so far so fast that risk pool configurations, tax "incentives", "consumer driven" schemes etc. by themselves simply cannot solve the problem through "free market" mechanisms by themselves, whatever the worshippers say or believe.

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