Paul Craig Roberts on Obamacare

[goodrich4bk]

Re: Paul Craig Roberts on Obamacare

Well, I must be a jerk, then, because I would vehemently object to any such plan.

[goodrich4bk]

Re: Paul Craig Roberts on Obamacare

And to what degree is this is different than your pre-ACA experience? To the extent you can parse the increase and identify the portion caused by ACA versus the portion that would have occurred anyway from generally rising healthcare costs, have you tried to value the ACA benefit of having coverage even if you lose your job with a pre-existing condition? Or the value of insuring your adult children on your employer-provided plan through the age of 23? Or the value of filling the donut hole for your Medicare parents?

[DSpencer]

Re: Paul Craig Roberts on Obamacare

Well, I must be a jerk, then, because I would vehemently object to any such plan.

That's the point, it was meant to be sarcastic. You state that the writer is a jerk because he doesn't approve of a plan that takes his money by force and gives it to the less fortunate. Yet unsurprisingly, you don't advocate other plans that do the same thing.

Perhaps you can explain why one situation is an appropriate function of government while the other is not?

[DSpencer]

Re: Paul Craig Roberts on Obamacare

And to what degree is this is different than your pre-ACA experience? To the extent you can parse the increase and identify the portion caused by ACA versus the portion that would have occurred anyway from generally rising healthcare costs, have you tried to value the ACA benefit of having coverage even if you lose your job with a pre-existing condition? Or the value of insuring your adult children on your employer-provided plan through the age of 23? Or the value of filling the donut hole for your Medicare parents?

Not much different. In our particular case last year's increase was much less, but I don't pretend this anecdote is the rule. But when you sign a bill that states in its name "Affordable Care Act" the expectation should be that it makes care more affordable. I see no evidence of this on the whole and see plenty of the opposite.

Insuring those who can't be legitimately insured is simply a redistribution of wealth from the healthy to the sick. Of course it has the "value" to the person getting insurance that will definitely cover more expenses than they will pay in premiums.

Again, forcing employers to subsidize the insurance of ADULTS WHO DON'T WORK THERE is advantageous to the people getting the insurance. It's disadvantageous to the business and the other employees who have to cover these inappropriate costs. There is no net gain in value. Simply a transfer from one to another.

And yet again, making Medicare a more robust coverage is advantageous to those who benefit from it. And equally disadvantageous to those who will pay for it.

I can see the "value" of taking all but a small amount of wealth from the billionaires in the US and giving it to orphans, the homeless, and sick people without insurance. That doesn't make it the right thing to do.

There's no great efficiency gained by the PPACA. Maybe single payer would have accomplished that at least. Instead, it picks winners and losers on many levels but does nothing to solve real problems.

[charliebrown]

Re: Paul Craig Roberts on Obamacare

I agree with this i think, until someone really smart points out my flaw.

Some gvt health clinic system is set up that will be free, low cost at cost etc. It would compete with the private sector health care. The service might not be as good, you might have to wait longer, maybe some procedure would not be provided etc, but you would have a choice. Either go gvt or if you think you are getting real value for your money you could go private.

[goodrich4bk]

Re: Paul Craig Roberts on Obamacare

That's the point, it was meant to be sarcastic. You state that the writer is a jerk because he doesn't approve of a plan that takes his money by force and gives it to the less fortunate. Yet unsurprisingly, you don't advocate other plans that do the same thing.

Perhaps you can explain why one situation is an appropriate function of government while the other is not?

I'd be happy to.

First, there is an important difference between providing basic healthcare to our citizens and providing food, shelter and clothing to the entire world. I do not support free healthcare for all but, rather, basic health insurance provided at taxpayer expense via a single payer. I have no objection to individuals purchasing additional coverage with their own money. So we are talking about a limited program paid for by all citizens which provides a benefit for all citizens. This is no different than national security, except that we are defending against the invasion of bacteria, viruses and accidental trauma to our physical body, rather than the invasion of a foreign army to our territory.

Second, taxes are not theft and one cannot separate his ability to make an income from the society in which the income is made. Taxes are the cost of living in our society. Absent that society --- which is the accumulated capital, culture, customs, laws, and knowledge of 300+ million Americans and their ancestors --- it would be virtually impossible for his to earn anything like the wealth he has earned in a civilized country. People who believe otherwise are living in a dream state, not in the real world.

Third, even for libertarians there is a good reason to use "force" to pay for everybody's healthcare. Unlike food, clothing and housing, there is no legal obligation of a grocer, clothing store or homeowner to provide food, clothing or housing to anybody who needs it. None. That is not true of medical care. Today, no hospital can turn down a needy patient, and we all pay for that care either through taxes or increased charges to those who have insurance. In short, Obamacare is about personal responsibility --- requiring everybody who already has a right to emergency care to pay for that care by becoming insured and taking more responsibilty for maintaining their own health.

I am open to changing my mind about this just as soon as we dissolve all government everywhere and see what happens. If after a reasonable test period the libertarian ideal is magically reached and nobody forces me to pay taxes for the myriad of other government programs I'll never need or want, I'll be happy to stop asking for any sort of collective healthcare. Until then, I'll just go along with every other developed country in the world and suggest that some sort of universal care is no more difficult than the 40 hour work week once appeared to be.

[charliebrown]

Re: Paul Craig Roberts on Obamacare

I just finished my enrolment for 2013. I work for a major U.S. corporation. This is the first time in 10 years that I have not received a premium increase.
I did have to sign and affidavit stating that none of my family smoked, and none was covered by an alternate insurance plan. If any of these were true,
my premium would have increased by 20% for each occurance. Maybe the smokers and employed spouses paid my premium increase. Also as you note,
Flex spending no longer covers my out of pocket expenses. I was tempted to go non deductable ppo plan. It was only a few dollars more if you go full out of pocket for the year.

[charliebrown]

Re: Paul Craig Roberts on Obamacare

Speaking for myself if the gvt would stop picking my pocket, I would have a larger amount of money to donate to charity. My church is having trouble this year and it might be because the state decided it needed 2% more of our citizens money, no larger deductible no where to hide you have 2% less money to spend. My church runs a food bank. All the socially minded types who petition law makers for more money for social programs. It comes from the workers, so when charities come calling asking for money I have less to give. There is no free lunch. And I suspect the state run version of these social have a bunch of exeuctives with 100K salaries.
My church's food bank is 100% volunteer.

[Ghent12]

Re: Paul Craig Roberts on Obamacare

Down in Uruguay (and Argentina) they have a public/private model that makes some sense. Everyone gets public healthcare, but it is not exceptional. So yes, you can break a leg of have a heart attack, but once you are stable, out you go -- literally. To family, or wherever. If you choose to buy supplemental, you get better care, obviously.

The idea that everyone is 'entitled' to the same healthcare is absolutely ridiculous. Under that idea there are NO limits. This my 86 yr old mom is 'entitled' to knee replacements, a serial killer is 'entitled' to a heart transplant, a immigrant who had been in country is 'entitled' to 30 years of dialysis even though they may have contributed to the system for only a couple years, a baby with no viable means of long term lifespan is 'entitled' to hundreds of thousands of 'lifesaving' procedures immediately upon birth, etc etc.

There ARE limits. Maybe that means 'death panels' if you cannot afford certain procedures on your own. Socializing the costs does not mean the costs go away, and shifting them will not eliminate them, they will remain. The 'entitlement' state is killing us, yet we selfishly clamor for more and try to pawn it off on the backs of the young.

It's as if people don't seem to understand that there is no such thing as a free lunch. There are resources and then there are ways to develop and disseminate those resources. If you don't have a self-correcting system, such as an unfettered free market, then you will always have the tendency for imbalances in supply and demand.

I'm sorry that people get sick, I really am. I'm also sorry that they get sick while being poor, or after being laid off, or whatever. It is tragic, but that doesn't make the costs of their care go away! Single payer is only rational from the perspective of bottom feeders, of those who do not contribute enough to society to command wages commensurate with a standard of living that includes regular and accessible health care. From the perspective of literally every person that puts forth enough real productivity and therefore can command wages high enough to cover basic costs associated with a decent standard of living, single payer systems are not rational. Now you can dither in the weeds of whether or not there should be some kind of safety net to catch people who happen to brake a bone after losing their health coverage or whatever, but let's not kid ourselves. There are limited resources and in order to maximize their utilization to the benefit of everyone, we must support a system that has inherent and empiric dynamic stability. An unfettered free market where the government doesn't pick winners and create losers is the system that ultimately discovers the true cost of health care or any other service or product, and therefore it is the only system that can maximize the health of a society.

The more balanced a government's intervention (meaning such that it harms all participants equally), and the less of that government intervention, the better in almost all cases. This is true even in Health Care, which doesn't have some exemption from logic, reason, or ordinary human interaction. There is no special case where free markets don't operate effectively, even though there are a precious handful of services the government can provide at relatively low costs such as dispute arbitration and national defense, although in practice the current reality suggests the inherent incentive for government to always provide services at higher and higher costs with decreasing results. Within the health care industry (not the health insurance industry, which is separate and is a whole 'nother can of 6 decade old government-subsidized worms), freedom of markets and choices tends to result in discovering the true cost of health care, which is vastly smaller than what a hospital bills insurance. See Oklahoma or all plastic surgery and laser eye surgery throughout their respective histories.

A doctor's time is not free. Medical equipment is not free. Hospitals are not free. Single payer doesn't change reality--it doesn't make healthcare free, it merely shifts the costs around and manipulates the incentives facing all the participants in the system.

[gwynedd1]

Re: Paul Craig Roberts on Obamacare

It's as if people don't seem to understand that there is no such thing as a free lunch.

If there is no such thing as a free lunch then what happended to all those lunches I paid for and never got?

[vt]

Re: Paul Craig Roberts on Obamacare

Smokers pay cigarette taxes and higher health premiums, and we tax alcohol. But how do we control the obesity epidemic that leads to earlier heart attacks, cancers, and diabetes?
Do we tax the foods that contribute to Obesity? Do we reward those who has less body fat and ideal rates with lower health premiums? I think we are doing a bit of this now. But how far should we go with the carrot and stick program?

[Thailandnotes]

Re: Paul Craig Roberts on Obamacare

It's as if people don't seem to understand that there is no such thing as a free lunch. There are resources and then there are ways to develop and disseminate those resources. If you don't have a self-correcting system, such as an unfettered free market, then you will always have the tendency for imbalances in supply and demand.

I'm sorry that people get sick, I really am. I'm also sorry that they get sick while being poor, or after being laid off, or whatever. It is tragic, but that doesn't make the costs of their care go away! Single payer is only rational from the perspective of bottom feeders, of those who do not contribute enough to society to command wages commensurate with a standard of living that includes regular and accessible health care. From the perspective of literally every person that puts forth enough real productivity and therefore can command wages high enough to cover basic costs associated with a decent standard of living, single payer systems are not rational. Now you can dither in the weeds of whether or not there should be some kind of safety net to catch people who happen to brake a bone after losing their health coverage or whatever, but let's not kid ourselves. There are limited resources and in order to maximize their utilization to the benefit of everyone, we must support a system that has inherent and empiric dynamic stability. An unfettered free market where the government doesn't pick winners and create losers is the system that ultimately discovers the true cost of health care or any other service or product, and therefore it is the only system that can maximize the health of a society.

The more balanced a government's intervention (meaning such that it harms all participants equally), and the less of that government intervention, the better in almost all cases. This is true even in Health Care, which doesn't have some exemption from logic, reason, or ordinary human interaction. There is no special case where free markets don't operate effectively, even though there are a precious handful of services the government can provide at relatively low costs such as dispute arbitration and national defense, although in practice the current reality suggests the inherent incentive for government to always provide services at higher and higher costs with decreasing results. Within the health care industry (not the health insurance industry, which is separate and is a whole 'nother can of 6 decade old government-subsidized worms), freedom of markets and choices tends to result in discovering the true cost of health care, which is vastly smaller than what a hospital bills insurance. See Oklahoma or all plastic surgery and laser eye surgery throughout their respective histories.

A doctor's time is not free. Medical equipment is not free. Hospitals are not free. Single payer doesn't change reality--it doesn't make healthcare free, it merely shifts the costs around and manipulates the incentives facing all the participants in the system.

This debate will never end...

Don’t think this is small stuff. The waste and fraud amount to hundreds of billions of dollars a year! Americans pay the highest prices for drugs in the world even though most of them were developed in the U.S. significantly based on government research, development and with tax credit subsidies for Big Pharma. Even Mr. Obama’s 2013 budget recognizes savings from excessive drug industry pricing.

The nation’s leading expert, Harvard’s Malcolm Sparrow, has estimated that computerized billing fraud and abuse is anywhere from 10 to 25 percent of the nation’s health bill. This adds up to $270 billion to $650 billion a year. A big slice of that fraud is taken out of Medicare and Medicaid.

A single-payer, full Medicare for all system – formerly supported by President Obama, Hillary Clinton and many members of Congress, before Mr. Obama took it off the table in 2009 – would cut present administrative costs in half. Canada’s system, which allows patients to freely choose their doctor and hospital, covers everyone for half of the $9000 per capita that Americans will pay this year. Our system leaves 50 million people uncovered of whom 45,000 will die this year alone due to lack of coverage, according to a peer-reviewed study by Harvard Medical School researchers.

Longer range savings come from reducing medical malpractice, hospital-induced infections and plain errors that annually cost 200,000 lives, and more injuries and sicknesses. Some hospitals are proving these savings can come quickly with common sense solutions: better sanitation, checklists and stronger internal peer reviews.

The trilogy of health care fraud, waste and abuse requires public discussion, along with the vastly greater returns from better funded policing of the healthcare system. Yet pundits and columnists ignore reaping savings from the bloated healthcare industry and assume the cuts must overwhelmingly come out of people’s hides – namely benefits.

As economist Dean Baker has written, we don’t need to cut Social Security benefits (already solid for the next 25 years) whether in money or later age eligibility.

Congress could also simply raise the social security tax on incomes above $115,000, increase the minimum wage, inflation adjusted, to that of 1968! And adopt other long-overdue improvements such as disability enforcement efficiencies. The initiatives will move the trust fund to sustainability for the next 75 years.

The deep bias of public dialogue here, whether in such reborn deficit-reduction commissions as Simpson-Bowles or in the general media is revealed in the use of the word “entitlements.” It is only used to apply to Medicare, Medicaid and Social Security, which involve recycling peoples’ tax dollars. It is not used to describe the massive corporate entitlements shoveled out daily to business welfarists in the form of subsidies, bailouts, giveaways, tax loopholes, debt revocations, loan guarantees, discounted insurance and other aid to dependent corporations. Why? Power produces privileges.

When 30 large companies, such as Verizon and General Electric, make a total of $160 billion in U.S. profits from 2008-2010 according to the Citizens for Tax Justice and pay NO federal income taxes there is a substantial loss of revenue to the U.S. Treasury. Two thirds of corporations pay no income tax on their profits under the Swiss cheese tax code.

Moreover, the corporate welfare they receive in various modes, including free research, development, and inflated government contracts (a disguised subsidy) is hardly a recycling of their taxes.

Just taxing corporations at the rate paid in the prosperous nineteen sixties would bring in hundreds of billions of dollars yearly. Another great revenue producer is a tiny Wall St. speculation sales tax, a far tinier rate than what you pay in sales taxes.

What about taxing capital gains and dividends the same as ordinary income? That was the case under Ronald Reagan. Then there is the bloated military budget, so full of redundancies, waste, boondoggle weapons programs such as the F-22, endless weapons cost over-runs, contracting fraud and boomeranging Empire expenditures as to boggle the minds. Even retired high military officers condemn giving the Pentagon such blank checks.

Nader

[BP]

Re: Paul Craig Roberts on Obamacare

Article by Walter E. Williams

Most politicians, and probably most Americans, see health care as a right. Thus, whether a person has the means to pay for medical services or not, he is nonetheless entitled to them. Let's ask ourselves a few questions about this vision.

Say a person, let's call him Harry, suffers from diabetes and he has no means to pay a laboratory for blood work, a doctor for treatment and a pharmacy for medication. Does Harry have a right to XYZ lab's and Dr. Jones' services and a prescription from a pharmacist? And, if those services are not provided without charge, should Harry be able to call for criminal sanctions against those persons for violating his rights to health care?

You say, "Williams, that would come very close to slavery if one person had the right to force someone to serve him without pay." You're right. Suppose instead of Harry being able to force a lab, doctor and pharmacy to provide services without pay, Congress uses its taxing power to take a couple of hundred dollars out of the paycheck of some American to give to Harry so that he could pay the lab, doctor and pharmacist. Would there be any difference in principle, namely forcibly using one person to serve the purposes of another? There would be one important strategic difference, that of concealment. Most Americans, I would hope, would be offended by the notion of directly and visibly forcing one person to serve the purposes of another. Congress' use of the tax system to invisibly accomplish the same end is more palatable to the average American.

True rights, such as those in our Constitution, or those considered to be natural or human rights, exist simultaneously among people. That means exercise of a right by one person does not diminish those held by another. In other words, my rights to speech or travel impose no obligations on another except those of non-interference. If we apply ideas behind rights to health care to my rights to speech or travel, my free speech rights would require government-imposed obligations on others to provide me with an auditorium, television studio or radio station. My right to travel freely would require government-imposed obligations on others to provide me with airfare and hotel accommodations.

For Congress to guarantee a right to health care, or any other good or service, whether a person can afford it or not, it must diminish someone else's rights, namely their rights to their earnings. The reason is that Congress has no resources of its very own. Moreover, there is no Santa Claus, Easter Bunny or Tooth Fairy giving them those resources. The fact that government has no resources of its very own forces one to recognize that in order for government to give one American citizen a dollar, it must first, through intimidation, threats and coercion, confiscate that dollar from some other American. If one person has a right to something he did not earn, of necessity it requires that another person not have a right to something that he did earn.

To argue that people have a right that imposes obligations on another is an absurd concept. A better term for new-fangled rights to health care, decent housing and food is wishes. If we called them wishes, I would be in agreement with most other Americans for I, too, wish that everyone had adequate health care, decent housing and nutritious meals. However, if we called them human wishes, instead of human rights, there would be confusion and cognitive dissonance. The average American would cringe at the thought of government punishing one person because he refused to be pressed into making someone else's wish come true.
None of my argument is to argue against charity. Reaching into one's own pockets to assist his fellow man in need is praiseworthy and laudable. Reaching into someone else's pockets to do so is despicable and deserves condemnation.

[don]

Re: Paul Craig Roberts on Obamacare

American healthcare is a fundamentally for profit endeavor, captured by FIRE. The rest - the above is an excellent example - is ideological window dressing.

[Mn_Mark]

Re: Paul Craig Roberts on Obamacare

Second, taxes are not theft and one cannot separate his ability to make an income from the society in which the income is made. Taxes are the cost of living in our society. Absent that society --- which is the accumulated capital, culture, customs, laws, and knowledge of 300+ million Americans and their ancestors --- it would be virtually impossible for his to earn anything like the wealth he has earned in a civilized country. People who believe otherwise are living in a dream state, not in the real world.

In a free market, each person pays for what he receives from others, and gets paid for what he provides to others. The accounts are balanced as society goes along. In a socialist country, the government starts by "giving" you some thing like a "free" public education and then argues that because of that, they now have an open-ended claim on your earnings for the rest of your life. This "you didn't build it" argument is the collectivists' open-ended claim on as much of your earnings as they want to take, and it all starts with their smiling, "caring" provision of some "free" good.

The answer is to move back to a real free market where people earn what they have or else ask for it from a charity funded with actual charitable donations.

Third, even for libertarians there is a good reason to use "force" to pay for everybody's healthcare. Unlike food, clothing and housing, there is no legal obligation of a grocer, clothing store or homeowner to provide food, clothing or housing to anybody who needs it. None. That is not true of medical care. Today, no hospital can turn down a needy patient, and we all pay for that care either through taxes or increased charges to those who have insurance. In short, Obamacare is about personal responsibility --- requiring everybody who already has a right to emergency care to pay for that care by becoming insured and taking more responsibilty for maintaining their own health.

This is a perfect example of the open-ended excuse. First, collectivists pass a law that says that 'no hospital can turn down a needy patient.' Then, they use that law as an excuse to impose a socialist health care system, arguing that everyone should be "responsible" for their health care costs.

What a repulsive perversion of the concept of "personal responsibility". What Orwellian language! They collectivize us, and call it "taking personal responsibility". Do you even understand what personal responsibility is? Hint: it is not something that is accomplished through government collectivization!

I am open to changing my mind about this just as soon as we dissolve all government everywhere and see what happens. If after a reasonable test period the libertarian ideal is magically reached and nobody forces me to pay taxes for the myriad of other government programs I'll never need or want, I'll be happy to stop asking for any sort of collective healthcare. Until then, I'll just go along with every other developed country in the world and suggest that some sort of universal care is no more difficult than the 40 hour work week once appeared to be.

How about if, instead of "dissolving all government everywhere", we simply restrict government to the provision of goods that are truly public goods - goods that cannot, by definition, be provided individually? Defense, police, courts, perhaps roads, environmental regulation protecting the shared environment. This collectivist idea that unless the government provides health care that people will be dying in the streets is simply wrong, and you only have to look back less than a century to see it. I found an old bill in my grandfather's records for a surgery and 12-day stay in the hospital that he had in 1944. The inflation-adjusted total cost was $1050 in 2012 dollars. That was before all the regulations like the one requiring hospitals to provide care to everyone without regard to their ability to pay, which drove the cost of an aspirin up to $600 for those of us who do pay. In my grandfather's time, there were charitable hospitals that provided care for the indigent.

The free market works, my friend. You don't need to fear it so much. Doctors and hospitals and pharmaceutical companies and medical device companies will compete to improve service and lower cost if you get the regulations and mandates out of the way and restore a real free market. It was the socialist mandates that made the market unworkable in the first place. Advocating more socialism to fix it is exactly like saying we need more Keynesianism to fix the problems caused by the previous Keynesianism.