Elfin Magic

"authors less talented than him..." Tsk, tsk.

Personally, I think it makes a lot more sense than, say, devoting the largest share of our national resources to the project of annihilating entire nations, killing more than a million mostly unarmed civilians, and sacrificing American sons and daughters, for the profits of of a relatively small group of powerful men. It also makes more sense to me than justifying such a rampage of profiteering slaughter - and the well-documented widespread torture of men, women AND children - on the alleged criminal actions of a few dozen men. Now, I could be wrong in assuming that in our country it might be a good idea for all insured parties to collectively carry the weight of those with chronic illnesses and in assuming that this makes more sense than bankrupting our nation in order to commit genocide for profit, but it could be that I'm mistaken.

Further on in the article St. Krugman says: "And it establishes the principle — even if it falls somewhat short in practice — that all Americans are entitled to essential health care."

What I don't understand is why does he restrict this entitlement to just Americans? Why not the whole world? Why dont the democrats just declare that everyone anywhere in the world is entitled to free healthcare at the cost of American taxpayers?

And why stop at heathcare? Why not food, water, clothing, entertainment, happiness?

An important thing to remember about Krugman is that much - if not most - of what he writes about does not fall within the realm of economics. On these issues his utterances are due no more respect than those of your local hobo. Maybe less.

Damn fine point. But that would be too obvious. No, the 'Progressives' have to get what they can politically at the moment. The rest will come later -- like when we give ourselves a new name with the word 'union' in it and go around and swallow up neighboring countries in order to sustain our entitlement programs. By that time, no one will notice that we had become exactly what Reagan sought to dismantle through strategy and even old Reaganites will be on board because 'the cause' will have a red, white, and blue appeal to it.

"Predisposition" is a troublesome word. Everyone, for example, has a "predisposition" to having their femur snapped by a vice, given sufficient pressure, and given that they have a femur. If an event occurs, we know that a "predispositon" for that event existed at the time of occurence. Events do not occur in the absense of "predispositions." Everyone that has ANY medical condition had a "predisposition" for that event, or it would not exist. To my knowledge, I do not have a "predisposition" to injure my wing.

It may sound a little Carlin-esque to ask what the difference between a "predisposition" and a "disposition" is, but what the hell? Sincere question here. Thanks.

Insurance companies right to weed out poor risks such as those who carry HIV, or have rare genetic diseases is a form of eugenics. This is because such people will likely die prematurely if they are unable to pay for expensive drugs and medical treatment. They will be less likely to pass on their "bad" genes if they die earlier on before they can reproduce. It will make a new hearty breed of American. Sick people are a burden on the rest of society. The insurance companies are just looking out for number one and in the process are making life better for the non-sick among us. I hate it when sick people cough without covering their mouths. Bad manners and bad hygenics lead can lead to epidemics of swine flu. I hope for god's sake that people with a nasty disease like that are quaranteened before they can spead their horrible germs to the rest of us. I'll gladly pay to put them on an island away from the general population.

Krugman cites Dickens to pull at the heart strings of idiots, like himself, who do not understand that without free markets, Uncle Scrooge would never have at the wherewithall to save Tiny Tim.

With reduced opportunity to profit from medical innovations, fewer innovations will be forthcoming. This will be the death of many a "Tiny Tim".

Krugman and Dickens are a pair: Both are blind to the beneficence that emeges as an unintended consequence of the pursuit of self-interest. Dickens' ignorance might be excused, but Krugman's, as a Nobel winner in Economics, cannot.

Jim,

You might like this, if you haven't read it already:

http://mises.org/daily/3952

Thank you; I thoroughly enjoyed it!

We have all heard politicians say that the rising cost of health care is unsustainable. Unlike the politicians I always thought that that was a good thing. If it is unsustainable then that means that prices cannot continue to go up in the future at the rate they have in the past.

If price increases are unsustainable then people like Dr Muirgeo and others in the health industry will have to adjust their prices to what people can actually afford. Widespread coverage with health insurance has already allowed providers of health care to push their rates to astronomic heights. (Didn't someone on this blog mention $80,000 for a 3 day hospital stay for appendicitis?)

Now even with the cost-spreading provided by health insurance, the costs are becoming out of reach leading to stripped down policies and more and more people unable to even afford insurance. Attempts by insurance companies to control costs are being demonized when they are merely responding to consumer demand for lower cost health care when they have little power to control the prices charged by providers.

So now the government is going to fix the health care cost problem. Not by expanding the supply of doctors and nurses. Not by reducing regulations that increase the costs of drugs. Not by allowing drugs to be imported at lower cost.

They are going to fix the cost of health care by increasing the supply of money going in. Those who think health insurance is too expensive and choose to opt out will not have that freedom. It doesn't matter if they are young and healthy--we must have their money too. Those who want a policy that excludes those with pre-existing conditions will not have that option. Those such as myself who have a high deductible HSA plan, sorry, that just makes too much sense.

Problem fixed. Rising health care costs ARE sustainable. At least until the next election.

I have not decided if Muirgeo is a bootlegger or a Baptist--probably both.

The thing I find amusing - in a tragic sort of way - is the use of "community ratings" so that the young and healthy who don't find health insurance a good value today will be forced to purchase it at a much higher price than is currently charged or is actuarily fair. Truly this is nothing more than a huge tax levied on the young and healthy. I guess that'll teach 'em for voting for Obama.

Who's pro-death panel now?

I am.

Me's Kants Wate 2 rite fer the Nu Yok Tymes! Edukashun is funkdamental!

Felicidades, Dom.

Yo he dejado de leer al señor K porque me da asco...

"The purpose of a country is to spread risk."

So... no one wanted to touch that one, huh?

This is one legitimate reason why people form governments; to spread and share some costs.

Isn't that one problem of having government - some are passing their costs onto other people?

Within reason, I think this is what a healthy society does.

I think this is OK as long as those costs are beyond people's control.

It's also a fact of life.

I have paid tons of money for home owners insurance despite never having filed a claim.

In general, I think risk pooling is an acceptable way of functioning and is part of the social contract. The problem with genetic testing is that it breaks this contract in a way that is totally logical but perhaps goes too far.

"The problem with genetic testing is that it breaks this contract..."

It would be much more cost beneficial to ban all genetic testing out-right?
Then you don't have to worry about preexisting genetic conditions at all.

You could ban it in the context of making coverage decisions but not treatment decisions.

The problem with genetic testing is that it's going to lead to people being cast out of the normal system. They will then accumulate in the government system.

No you have to ban it all outright. No cherry picking when you get to use it or not.
My point is that everything has a hidden cost. If you ban it then you lose all the advantages of it. Yet if you keep it then you have to take the disadvantages of it as well. You can't just close your eyes like they don't exist.
So what would you have. Ban it and then live with all the ramifications (misdiagnosis, and mistreatment) or keep it and live with the ramifications (the ones that have a higher cost of care will have to pay a higher proportion of coverage)?

Were you threatened with large fines or prison if you didn't obtain home owners' insurance? Why do you want to fine me and/or jail me if I don't want to pay your medical bills?

It's one thing to ask for charity, or to build up a medical co-op or prepaid plan, where you and everyone else willing pay to cover likely events. It's a totally different thing to force others to do your bidding.

I don't rob you to pay for my medical bills. Please don't rob me to pay yours.

Within reason, this is the cost of living in a society.

I see you also do not understand the distinction between government and society.

And you're confusing libertarianism with anarchism.

Not at all.
Libertarianism involves limited government, anarchism an absence of government.

You are confusing government with society. It shows when you talk of the social contract. The social contract is a tool to confuse the distinction between government and society. It only exists so that those who believe in it will not object when government steps out of bounds, because they believe it is for their own good.

It's a cost you are imposing on me, with no reason other than you have a sob story and do a lot of arm waving. If you want charity, ask for it. I might even donate.

Don't just take things that don't belong to you. It's not civilized.

Good point. The modern assumption is that any service provided by charity isn't provided at all, and hence government must step in.

It was such a dumb statement on its face I didn't think it worth refuting.

muirgeo does not understand the distinction between society and government.

Too silly to worry with.

The purpose of a country is to spread risk. Likewise for insurance. In this country from here on out if you want to sell health insurance or newspapers for that matter you can not discriminate. As long as the rules are the same for all competing companies there should be no problem.

Of course we could go with the free market option that allows insurance companies to decline coverage or terminate coverage of teenagers with leukemia thus allowing the disease to take it's natural course. But we are a civilized country and because we don't let our citizens die in such ways it makes complete sense to remove or not allow adverse selection to exist in the system. We're no longer barbarians... we've moved past that.

Such rules are not good for the profit driven insurance companies bottom line but this country exist for its people and not for its corporations. That is the battle that rages... people versus corporations.... People are beautiful, amazing,complex and good while corporations are soul-less, faceless, cancerous and dangerous... we will win!

"The purpose of a country is to spread risk."

I do not know what country you're referencing but I can assure you that this country, as defined by our founding fathers, does not exist to spread risk.

Sure it does, "We the People of the United States, .... establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare...."

And the fact that your whiney ass does nothing but complain while taking advantage of your assurance of your justice, of your tranquiity and of your safety is a statement that you think on level with a teenager who's not had to go forth and produce and defend for himself. And likewise you are too much of a hypocrite and a leech to uproot and go to another country where society is ordered and things are done as you would wish. People like you must have been raised without rules and never taught any lessons on sharing. Where you an only child by chance?

In successive posts on this thread you asserted:

In this country from here on out if you want to sell health insurance or newspapers for that matter you can not discriminate.

and then this:

Early on, as with many things you use the system little and pay into it little. As you age you use it more and pay into it more.

Ruffly...if I had my choice this would be paid for by a 1.0% tax on incomes above $50,000 and going to 5% for incomes above say $5,000,000.

I notice you show up to comment here, but aren't interested in defending your hypocrisy about discrimination, as pointed out by LCJ.

He wont defend it, either. He'll pretend that he didn't write it or that somehow it is not hypcritical. He probably snapped his fingers -- Chandler Bing style [(NBC show) Friends reference] -- and muttered that that didn't just happen. Does he also pretend to know what he's doing while treating his young patients?

Promote the general welfare? Read the Invisible Hand quote to understand what the word 'promote' means in context of the others [hint: it's used three times as a verb that shows how the welfare-of-all is enhanced through the indirect nature of people acting in their own self-interets]!

But go on and play stupid, SAFI, and pretend to ellipses away from a verb much more powerful and direct. That verb: 'SECURE'. As in:

....and secure the Blessings of Liberty to ourselves and our Posterity

You, Doctor, are no fan of liberty. So your credibility while quoting the U.S. Constitution is laughable.

Yasafi claims that only (leftist) politicians can determine how much liberty a man needs in order to be free.

I've read the Constitution hundreds of times, but can't find the clause or amendment that makes this assertion.

You're a smear merchant and wrong to boot. Our government, as it was envisioned by the founding fathers, was geared towards this principal: "That all men are by nature equally free and independent, and have certain inherent rights, of which, when they enter into a state of society, they cannot, by any compact, deprive or divest their posterity; namely, the enjoyment of life and liberty, with the means of acquiring and possessing property, and pursuing and obtaining happiness and safety."

Redistribution, by its very definition, alters the means of acquiring and possessing property.

"People like you must have been raised without rules and never taught any lessons on sharing. Where you an only child by chance?"

I pity you...

You didn't just quote from The Virginia Declaration of Rights did you??? Have you read that through??


That government is, or ought to be, instituted for the COMMON BENEFIT, protection, and security of the people, nation or community; of all the various modes and forms of government that is best, which is capable of producing the GREATEST DEGREE OF HAPPINESS AND SAFETY and is most effectually secured against the danger of maladministration; and that, whenever any government shall be found inadequate or contrary to these purposes, a MAJORITY of the community hath an INDUBITABLE, UNALIENABLE AND INDEFEASIBLE RIGHT to reform, alter or abolish it, in such manner as shall be judged MOST CONDUCTIVE TO THE PUBLIC WEAL.

Sure I did because it is derived from Locke's "no one ought to harm another in his life, health, liberty, or possessions."

I can't believe I'm saying this, but I agree.

And yet Medicare rejects a higher percentage of claims than the major health insurance companies, or had you forgotten that?

And the choice here isn't between people and corporations. It's between corporations and government. Since all of the greatest crimes in modern history were carried out by governments, I'm not sure why there is even argument.

And the choice here isn't between people and corporations.

Actually, the choice is between a monopoly corporation (government) or competing corporations.

If corporations were eliminated, then the same people who are running them now would be running the government agencies that replace them.

In this country from here on out if you want to sell health insurance or newspapers for that matter you can not discriminate.

Of course you can. Just because some body passes a law that states you cannot do X means very little. I mean, if your reasoning made any sense than people would have stopped drinking during Prohibition. There is no way this system will work without all sorts of "outs" and means by which to bypass the system, which makes the system of a lie and illustrates just how many people it harms. An analogy can be made to wage and insurance laws associated with employment; in order for them to "work" so much employment has to under the table that it is well above a non-trivial amount. When black markets arise - as they have in employment - there is a significant problem with government policy; we already have a black market in health care in the U.S. and it will become more prominent as a result of this new legal regime.

But we are a civilized country and because we don't let our citizens die in such ways it makes complete sense to remove or not allow adverse selection to exist in the system.

Every country with "universal health care" let's their citizens die in myriad of ways, some of who of course have leukemia. They let them die because those who die have not met some cost-benefit analysis which the state has set up or because they are over some universal yearly cap on medical spending. Under a free market system one can bypass such problems via charity; charity is attacked as 'waste' under universal health care systems.

People are beautiful, amazing,complex and good while corporations are soul-less, faceless, cancerous and dangerous... we will win!

Corporations are made up of people; so if corporation are all of those things, then the people in them are soul-less, faceless, cancerous and dangerous according to you.

Or to put it another way "free market health has death panels too but they're honest ones".

"Or to put it another way 'free market health has death panels too but they're honest ones.'"

Yes -- but what's your point?

Libertarians like to scare people with 'death panels' talk as if they wouldn't exist in a free market.

They wouldn't. In a true single payer system the government bans access to the health care system to simple fee-for-service patients. In Canada, if the government tells you that you cannot have a recommended procedure your only choice is to flee the country, usually to the U.S., where you can always pay cash and get the procedure.

| People are beautiful, amazing,complex and good while corporations are soul-less, faceless, cancerous and dangerous...

Oh, the irony. Corporations, as we know, are not controlled by humans. They must be controlled by demons, or aliens, or something. Who are Evil.

Btw, is the clinic you own a partnership, or a corporation?


| terminate coverage of teenagers with leukemia

Avoid that problem: find an insurance company that offers a contract that doesn't say it can be modified or terminated unilaterally. If you can't find one, start your own! You're an expert in the medical field, so it should be a cinch, right? Wouldn't that be the civilized thing to do instead of either letting that poor teenager suffer, or instead of robbing your neighbor?

"If you can't find one, start your own!"

So if it's that simple why does no such plan exist?

>So if it's that simple why does no such plan exist?

Whole Foods

So if it's that simple why does no such plan exist?

It actually might exist; did you check? And if it doesn't there's three possible explanations that I can think of off the top of my head. 1) the state governments don't allow for it 2) consumers are not willing to pay the premium required for someone to offer it 3) [much like two] no one is willing to supply that type of insurance because the risk of losing money [or not clearing sufficient economic profits] is too great.

But, if you knew anything about how commerce works, you'd have been able to answer that question yourself. In fact, if you knew how commerce works and appreciated it, you would be the troll on this blog that you are.

In a number of states that sort of insurance is very difficult to craft because of the regulatory and legal regimes that insurers have to live under.

I am shocked, shocked to hear that government might be the problem.

So if the cost of risk is socialized, then people don't have to bear the full consequences of risky behavior. Isn't that how it works?

Things like Polycystic Kidney Disease are not behavioral.

They are purely genetic.

Things like Polycystic Kidney Disease are not behavioral.

They are purely genetic.

Nonetheless, medical treatment is not withheld from people due to behavioral origins. Risk is risk.

The question is whether we as a society want to force people to bear the full weight of risks that they have no control over.

Of course, you can take this too far.

However, I'm concerned with swings to the other extreme.

You've chosen to reproduce knowing you have the disease. Reproduction is a choice. Why should everyone else have to pay for the reproductive choices of your family?

Of course, you can take this too far.

You can count on it going too far, eventually.

Of course, in the long run, we are all dead, but someone will have to live under an agency that has gone too far before it collapses.

The problem is the giving of absolute power to any agency.
It is much more difficult to take it back than to give it away.

Hey, I have my own, rare genetic disorder that requires regular medical intervention.

Fortunately, my family is with Kaiser via my wife's job.

I want you to answer just one question about this. Do not duck it, please, as I will make a rare attempt at civility with you [and not bring up all my disagreements with your reply here]:

If the risk should be spread across the whole country, should every one individual person being covered, pay the same amount in premium regrdless of their income?

Yes and no. Early on, as with many things you use the system little and pay into it little. As you age you use it more and pay into it more.

Ruffly...if I had my choice this would be paid for by a 1.0% tax on incomes above $50,000 and going to 5% for incomes above say $5,000,000.

Something like that and it would probably be more then we need. I'd also be OK with some user related fees.

I promised civility but wont promise it beyond THIS post. I do appreciate your candid answer. However, your candid answer reveals discrimination on two fronts; age and capacity to earn an income. Therefore, it appears that you have your own values in which you choose to discrimate on.

I happen to disagree with this. There are many people out there, including members of my wife's family, with genetic predispositions to develop certain diseases like Polycystic Kidney Disease. Not everyone who has these diseases can afford to pay higher premiums. By forcing insurers to be risk-blind about genetic conditions, you are ensuring that these cases will be spread around and not concentrated in government-run plans.

Think of it this way. If Government had done what you want them to do, 30 years ago, you wouldn't have to worry about genetic diseases because no one would have developed the techniques to find them.

PCR is the workhorse for all DNA testing and that was technique was refined by a private company. (Kary Mullis working for Cetus Corporation)
Godfrey Hounsfield one of the inventors of modern CT scanning tech, did his work working for EMI Central Research Laboratories, a private company that used profits from the Beatles music sales to subsidize research.

Ironically the best treatment for PKD is kidney translplant. Thanks to government intervention, kidneys are more valuable than Dark Matter. If Government would let a market develop for organs, we would see a 1000 fold increase in transplants and saved lives.

Forcing insurers to be risk-blind will ensure higher premiums for everyone, or will ensure that insurance companies stop offering policies that are cover by risk-blind rules, OR, force insurance companies out of the insurance business thus ensuring that everyone ends up in government run plans.

Apparently it is okay to make other pay for your benefits.

Well, the problem is that the political state, though various rhetorical constructions, makes conscription a sanctioned alternative to persuasion and charity.

Thus slavery, enacted via the democratic process and enforced by the political state, becomes a "proper" means to various ends.

"The State is the great fiction by which everyone tries to live at the expense of everyone else" - Bastiat.

It'll never happen. Everyone always pays for his own benefits even if it's in ways that are not easily counted.

That's because costs are not always monetary. Everyone pays in one way or another...I completely agree. We just all get to pay with substandard care, queues and lack of innovation. But look on the bright side, don't you feel better now?!?!

Given that we are still generally in an era of little to no genetic testing, things won't change from the status quo.

Yes, but coverage can be withheld if it is determined that you were aware of, but did not tell of a preexisting condition when applying for insurance.

But where do you draw the line with that type of reasoning? Everyone has a genetic predisposition that puts them at some sort of disadvantage to someone else. Should the government take a hand in forcing us to treat all of our fellow citizens as if those predispositions don't exist? Should NBA players be of average height? Should physics professors have average IQ's? Should models have average looks and singers have average voices?

You're completely missing the point.

Of course, people are different.

I'm talking about health problems that people have no control over but that are extremely expensive to manage, not basic things like height or eye color.

It doesn't cost you $1 million to manage the consequences of your height over your lifetime, as it cost my father in law (or more properly his insurance company) to manage his polycystic kidney disease and as it will cost my sister in law.

There was also nothing he could do in terms of lifestyle changes.

The issue is that insurance companies will try to use that against people, and my concern is that that can be taken too far.

Worst case, all of the high-risk patients will be pushed into the government pool.

You are talking about the dole, not insurance. At least not insurance for the living. Insurance is risk spreading of uncertain events. Your case is apparently not uncertain. There is nothing to insure. One insures against hurricanes, lightning strikes, breaking a leg, getting cancer, or running into a pole on accident. This is an expensive condition that happened at conception, purportedly.

If we are going to to go a genetic-insurance regime then at least let's be honest about it. I'm not so sure it is a good idea given the perverse incentives it creates. Everyone is sympathetic to the specific case.

I suppose that, given the size of government, we could design a program to insure people from uncontrollable genetic diseases. In theory, there are useful individuals who's lives are worth more than the treatment costs and they are not identifiable ahead of time. That said, there are obvious problems in defining and executing a solution. Where is the line drawn? Who decides? Do you have to turn over all of your wealth to the state to avail yourself of a $1,000,000 subsidy? Further, this reasoning can be applied to all conditions; i.e., stupidity, sloth, socio-economic status, etc.

Why should anyone bear the costs of their own genetics and family's economic status? After all, one has no control over any of that. Does it not follow that people should only get to keep enough of their resources to give them incentive to work hard and the rest belongs to society? Talent is not earned; it's luck. That is a variant of Marx. That is where this leads.

OF course, as a government managed economy increases the scarcity of resources, we can, collectively, forbid people with resource exhausting genetic conditions from reproducing.

Garbage.

This is a standard slippery slope argument (which is a logical fallacy).

Stupidity is not remediable and sloth is, which makes them totally different cases.

All universal health care systems find ways to deny people coverage - or rather, treatment. So they are "covered," however, as a result of a "universal budget," or because the treatment doesn't pass some cost-effectiveness measure, etc. they cannot get the treatment they desire. It is all a shell game that in part exists to make self-righteous politicians look good for their re-election purposes.