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Da Boss wrote:I'm currently undecided, but I disagree with any plans to run private practices from state owned hospitals.

Thank you for touching on another point I had forgotten. In the US there is a strong feeling that individuals should be free to pursue a livelihood of their choosing as long as it has no negative impact on the community (prostitution being an obvious example, although there are clearly parts of the US that have different opinions on that as well). A necessary precondition in the US for nationalizing health care is making it a civil and criminal offense to practice private medicine. I'm sure it doesn't take a great leap of understanding to see why those two may be exceedingly difficult to reconcile-it is pretty much simply un-American to punish someone (under either civil or criminal law) for the "offense" against the community of selling medical services to private clients. Just really not going to fly too well . . .

O_O
They'd have to make private care illegal?
Why?

Da Boss wrote:O_O
They'd have to make private care illegal?
Why?

In the confines of the existing US hodge-podge of state systems and regulations, if you wanted to transfer it to a state-run enterprise, you would have to force the change along. I suppose someone could devise some particularly creative system without using this, but the initial push would most likely end up using the bludgeoning/sledgehammer method or something pretty close to it.

Basically, if you go to state-run while leaving the private option in place, you are going to have too much hold-over/resistance/ingrained opposition amongst existing insurance users. The entire problem being addressed by state healthcare is related is fundamentally free-rider issues: costs from the unsinsured distorting the market and creating various distortions on account of providers (hospitals) have a federal legal obligation to provide service without asking questions.

If you don't mandate the change, too many people don't switch and all that you're left with is unpaying previously uninsured customers-and then you're back in the same fiscal hole you came from. The system needs the people who are happy with their existing coverage and who would not switch without a powerful incentive (you could provide people with hugely subsidized coverage as an incentive, but ultimately you have to pay for it somewhere and you either end up instituting broad tax increases for a transpearent purpose or raising rates shortly to large public outcry).

This is why the state-driven reforms I mentioned above coerce you into buying someone's coverage (of your choice)-if you let people not participate in the system it doesn't work.

So how do you get around this? You mandate the switch. Mandating the switch requires coercion, and that includes making private practice illegal. It can be dressed up nicely if you want, but it ends up the same in the end.

While it may be possible to re-liberalize within a full state system, but the initial change would require some significant measures to go into effect (yes, ironically the public resistance to the initial change-over would necessitate the accompanying harsh measures I described).

Now I gave the caveat-it may be possible to find a way around this. I'm just skeptical that those pushing the state's role will give too much thought to such niceties if they ascend to the point of having the political sway to make this happen in the first place.

To briefly resurrect an earlier topic of discussion-I would add that California's experience with the plebiscite/initiative/referendum is all the evidence needed that putting healthcare "under the voters" is not such a good idea. Whatever your political persuasion, its not really debatable that the electorate here has a demonstrated proclivity to vote for what it wants in the short term (or thinks it wants . . . thanks television! ) without regard for long-term consequences/costs. The things they have voted for have also significantly decreased the power of the legislature and strongly interferred with the ability of the legislature and the governor to "govern", slaving them to the policy choices of generations past and in some cases 6 feet under (due to the difficulty of changing initiatives without anything other than the lawsuit or another dose of the same). Putting healthcare under the jurisdiction of that same electorate is ehm not progress (to me at least).

While I know that you did not literally mean putting changes in health care policy to the vote (I think so anyway) I hope that the observable effect of placing policy outcomes too easily within reach of the electorate can have bad outcomes, as much as we might want to trust in the mythical "judgement/wisdom of the people." And things involving my health/access to medical care are important enough to me to encourage wariness to over-reform (to mix a few analogies, if you try and kill something small and squishy with a glass sledgehammer, bad things may happen somewhere along the line).

Heh. Yes, I can see that a change over would be pretty impossible in current circumstances. Very well explained.

I'm interested in what you said about the californian electorate. What kind of stupid decisions did they make?

California law can be changed by referendum during an
election. If a proposition makes it to ballot, and 50% (I
don't know if it's of voters or of population) approve it,
then it becomes law.

Da Boss wrote:I'm interested in what you said about the californian electorate. What kind of stupid decisions did they make?

That depends upon what your political persuasion is-some votes are the wisdom of ages being passed down, while others are lengendary only for their infamy. However, both left and right will find something to like or dlislike strongly. Those who finance the initiative process, after all, are ideologues doing this to get something they want-not much middle ground. Each of the below has some positive light to them-I'm just going to give you the negative spin to understand the problems created out of good intentions.

Proposition 13: Fixed increases in property taxes to grow at 1% of assessed value at time of sale. Since real estate prices over time rise more than this, with corresponding increases in the cost of delivering services also growing more than 1%, this creates massive inequalities in taxation between different properties based on the date of last sale. This not only patently unjust (basically, you get tax relief based only on how long you've lived at the same address) it hamstrings the ablity of cities/schools and other jurisdictions that depended on property taxes to grow their tax base, make sound financial forecasts, and generally function smoothly (basically, all increases in property tax revenue have to be forecasted based not only off of growth in valuation as would normally be the case, but also on rate of turn-over of existing owned properties). This also created certain potential abuses with real estate owned by business entities (Corporation XYZ owns parcel A, Company DEF buys a controlling stake in Corporation XYZ, parcel A is never adjusted because it was never sold per se, Corporation XYZ owns the whole time). There are ways of creating/implementing special assessments but these are usually controversial and difficult to implement even for normally popular causes like community colleges and K-12 education.

This in turn makes county/local government extremely dependent on the state and federal levels of government for supplemental income to fund their ongoing operations and distorts the normal balance of power between these levels of government, compromising local autonomy.

This tax structure also forces local government to depend heavily upon local sales tax revenue (they get a piece of it in California) for fiscal survival and providing fire/police, etc. This forces planning agencies and permitting agencies to favor sales-tax generating businesses (think car dealerships) that may not provide the best jobs over office complexes (no sales, but good jobs) and housing (costs the city more money to provide services than it will generate in taxes in the long run)-this contributes heavily to the high cost of housing in California (minimal new housing production in core urban areas).

This train wreck only goes on of course. The need to minimize current expenses forces local governments to come up with creative benefits to current employees that are paid "some day in the future"-think expensive guaranteed health care in retirement, pensions at 100%+ of current salary, amongst others. For years governments were not required to dislose the cost of these future obligations on their books-recent US accounting reforms have forced this into the light and revealed that many local governments made promises that they will never really be able to keep. Of course our state laws also prevent local governments from discharging their retirement obligations in bankruptcy-former employees get money before current employees/services. This means that even in bankruptcy future leaders will need to raise taxes heavily or cut services heavily. I do not envy them.

Next is Proposition 98. This mandates that the state's spending on K-12 education and community colleges may not shrink as a percentage of state revenues (henceforth the baseline) and mandates that education must receive a proportionate share of all future spending increases. Since education is basically the single biggest programatic expenditure, this basically sets the existing state spending priorities in stone for all time. Growing any category outside of its historic size (for instance, urgently needed repairs to the Sacramento Delta) requires sacrifice from another constituency's pet slice of the pie. One of the greatest powers of the Legislature (if not the foremost of any such body) is the power of the Purse, but 98 and its attendant effects strip this power away in California for the most part.

Several years ago California voters passed Proposition 1A. This basically legalizes Indian casino gaming for all time in California. The measure contained what many neighboring communities believed at the time, and continue to contend, are inadequate provisions for the protection of communities adjacent to casinos and pitifully lacking measures to redistribute gaming revenues to communities to deal with these new problems (growth in vice crimes, addictions, theft to fund said addictions, etc.). Due to the nature of the initiative this can never really be dealt with, except peripherally through new gaming compacts for tribes that want new slot machines. Of course the state's pressing need for new revenues to fund new programs (see above) curtails state negotiators' ability to press for provisions to protect marginalized rural communities that aren't important constituencies (there's a reason you won't see a casino in downtown LA . . . they matter).

There's a few more examples lurking around, but that should give you an adequate sampling to start mulling over.

malfred wrote:California law can be changed by referendum during an
election. If a proposition makes it to ballot, and 50% (I
don't know if it's of voters or of population) approve it,
then it becomes law.

While it is theoretically possible to do this, the expense involved in qualifying an initiative and the expense involved in campaigning makes this prohibitive in the extreme-particularly given the lengths to which one's opposition will go to defend their current benefits.

Oops, was just my lame understanding of how the
propositions worked.

malfred wrote:Oops, was just my lame understanding of how the
propositions worked.

California is a crazy enough place politically to prompt a whole lots of "Oops"

Alpharius Walks wrote:
Several years ago California voters passed Proposition 1A. This basically legalizes Indian casino gaming for all time in California. The measure contained what many neighboring communities believed at the time, and continue to contend, are inadequate provisions for the protection of communities adjacent to casinos and pitifully lacking measures to redistribute gaming revenues to communities to deal with these new problems (growth in vice crimes, addictions, theft to fund said addictions, etc.). Due to the nature of the initiative this can never really be dealt with, except peripherally through new gaming compacts for tribes that want new slot machines. Of course the state's pressing need for new revenues to fund new programs (see above) curtails state negotiators' ability to press for provisions to protect marginalized rural communities that aren't important constituencies (there's a reason you won't see a casino in downtown LA . . . they matter).

HA! White people needing protection from Indians and there economy.


I would have guessed it was obvious that I was playing more of a Devil's Advovate position in earlier threads by now. I've enjoyed Alpharius's insights into the situation quite a bit. I think something needs to be done about health care, though I'm not sure the knee jerk reactions of either full on universal or fully private (which is what politicians seem to argue mostly) are the answer. We have a few smart people around here somewhere who should be able to come up with some kind of solution, though it won't happen quickly, that can make the best of it. There will never be a plan that makes everyone happy as it will either be to much or not enough, but we need to do something as opposed to nothing.

The language is often a problem. Nanny State is just loaded language and turns off people right away and doesn't really help the dialogue. It's like the abortion issue. It's not Pro-choice and Anti-choice, or Pro-Abortion and Anti-abortion, it is Pro-Choice and Anti-abortion, so the language there works for and against everyone. It is going to take people who move beyond the limits of loaded language to delve into the issue without turning it into a pundit battle or parrots reciting their favorite political talk-show host. Unless it is Dennis Miller, he's just nifty.

Ahtman wrote:
HA! White people needing protection from Indians and there economy.

I considered presenting it from the perspective of those tribes that were not initially given casinos and are now actively opposed by current gaming tribes that have the dollars on hand to buy an end to their potential competitors' aspirations, but I figured that might have too many local nuances to be easily presented to an international reader-local mitigation is something that people seem to pick up on much easier.

I'm glad to hear that my observations made sense to someone else though-or at least a touch of amusement.

You've been very clear throughout I thought.
Ahtman: I used Nanny State because that was the phrase used in the post that inspired this thread. I prefer socialist state myself.

I agree that sweeping changes wouldn't work in the US, or most places for that matter. (I hate talking about the US as if it was some monolith block actually, since I know there is great variation between states).
I was just interested in the rationale behind the POV that socialist government is bad that I had seen expressed fairly strongly in a few places.
I can see now that it's not too widely disliked, at least by posters here.

FYI Da Boss your sig line is pure excellence.

Alpharius Walks wrote:

Ahtman wrote:
HA! White people needing protection from Indians and there economy.

I considered presenting it from the perspective of those tribes that were not initially given casinos and are now actively opposed by current gaming tribes that have the dollars on hand to buy an end to their potential competitors' aspirations, but I figured that might have too many local nuances to be easily presented to an international reader-local mitigation is something that people seem to pick up on much easier.

I'm glad to hear that my observations made sense to someone else though-or at least a touch of amusement.

I'm well aware of the nuances of it, but I liked the wording. Just listening to people talking the average Joe thinks all Indians are getting money from casinos. That makes good sense. I know that I get money from Microsoft becuase Bill Gates is white and we both reside in America.

But what happens to people who come down with cancer or some other terminal condition, if they don't have any medical cover aren't they not treated? Also what about the fact the companies that provide the cover do their best to wriggle out of paying for treatment?

Ahtman wrote:

I know that I get money from Microsoft becuase Bill Gates is white and we both reside in America.

Wait, you mean you don't!?

So much for "assimilation." *grumble mutter*

Wolfstan wrote:But what happens to people who come down with cancer or some other terminal condition, if they don't have any medical cover aren't they not treated? Also what about the fact the companies that provide the cover do their best to wriggle out of paying for treatment?

You know if it is terminal medicine can't save them because well, they are terminal. That is kinda what it means. Other than that I would say that the person is going to do the same thing that is going to happen to the rich person with cancer. They die or they don't, then they die at a later date. Lack of health care isn't what kills us more often then not, it's being alive that does that; there is a 1:1 correlation between the two. Besides, there are a lot of programs out there that do help people and they don't need the governments blessing to exist or work, on top of many local and state programs that help.

Sorry, I messed up on that statement. What I meant was long term. For example you have a curable cancer but it's going to take months of chemo to fix it.

There are certainly a lot of folks out there who could survive if they got the proper care in time. Many forms of cancer are treatable and can be beaten with early enough intervention. People who don’t have insurance don’t get preventive treatment, don’t get regular checkups, and are much more likely to let minor symptoms go unchecked until it’s too late. Sometimes folks who DO have insurance get denied the care they need, and the consequences can be fatal.

I'll just point out that major feth ups do happen in a more socialist system too- our government ignored warnings that piece of equipment in a cancer diagnostic lab was faulty, didn't replace it, and hundreds of women were given the all clear when they were not in fact all clear. Various other problems of that sort happen all the time, I really could go on all day even with just personal anecdotes. I still prefer my own system as it is less complicated for me personally (I don't need to worry about my healthcare plan, that's the government's job) and the option for private care is still there.