Socialized medicine controls of treatments offered

[DrMom]

Under socialized medical systems, there are parameters under which patients may and may not get various medical treatments. I thought this was an interesting new twist. (To be perfectly honest, "rules" like this already exist under some US systems, too. Still interesting topic)

http://www.timesonline.co.uk/article/0,,2-1917453,00.html

Hospitals may ban treatment for smokers and drinkers
By Nigel Hawkes, Health Editor

SMOKERS, drinkers and the seriously overweight may be denied medical treatment if their lifestyle makes it ineffective, the Government’s treatment watchdog said yesterday.
The National Institute for Health and Clinical Excellence (NICE) said that doctors who considered that a particular treatment might not be effective, or cost-effective, because of the lifestyle of the patient, may be entitled to withhold it.

However, doctors should not discriminate on the ground that a disease was self-inflicted. Even those who had brought their problems on themselves deserved treatment.

It makes clear, to the delight of campaigners, that discrimination on the ground of age alone is equally unacceptable. However, when a patient’s age affects the chances that a treatment will work, it can be taken into account.

The new guidance seems certain to be cited in cases such as the recent ruling by three primary care trusts in East Suffolk that obese patients could not have hip or knee transplants. The trusts were widely criticised, but could now use the NICE guidance in their defence — arguing that operations are less safe for the obese, and that for such patients hip and knee implants are less effective as they wear out sooner.

The guidance could also be cited when heavy drinkers seek liver transplants, or when smokers need heart bypass operations. In each case, the intervention would be rendered less effective by the habit.

The NICE guidance, which is still in draft form, was developed by its citizens council, a group of people who offer advice on a wide range of social issues. But it was finalised by the NICE board.

Vivienne Nathanson, the head of science and ethics at the British Medical Association, said that the guidance reinforced what had always been good medical practice. “I am delighted that NICE has not proposed a blanket ban on some treatments for some groups of people,” Dr Nathanson said. “That would have been wholly unacceptable.

“It would also be wrong if this guidance were to be used to ration healthcare.

“The judgment should always be, ‘Does this person need treatment?’ and ‘Will this treatment be of benefit?’ Every case should be considerd on an individual basis.”

The NICE report said that it could be difficult to determine whether someone’s illness was self-inflicted or not. There was no way of knowing, for example, whether smokers who had a heart attack would have suffered one had they not smoked.

As a result, it said, NICE should avoid discriminating against patients with conditions that are, or may be, self- inflicted.

But it added: “A patient’s individual circumstances may only be taken into account when there will be an impact on the clinical and cost-effectiveness of the treatment.”

The report, Social Value Judgments: Principles for the Development of NICE Guidance — considered whether social background, age or lifestyle choices should ever influence the care provided by the NHS.

It concluded that clinical guidance should recommend a treatment for a particular age group only where there was clear evidence of a difference in the treatment’s effectiveness for that age group.

NICE has previously made judgments of this sort, for example recommending that drug treatment for flu should be available for the over-65s as they are a vulnerable group and likely to be more seriously affected by flu than younger people, or that IVF treatment should be avail-able to women aged 23-39 because it was most likely to be effective in that group.
Professor Sir Michael Rawlins, the NICE chairman, said: “On age we are very clear — our advisory groups should not make recommendations that depend on people’s ages when they are considering a particular treatment, unless there is clear evidence of a difference in its effectiveness for particular age groups. Even then, age should only be mentioned when it provides the only practical marker of risk or benefit. NICE values people, equally, at all ages.”

In the NICE programme of work there are a number of guidelines and technology appraisals in progress that may be influenced by the report. They include appraisals of statins; of pharmaceuticals for treating drug addiction; of coronary artery stents; and of treatments for lung cancer, and of falls, a problem found mostly but not exclusively in the elderly.

Among guideliness that may be influenced are those in preparation on drug misuse, high blood presssure, obesity and osteoarthritis.

Steve Webb, the Liberal Democrat health spokesman, said: “There is no excuse for cash-strapped hospitals denying treatment to people whose lifestyle they disapprove of.

“Treatment decisions involving people’s lifestyle should be based on clinical reasons, not grounds of cost. The NHS is there to keep people healthy, not to sit in judgment.”

Jonathan Ellis, policy manager of Help the Aged, said: “This is a real U-turn for NICE, which previously, and rather carelessly, suggested that age, rather than individual need, should be used to determine a person’s treatment.

“We’re pleased to see NICE has finally shown an understanding of the importance of tackling age discrimination within health care.

“Barring the use of age as a criterion for developing guidelines on NHS treatment and care will now make it more difficult to make false assumptions about someone’s age to influence clinical decisions.

“It will ensure a fairer deal all round for older people using the NHS.”

A lifelong drinker destroys his liver and seeks a transplant, with no plans to give up drink. A surgeon could refuse to carry out the operation on the ground that liver transplants are of limited effectiveness in alcoholics. Most surgeons already do.

HOW GUIDANCE COULD APPLY

A heavy smoker develops heart disease, and seeks treatment. A surgeon might refuse a heart bypass, because smoking increases the risk of the operation, cutting the cost-effectiveness of the treatment. He might offer to do it if the smoker gave up, because promptly quitting reduces operation risks.

An obese patient is suffering osteoarthritis. Painkillers are appropriate, but an operation to replace hips or knees may not be. However, a surgeon may alternatively argue that the pain makes it hard to exercise and without exercise it is difficult to lose weight. An operation might therefore be justified both to treat the arthritis and the obesity.

The evidence may be the tricky factor. Few trials have ever sought to include smokers, drinkers or the obese; thus, demonstrating that a particular treatment works less well for them will not always be possible.

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[bananaface]

Is that any different than what goes on here aside from the fact that prescribers in socialized systems might take the time to consider cost effectiveness a bit more scrupulously when it comes to prescribing options?

 

[Lindyhopper]

Resources are always limited. There has to be some system of allocating or "rationing" limited rescources.
For any workable system of universal care to be acceptable to Americans it would have to include the option of spending one's own money to buy services that aren't covered. (Or purchasing additional insurance.)

 

[Megalofyia]

Resources are always limited. There has to be some system of allocating or "rationing" limited rescources.
For any workable system of universal care to be acceptable to Americans it would have to include the option of spending one's own money to buy services that aren't covered. (Or purchasing additional insurance.)

That is an option in Europe already.

 

[efex101]

Yup and most folks that can afford it get private insurance.

 

[Shredder]

Resources are always limited. There has to be some system of allocating or "rationing" limited rescources.

 

[QuikClot]

So you can have a system in which medical treatments are witheld when they aren't going to help, or one in which they are witheld because of a bad credit report. That's a stumper.

 

[chef_NU]

Right. So how do we avoid all these dilemmas about jurisdiction? After all, who are you to tell me whether or not I deserve medical treatment?

This is the problem with policies based upon "to each according to his own need".

They don't work.

If you want government involved, fine. Have them pay catastrophic insurance premiums. But we need high deductibles to dissuade patients from unnecessary/cost ineffective treatments.

 

[chef_NU]

Also, for all those who think that we shouldn't allow foreign medical students to compete in the US market: I have news for you. You are one of the spoiled brats who think that their special interests deserve special legislation. If you can't capitalize on the amazing institutions and wealth that America has to offer, but someone from a situation of economic hardship can, you are tough out of luck sir.

 

[Shredder]

Also, for all those who think that we shouldn't allow foreign medical students to compete in the US market: I have news for you. You are one of the spoiled brats who think that their special interests deserve special legislation. If you can't capitalize on the amazing institutions and wealth that America has to offer, but someone from a situation of economic hardship can, you are tough out of luck sir.

 

[QuikClot]

Right. So how do we avoid all these dilemmas about jurisdiction?

What do you mean?

After all, who are you to tell me whether or not I deserve medical treatment?

If you read what was posted, it says they are witholding treatments that are unlikely to help, not witholding treatments because people don't "deserve" them. Whether a therapy is going to help the patient is a medical decision, no different than deciding which of many medical therapies to use. Who am I to decide you need cardioversion? I'm the healthcare professional.

This is the problem with policies based upon "to each according to his own need".

They don't work.

That's your ideological position. It isn't reality. Single-payer systems provide better care to more people for less money. And even in our capitalist's paradise, there are many services -- fire protection, K-12 education, immunizations, roads -- which are universally available. The question is not whether there should be "socialist" elements to our economy, nor whether they work -- they do. It's whether healthcare should be among the things that society provides to all its members regardless of their ability to pay.

If you want government involved, fine.

Again, this isn't reality. The government is already involved. Medicare and Medicaid cost hundreds of billions a year. The uninsured end up in the EMS system and ultimately in the emergency room, which we all pay for. So the question is not whether the government should be involved, but how.

America's government spends about $5,500 per person, per year, on healthcare. It's a lot of money; roughly as much as Germany and Britian spend, per person, to provide care to their entire populations.

 

[chef_NU]

If you read what was posted, it says they are witholding treatments that are unlikely to help, not witholding treatments because people don't "deserve" them. Whether a therapy is going to help the patient is a medical decision, no different than deciding which of many medical therapies to use. Who am I to decide you need cardioversion? I'm the healthcare professional.

Yes, but dessert is the idea isn't it? After all, they aren't talking about withholding treatments from people with some underlying genetic or environmental disorder that would render some standard treatment ineffective. While the policy is probably worded nicely, I think it echoes the discouragement of health care providers.

That's your ideological position. It isn't reality. Single-payer systems provide better care to more people for less money. And even in our capitalist's paradise, there are many services -- fire protection, K-12 education, immunizations, roads -- which are universally available. The question is not whether there should be "socialist" elements to our economy, nor whether they work -- they do. It's whether healthcare should be among the things that society provides to all its members regardless of their ability to pay.

Well, to put it in your words, "that's your ideological position". You claim single payer systems provide better care to more people for less money. But lets check out all the cases where we have such a system: Canada, the UK, etc. Their health care systems are in shambles. The reason the US is still hobbling along is because it's trying to combine the "everyone demands the best" with the "government pays for it" mantras. That's our problem. If you could, why don't you cite some examples of where free markets have failed to provide quality, low-cost commodities.

Again, this isn't reality. The government is already involved. Medicare and Medicaid cost hundreds of billions a year. The uninsured end up in the EMS system and ultimately in the emergency room, which we all pay for. So the question is not whether the government should be involved, but how.

America's government spends about $5,500 per person, per year, on healthcare. It's a lot of money; roughly as much as Germany and Britian spend, per person, to provide care to their entire populations.[/]

I didn't claim the government wasn't involved. I just said that in a new system, it has the possibility to be integrated. I'm saying that the government shouldn't be paying for the medically indigent in the emergency room. America's government spends too much because they agree to pay the health care costs resulting from the unrestrained demand of the American people. Germany spends so little because it simply artificially restricts the access and quality of care.

 

[QuikClot]

Yes, but dessert is the idea isn't it? After all, they aren't talking about withholding treatments from people with some underlying genetic or environmental disorder that would render some standard treatment ineffective. While the policy is probably worded nicely, I think it echoes the discouragement of health care providers.

Certainally -- and that discouragement is well-founded. It is intensely frustrating to waste scarce resources on therapies which are futile. Our system recognises this is some respects -- we don't do liver transpants for people who insist on drinking, for example -- but in most cases we follow a "do everything a lawyer could ask you if you could have done" which is not a good system.

You claim single payer systems provide better care to more people for less money. But lets check out all the cases where we have such a system: Canada, the UK, etc. Their health care systems are in shambles.

Says who? Canada, Japan, Scandinavia, the UK, all a shambles? Sorry, no. How about some evidence?

The reason the US is still hobbling along is because it's trying to combine the "everyone demands the best" with the "government pays for it" mantras. That's our problem. If you could, why don't you cite some examples of where free markets have failed to provide quality, low-cost commodities.

I make it a rule never to involve myself with another man's religion. This thread is about the healthcare system we have, not your magic fantasy world where money died for us and rose on the third day.

You are claiming that "do each according to his need" does not work, and to support that, you claim that single-payer systems are a shambles (when they have survived and propered for decades and virtually conquered the world). If, indeed, it doesn't work, we would expect the most "according to need" economies to be the least competitive:

The World Economic Forum has been producing The Global Competitiveness Report for 26 years, and its unique mix of hard and soft data has made it possible to accurately capture the broad range of factors seen to be essential to a better understanding of the determinants of growth. Each year it has delivered a comprehensive overview of the main strengths and weaknesses in a large number of countries, making it possible to identify key areas for reform and policy formulation.

Highlights

* Finland is number one in the Growth Competitiveness Index (GCI) rankings and holds this position for the fourth time in the last five years. The country is very well managed at the macroeconomic level, but it also scores very high in those measures that assess the quality of its public institutions. Furthermore, the private sector shows a high proclivity for adopting new technologies and nurturing a culture of innovation. The United States, as last year, is ranked second: the country demonstrates overall technological supremacy, with a very powerful culture of innovation. However, technological prowess is partly offset by a weaker performance in other areas measured by the index. The US has a relatively low rank of 20 for the contracts and law indicator, with particular concerns on the part of the business community about the government's ability to maintain arm's-length relationships with the private sector, and in the formulation of policies more generally. But the country's greatest weakness concerns the health of its macroeconomic environment, where it ranks a low 47th overall. This echoes the increasingly vocal international concerns about the macroeconomic imbalances in the US economy, especially as regards the public finances.
* The Nordic countries continue to hold prominent positions in the rankings among the top 10 most competitive economies this year, with Finland (1), Sweden (3), Denmark (4), Iceland (7) and Norway (9) all in privileged places. The stellar performance of these countries demonstrates the great diversity within Europe, with some countries doing very well by any measure, while others struggle behind. The Nordics are also challenging the conventional wisdom that high taxes and large safety nets undermine competitiveness, suggesting that what is important is how well government revenues are spent, rather than the overall tax burden per se.

What does the world economic forum think is the major problem with the US economy? Public finances. And what is the single largest libabilty on the public book? Heathcare costs.

There is a better system. Ask the most competitive economies in the world --the Scadanavians.

I didn't claim the government wasn't involved.

You said:

If you want government involved, fine.

Which implies the government isn't involved now -- that I am proposing involving the government in something they have previously not been involved in.

I just said that in a new system, it has the possibility to be integrated. I'm saying that the government shouldn't be paying for the medically indigent in the emergency room.

So you're having a heart attack and you can't pay. What happens?

So a four-year-old spiked a fever and is seizing. Dad has bad credit. What happens next? No ER, remember.

Ultimately either you treat them at the ER (present system) or you treat them before they need the ER (better system) or you let them die in the street.

America's government spends too much because they agree to pay the health care costs resulting from the unrestrained demand of the American people. Germany spends so little because it simply artificially restricts the access and quality of care.

"The German system is a mix of private and public interests with government oversight. Non-profit sickness funds provide health coverage for the vast majority of Germans, with a minimum benefit package set by law. Patients are free to visit the doctor or hospital of their choosing. Rates for medical services are set by collective bargaining agreements involving sickness funds, healthcare providers, and the government. "

Where's the artificial restriction? Artificial stimulation, maybe, but I don't see artificial restrictions on anything but the price. I have a sneaking suspicion that you don't know anything about the German healthcare system, and are simply reading from the Book of Rand what you believe must be the case for a system to be cheaper than the capitialist paradise.

 

[Gut Shot]

CI have a sneaking suspicion that you don't know anything about the German healthcare system,

I've been wondering when someone might point out this glaringly obvious fact. Also, the "to each according to his needs" is half of a Karl Marx quote. I'd love for Chef_NU to go inform some Germans that their society is Marxist.

Watching Chef and Shredder discuss healthcare policy, especially considering their *vast* experience in the healthcare arena, is like watching 4th graders discuss sex; painful, and yet somehow strangely entertaining.

 

[chef_NU]

You're having a heart attack and you can't pay. Your 4-year-old is having a heart attack and siezing. You're damn right the government doesn't pay for it. If people or private organizations want to lend a helping hand, let them. We shouldn't be coercing people to be charity though.

I think your criticism of the United States economic state is well founded. It's certainly not a capitalist utopia (as you seem to categorize it). And it certainly doesn't keep the private sector at arms length. It promotes the special intersests of particular industries just as much as it promotes the special interests of the stupid, lazy, and unfortunate. Does that in itself completely discredit my ideas? That's up for you to decide I suppose.

As for Germany, yes, I would have no problem telling them that they are a Marxist society. Why should I have a problem with that? Of course, they are not the epitome of communism, but they are far towards the "strong government intervention" side of the spectrum.

 

[chef_NU]

I'd love to give you thousands of sources citing how socialized health care systems are breaking down (and as a result, how fee-for-service, illegal enterprises are making a comeback), I'll do so as time permits. Here's a small example.

Rationing : “Everything is Free but Nothing is Readily Available” (Frogue et al, 2001) Like other nations experiencing limitless demand, an ageing population and the costlyadvance of medical technology, Canada has faced pressure to control health expenditure. It has done so through explicit rationing. Set up in 1989, the Canadian Co-ordinating Office for Health Technology Assessment is the Canadian predecessor to our NICE, charged with exactly the same brief and, it seems, carrying out its function in the same way. For example, in the case of new cancer treatment, the latest pharmaceuticals (such as visudyne for macular degeneration), and high-tech diagnostic tests, Canadian governments simply reduce their expenses by limiting the service. Such a method of rationing is only possible in a single-payer monopoly. Medicare also shares other defining characteristics of monopolies: limited information, little transparency and poor accountability. Canada has faced increased pressure to reform hospital structures to accommodate the changing pattern of care from an institutional to a community-based model. Reforms have attempted to limit growth and manage the system more effectively. Provinces have proven their ability to manage cost control by the use of their monopsonistic power associated with the single payer structure (WHO, 1996). Hospitals are paid through the imposition annual global budgets by provincial governments. The downside of this cost controlling efficiency is evident by the problem of waiting lists and dilapidated technology and equipment.

For example, in its 2001 annual survey involving more than 2,500 doctors in twelve different specialties, the Canadian think tank, the Fraser Institute, found that, for patients requiring surgery, the total average waiting time from the initial visit to the family doctor through to surgery was sixteen weeks, a significant increase over the last year of the study. In everycategory, physicians felt waiting times had exceeded “clinically reasonable” delays (Gratzer, 2002, pg 20). Canadians wait an average of 5 months for a cranial MRI scan; Americans just 3 days (Bell, et al, 1998). Indeed, Canada has fewer MRIs per capita than Iceland, Hungary, South Korea, and the Czech Republic (Gratzer, 2002, pg 53). Unsurprisingly, many choose to fly south to the US for diagnosis and treatment.

I appreciate the comments such as "chef_nu is a 4-hear old talking about sex"... they really lend weight to your arguments.

 

[scalded]

You're having a heart attack and you can't pay. Your 4-year-old is having a heart attack and siezing. You're damn right the government doesn't pay for it. If people or private organizations want to lend a helping hand, let them. We shouldn't be coercing people to be charity though.

I think your criticism of the United States economic state is well founded. It's certainly not a capitalist utopia (as you seem to categorize it). And it certainly doesn't keep the private sector at arms length. It promotes the special intersests of particular industries just as much as it promotes the special interests of the stupid, lazy, and unfortunate. Does that in itself completely discredit my ideas? That's up for you to decide I suppose.

As for Germany, yes, I would have no problem telling them that they are a Marxist society. Why should I have a problem with that? Of course, they are not the epitome of communism, but they are far towards the "strong government intervention" side of the spectrum.

Boys what we have here is a Libertarian. This solitary creature is often found in rugged terrain such as Alaska, or their parent’s basement. A loner by nature, they are seldom found in groups, but their tenacity and inability to see the shortcomings of a purely capitalistic society makes even a single one dangerous to rational thinker's blood pressure.

While they are an important part of the ecosystem, (they keep the communist, their natural prey in check), an over abundance can result in a stratified class society with huge concentrations of wealth in the hands of a few (see the gilded age).

 

[QuikClot]

Chef, you may be comfortable with the idea that people will be left to die in the street, but I'm not, and most Americans are not, which is why that is not the system we presently have.

I am not sure why you think health care being rationed in other systems is an argument against them, considering what you are proposing is also a rationing of healthcare, one that instead of saying "sickest first" says "richest only." The fact of the matter is that virtually the entire industrialized world, except us, has some form of universal care, including the most competitive economies is the world. Your ideology says that it shouldn't work; nevertheless, it does. You can try dealing with that fact, or, alternatively, you can demonstrate that waiting for nonessential care is a terrible evil, and leaving children to die of preventable illness and treatable injury is preferable to waiting six months for a hip replacement.

Also, "fee for service," i.e., paying for your own care, is legal is these systems; in fact, in most cases they are truly free only to the poorest. If you want to do something on your own dime, there's no law against it in Canada or Germany or France of Belgium (for example.)

The "coerced charity" argument assumes an absolute moral right to one's property, which is a far dicer proposition than you realize. Without a long, deep philosophical discussion, I would just point out that in our society, the right to one's money is not an absolute.

Wealth exists only so far as a society exists to support it -- there is no wealth without a functioning social contract. "Your" money is partly "yours" and partly belongs to society as a whole. Hence, taxation is not a violation of your freedom; indeed, the enforcement of strict property rights is a violation of the freedom of those that don't have enough.

"Socialized medicine" as defined herein, is practiced throughout Europe, in Canada, New Zealand, Austrialia, and in most of the rest of the world. Our system is the exception, and our system is badly broken. When and if you work in healthcare, you will realize that triage of scarce resources is an inevitable part of medicine, not a strange and frightening invention of the Reds.

Here's a handy website with some basic information about how these systems work:

1.In a single-payer national health insurance system, as demonstrated by Canada, Denmark, Norway, and Sweden, health insurance is publicly administered and most physicians are in private practice.

2. Great Britain and Spain are among the OECD countries with national health services, in which salaried physicians predominate and hospitals are publicly owned and operated.

3. Highly regulated, universal, multi-payer health insurance systems are illustrated by countries like Germany and France, which have universal health insurance via sickness funds. The sickness funds pay physicians and hospitals uniform rates that are negotiated annually (also known as an “all-payer” system).

http://www.pnhp.org/facts/international_health_systems.php?page=all

Don't be like the theologians of the Middle Ages, who thought they could deduce everything they needed to know about science from Scripture. Get into the details a little bit, you'll be more fun to argue with.

 

[QuikClot]

Boys what we have here is a Libertarian. This solitary creature is often found in rugged terrain such as Alaska, or their parent’s basement. A loner by nature, they are seldom found in groups, but their tenacity and inability to see the shortcomings of a purely capitalistic society makes even a single one dangerous to rational thinker's blood pressure.

While they are an important part of the ecosystem, (they keep the communist, their natural prey in check), an over abundance can result in a stratified class society with huge concentrations of wealth in the hands of a few (see the gilded age).

Looking at the bottom line of healthcare -- mortality -- suggests that the "collapsing" world of universal care works far better than our catch-as-can-can system:

The U.S. infant mortality rate is about double the rate found in Hong Kong (3.1) and Japan (3.4), according to "America’s Health." Those numbers were drawn from a 1999 report from the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention. In that NCHS survey, the U.S. ranked 28th among 37 nations.

link

The health of the people in the United States of America, the world's richest and most powerful country, has declined relative to other countries, according to the latest United Nations Human Development Report released yesterday. Table 1 of the report shows that of all the countries in the world, the US this year tied for 26th place, with Barbados, in life expectancy (average number of years lived), dropping from 25th place last year. [2003]

link

 

[chef_NU]

The "coerced charity" argument assumes an absolute moral right to one's property, which is a far dicer proposition than you realize. Without a long, deep philosophical discussion, I would just point out that in our society, the right to one's money is not an absolute.

Wealth exists only so far as a society exists to support it -- there is no wealth without a functioning social contract. "Your" money is partly "yours" and partly belongs to society as a whole. Hence, taxation is not a violation of your freedom; indeed, the enforcement of strict property rights is a violation of the freedom of those that don't have enough.

Don't be like the theologians of the Middle Ages, who thought they could deduce everything they needed to know about science from Scripture. Get into the details a little bit, you'll be more fun to argue with.

I'm interested in getting into the details. I'm extremely interested as to what kind of hoops you jumped through to arrive at this conclusion about "wealth exists only so far as a society exists to support it". Personally, this sound like a bunch of hogwash, but I'd be very interested to see you explain it.

It's becoming increasingly clear to me that there are two kinds of political philosophies: those who put a premium on justice and freedom, and those who put a premium on equality and compassion. I, for one, am a wholehearted ascriber to the former. It's very apparent that each system has its disadvantages as well. I.e, the justice and freedom allows for inequality and polarity while the equality and compassion allows for injustice and forced agreement. And you are right as well about the popular opinion: most people are in your boat. But I don't think that such a circumstances grants you intellectual superiority in your arguments. As for the rest of the people on this thread, I want to make this a respectul debate. Not a mudslinging competition (although I do think the libertarian thing was funny ).

 

[QuikClot]

I'm interested in getting into the details. I'm extremely interested as to what kind of hoops you jumped through to arrive at this conclusion about "wealth exists only so far as a society exists to support it". Personally, this sound like a bunch of hogwash, but I'd be very interested to see you explain it.

I'd be happy to, but this isn't really the place. Oh, all right, see below.

It's becoming increasingly clear to me that there are two kinds of political philosophies: those who put a premium on justice and freedom, and those who put a premium on equality and compassion.

Many of us went through a stage when this was clear to us. If you keep an open mind, you will grow out of it.

And you are right as well about the popular opinion: most people are in your boat. But I don't think that such a circumstances grants you intellectual superiority in your arguments.

No, of course not. However, there are different arguments going on here. The most basic is -- "What works better -- the present system, or "socialized medicine?" And to answer that question, you must ask, "What are we trying to acheive?" That is where what most people want comes in. Most people want the four-year-old to survive, as long as the means exist to care for him or her. Than the question becomes -- "What system best achieves that end?"

You may want to debate capitial vs. equality, but the thread is actually about well socialized medicine works compared to our system, not which is more just. You may argue that a system in which people are left to die in the streets is more just, but that is off the point, since neither the present system, nor socialized medicine, nor the wishes of the body politic, allow that as an option.

And now for the discussion you really want to have:

Question one: What is your moral basis for defining a low-tax no-safety-net society as more just than a socialist one?

 

[chef_NU]

No, of course not. However, there are different arguments going on here. The most basic is -- "What works better -- the present system, or "socialized medicine?" And to answer that question, you must ask, "What are we trying to acheive?" That is where what most people want comes in. Most people want the four-year-old to survive, as long as the means exist to care for him or her. Than the question becomes -- "What system best achieves that end?"

Question one: What is your moral basis for defining a low-tax no-safety-net society as more just than a socialist one?

The answer to your question is no doubt a moot point. A universal health care system is certainly better than the one that is implemented in the United States today. We're trying to have the benefit of partially socialized health care without paying for it. And we're beginning to see the consquences of such shortsighted policy (among other entitlement programs we have been saddled with since FDR).

You say that the question is "what do most people want". Well put. However, it is not simply whether or not the 4-year-old survives. Of course, in a perfect world, everyone picks the 4 year old surviving. The real issue is how are we going to resolve the conflict of interest between attaining our moral goal and at the same time attaining our economic goal (i.e. maximize cost-effective health care and minimizing health care spending).

As for the moral basis question, I'll save it tomorrow. I would like to know if you are a religious person or not. My approach to morality is fairly unconventional, and if you are religious, I will certainly offend you.

 

[QuikClot]

The answer to your question is no doubt a moot point. A universal health care system is certainly better than the one that is implemented in the United States today. We're trying to have the benefit of partially socialized health care without paying for it. And we're beginning to see the consquences of such shortsighted policy (among other entitlement programs we have been saddled with since FDR).

I'm glad we agree on that, if not for the same reasons.

You say that the question is "what do most people want". Well put.

Not to nitpick, but I said that's one of the questions -- it's not the only important question, the other stuff matters too.

However, it is not simply whether or not the 4-year-old survives. Of course, in a perfect world, everyone picks the 4 year old surviving. The real issue is how are we going to resolve the conflict of interest between attaining our moral goal and at the same time attaining our economic goal (i.e. maximize cost-effective health care and minimizing health care spending).

Sure. And I would argue that the prominiant place of the Nordic countries in the world competitiveness rankings shows that the moral goal can be met whilst still retaining a healthy capitialist economic engine (which is needed, among other things, to fund the social safety net).

As for the moral basis question, I'll save it tomorrow. I would like to know if you are a religious person or not. My approach to morality is fairly unconventional, and if you are religious, I will certainly offend you.

No, I am not religious. Perhaps I should narrow the question. You've already said that the society you support is the most just and the most free. Presumably freedom and justice are the reasons it is more moral. Can you explain why these are the values which take prority, and why you believe your model is superior in these virtues?

 

[Gut Shot]

I appreciate the comments such as "chef_nu is a 4-hear old talking about sex"... they really lend weight to your arguments.

No arguments, just an observation. And I didn't say you are a 4-hear (sic) old talking about sex, I said reading your posts is like watching 4th graders discuss sex. Honestly.

 

[scalded]

As for the moral basis question, I'll save it tomorrow. I would like to know if you are a religious person or not. My approach to morality is fairly unconventional, and if you are religious, I will certainly offend you.

This should be interesting. My guess is that his "unconventional" approach to morality is something to do with survival of the fittest, maybe with a sprinkling of euthanasia mixed in (but only if you can't pay the medical bills). Of course that is hardly unconventional for a true free market thinker so I’m hoping that he goes all out and it has to do with soylent green. That would make for a much more interesting discussion.

 

[Gut Shot]

As for Germany, yes, I would have no problem telling them that they are a Marxist society. Why should I have a problem with that? Of course, they are not the epitome of communism, but they are far towards the "strong government intervention" side of the spectrum.

Hmmm, let's look at the German healthcare system. The actual one, that is, not the one you've made up.

- Compulsory enrollment in one of several public insurance companies for 90% of population.
- These public insurance companies are funded by premiums, not tax money.
- 50% of premiums are paid by employers (sound familiar?).
- For remaining 10% of population (the wealthiest 10%), there is a "vast number of private health insurers, offering various insurance plans." [1] These include both domestic and foreign insurance companies competing in the German market.
- While the German government has a strong say in health policy, "except for the funding of some benefits and the planning and financing of hospitals, the responsibility for administering and providing health care has been delegated to non-state entities, including national and regional associations of health care providers, Land hospital associations, nonprofit insurance funds, private insurance companies, and voluntary organizations." [2]

Those commies.

Finally, from Just Landed:

"The German health care system has the reputation of being one of the best in the world. There is an extensive network of hospitals and doctors covering even the remotest areas of Germany.

Waiting lists for treatments are rare. Medical facilities are equipped with the latest technology and the statutory health insurance scheme provides nearly full cover for most medical treatments and medicines. Almost everybody in Germany has access to this system, irrespective of income or social status.

The downside is that medical costs are high. Health care costs - for doctors, hospital stays and even medicines - are among the most expensive in the world. There is no such thing as "free" treatment in Germany, not even in state hospitals. All care, including emergencies, has to be paid for by you or your health insurance!

When coming to Germany, it is therefore extremely important to have a full health care insurance, as a serious illness could cause a financial disaster."

Oh, and one more thing.

Per capita health care expenditures 2000:

United States: $4,631
Germany: $2,748

 

[Gut Shot]

Of course that is hardly unconventional for a true free market thinker so I’m hoping that he goes all out and it has to do with soylent green. That would make for a much more interesting discussion.

Very true, but these discussions all play out the same way:

FMT (Free market thinker): Socialized medicine sucks!

RP (Random passerby): Well, all systems you would classify as "socialized" spend a fraction of what we do and cover their entire populations.

FMT: Yeah, but their health care quality sucks!

RP: Actually, when you look at outcomes like life expectancy and infant mortality, we're near the bottom of the pack. Our stunning quality of high-end care is more than offset by our pitiful access to it.

FMT: Yeah, but if everyone had access then we'd be commies! And free markets rule!

RP: How we obtain health care is only one aspect of our lives, and offering universal coverage through a national health plan would both unburden our employers and improve the overall health of our workforce. Both of those would improve our economy's competitiveness on the global markets, and might even be cost effective in their own right. Besides, we already have the most "free market" healthcare system in the industrialized world, and it's also the most bureacratic, inefficient, and the costliest. Healthcare is an inherently imperfect market, so expecting capitalism to work its wonders is like cramming the square peg of expectation through the triangular hole of futility.

FMT: At least in a free market I won't have to pay for anyone else with MY money! Poor people should die if they can't afford treatment!

RP: Okay, so earlier you wanted to institute free market healthcare because it would be more efficient, lower costs, increase access, improve quality, and generally be a better system. Faced with the fact that free market healthcare (either through profit-driven insurance or fee-for-service) does the opposite, now we're supposed to institute it anyways because poor people don't deserve healthcare. Interesting. Actually this does define America's system pretty well: best in the world, if you can afford it.

FMT: Hey, at least we're not in Canada. They have to wait for care.

RP: Canada does have a problem with waiting, which is why organizations like the Wait Time Alliance have been formed to address the problem. Canada has faced budget problems similar to ours over the past decades, and funding of healthcare has suffered with predictable results. However, they do reap some pretty significant advantages with their system. In general they can see a doctor, get treatment and afford their medications without being financially crippled. Also, nobody in Canada goes bankrupt for lack of medical coverage. Try and say that about the US, where medical bills are a leading cause of financial ruin. In fact, we're all just one little cerebral aneurysm away from a lifetime of MASSIVE medical bills.

Speaking of the US, you want to talk about wait times? If you're uninsured and diabetic, guess what your wait time is to receive medication? However long it takes for you to enter DKA! Need more? Just wait until you're blind and qualify for disability. Then you'll be living on the public dime AND unemployable, another accidental social parasite.

FMT: Screw them.... MY money!

RP: Gee, every analyze the term "health insurance"? See that second word, there? "Insurance"? Insurance is, by definition, pooling money of the many so everyone can have security in the face of random ill fortune. Security is what you're paying for, and the most efficient way to administer such a program is to put everyone in the same risk pool and make relatively level payments into the system throughout your life. If you're rich, I'm sure there will be a company that will give you additional, platinum-plated coverage should you want it. With the exception of organ transplantation, you can already buy practically any treatment you want right now.

FMT: America... **** yeah!

 

[chef_NU]

Very true, but these discussions all play out the same way:

FMT (Free market thinker): Socialized medicine sucks!

RP (Random passerby): Well, all systems you would classify as "socialized" spend a fraction of what we do and cover their entire populations.

FMT: Yeah, but their health care quality sucks!

RP: Actually, when you look at outcomes like life expectancy and infant mortality, we're near the bottom of the pack. Our stunning quality of high-end care is more than offset by our pitiful access to it.

FMT: Yeah, but if everyone had access then we'd be commies! And free markets rule!

RP: How we obtain health care is only one aspect of our lives, and offering universal coverage through a national health plan would both unburden our employers and improve the overall health of our workforce. Both of those would improve our economy's competitiveness on the global markets, and might even be cost effective in their own right. Besides, we already have the most "free market" healthcare system in the industrialized world, and it's also the most bureacratic, inefficient, and the costliest. Healthcare is an inherently imperfect market, so expecting capitalism to work its wonders is like cramming the square peg of expectation through the triangular hole of futility.

FMT: At least in a free market I won't have to pay for anyone else with MY money! Poor people should die if they can't afford treatment!

RP: Okay, so earlier you wanted to institute free market healthcare because it would be more efficient, lower costs, increase access, improve quality, and generally be a better system. Faced with the fact that free market healthcare (either through profit-driven insurance or fee-for-service) does the opposite, now we're supposed to institute it anyways because poor people don't deserve healthcare. Interesting. Actually this does define America's system pretty well: best in the world, if you can afford it.

FMT: Hey, at least we're not in Canada. They have to wait for care.

RP: Canada does have a problem with waiting, which is why organizations like the Wait Time Alliance have been formed to address the problem. Canada has faced budget problems similar to ours over the past decades, and funding of healthcare has suffered with predictable results. However, they do reap some pretty significant advantages with their system. In general they can see a doctor, get treatment and afford their medications without being financially crippled. Also, nobody in Canada goes bankrupt for lack of medical coverage. Try and say that about the US, where medical bills are a leading cause of financial ruin. In fact, we're all just one little cerebral aneurysm away from a lifetime of MASSIVE medical bills.

Speaking of the US, you want to talk about wait times? If you're uninsured and diabetic, guess what your wait time is to receive medication? However long it takes for you to enter DKA! Need more? Just wait until you're blind and qualify for disability. Then you'll be living on the public dime AND unemployable, another accidental social parasite.

FMT: Screw them.... MY money!

RP: Gee, every analyze the term "health insurance"? See that second word, there? "Insurance"? Insurance is, by definition, pooling money of the many so everyone can have security in the face of random ill fortune. Security is what you're paying for, and the most efficient way to administer such a program is to put everyone in the same risk pool and make relatively level payments into the system throughout your life. If you're rich, I'm sure there will be a company that will give you additional, platinum-plated coverage should you want it. With the exception of organ transplantation, you can already buy practically any treatment you want right now.

FMT: America... **** yeah!

You seem to be missing my point. I am not comparing socialized medicine to the American system, and claiming the American system is better. It's not, as I have stated above. What I'm offering is an alternative which everyone seems to want to equate to the way things are now. I just want to be clear that I am BY NO MEANS advocating that things stay the way they are. The system that I propose will ration health care spending and avert the economic tar pit that awaits us within the next 30 years. The difference is that the people make the choice how to limit their health care spending rather than the government.

 

[chef_NU]

This should be interesting. My guess is that his "unconventional" approach to morality is something to do with survival of the fittest, maybe with a sprinkling of euthanasia mixed in (but only if you can't pay the medical bills). Of course that is hardly unconventional for a true free market thinker so I’m hoping that he goes all out and it has to do with soylent green. That would make for a much more interesting discussion.

I suppose you could tie "survival of the fittest" phrase into my conception of morality if you wish. Here goes:

I don't claim to be an expert anthropologist, but I do know a bit about the environment that early human beings spent the majority of their time in. Thus, this environment shaped many of the behaviors that are common to all human groups. I believe that all human behavior is ultimately based in biology; namely, certain behaviors were selected in order to (1) improve survival or (2) to maximize the "passing on" of an individuals genes. During most of human evolution, human beings spent their time in small groups of about 50-100 people called bands. In such groups, the vast majority of people are related to one another, at least fairly closely. Let us bear in mind that in these groups we have no established "rule of law" or separate law-enforcement body. The bands are meagerly organized at best. Now of course conflicts arise in these groups between individuals. In the traditional "every man for himself" view, this results in grudges, murder, and general disarray, causing the band to break apart and ultimately perish. After all, the best way to ensure that one doesn't have competition from another individual is to either kill him or teach him a lesson will make him not want to come back to the band's environment. This is where the dilemma arises. Such conflict inevitably leads to LOWER survivability for EVERYONE. But nature finds another way. What if, by chance, particular bands learn to adopt a policy of foregoing their selfish interests to some extent for the sake of the survival of the group. I call this foregoance: morality. Why would groups want to do this? Well first off, there is less death and mischief in the band. But there is another reason: when you promote the survival of others in the band, since most of you are at least somewhat related, you are, in fact, promoting your own genes to some extent. Thus, from the inception of community living among humans until the present day, there has been a selection for societies which adopted (probably both biologically and culturally) a predisposition to be "moral". Morally cultured societies eventually lead to the beginnings of government, and are ultimately much more successful than other societies that perish from their own disagreements (of course, such organizational progress doesn't happen in other group-dwelling animals, simply because they lack the intellectual capacity of human beings).

Conclusion: When groups of human beings behave according to a "moral" code, they are, in fact, behaving in their own self interest.

Caveat: This conclusion applies to human beings living in small, poorly organized groups, with no law enforcing body.

Which leads me to my present view of government in the modern world...

To be continued

 

[scalded]

You seem to be missing my point. I am not comparing socialized medicine to the American system, and claiming the American system is better. It's not, as I have stated above. What I'm offering is an alternative which everyone seems to want to equate to the way things are now. I just want to be clear that I am BY NO MEANS advocating that things stay the way they are. The system that I propose will ration health care spending and avert the economic tar pit that awaits us within the next 30 years. The difference is that the people make the choice how to limit their health care spending rather than the government.

I feel bad about making fun of you chef because I do believe in free markets for a lot of areas. They even have a place in things like pollution control (see sulfur credits and how they helped lower acid rain). The problem is that I'm not convinced that free markets are the best tool for every situation.

Healthcare isn't an ideal free market good for a few reasons. 1.) Demand is inflexible, (If you have kidney failure you can't decide that you will wait a few months to see if the price for care changes). 2.) You can't store medical care when the price is low. 3.) Most consumers are limited in the area they can travel for healthcare (although you do have some medical tourism to Mexico, India etc.)

Now are there parts of the healthcare system that can be made more efficient with free markets? Yes. Areas such as optometry and pharmacy become more efficient through large corporations and their expertise in supply chain management. But those are both very product heavy fields.

 

[chef_NU]

I feel bad about making fun of you chef because I do believe in free markets for a lot of areas. They even have a place in things like pollution control (see sulfur credits and how they helped lower acid rain). The problem is that I'm not convinced that free markets are the best tool for every situation.

Healthcare isn't an ideal free market good for a few reasons. 1.) Demand is inflexible, (If you have kidney failure you can't decide that you will wait a few months to see if the price for care changes). 2.) You can't store medical care when the price is low. 3.) Most consumers are limited in the area they can travel for healthcare (although you do have some medical tourism to Mexico, India etc.)

Now are there parts of the healthcare system that can be made more efficient with free markets? Yes. Areas such as optometry and pharmacy become more efficient through large corporations and their expertise in supply chain management. But those are both very product heavy fields.

Make fun of me as you like. I'm not perfect, and I always like to hear opposing viewpoints because they make me think about why I believe what I believe more deeply. You're not going to hurt my feelings.

In response to your objections:

1. Demand is inflexible

So is demand for many consumable commodities, such as gasoline, food, rent, you name it.

2. You can't store medical care when the price is low.

Nor can you with other service-based commodities (I think this one is self-explanatory).

3. Most consumers are limited by their area.

True. I live in Texas, and I like to snowboard. I can't, though. Instead, I find other avenues for entertainment which exist in my environment.

 

[Gut Shot]

The system that I propose

Save a brother some trouble and either link or cut-and-paste this proposal. Thanks!

 

[chef_NU]

Save a brother some trouble and either link or cut-and-paste this proposal. Thanks!

I believe this site was originally posted by Shredder:

http://www.marketmed.org/fmm.asp?fmmfont=fontsml

It bases policy propositions upon the same basic ideas that I am proposing, and delves into some more complex issues that I haven't had the time to think about thoroughly. Quite an interesting read.

 

[chef_NU]

Conclusion: When groups of human beings behave according to a "moral" code, they are, in fact, behaving in their own self interest.

Caveat: This conclusion applies to human beings living in small, poorly organized groups, with no law enforcing body.

Which leads me to my present view of government in the modern world...

To be continued

So then... what are the principles that should guide government in the contemporary setting, I.e. where we already have the institutions set up to protect life and property? Certainly government should have no hand in any moral affairs whatsoever, as they are completely arbitrary human creations. If citizens have a certain moral code that they wish to live by, let them. The idea is basically that since we have no "supernatural" principle to govern our behavior, it is up to the individual to pursue his or her own vision of happiness (or unhappiness, it is irrelevant) in whatever way he or she sees fit. They can have good reasons, or they can have no reasons. Government is simply there to ensure that people don't step on each others toes by using institutions to accomplish their own goals at the expense of others' freedom.

When you build power into government, you advance the personal interests of those who govern in every case. (This is the source of my "power corrupts" thread) Surely you see now why I champion justice and freedom as opposed to compassion and equality. Every viewpoint should have the opportunity to promote his or her lifestyle regardless to the judgements of others, because they are all fundamentally arbitrary, and thus fundamentally equallly valid. Imposing another viewpoint based upon morality is utterly bigoted and uncompromising. Eventually, you come to the conclusion that government should have the bare minimum required to maintain order and protect life and property (the job that morality had in our precivilized days). Of course, this is not how most people think. People see the world through a worldview based upon certain preconceptions that they feel trump all other considerations. This is why I say that there should be no preconceptions and no considerations. They are all equally valuable, all equally worthless, and thus deserve to be left alone just as much as the next one. The best government is limited government.

 

[scalded]

Make fun of me as you like. I'm not perfect, and I always like to hear opposing viewpoints because they make me think about why I believe what I believe more deeply. You're not going to hurt my feelings.

In response to your objections:

1. Demand is inflexible

So is demand for many consumable commodities, such as gasoline, food, rent, you name it..

With things like gasoline and food there are alternatives. corn too expensive? well eat potatoes. Not as easy for medical care. need a kidney transplant? well how bout a liver instead? Also anyone who says the oil or food market is a free market better do a little more research.

2. You can't store medical care when the price is low.

Nor can you with other service-based commodities (I think this one is self-explanatory).

I agree that it is like other services in that respect, but when combined with the inflexible demand, High cost of entry into the market, and the fact that if you are having a heart attack you aren’t going to be a "good" consumer and price check the hospital The best you can hope for is some kind of duopoly with 1 or 2 hospitals in the immediate area. I doubt it would be very efficient, they generally aren’t anyway. (Things like breast implants that are voluntary procedures I think we can both agree are perfectly suited to the free market model.)

3. Most consumers are limited by their area.

True. I live in Texas, and I like to snowboard. I can't, though. Instead, I find other avenues for entertainment which exist in my environment.

I don't think that really is the same as having a sick kid and not being able to comparison shop a doctor 6 hours away for care. Again I’m not saying a privatized system wouldn’t work. I’m just saying it wouldn’t work better than a socialized system for most people in terms of efficiencies.

It would probably be better for healthy people and rich people of course. If I didn’t have to pay for sick people on my insurance my premiums would drop by huge amounts. Of course that wouldn’t be so good for sick people I suppose.

 

[chef_NU]

Just as an addendum, when I say "protect life and property" I am trying to convey:

"protect the theft of life and property"

Don't let my words mislead you.

 

[scalded]

So then... what are the principles that should guide government in the contemporary setting, I.e. where we already have the institutions set up to protect life and property? Certainly government should have no hand in any moral affairs whatsoever, as they are completely arbitrary human creations. If citizens have a certain moral code that they wish to live by, let them. The idea is basically that since we have no "supernatural" principle to govern our behavior, it is up to the individual to pursue his or her own vision of happiness (or unhappiness, it is irrelevant) in whatever way he or she sees fit. They can have good reasons, or they can have no reasons. Government is simply there to ensure that people don't step on each others toes by using institutions to accomplish their own goals at the expense of others' freedom.

When you build power into government, you advance the personal interests of those who govern in every case. (This is the source of my "power corrupts" thread) Surely you see now why I champion justice and freedom as opposed to compassion and equality. Every viewpoint should have the opportunity to promote his or her lifestyle regardless to the judgements of others, because they are all fundamentally arbitrary, and thus fundamentally equallly valid. Imposing another viewpoint based upon morality is utterly bigoted and uncompromising. Eventually, you come to the conclusion that government should have the bare minimum required to maintain order and protect life and property (the job that morality had in our precivilized days). Of course, this is not how most people think. People see the world through a worldview based upon certain preconceptions that they feel trump all other considerations. This is why I say that there should be no preconceptions and no considerations. They are all equally valuable, all equally worthless, and thus deserve to be left alone just as much as the next one. The best government is limited government.

So we have a nice argument for relativism. What I never understood about libertarians/relativists is why they think morals are relative and what I do should have nothing to do with what you do, yet they see personal property as sacrosanct. Why the arbitrary distinction? If morals are relative then why should society protect your property if I am strong enough to take it from you?

What you really seem to want is protection for your particular skillset. Those people that have a certain set of abilities that enables them to hord gold or paper with dead presidents on it at a greater rate than other people.

I guess I just never understood the line drawn between libertarians and anarchists.

(I know that libertarians are not always relativists, but from your comments I assume the description is somewhat accurate)

 

[QuikClot]

I suppose you could tie "survival of the fittest" phrase into my conception of morality if you wish. . . . Conclusion: When groups of human beings behave according to a "moral" code, they are, in fact, behaving in their own self interest.

This is a little different from what I was talking about. I was asking you about your moral values, not what you believe to be the anthropologial origin of morality.

Now, there's a lot here, so I'm going to stick to my line of questioning, and backtrack later.

So then... what are the principles that should guide government in the contemporary setting, I.e. where we already have the institutions set up to protect life and property? Certainly government should have no hand in any moral affairs whatsoever, as they are completely arbitrary human creations.

If citizens have a certain moral code that they wish to live by, let them. The idea is basically that since we have no "supernatural" principle to govern our behavior, it is up to the individual to pursue his or her own vision of happiness (or unhappiness, it is irrelevant) in whatever way he or she sees fit. They can have good reasons, or they can have no reasons. Government is simply there to ensure that people don't step on each others toes by using institutions to accomplish their own goals at the expense of others' freedom.

So, true or false: you believe your system is superior because it allows maximum freedom for the individual. Imposing constraints on the individual is undesirable. Is that a fair description?

 

[chef_NU]

This is a little different from what I was talking about. I was asking you about your moral values, not what you believe to be the anthropologial origin of morality.

You missed the point then. I don't have any moral values.

 

[chef_NU]

So, true or false: you believe your system is superior because it allows maximum freedom for the individual. Imposing constraints on the individual is undesirable. Is that a fair description?

absolutely right. it allows the maximimum freedom without disturbing anyone else's freedom.

 

[chef_NU]

So we have a nice argument for relativism. What I never understood about libertarians/relativists is why they think morals are relative and what I do should have nothing to do with what you do, yet they see personal property as sacrosanct. Why the arbitrary distinction? If morals are relative then why should society protect your property if I am strong enough to take it from you?

Why is personal property sacrosant? Because that's just what it is: personal. The state has no business in personal affairs. Why should government protect property from the theft of others? Because this means that one party is directly and expressly violating another person's freedom to pursue their own conception of happiness to the best of their ability.

What I want to hear is why all you moralists think you have the high ground. In my opinion, you don't. All you have is popular opinion and convention to back you up. Please LOGICALLY explain your basis for morality.

 

[QuikClot]

absolutely right. it allows the maximimum freedom without disturbing anyone else's freedom.

So it would protect my freedom to say what I want, think what I want, go where I want, do what I want, as long as in doing so I don't compromise someone else's right to do the same thing?

[Yes.]

So can I walk into an orchard, pick an apple, and rest under the tree to eat it?

 

[QuikClot]

Why is personal property sacrosant? Because that's just what it is: personal. The state has no business in personal affairs.

My toothbrush is personal. My stock options are not. What is the basis for calling property personal? If a car is sitting on the street, and I get into it and drive somewhere, why should the state violate my freedom by defining that as theft?

This is the crux of the matter. You say:

Why should government protect property from the theft of others? Because this means that one party is directly and expressly violating another person's freedom to pursue their own conception of happiness to the best of their ability.

But the same thing could be said about banning the use of "owned" property; by forbidding "theft" you are directly violating the "thief"'s right to personal freedom.

In contrast, I do not see how you get from a "person's freedom to pursue their own conception of happiness to the best of their ability" to the exclusive control over certain objects to the exclusion of other people's rights of freedom of action.

You may not like not having a car, but I haven't taken away your "freedom to pursue . . . happiness." As a wise man once said, freedom to pursue happiness does not mean the right to get it!

 

[Lindyhopper]

You can discuss the basis of morality in the abstract but it seems to not be taking the discussion anywhere near proposing a broad based, efficient health care system.

 

[QuikClot]

You can discuss the basis of morality in the abstract but it seems to not be taking the discussion anywhere near proposing a broad based, efficient health care system.

See earlier in the thread. We've drifted a little and are now talking about the fundemental philosophy underpinning some SDNers hostility to state involvement in healthcare or anything else.

 

[Gut Shot]

I believe this site was originally posted by Shredder:

http://www.marketmed.org/fmm.asp?fmmfont=fontsml

It bases policy propositions upon the same basic ideas that I am proposing, and delves into some more complex issues that I haven't had the time to think about thoroughly. Quite an interesting read.

Interesting, and also loaded with more assumptions than one can shake a stick at. In the end, I fail to see how all of the changes that are proposed will lead to anything but the (re)creation of a fragmented private health insurance industry that does not differ very much from the one in existence now. Actually I shouldn't say that - things can always be worse.

Perhaps I'm a cynic, but look at it this way. If you compare this year to next year, about the same number of people are going to get sick and hurt. The same number of people are going to show up in doctor's offices and ER's, and the same number are going to require hospitalization. Doctors are going to order the same tests and scans, and prescribe roughly the same therapies. The big question is "who pays for all this"?

The cure for bleeding is to stop the bleeding, not open the wound wider hoping that the body will have extra-incentive to stop bleeding on its own. Likewise, I just cannnot fundamentally believe that the solution to out-of-control costs is to make things more costly for individuals. Sorry, but the "trust us, costs will decline" line just doesn't fly. Doctors are still going to follow evidence-based guidelines for diagnosis and treatment, and without massive reduplication of services there will be no competition to speak of.

Unless I missed it, the authors of the site cannot point to any functioning free-market medical system in existence. I suspect there is a reason for this. I also suspect that the mantra to privatize and deregulate will yield the same results that it has in our little third world experiments.

Take Chile, for example:

"In 1973, the year the general [Augusto Pinochet] seized power, Chile's unemployment rate was cut by 4.3 per cent. In 1983, after 10 years of free-market modernisation, unemployment reached 22 per cent. Real wages declined by 40 per cent under military rule. In 1970, 20 per cent of Chile's population lived in poverty.

By 1990, the year 'President' Pinochet left office, the number of destitute people had doubled to 40 per cent. Quite a miracle.

Pinochet did not destroy Chile's economy all by himself. He had the help of academia's most brilliant minds: a gaggle of Milton Friedman's trainees, the Chicago Boys. Under their spell, the General abolished the minimum wage, outlawed union bargaining, privatised the pension system, abolished all taxes on wealth and business profits, slashed public employment, privatised 212 industries and 66 banks and ran a fiscal surplus.

Free of the dead hand of bureaucracy, taxes and unions, the country took a giant leap... into bankruptcy and depression. After nine years of Chicago-style economics, Chile's industry keeled over and died.

In 1982 and 1983, GDP dropped by 19 per cent. Blood and glass littered the laboratory floor, yet the mad scientists of Chicago declared a success. The US State Department concluded: 'Chile is a casebook study in sound economic management.' It was Friedman who himself coined the phrase 'Miracle of Chile'. Friedman's sidekick, economist Art Laffer, preened that Pinochet's Chile was, 'a showcase of what supply-side economics can do'.

It certainly was. More exactly, Chile was a showcase of deregulation gone beserk. The Chicago Boys persuaded the junta that removing restrictions on the nation's banks would free them to attract foreign capital to fund industrial expansion. Pinochet sold off the state banks - at a 40 per cent discount against book value.

They fell into the hands of two conglomerate empires, controlled by speculators Javier Vial and Manuel Cruzsat. Using these banks, Vial and Cruzat bought up manufacturers, then leveraged these assets with loans from foreign investors panting for their piece of the state giveaway.

By 1982, the pyramid finance game was up. The Vial and Cruzat 'Grupos' defaulted. Industry shut down, private pensions became worthless, and the currency swooned. Riots and strikes by a population too desperate to fear bullets forced Pinochet to boot out his beloved Chicago experimentalists.

Reluctantly, the General restored the minimum wage and collective bargaining. Having previously decimated the ranks of state employees, he authorised a programme to create 500,000 jobs.

Chile was pulled from depression by dull old Keynesian remedies, all Franklin Roosevelt, zero Margaret Thatcher. (The junta even instituted what is today South America's only law restricting the flow of foreign capital.)

New Deal tactics rescued Chile from the panic of 1983, but the nation's long-term recovery and growth is the result of (cover the children's ears) a large dose of socialism."

All this said, I would be TOTALLY in favor if giving such a free-market system a 10 year trial. If I am wrong, then great! If not, then perhaps we can put the whole thing to rest once and for all.

 

[chef_NU]

My toothbrush is personal. My stock options are not. What is the basis for calling property personal? If a car is sitting on the street, and I get into it and drive somewhere, why should the state violate my freedom by defining that as theft?

This is the crux of the matter. You say:



But the same thing could be said about banning the use of "owned" property; by forbidding "theft" you are directly violating the "thief"'s right to personal freedom.

In contrast, I do not see how you get from a "person's freedom to pursue their own conception of happiness to the best of their ability" to the exclusive control over certain objects to the exclusion of other people's rights of freedom of action.

You may not like not having a car, but I haven't taken away your "freedom to pursue . . . happiness." As a wise man once said, freedom to pursue happiness does not mean the right to get it!

Ok, you guys seem to be distorting what I am trying to say. What I am trying to convey is basically that everyone plays by the same rules. No law should ever favor a particular group, regardless of the situation. Any government at all eventually leads to nepotism and favoritism. I'm saying we need to avoid all of that. Minimize government; minimize special treatment.

I appreciate your nitpicking of my arguments, but how about you guys explain your basis for morality? And why we should have a particular type of morality in government? And why equality is more important than freedom? You all seem like you have simply beeen attacking my arguments. I've responded. I'm interested in you explaining your viewpoints.

 

[QuikClot]

Ok, you guys seem to be distorting what I am trying to say. What I am trying to convey is basically that everyone plays by the same rules. No law should ever favor a particular group, regardless of the situation. Any government at all eventually leads to nepotism and favoritism. I'm saying we need to avoid all of that. Minimize government; minimize special treatment.

I appreciate your nitpicking of my arguments, but how about you guys explain your basis for morality? And why we should have a particular type of morality in government? And why equality is more important than freedom? You all seem like you have simply beeen attacking my arguments. I've responded. I'm interested in you explaining your viewpoints.

I’m not trying to attack you, nor am I trying to nitpick, but rather to meet an abstract philosophical attitude (which one often encounters on SDN) with some abstract, philosophical objections. I did not come up with these ideas to befuddle you, but rather because I once was a minimal-government believer and I had to think about the answers to arguments I had once espoused.

This is my thinking in a nutshell; the moral argument of minimalism is the argument from freedom. It is an absolutist argument in the sense that just as ideally we would have no constraints on our freedom of speech, so ideally (it is thought) the government would not use armed force to compel us to contribute our property to projects not related to maintaining the necessary monopoly of force.

However this argument depends on the notion that property is personal -- that my capital belongs to me in the same sense my body does. I now think that that little-examined assumption is wrong.

The theory of capital states that the right to capital is permanent and absolute, such that if capital is only voluntarily transferred from one person to another, the system is equitable in not favoring one group over another. However, this is only equitable if all transfers take place in a perfect free market, and if the previous owners had a valid claim to the capital. (You can also create new capital, but since new capital must come, in part, from old capital, the problem of its origin remains (if I steal a hundred dollars and buy lottery tickets, any money I win belongs to the true owner, not to me.)

In the real world capital has been stolen and re-stolen so many times that its distribution in the present day cannot be considered just, or equitable, or natural. The doctrine of personal property turns out not to be equitable, the argument from freedom is nullified (since there’s no way of telling what “person” the “personal property” truly belongs to), and we are left with two things; the argument from law, and the argument from efficiency.

Before I turn to those, I’ll take a break, and you can pick at my ideas for a bit.

 

[Gut Shot]

Any government at all eventually leads to nepotism and favoritism. I'm saying we need to avoid all of that.

Dude, any system that lacks a dynamic tension between competing interests will eventually decline into neopotism and favoritism. Do you think the sons of John D. Rockefeller were ever concerned about working 14/6 shifts at textile mills? Hell no, they were deciding which Ivy had the best skirt to chase. Goverments have no monopoly, so to speak, on corruption and cronyism.

I appreciate your nitpicking of my arguments, but how about you guys explain your basis for morality?

I don't know if you're talking to me here, but I don't have a defined basis for my morality. It would require me to develop an algorithm that, frankly, I don't have the patience for. It's much simpler for me to avoid dwelling in the abstract and instead try to be a pragmatist.

 

[chef_NU]

I’m not trying to attack you, nor am I trying to nitpick, but rather to meet an abstract philosophical attitude (which one often encounters on SDN) with some abstract, philosophical objections. I did not come up with these ideas to befuddle you, but rather because I once was a minimal-government believer and I had to think about the answers to arguments I had once espoused.

This is my thinking in a nutshell; the moral argument of minimalism is the argument from freedom. It is an absolutist argument in the sense that just as ideally we would have no constraints on our freedom of speech, so ideally (it is thought) the government would not use armed force to compel us to contribute our property to projects not related to maintaining the necessary monopoly of force.

However this argument depends on the notion that property is personal -- that my capital belongs to me in the same sense my body does. I now think that that little-examined assumption is wrong.

The theory of capital states that the right to capital is permanent and absolute, such that if capital is only voluntarily transferred from one person to another, the system is equitable in not favoring one group over another. However, this is only equitable if all transfers take place in a perfect free market, and if the previous owners had a valid claim to the capital. (You can also create new capital, but since new capital must come, in part, from old capital, the problem of its origin remains (if I steal a hundred dollars and buy lottery tickets, any money I win belongs to the true owner, not to me.)

In the real world capital has been stolen and re-stolen so many times that its distribution in the present day cannot be considered just, or equitable, or natural. The doctrine of personal property turns out not to be equitable, the argument from freedom is nullified (since there’s no way of telling what “person” the “personal property” truly belongs to), and we are left with two things; the argument from law, and the argument from efficiency.

Before I turn to those, I’ll take a break, and you can pick at my ideas for a bit.

When you look at the minimalist perspective, I would agree with you that the "inconsistent starting point" is a legitimate objection. I don't think, however that it is grounds for chronic social welfare. And I don't think that it completely abolishes the notion of a right to personal property. I would be open to the idea of government intervention early in life. For example, I wouldn't have a significant problem with paying taxes to seriously revamp the public school system; I think that a goal of government is to provide a high-quality standardized education system. I also would consider the implementation of something like universal health care for those under 18. Granted, with any government program, you run into the problem of corruption, special interest, and political entrenchment. I suppose that it is worth it in this case. The idea is to give everyone at least a semblance of equal opportunity -- but to an extent.

Here's the catch. We can give you a chance. But if you screw up, that's it. Given that government provides reasonable equality of opportunity (of course, it will never provide a perfect system, but it can do an acceptable job), there is no reason for others to fund a safety net for adults who just don't make it. And if you look at government spending, this is where it goes. What are the top 3 government expenditures in the US? Defense, social security, and medicare. All are essentially the pork projects of special interests (defense contractors, the old, and the infirm). I'm not saying that these groups don't need this money. After all, defense contractors need business, the old need money, and the old and infirm need medical care. I'm just saying they don't have a right to these things. And I don't think there's any good argument why they should have a right to these things. Spare me the sob story, humanistic perspective. I really don't care.

So, yes. Let me revise. Government should protect the right to personal property, and it should also do its best to provide equal opportunity as well. However, let me make the distinction that equal opportunity and social welfare programs are two completely different ideas. I suppose that in my previous posts I somewhat disregarded the equal opportunity function. Mark my words, I think it is extremely legitimate. As I like to say, socialism treats the symptom, education treats the disease. My view is basically give them a shot, but there are no second chances.