I asked "in the context of population biology and fair (read: open) immigration policy" and you answered in the context of neither. I should stop here, but I'm too much of a rockstar pre-med to stop running my pretentious mouth.
I'm not clever enough to know if that rockstar pre-med, pretentious mouth comment is directed at me or not. If it is, let's just keep it civil, no personal attacks.
You based most of your points on the premise that since we don't have open immigration, it's okay to ignore it as a direction to go in with other aspects of policy. Maybe we should start by asking if people should be able to move wherever they please or if it's acceptable to fence off entire sections of the planet and say "Sorry folks, all full here." If you agree the first is the only reasonable answer, then how can you support major legislation that would make the borders impossible to open? That fully runs on its ability to keep the majority of the population rich and healthy and not poor and sick? If you have a political ideology, you don't take each bill and accept it if it fits with the current system, you take steps in every place you can to fulfill your ideology. If your worldview supports open borders, the other things you support must fit consistently. If we don't agree on this point, there is no reason to go further with the conversation about appropriate healthcare policy.
Furthermore, the bill mandates that insurance companies use 80% of consumer premiums on paying for actual services (as opposed to administrative costs and profits). This is one step closer to a mirror of Swiss healthcare. In Switzerland, healthcare is mandated for all, but provided by approved private insurers who are heavily regulated, and cannot profit of the basic plan (but can profit off of more luxurious insurance policies)
You're creating a false polarization of immigration policy between an open border system, and saying "No" to everyone, when in actuality most countries allow immigration to some extent, but not free flow, so it's a middle-ground. We don't say "Sorry, we're full," but we do limit immigration. This is the system (reality) upon which I base my support for socialized medicine.
I understand that you have a bigger picture for world order, and that socialized medicine may be incompatible with that ideal, but I want to focus on policies which can help real people today, with more practical goals of what society will become (meaning I doubt we'll have open borders anytime soon).
I see no need to refrain from implementing socialized medicine while our borders are still semi-closed. If your ideal is ever realized, then perhaps we can reconsider.
Most other countries that have socialized medicine have closed borders and/or good geographic isolation from impoverished nations (think UK and Canada), so any comparison here makes little sense. Also, those systems are just as unsustainable as ours would be. It's not about "functional for now," my post was about sustainability.
I was comparing sustainability in a semi-closed border society. How are those system unsustainable? They have been running for over half a century, do you have reason to believe they will fail anytime soon?
The difference, of course, between insurance "socialism" and socialized medicine is that people opt into it when they can afford it. In socialized medicine, everyone is by definition forced to be included in the pool. When your pool has more poor, sick people than healthy, rich people, the system fails.
That's a valid point that insurance is optional (although that's no longer the case in the US), however people are not completely denied emergency care when they don't have insurance. This creates a system where people volunteer to pay, and some don't. Then the ones that don't end up getting very sick and can't/don't pay their bills so the volunteers end up paying for them as well. Is this fair? No! Why not require everyone to pay their fair share? The other alternative is to deny care to people who can't afford it, which most people will have trouble doing (think empathy).
When we open our borders with socialized medicine, the poor, sick people will come flooding in. At first we will take care of them because our system is rich. We give them food, unemployment checks, and pay their medical bills. Everyone feels good. This is where population biology happens (something you never even mentioned in your response). Because these poor, sick people are now well fed and healthy people, they start having babies. Lots of babies. More babies than we could pay for with what we had to give. I know, let's just take 10% more from the rich in taxes. This is compassionate, and seems sensible at the time. The cycle continues until the pool is more poor, sick people than healthy, rich people because resources are spread so thin.
This would still happen even with closed borders, just more slowly. The whole world has population problems and we are growing exponentially. Population growth does not stop until people begin to die as fast as they are born. Instead of accepting our fate that our populations will grow until we have an equal birth/death ratio and allowing poverty to exist now, socialization and welfare policies will support a much larger population until the planet itself is sucked dry of resources in a tiny fraction of the time. This is a depressing reminder that we are just animals and are not, as we today seem to assume, excluded from the rules.
First, do you propose that we use healthcare restriction as a form of population control? I find that to be unethical, as it favors the death of the poor, perhaps before they have had a chance to work or climb in society.
Secondly, you make a lot of claims that just aren't backed by real world observations. You claim that welfare states are unsustainable because they allow the poor to breed uncontrollably, and then we will run out of resources. However, examination of European socialized states shows that they have very stable growth rates and some are even shrinking. This is because elevating people out of poverty causes them to reproduce LESS. It is well known that the impoverished have more children, creating some sort of economic stability means that LESS children are born. This is evidenced by the current population biology of European welfare states. Where is the evidence for your assertions, aside from thought experiments?
Healthcare isn't a right. They shouldn't have let their insurance lapse, that's what COBRA is for. If you wan't good healthcare you have to pony up. The healthcare bill doesn't cut costs other than by cutting physicians reimbursements. Until people are willing to accept a lower standard they'll continue to pay out the nose.
Can anyone comment on this? MetalgearHMN?
Yes the healthcare bill did cut physician reimbursements from medicare. However the cut is meant to be temporary, and I believe the cut ends on November 30, 2010. Also, the bill cuts costs through other avenues as well. We are all aware of the phenomenon of uninsured people waiting to see a physician until their condition has gotten out of hand. Waiting until drastic measures are needed means we utilize more expensive measures (ER over Family Doc). By mandating that everyone have insurance, costs will be reduced because the previously uninsured will receive preventative and primary treatment, instead of expensive treatment in the ER and ICU after their conditions have advanced. There is expected to be an initial jump in healthcare costs, due to the onboarding of millions of previously uninsured, eventually the savings will offset this. This is one of the many reasons that the Congressional Budget Office (an independent and non-partisan body) stated that the bill help save money.
