What is the SDN opinion on Single Payer Health Care?

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Repealing the federal income tax is politically impossible. Undoing social security benefits is politically impossible. Skinny repeal of ACA was one vote shy of being extremely possible. To the point of reality, really. Your bar for "impossible" must be pretty low.
"Skinny" repeal was rightly called so because it only sought to repeal some provisions (and even then it failed.) This is what I meant by using the word "altogether," because as you know the "altogether" repeal of the act failed by more than one vote.
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So your argument is 100% public option or bust? Reducing the share of the private sector reduces its bargaining power in a graded fashion just like any other market. Just because you take 33% of the market power away and split it up among a lot of smaller companies doesn't mean that that 67% market power under a single public option goes poof. As I say below, as long as you're arguing for a public option that competes with private options in the market and let the pieces fall where they may, I would accept any allocation that results from that - whether it's 99% public or 50%. The question is, would you?
Absolutely, and my argument was never 100% public option or bust. I think that the incentive of the public option being favorable is good and entails a larger public share, but I don't say I want the public share to be as big as possible in that it removes private options by legislation, only in that, as is the case elsewhere, the public favors it overwhelmingly over adding an additional private choice.

And why can those countries pay less? Because we're the cash cow here for pharma. We effectively subsidize the rest of the world's drugs. Take that away and who eats the cost? You seem to be under the impression that you can just take some money away and no one will have to bear the cost. Who bears the cost? The pharma companies. What do they do to bear the costs? Invest less. It's not rocket science here. Just basic accounting. Other countries can pay less now because we pay more. And when that goes, not only is pharma revenue and investment going to drop, they're also going to have to charge other countries higher prices. I wonder what will happen to the costs in other countries then.
I know you put this later in your post, but I'm clumping the answer alongside the one below this one so I don't repeat myself too much.

It's not a deduction, it's from experience working in and with pharma. Throughout my PhD in chemistry, I worked with pharma companies and saw a lot of what goes on behind the scenes in their marketing and R&D schemes. A big pharma company isn't going to cut marketing just because you stop paying them as much for their drugs. They're going to cut R&D and shift risk to smaller companies by buying up drugs that the smaller companies develop first. Small companies may not have the marketing divisions or market power to bring their drug all the way to market and so they sell out to the bigger companies. This is happening today at a faster and faster rate. It's how the world works. So no, R&D isn't necessary to have exclusive rights to some product. Not if they can acquire it from a smaller company, which is what they're doing now to a large extent.
Smaller companies taking risks are a finite resource as well, which is why, as opposed to a halt in R&D countries with much smaller populations, those countries continue to invest, and, to quote a 2010 study :

"Pharmaceutical innovation is an international enterprise. Although the United States is an important contributor to pharmaceutical innovation, we found that more than 20 countries contributed to the development of the 288 NMEs with patents at the time of approval. More than 171 companies were involved in the development of these NMEs, and the vast majority of companies were multinationals with facilities located in more than 2 countries. We also found that the United Kingdom, Switzerland, Belgium, and a few other countries innovated proportionally more than their contribution to the global GDP or prescription drug spending, whereas Japan, Spain, Australia, and Italy innovated less.

In contrast with the United States, all other countries investigated had instituted at least 1 form of drug pricing regulation.Critics of drug price regulation argue that free market pricing strategies and higher prices in the United States are instrumental to innovation.20,21 One might therefore expect the United States to be the most innovative given that it is the only country with a predominantly unregulated pharmaceutical market. However, US pharmaceutical innovation appeared to be roughly proportional to its national wealth and prescription drug spending. Our data suggest that the United States is important but not disproportionate in its contribution to pharmaceutical innovation. Interestingly, some countries with direct price control, profit control, or reference drug pricing appeared to innovate proportionally more than their contribution to the global GDP or prescription drug spending."


I hate to have an article make my argument for me because it's a bit lazy, but it conveys that the United States isn't "bearing the burden" for everyone else's price-controlling practices to be viable, as you seem to suggest. I think you'd be pressed to argue that pharmaceutical industries abroad subsist by cannibalizing smaller companies and have done so for the last few decades.

Most of the costly parts of R&D are born out by pharma companies, not by NIH-funded research. Even if I grant you that 60% of NIH funding goes on to produce a useful therapeutic for human use, that's far outshadowed by the billions that pharma companies sink into developing even just one drug (Innovation in the pharmaceutical industry: New estimates of R&D costs - ScienceDirect). That amount of NIH funding is equivalent to developing 7 or 8 drugs a year (and that data is old, not taking into account the even higher costs needed to develop biologics and precision medicine nowadays). And that's a generous estimate for the NIH since a lot of NIH funding ends up in projects that further human knowledge but do not end up being used to benefit humans clinically.
This was neither my contention nor yours, if 60% of NIH funding goes into useful therapeutic use, given about $67 billion in private "biopharmaceutical" research spending that clocks at about a fifth of all R&D spending, which is not a small fraction or a small cost. I never suggested it was the majority.

Save us both the time by being clear with what you're supporting. First you argue for "single-payer" systems and now you believe that some private competition is okay? How much? You think that 33% market share is too high. Give me a number at which that share would be acceptable to you.
As we've discussed before, there seems to be discrepancy in how we use "single-payer," which I thought was clearer since we are talking about the United Kingdom and Spain, neither of which bars private competition. Though I'd be too arrogant to put a single number of what I find is reasonable, the United Kingdom clocks at a healthy 10.5% of citizens having private insurance as of 2015—I don't think under 20% is a serious bargaining ability loss, but any number I give relies on data that we simply do not have (for every increasing % market participation of private sector, how much does the incentive of pharmaceutical and technology companies to negotiate with the government for public inclusion change?) I can however, reasonably guess that there is a negative correlation in there.

I understand your point. But realize that you are not arguing for a single payer system or even very much of a two-tiered system. What you're arguing for is a public option with a set benefit schedule that competes with private options equally in the market. And let the pieces fall where they may. If 99% of people elect to take up the public option and only that, then that means that 99% of people believe that the public option is sufficient to meet their goals. If this is the case, then I have no quarrel with that. As long as the private option exists and people have the right to freely choose to purchase private coverage (even if everyone contributes to the public option).
I'm arguing for a system where, as in the United Kingdom, the single-payer system isn't something you opt out of but something you can add private insurance to. I'm glad we're finally clear on that. These posts are getting too long.

My only concern in that case would be what premiums the public option would set - I would agree only if they were actuarially fair or very close to it.
If everyone contributes to the public option, I don't think there would be a need to set "premiums," as systems like the NHS receive their funding directly from general taxation, i.e. they're not going on the market and setting price levels rather than everyone pays for it and whoever so chooses can go ahead and add private insurance (sometimes, provided optionally through an employer or a professional union)

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"Skinny" repeal was rightly called so because it only sought to repeal some provisions (and even then it failed.) This is what I meant by using the word "altogether," because as you know the "altogether" repeal of the act failed by more than one vote.

Sure. Repeal and replace failed by 7 votes. Hardly impossible. Impossible would be removing Stephen Breyer, who was confirmed 87-9. You and I have different scales for impossible. But that's fine. Now they're can be calibrated.

Absolutely, and my argument was never 100% public option or bust. I think that the incentive of the public option being favorable is good and entails a larger public share, but I don't say I want the public share to be as big as possible in that it removes private options by legislation, only in that, as is the case elsewhere, the public favors it overwhelmingly over adding an additional private choice.

I generally don't have a problem with a public option competing with private options. The main problem in the future would be those inherent to any monopoly. If the public option was "so good" that it became the sole competitor left in the market, then it holds a monopoly and can then dictate whatever it wants if there are substantial barriers to entry into the market (as there likely are for healthcare since risk-pooling necessitates a big enough pool for the law of large numbers to apply). Further, since tax revenue would be used for this whole scheme, it's easy for the government to raise taxes, skim some of that tax revenue off the top, and use it for other things. Then it could become a giant Ponzi scheme like what Medicare is today. That's an issue for the future and I would be willing to try a public option out and see where it goes. If it gains a monopsony and starts acting like that, then I think protections would be warranted in that case.

I hate to have an article make my argument for me because it's a bit lazy, but it conveys that the United States isn't "bearing the burden" for everyone else's price-controlling practices to be viable, as you seem to suggest. I think you'd be pressed to argue that pharmaceutical industries abroad subsist by cannibalizing smaller companies and have done so for the last few decades.

That article does not take into account the fact that even though other countries pay into R&D but negotiate down prices, the U.S. still remains a market that does not do so and thus companies can afford to make less in those countries if they can make it up by charging more here. Again, we're subsidizing everybody else. If we also dictate low costs to these companies, who's left to eat the cost? Where can they make it up then? Again, you seem to be under this grand impression that we can both cut costs and make everybody happy at the same time. We can't. You have a small margin with which to work where they'll take reduced profits but after that, you're cutting into R&D and marketing funds - simultaneously.

The difference is that the U.S. is a huge system compared to these other countries. The U.S. is a huge source of revenue for pharma. Take a look: Pharma revenue: worldwide share by country 2017 | Statistic. All of Western Europe still only makes up 67% of what the U.S. pharma revenue is. It's easy for someone on the outside to say that you can just cut costs. But once you see their balance sheets, it becomes a lot harder. I've been there.

This was neither my contention nor yours, if 60% of NIH funding goes into useful therapeutic use, given about $67 billion in private "biopharmaceutical" research spending that clocks at about a fifth of all R&D spending, which is not a small fraction or a small cost. I never suggested it was the majority.

A fifth at maximum. As I have already noted, 60% is likely a generous estimate since the vast majority of NIH research is basic science and only a small percentage of that makes it into improving human health. Further, new drugs are costing more. You're citing data from 2010. More recent data: http://www.sciencemag.org/news/2017...t-share-basic-research-funding-falls-below-50. Not only is U.S. government funding falling, but the private sector spent over $100 billion on R&D in 2015. So government funding of R&D that eventually makes it into clinical use is much smaller than 20%. So yes, it is a small fraction. Talk to anybody - quite literally anybody - with knowledge of the industry and they'll say the same thing. Academics just like to delude themselves into thinking that they are doing most of the work.

As we've discussed before, there seems to be discrepancy in how we use "single-payer," which I thought was clearer since we are talking about the United Kingdom and Spain, neither of which bars private competition. Though I'd be too arrogant to put a single number of what I find is reasonable, the United Kingdom clocks at a healthy 10.5% of citizens having private insurance as of 2015—I don't think under 20% is a serious bargaining ability loss, but any number I give relies on data that we simply do not have (for every increasing % market participation of private sector, how much does the incentive of pharmaceutical and technology companies to negotiate with the government for public inclusion change?) I can however, reasonably guess that there is a negative correlation in there.

I think that anything termed "single payer" should be used when there is only one payer. Hence "single payer." Imagine how outrageous it would be if I barged into the "single occupancy" stall you were sitting in. Sure, I just wanted to have some sort of number to visualize this. So would this still be the system you argue for if there is 25% intrusion by the private sector (because people wanted the extra coverage)? In other words, say a pharma company sets a drug price at $1000 and the public option won't pay more than $100. But the private insurance market (25% of the total market) will. Is that an acceptable outcome to you?

If everyone contributes to the public option, I don't think there would be a need to set "premiums," as systems like the NHS receive their funding directly from general taxation, i.e. they're not going on the market and setting price levels rather than everyone pays for it and whoever so chooses can go ahead and add private insurance (sometimes, provided optionally through an employer or a professional union)

I'm being lax with terms here. As with any public system, a "premium" would be paid directly to the government in the form of taxes. It's just to keep terms analogous between the public and private options here because we would have both. Presumably you would agree with an actuarially-fair premium/tax, community rated? Otherwise, I'd like to hear any argument that advocates for a higher premium/tax. And I don't believe that employer-based or professional union-based private options, as is common in Germany and Japan, should be the only options. Why exclude the people who don't or can't work? The private market should have options for everybody who wants to be covered by the private market so there should be a private marketplace.
 
My opinion is: it's good.

Guaranteed universal free healthcare is imperative. Healthcare should not be a business and thinking that "the market" will efficiently and humanely distribute healthcare is evil and completely delusional and detached from reality, given the clear evidence of how insanely wasteful and expensive healthcare is in this country.

Single payer is one good way to achieve universal coverage. It's not the only way, but Medicare For All is the best thing to support right now because it is a good policy that is actually being discussed and has growing support behind it.
 
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Wait until you see what Medicaid pays. Then take out the private payers that keep the lights on.


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So to be clear, you're ok ever-rising healthcare costs and 10% of the population having no insurance to pay for it (a number sure to rise itself now that there is no mandate)? Unlike most of the posters here that have contributed thoughtful, educated opinions, yours have been nothing but snark - how about starting with whether our healthcare systems has the problems I've mentioned, and if so, what you would do to fix them.
 
The difference is that the U.S. is a huge system compared to these other countries. The U.S. is a huge source of revenue for pharma. Take a look: Pharma revenue: worldwide share by country 2017 | Statistic. All of Western Europe still only makes up 67% of what the U.S. pharma revenue is. It's easy for someone on the outside to say that you can just cut costs. But once you see their balance sheets, it becomes a lot harder. I've been there.

What about all that money they spent to lobby congress during the drafting of the ACA, or to get Medicare part D passed so they can charge whatever they want for drugs? How can you tout the free market solution to healthcare when these companies use their clout to influence legislation that essentially gives them monopolies on what they can charge?
 
So to be clear, you're ok ever-rising healthcare costs and 10% of the population having no insurance to pay for it (a number sure to rise itself now that there is no mandate)? Unlike most of the posters here that have contributed thoughtful, educated opinions, yours have been nothing but snark - how about starting with whether our healthcare systems has the problems I've mentioned, and if so, what you would do to fix them.
The loss of huge portions of the population as customers would be it’s own cost control mechanism.....much like college loans, “everyone can afford everything” makes it expensive
 
Sure. Repeal and replace failed by 7 votes. Hardly impossible. Impossible would be removing Stephen Breyer, who was confirmed 87-9. You and I have different scales for impossible. But that's fine. Now they're can be calibrated.
This is a purely semantic argument, I think we both understand that the chances that every provision of the ACA is repealed are very low in the foreseeable future despite much rhetoric to the contrary in years previous to, and leading up into election year, and not because of party line votes. Certainly, political stakes can conceivably change, but the fact a majority-GOP congress and president (and a respective constituency as well) who seemed to overwhelmingly advocate "repeal and replace" were unable to do so (despite repealing some portions which did have their fare share of problems, because the ACA was far from an infallible piece of legislation) is a solid indicator that the ground has been shifted.

I generally don't have a problem with a public option competing with private options. The main problem in the future would be those inherent to any monopoly. If the public option was "so good" that it became the sole competitor left in the market, then it holds a monopoly and can then dictate whatever it wants if there are substantial barriers to entry into the market (as there likely are for healthcare since risk-pooling necessitates a big enough pool for the law of large numbers to apply). Further, since tax revenue would be used for this whole scheme, it's easy for the government to raise taxes, skim some of that tax revenue off the top, and use it for other things. Then it could become a giant Ponzi scheme like what Medicare is today. That's an issue for the future and I would be willing to try a public option out and see where it goes. If it gains a monopsony and starts acting like that, then I think protections would be warranted in that case.
OK. Nobody said sole competitor but I see how the government could use health-allocated revenue for other uses than healthcare (though this does not go unnoticed by political adversaries.) As for the solvency of private risk pool with a small market share, refer to my post at the bottom of page 4.

That article does not take into account the fact that even though other countries pay into R&D but negotiate down prices, the U.S. still remains a market that does not do so and thus companies can afford to make less in those countries if they can make it up by charging more here. Again, we're subsidizing everybody else. If we also dictate low costs to these companies, who's left to eat the cost? Where can they make it up then? Again, you seem to be under this grand impression that we can both cut costs and make everybody happy at the same time. We can't. You have a small margin with which to work where they'll take reduced profits but after that, you're cutting into R&D and marketing funds - simultaneously.
The difference is that the U.S. is a huge system compared to these other countries. The U.S. is a huge source of revenue for pharma. Take a look: Pharma revenue: worldwide share by country 2017 | Statistic. All of Western Europe still only makes up 67% of what the U.S. pharma revenue is. It's easy for someone on the outside to say that you can just cut costs. But once you see their balance sheets, it becomes a lot harder. I've been there.
You can't make the industries which profit disproportionately from their products happy by cutting costs, but this does not halt the financial incentive that research elicits, which is the reason that they invest in R&D and (in some cases, twice as much in) marketing . That the returns on investing on research decrease does not mean that pharmaceutical companies do not still use R&D at home and abroad for the safe market that an exclusively manufactured drug represents. This isn't a change in the incentive system, which is what powers research, it's a change in the profits. Though this depends on the magnitude of the change, this analysis in Nature (chart under this) shows that "large revenue declines" did not result in a decrease in R&D for most sampled companies, and where there were cuts most of those were exceeded by the administrative, selling and general expenses (meaning that R&D grew as a percent of company budget relative to this.) The diminishing returns inherent of R&D may present an even more serious existential threat to R&D unrelated to healthcare systems.

nrd.2017.81-f1.jpg


This claim also ignores the point made in the previously cited study (and in this one) that the United State's production of NMEs is smaller relative to their share of sales in the global market. The implication here is not that the size of the United States market doesn't make it the most important single contributor to global pharmaceutical R&D, it is that, as the chart above also suggests, companies can operate at lower levels of revenue without killing R&D. Could we see a smaller R&D investment independent of aforementioned reasons if the U.S. per capita spending on pharmaceuticals decreased by 30%, to a level closer to that of Germany? Perhaps, but this doesn't mean a halt on research and it would reduce the burden that that Americans take. If this is disruptive to drug discovery, it is up to the United States but also our European neighbors to make for a more equitable burden and thus avoid an outcome that is to everybody's detriment, because at the present costs are hurting Americans more than they're hurting Europeans (or perhaps than they're even helping Americans by the unquestionable benefit of research.)

It's also worthy of note that 1)a good chunk of pharmaceutical costs are incurred in paying middlemen, including pharmacy benefit managers and wholesalers, not manufacturers, and 2)the setting of prices at a more reasonable level does not necessitate legislating price controls or profit controls, which some countries do, or for that matter legislating those at any particular level. Even if we assume that these companies are operating on tight budgets and barely making dividends for shareholders and owners, we could lower costs without even touching manufacturers.

A fifth at maximum. As I have already noted, 60% is likely a generous estimate since the vast majority of NIH research is basic science and only a small percentage of that makes it into improving human health. Further, new drugs are costing more. You're citing data from 2010. More recent data: http://www.sciencemag.org/news/2017...t-share-basic-research-funding-falls-below-50. Not only is U.S. government funding falling, but the private sector spent over $100 billion on R&D in 2015. So government funding of R&D that eventually makes it into clinical use is much smaller than 20%. So yes, it is a small fraction. Talk to anybody - quite literally anybody - with knowledge of the industry and they'll say the same thing. Academics just like to delude themselves into thinking that they are doing most of the work.
Again, you're trying to pin me into something I did not argue. I don't think a fifth is a small fraction, especially considering the amount that fifth is. That the pharmaceutical industry that profits from those breakthroughs invests more is sensible and expected (for the sake of not having to guess, this study stressing the importance of private pharma estimates spending in different phases as seen below)

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I think that anything termed "single payer" should be used when there is only one payer. Hence "single payer." Imagine how outrageous it would be if I barged into the "single occupancy" stall you were sitting in.
In public consultations and hospitals, there is usually indeed a single payer, and private insurances operate as a separate system from the NHS (with no deductions to those who add them on) which is why its, for the sake of simplicity, called single payer by some sources. I can see how it can be confusing, however.


Sure, I just wanted to have some sort of number to visualize this. So would this still be the system you argue for if there is 25% intrusion by the private sector (because people wanted the extra coverage)? In other words, say a pharma company sets a drug price at $1000 and the public option won't pay more than $100. But the private insurance market (25% of the total market) will. Is that an acceptable outcome to you?
It's not a desirable outcome for a medication to only be available privately because it excludes 75% of the market in this scenario, but assuming that 25% of the market is private sector and the manufacturer/distributors aren't compelled to lower prices by the prospect of 75% market exclusion and negotiation is unfruitful, yes, that is an acceptable outcome. The idea is to make that outcome as unlikely as possible, since it can incentivize further private inclusion and loss of competitiveness by the public option.

I'm being lax with terms here. As with any public system, a "premium" would be paid directly to the government in the form of taxes. It's just to keep terms analogous between the public and private options here because we would have both. Presumably you would agree with an actuarially-fair premium/tax, community rated?
Provided that this tax offers adequate coverage, yes. Community rating, in the sense of not raising costs on the basis of individual characteristics, appears entirely sound.

Otherwise, I'd like to hear any argument that advocates for a higher premium/tax. And I don't believe that employer-based or professional union-based private options, as is common in Germany and Japan, should be the only options. Why exclude the people who don't or can't work? The private market should have options for everybody who wants to be covered by the private market so there should be a private marketplace.
Didn't say this was the only option, only the most frequent one. About a third of people using private insurance in the UK, for instance, do so on their own and pay for it on their own, which is a real option. The rest do so through employers.
 
My opinion is: it's good.

Guaranteed universal free healthcare is imperative. Healthcare should not be a business and thinking that "the market" will efficiently and humanely distribute healthcare is evil and completely delusional and detached from reality, given the clear evidence of how insanely wasteful and expensive healthcare is in this country.

Single payer is one good way to achieve universal coverage. It's not the only way, but Medicare For All is the best thing to support right now because it is a good policy that is actually being discussed and has growing support behind it.
Healthcare is sinply not a right
 
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Healthcare is sinply not a right
I don't wanna hog the conversation, but I've been meaning to ask you and this is a good chance. What do you think makes a right?
 
You're deluding yourself if you think any of that is "free."

Free at the point of delivery is obviously what I meant. And on a broader level it's impossible to defend the US healthcare system as being more efficient than the less market-centric systems in other countries. A cursory look at the data will show you that this simply isn't true. We pay more for worse outcomes.

Healthcare is sinply not a right

Yes, it is.
 
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I don't wanna hog the conversation, but I've been meaning to ask you and this is a good chance. What do you think makes a right?
Are you familiar with the concept of negative rights as opposed to claims of positive "rights"?
 
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Are you familiar with the concept of negative rights as opposed to claims of positive "rights"?
Yep. Adding quotes doesn't make them less justifiable as a category. This isn't to say that every positive right is justifiable or that positive rights are more inherently right or wrong than negative rights.
Do you think you can deduce how positive rights are wrong, or less real without using value judgments?
 
Free at the point of delivery is obviously what I meant. And on a broader level it's impossible to defend the US healthcare system as being more efficient than the less market-centric systems in other countries. A cursory look at the data will show you that this simply isn't true. We pay more for worse outcomes.



Yes, it is.
Statistics from the CDC:
"Health risk behaviors are unhealthy behaviors you can change. Four of these health risk behaviors—lack of exercise or physical activity, poor nutrition, tobacco use, and drinking too much alcohol—cause much of the illness, suffering, and early death related to chronic diseases and conditions.

  • In 2015, 50% of adults aged 18 years or older did not meet recommendations for aerobic physical activity. In addition, 79% did not meet recommendations for both aerobic and muscle-strengthening physical activity.7
  • More than 1 in 3 adults (about 92.1 million) have at least one type of cardiovascular disease.8 About 90% of Americans aged 2 years or older consume too much sodium, which can increase their risk of high blood pressure.9
  • In 2015, more than 37% of adolescents and 40% of adults said they ate fruit less than once a day, while 39% of adolescents and 22% of adults said they ate vegetables less than once a day.10
  • An estimated 36.5 million adults in the United States (15.1%) said they currently smoked cigarettes in 2015.11 Cigarette smoking accounts for more than 480,000 deaths each year.12 Each day, more than 3,200 youth younger than 18 years smoke their first cigarette, and another 2,100 youth and young adults who smoke every now and then become daily smokers.12"

Of course we have worse outcomes, we have a sicker population than all of those countries. Our citizens should have access to healthy food options and good health advice. People should have a right to emergency services, people should have a right to yearly check ups and very basic services, but people don't have a right to treat their body like crap and engage in health risk behavior and then force me to pay for the chronic illnesses that develop. Individuals need to take responsibility for their own health. I'm not saying the current system is the answer, but that universal free healthcare is not the answer either. Someone has to pay for the enormous price tag on that and hoisting it upon the rest of the country is not ethical.

We need to make our population healthier, and free healthcare doesn't fix that. Until we encourage people to take responsibility for their own health then our problems will persist.
 
Yep. Adding quotes doesn't make them less justifiable as a category. This isn't to say that every positive right is justifiable or that positive rights are more inherently right or wrong than negative rights.
Do you think you can deduce how positive rights are wrong, or less real without using value judgments?
In the same way that you can't prove how murder isn't wrong without using a value judgement......it's an odd task to ask of someone

I don't have any claim to someone's goods and or services without their consent. So making someone buy my healthcare is not something I have a right to do. If I die for lack of care, no one has violated my rights just because they didn't provide it to me (unless we had agreed on a price, I paid it, and then they failed to deliver)
 
In the same way that you can't prove how murder isn't wrong without using a value judgement......it's an odd task to ask of someone
Except it's much easier to conceive of someone (like @hat) supporting positive rights than it is to conceive of people who want to prove murder isn't wrong. It's not even slightly equivalent (society doesn't collapse because you have some positive rights)

I don't have any claim to someone's goods and or services without their consent. So making someone buy my healthcare is not something I have a right to do. If I die for lack of care, no one has violated my rights just because they didn't provide it to me (unless we had agreed on a price, I paid it, and then they failed to deliver)
This relies on those value judgments, with the same certainty with which you say nobody has a claim to your goods or services, I can say that the government whose representatives we democratically elect has a claim to a portion of our wealth to better the lives of its constituents. And that if you die for lack of a care that exists and can be available to you, somewhere along the line of healthcare production and distribution we have failed to provide you with the positive right to have adequate healthcare to the extent it is humanly and logistically possible and therefore not be subject to debilitating or lethal conditions that threaten your basic well-being.
This isn't to say that I am by default right or wrong in making this value judgment, only that it exists, it is prevalent, and it is not comparable to murder in justification or effect.
 
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Except it's much easier to conceive of someone (like @hat) supporting positive rights than it is to conceive of people who want to prove murder isn't wrong. It's not even slightly equivalent (society doesn't collapse because you have some positive rights)


This relies on those value judgments, with the same certainty with which you say nobody has a claim to your goods or services, I can say that the government whose representatives we democratically elect has a claim to a portion of our wealth to better the lives of its constituents. And that if you die for lack of a care that exists and can be available to you, somewhere along the line of healthcare production and distribution we have failed to provide you with the positive right to have adequate healthcare to the extent it is humanly and logistically possible and therefore not be subject to debilitating or lethal conditions that threaten your basic well-being.
This isn't to say that I am by default right or wrong in making this value judgment, only that it exists, it is prevalent, and it is not comparable to murder in justification or effect.
You can claim that society doesn't collapse if we wrongly adopt a notion of positive rights, but at that point we are violating the negative rights of those forced to pay for everyone else.....that is not acceptable and the number of people liking the ability to take other people's stuff can't make it right. It just becomes a popular violation of rights
 
Statistics from the CDC:
"Health risk behaviors are unhealthy behaviors you can change. Four of these health risk behaviors—lack of exercise or physical activity, poor nutrition, tobacco use, and drinking too much alcohol—cause much of the illness, suffering, and early death related to chronic diseases and conditions.

  • In 2015, 50% of adults aged 18 years or older did not meet recommendations for aerobic physical activity. In addition, 79% did not meet recommendations for both aerobic and muscle-strengthening physical activity.7
  • More than 1 in 3 adults (about 92.1 million) have at least one type of cardiovascular disease.8 About 90% of Americans aged 2 years or older consume too much sodium, which can increase their risk of high blood pressure.9
  • In 2015, more than 37% of adolescents and 40% of adults said they ate fruit less than once a day, while 39% of adolescents and 22% of adults said they ate vegetables less than once a day.10
  • An estimated 36.5 million adults in the United States (15.1%) said they currently smoked cigarettes in 2015.11 Cigarette smoking accounts for more than 480,000 deaths each year.12 Each day, more than 3,200 youth younger than 18 years smoke their first cigarette, and another 2,100 youth and young adults who smoke every now and then become daily smokers.12"

Of course we have worse outcomes, we have a sicker population than all of those countries. Our citizens should have access to healthy food options and good health advice. People should have a right to emergency services, people should have a right to yearly check ups and very basic services, but people don't have a right to treat their body like crap and engage in health risk behavior and then force me to pay for the chronic illnesses that develop. Individuals need to take responsibility for their own health. I'm not saying the current system is the answer, but that universal free healthcare is not the answer either. Someone has to pay for the enormous price tag on that and hoisting it upon the rest of the country is not ethical.

We need to make our population healthier, and free healthcare doesn't fix that. Until we encourage people to take responsibility for their own health then our problems will persist.

Preventative healthcare helps to address all of these lifestyle factors. People will be more likely to "take responsibility for their own health" if they get free preventative healthcare. We don't have a sicker population than other countries just because we are inherently more lazy and irresponsible. It's because we can't afford healthcare and because of social and economic factors that are known to reliably lead to poor health outcome. For example, poverty and inequality:

"There is a strong relationship between income and health within countries. In any nation you will find that people on high incomes tend to live longer and have fewer chronic illnesses than people on low incomes. Yet, if you look for differences between countries, the relationship between income and health largely disintegrates. Rich Americans, for instance, are healthier on average than poor Americans, as measured by life expectancy. But, although the US is a much richer country than, say, Greece, Americans on average have a lower life expectancy than Greeks. More income, it seems, gives you a health advantage with respect to your fellow citizens, but not with respect to people living in other countries…. Once a floor standard of living is attained, people tend to be healthier when three conditions hold: they are valued and respected by others; they feel ‘in control’ in their work and home lives; and they enjoy a dense network of social contacts. Economically unequal societies tend to do poorly in all three respects: they tend to be characterised by big status differences, by big differences in people’s sense of control and by low levels of civic participation…. Unequal societies, in other words, will remain unhealthy societies – and also unhappy societies – no matter how wealthy they become. Their advocates – those who see no reason whatever to curb ever-widening income differentials – have a lot of explaining to do."

(Happiness, Health and Inequality | naked capitalism)

In regards to your concern about "Someone has to pay for the enormous price tag on that and hoisting it upon the rest of the country is not ethical" - per capita healthcare spending in the US is about twice as much as in other developed countries. We aren't saving money by making everyone pay their own way. If you are opposed to the very principle of society having a collective responsibility to care for its most vulnerable members, even if doing so would save everyone money, then I guess that comes down to a difference in value judgment.
 
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You can claim that society doesn't collapse if we wrongly adopt a notion of positive rights
If we assume that they are wrongly adopted by virtue of being positive rights

but at that point we are violating the negative rights of those forced to pay for everyone else.....
Assuming that there is a negative right not to have your wealth taxed for the benefit of others.
that is not acceptable and the number of people liking the ability to take other people's stuff can't make it right. It just becomes a popular violation of rights
It is not acceptable to you, and that many people like the government having some taxation powers does not make it right, nor did I imply that. What it does is suggest that it isn't some outrageous act comparable to murder to most people, including most constituents, as you did imply.
 
Preventative healthcare helps to address all of these lifestyle factors. People will be more likely to "take responsibility for their own health" if they get free preventative healthcare.

Preventative healthcare is largely already free. No one needs "free healthcare" to tell them to eat better, exercise more, drink less alcohol, or stop using tabacco. In my post I agreed that people should have access to low cost yearly check ups and physicals and basic services. This doesn't translate to "universal free healthcare." Not being able to afford healthcare is not what is making us sick when 1 in 3 adults are obese, 1 in 5 smoke, and 24 million Americans have diabetes.

As for poverty and inequality we need to find a way to bring the bottom up, not force the top down. Taking from the rich to give to the poor is morally wrong as it, quite literally, is stealing. Instead of stealing people's money we need ideas that provide greater access to education and provide easier access to healthier food.
 
Preventative healthcare is largely already free. No one needs "free healthcare" to tell them to eat better, exercise more, drink less alcohol, or stop using tabacco. In my post I agreed that people should have access to low cost yearly check ups and physicals and basic services. This doesn't translate to "universal free healthcare." Not being able to afford healthcare is not what is making us sick when 1 in 3 adults are obese, 1 in 5 smoke, and 24 million Americans have diabetes.

Preventative healthcare is not already free. What country are you living in? Premiums are expensive, copays are expensive, deductibles are high, the mysteries of coding lead to unexpected bills for even low-level service, insurance companies randomly decide to stop covering medications for chronic conditions. And all of these things are getting worse. And again, those statistics you keep pointing to can't be detached from the healthcare system. Unless you are contesting that there is something unique to American culture or genetics that makes them less responsible.

As for poverty and inequality we need to find a way to bring the bottom up, not force the top down. Taking from the rich to give to the poor is morally wrong as it, quite literally, is stealing. Instead of stealing people's money we need ideas that provide greater access to education and provide easier access to healthier food.

There is no way to provide goods and services that doesn't involve the redistribution of wealth. Moreover, the level of wealth inequality in America cannot be justified unless you are an extreme free-market fundamentalist. The wealthiest people in the world have had to use public technology and infrastructure, and are dependent on massive numbers of workers along their entire supply chains for their profits, who more often that not are underpaid to lower labor costs. Not to mention the massive corporate subsidies, tax breaks, and deregulation that have made their wealth possible.

A lot of this comes down to a disagreement over what it means to "earn" something, but I just don't see how anyone could reasonable claim that just because someone does have a certain amount of money, means they should have that amount of money. I'd say that people "earn" more than they are paid when they are working for a minimum wage that has gone down over the past 50 years when adjusting for inflation. The fact that they are paid less then they deserve means their employers get to save that much in labor costs and make that much more profit for themselves. So if you want to talk to me about "stealing," lets also talk about the discrepancy between what an employee earns for their company, vs what they get paid. Or the fact that employers steal billions of dollars annually from their employees in illegal wage theft.

The rub of all this is that redistributing money for social welfare is more defensible than leaving things as they are.

You can claim that society doesn't collapse if we wrongly adopt a notion of positive rights, but at that point we are violating the negative rights of those forced to pay for everyone else.....that is not acceptable and the number of people liking the ability to take other people's stuff can't make it right. It just becomes a popular violation of rights

The distinction between negative and positive rights would maybe make more sense in a society that had a completely different structure than ours, but it doesn't really stand up to scrutiny in a liberal capitalist society. The libertarian fantasy that everyone is a fully autonomous, self-reliant entity born into a blank slate is not real. Even in your ideal world in which the law only enforces contracts and does nothing else, an individual born into this world is not born into a blank slate. Free market capitalism leads inevitably to the concentration of wealth and property into a small number of hands - that's not a value judgment, it's an observation. And there is no reason to assume that that distribution of wealth and property is inherently ethical. At best you can say it's better than the alternative (the victims of communism and whatnot), but all is not in fact "for the best in the best of all possible worlds."

At some point along the way you have to stop and acknowledge that, okay, maybe it isn't actually right that Bill Gates, Jeff Bezos, and Warren Buffet collectively have more wealth than the entire poorest half of the US. And what is the implication of that? There is a limited amount of resources in the world, and they have more than they deserve, and others have less than they deserve. That's an injury. It's a deprivation.

So you're not free - you have no choice over the structure of society you are born into, nor the position you are born into within that society, and you are subject to the law which enforces property rights and contracts, which due to that accumulation disproportionately advantages people who have the most. This isn't anarchism. It's not every-man-for-himself. So to allow increasing inequality to go on unabated, to decline to alleviate the suffering of the growing precarious underclass, and to then use the state's monopoly on legitimate violence to defend wealth and property, the distribution of which is not ethical - that's a diabolical plan that will eventually lead to the reinstatement of feudalism or even slavery.

Like they say, "When the people are being beaten with a stick, they are not much happier if it is called 'the People's Stick'" - but I'd addend that to say they also aren't much happier if it's called "the Private Stick."
 
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If we assume that they are wrongly adopted by virtue of being positive rights


Assuming that there is a negative right not to have your wealth taxed for the benefit of others.

It is not acceptable to you, and that many people like the government having some taxation powers does not make it right, nor did I imply that. What it does is suggest that it isn't some outrageous act comparable to murder to most people, including most constituents, as you did imply.
it is an outrageous act comparable to theft because it is literally theft

Preventative healthcare is not already free. What country are you living in? Premiums are expensive, copays are expensive, deductibles are high, the mysteries of coding lead to unexpected bills for even low-level service, insurance companies randomly decide to stop covering medications for chronic conditions. And all of these things are getting worse. And again, those statistics you keep pointing to can't be detached from the healthcare system. Unless you are contesting that there is something unique to American culture or genetics that makes them less responsible.



There is no way to provide goods and services that doesn't involve the redistribution of wealth. Moreover, the level of wealth inequality in America cannot be justified unless you are an extreme free-market fundamentalist. The wealthiest people in the world have had to use public technology and infrastructure, and are dependent on massive numbers of workers along their entire supply chains for their profits, who more often that not are underpaid to lower labor costs. Not to mention the massive corporate subsidies, tax breaks, and deregulation that have made their wealth possible.

A lot of this comes down to a disagreement over what it means to "earn" something, but I just don't see how anyone could reasonable claim that just because someone does have a certain amount of money, means they should have that amount of money. I'd say that people "earn" more than they are paid when they are working for a minimum wage that has gone down over the past 50 years when adjusting for inflation. The fact that they are paid less then they deserve means their employers get to save that much in labor costs and make that much more profit for themselves. So if you want to talk to me about "stealing," lets also talk about the discrepancy between what an employee earns for their company, vs what they get paid. Or the fact that employers steal billions of dollars annually from their employees in illegal wage theft.

The rub of all this is that redistributing money for social welfare is more defensible than leaving things as they are.



The distinction between negative and positive rights would maybe make more sense in a society that had a completely different structure than ours, but it doesn't really stand up to scrutiny in a liberal capitalist society. The libertarian fantasy that everyone is a fully autonomous, self-reliant entity born into a blank slate is not real. Even in your ideal world in which the law only enforces contracts and does nothing else, an individual born into this world is not born into a blank slate. Free market capitalism leads inevitably to the concentration of wealth and property into a small number of hands - that's not a value judgment, it's an observation. And there is no reason to assume that that distribution of wealth and property is inherently ethical. At best you can say it's better than the alternative (the victims of communism and whatnot), but all is not in fact "for the best in the best of all possible worlds."

At some point along the way you have to stop and acknowledge that, okay, maybe it isn't actually right that Bill Gates, Jeff Bezos, and Warren Buffet collectively have more wealth than the entire poorest half of the US. And what is the implication of that? There is a limited amount of resources in the world, and they have more than they deserve, and others have less than they deserve. That's an injury. It's a deprivation.

So you're not free - you have no choice over the structure of society you are born into, nor the position you are born into within that society, and you are subject to the law which enforces property rights and contracts, which due to that accumulation disproportionately advantages people who have the most. This isn't anarchism. It's not every-man-for-himself. So to allow increasing inequality to go on unabated, to decline to alleviate the suffering of the growing precarious underclass, and to then use the state's monopoly on legitimate violence to defend wealth and property, the distribution of which is not ethical - that's a diabolical plan that will eventually lead to the reinstatement of feudalism or even slavery.

Like they say, "When the people are being beaten with a stick, they are not much happier if it is called 'the People's Stick'" - but I'd addend that to say they also aren't much happier if it's called "the Private Stick."
we do not actually have to declare that it’s wrong for someone to have 2, 20 or even 2,000,000,000 times as much money as someone else
 
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it is an outrageous act comparable to theft because it is literally theft
It isn't morally equivalent to theft despite being an involuntary levy. It is chosen by elective representatives and levied over established periods of time, which is qualitatively very different from someone taking your wallet.
If we're to take such a reductivist logic, any taxation and anything other than money given voluntarily is theft. Could I decline paying for representative government, armies for basic self defense, and the basic functions of government and law enforcement (i.e. stopping burglars and murderers,) provided for in the constitution because I disagree with or am indifferent to them? Or does the end of this taxation being likely in my self interest trump my consent?

we do not actually have to declare that it’s wrong for someone to have 2, 20 or even 2,000,000,000 times as much money as someone else
The assumption you make here being that higher taxes serve a punitive role, whereas their role is to make taxation amenable to everyone beyond the point where the burden threatens individual welfare to a point we consider unreasonable.
 
It isn't morally equivalent to theft despite being an involuntary levy. It is chosen by elective representatives and levied over established periods of time, which is qualitatively very different from someone taking your wallet.
If we're to take such a reductivist logic, any taxation and anything other than money given voluntarily is theft. Could I decline paying for representative government, armies for basic self defense, and the basic functions of government and law enforcement (i.e. stopping burglars and murderers,) provided for in the constitution because I disagree with or am indifferent to them? Or does the end of this taxation being likely in my self interest trump my consent?


The assumption you make here being that higher taxes serve a punitive role, whereas their role is to make taxation amenable to everyone beyond the point where the burden threatens individual welfare to a point we consider unreasonable.
It’s irrelevant how many people take my money at the threat of gun point when discussing theft’s morality.
It is wrong when 5 guys do it, when 500 do it, or when 51% of my neighbors do it

And yes, higher income taxes on the wealthier are punitive
 
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It’s irrelevant how many people take my money at the threat of gun point when discussing theft’s morality.
It is wrong when 5 guys do it, when 500 do it, or when 51% of my neighbors do it
I didn't know the IRS came to take your taxes at gunpoint, the 1098EZ really IS the easy way to pay!
(This is a jokey way of saying, you're making things up. Nobody is coming to the houses of every tax-paying American and pointing guns at them. I understand how being arrested for tax evasion entails going to a station and eventually prison at the hands of armed law enforcement, but claiming that this is some sort of frequent happening or that the fact that it can happen means that it is happening is, obviously, not true. It's a poor way to rhetorically give taxation the qualitative features of what everyone actually means by theft, which is the illegal taking of another person's property without their consent)

And yes, higher income taxes on the wealthier are punitive
Repeating that it is punitive does not make it so.

Oh, and you didn't answer my earlier question. Let me add the quote below for you in case you missed it
Could I decline paying for representative government, armies for basic self defense, and the basic functions of government and law enforcement (i.e. stopping burglars and murderers,) provided for in the constitution because I disagree with or am indifferent to them? Or does the end of this taxation being likely in my self interest trump my consent?
 
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This is a purely semantic argument, I think we both understand that the chances that every provision of the ACA is repealed are very low in the foreseeable future despite much rhetoric to the contrary in years previous to, and leading up into election year, and not because of party line votes. Certainly, political stakes can conceivably change, but the fact a majority-GOP congress and president (and a respective constituency as well) who seemed to overwhelmingly advocate "repeal and replace" were unable to do so (despite repealing some portions which did have their fare share of problems, because the ACA was far from an infallible piece of legislation) is a solid indicator that the ground has been shifted.

Shifted? Sure. Impossible to get rid of? I hardly think so. Very hard at this stage, yes. It really all depends on what happens in the midterms elections and what direction the country is going in. Repeal and replace failed not due to the repealing part but the lack of a viable alternative solution - at least to many of those who voted against it. The ACA itself is a flawed piece of legislation and I would not be surprised if a more suitable alternative was developed and passed in the future. To think that it's infallible is to think that Hilary's victory was inevitable.

OK. Nobody said sole competitor but I see how the government could use health-allocated revenue for other uses than healthcare (though this does not go unnoticed by political adversaries.) As for the solvency of private risk pool with a small market share, refer to my post at the bottom of page 4.

Putin has his political adversaries too. So does Trump. That statement is a truism in and of itself. What's more important is whether there is a sufficient system in place that can check that sort of abuse before it occurs. Don't want a repeat of Medicare.

You can't make the industries which profit disproportionately from their products happy by cutting costs, but this does not halt the financial incentive that research elicits, which is the reason that they invest in R&D and (in some cases, twice as much in) marketing . That the returns on investing on research decrease does not mean that pharmaceutical companies do not still use R&D at home and abroad for the safe market that an exclusively manufactured drug represents. This isn't a change in the incentive system, which is what powers research, it's a change in the profits. Though this depends on the magnitude of the change, this analysis in Nature (chart under this) shows that "large revenue declines" did not result in a decrease in R&D for most sampled companies, and where there were cuts most of those were exceeded by the administrative, selling and general expenses (meaning that R&D grew as a percent of company budget relative to this.) The diminishing returns inherent of R&D may present an even more serious existential threat to R&D unrelated to healthcare systems.

I never said that it would "halt" research. You can be perfectly content arguing against that straw man you created but your solution would undoubtedly reduce the financial incentive of research. Less revenue = less financial incentive. Could they make cuts elsewhere too? Sure. But you by definition change the whole financial structure if one sole buyer negotiates down prices for the entire market. What I'm seeing in that paper is 1) that R&D spending closely tracks revenue except in the last few years where there is divergence and exception for a few companies and 2) their scatter plot measures changes in spending from one year to the next immediately after a year in which there was a decline in revenue. R&D decisions, against which I've personally been involved in, are not decisions you make on a year-to-year basis. The people in charge of R&D are different from the people in charge of strategy. Declines in revenue necessitates longer-term restructuring of the company's financial outlays and that restructuring manifests in more long-term changes in spending. For instance, I would expect to see less R&D spending over a period of 1 to 3 years after a period of 3+ years of consistent revenue decline from my experience in the industry. Companies typically don't make spending budgets based on just one or two years of revenue declines. They prefer to look at longer-term market trends. The main shortcoming of this study is that it focuses on a very specific time frame because it's looking for a specific answer that the authors set out to look for. I would vet your studies more before citing them.

This claim also ignores the point made in the previously cited study (and in this one) that the United State's production of NMEs is smaller relative to their share of sales in the global market. The implication here is not that the size of the United States market doesn't make it the most important single contributor to global pharmaceutical R&D, it is that, as the chart above also suggests, companies can operate at lower levels of revenue without killing R&D. Could we see a smaller R&D investment independent of aforementioned reasons if the U.S. per capita spending on pharmaceuticals decreased by 30%, to a level closer to that of Germany? Perhaps, but this doesn't mean a halt on research and it would reduce the burden that that Americans take. If this is disruptive to drug discovery, it is up to the United States but also our European neighbors to make for a more equitable burden and thus avoid an outcome that is to everybody's detriment, because at the present costs are hurting Americans more than they're hurting Europeans (or perhaps than they're even helping Americans by the unquestionable benefit of research.)

Again, I do not argue that it would halt research. It just alters the financial incentives (reduces) for research. Yet again, you're ignoring the fact that causing big structural changes to the system changes that system itself in such a way that previous assumptions no longer necessarily hold. That is, your study is basically a cross-sectional one. It shows what's happening at some set point in time. It makes no observations about what would happen if big structural changes happen. In other words, just because another country can operate on a single payer system and negotiate down prices without affecting pharma R&D overall doesn't mean that the U.S. can suddenly do that too because that changes the system and you would have to expect structural changes in response. Find a longitudinal study that measures the effect of a large, global market changing from a free market to one that negotiates down pharma prices on pharma R&D spending. That'll make you more believable.

It's also worthy of note that 1)a good chunk of pharmaceutical costs are incurred in paying middlemen, including pharmacy benefit managers and wholesalers, not manufacturers, and 2)the setting of prices at a more reasonable level does not necessitate legislating price controls or profit controls, which some countries do, or for that matter legislating those at any particular level. Even if we assume that these companies are operating on tight budgets and barely making dividends for shareholders and owners, we could lower costs without even touching manufacturers.

I'll address (2) here. What functional difference is there between legislating a price ceiling and a single-payer government saying "No, we won't pay you a price above this"? Who defines reasonable? In both cases, it's the government that defines reasonable. So the difference is a legal and not functional one.

Again, you're trying to pin me into something I did not argue. I don't think a fifth is a small fraction, especially considering the amount that fifth is. That the pharmaceutical industry that profits from those breakthroughs invests more is sensible and expected (for the sake of not having to guess, this study stressing the importance of private pharma estimates spending in different phases as seen below)

As I already stated above, with evidence, that number is much likely much much less than 1/5. It is reasonable that pharma invests more given that they profit more. But that's not the point of the argument. You made the argument that a significant amount of R&D funding comes from the taxpayer. It does not.

In public consultations and hospitals, there is usually indeed a single payer, and private insurances operate as a separate system from the NHS (with no deductions to those who add them on) which is why its, for the sake of simplicity, called single payer by some sources. I can see how it can be confusing, however.

Perhaps the term "Beveridge model" should enter into your vocabulary.

It's not a desirable outcome for a medication to only be available privately because it excludes 75% of the market in this scenario, but assuming that 25% of the market is private sector and the manufacturer/distributors aren't compelled to lower prices by the prospect of 75% market exclusion and negotiation is unfruitful, yes, that is an acceptable outcome. The idea is to make that outcome as unlikely as possible, since it can incentivize further private inclusion and loss of competitiveness by the public option.

Nobody is arguing that it's desirable. In an ideal world, everybody would have everything they could possibly want and not have to work. Too bad I don't live in that world. As long as you can accept that the public option and the private options will compete and let the chips fall where they may, then that's fine with me.

Provided that this tax offers adequate coverage, yes. Community rating, in the sense of not raising costs on the basis of individual characteristics, appears entirely sound.

It offers what you define to be adequate coverage at an actuarially fair price for that coverage. Is there another sense of community rating that I am not aware of?
 
What about all that money they spent to lobby congress during the drafting of the ACA, or to get Medicare part D passed so they can charge whatever they want for drugs? How can you tout the free market solution to healthcare when these companies use their clout to influence legislation that essentially gives them monopolies on what they can charge?

1) It's not a monopoly because there are many competitors. Patents create virtual monopolies for specific drugs but they also do so in other fields and are necessary for innovation.

2) Every industry lobbies Congress. If I had it my way, there would be no lobbying at all. But alas, the existence of lobbying is what makes us a democracy.

3) Can you be more specific on what pieces of legislation you're referring to?
 
I didn't know the IRS came to take your taxes at gunpoint, the 1098EZ really IS the easy way to pay!
(This is a jokey way of saying, you're making things up. Nobody is coming to the houses of every tax-paying American and pointing guns at them. I understand how being arrested for tax evasion entails going to a station and eventually prison at the hands of armed law enforcement, but claiming that this is some sort of frequent happening or that the fact that it can happen means that it is happening is, obviously, not true. It's a poor way to rhetorically give taxation the qualitative features of what everyone actually means by theft, which is the illegal taking of another person's property without their consent)


Repeating that it is punitive does not make it so.

Oh, and you didn't answer my earlier question. Let me add the quote below for you in case you missed it
The threat of them showing up at gun point....which they will totally do....is how taxes get paid.
 
So to be clear, you're ok ever-rising healthcare costs and 10% of the population having no insurance to pay for it (a number sure to rise itself now that there is no mandate)? Unlike most of the posters here that have contributed thoughtful, educated opinions, yours have been nothing but snark - how about starting with whether our healthcare systems has the problems I've mentioned, and if so, what you would do to fix them.

The poster above me said Medicare for everyone was the best plan to support. My post is not snark, it’s a fact. Take away private insurance and substitute Medicare for everyone and watch what happens. You will be in trouble if you’re the one responsible for keeping the lights on and paying the ancillary staff. Nurses and techs don’t bill and equipment doesn’t pay for itself. Go look what Medicaid pays for some procedures. What you get vs Private Insurance. What the facility fees are. There’s a reason many physicians don’t accept Medicaid/Medicare patients, or limit their census.


--
Il Destriero
 
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Shifted? Sure. Impossible to get rid of? I hardly think so. Very hard at this stage, yes. It really all depends on what happens in the midterms elections and what direction the country is going in. Repeal and replace failed not due to the repealing part but the lack of a viable alternative solution - at least to many of those who voted against it. The ACA itself is a flawed piece of legislation and I would not be surprised if a more suitable alternative was developed and passed in the future. To think that it's infallible is to think that Hilary's victory was inevitable.

I don't think a better alternative in terms of coverage is unlikely, no contest there. What I think is, if not impossible then very unlikely is returning to less coverage and to a lack of controls in preexisting conditions.

Putin has his political adversaries too. So does Trump. That statement is a truism in and of itself. What's more important is whether there is a sufficient system in place that can check that sort of abuse before it occurs. Don't want a repeat of Medicare.
Unlike Mr. Putin, we don't jail or exclude political adversaries from government, and, as is the case in other countries, programs that affect the population at large carry more political weight. This doesn't mean a national insurance will automatically turn out better than Medicare, but it does mean that for about 10 percent of our population (about two thirds of the currently Medicare-enrolled population) which lack any coverage whatsoever there would indeed be some coverage.

I never said that it would "halt" research. You can be perfectly content arguing against that straw man you created but your solution would undoubtedly reduce the financial incentive of research.
I took the quote below "R&D goes first - that's why so many big companies now have M&A departments instead of R&D" to mean just that. If I misinterpreted it, I apologize.
I agree that marketing and administration costs can be cut. But you're assuming that if revenue declines for a pharma company, they cut marketing and administration first before digging into R&D. That's usually not the case. R&D goes first - that's why so many big companies now have M&A departments instead of R&D. It's easier for them to shift risk onto smaller companies - and those companies don't have the marketing budget to cut.



Less revenue = less financial incentive. Could they make cuts elsewhere too? Sure. But you by definition change the whole financial structure if one sole buyer negotiates down prices for the entire market. What I'm seeing in that paper is 1) that R&D spending closely tracks revenue except in the last few years where there is divergence and exception for a few companies and 2) their scatter plot measures changes in spending from one year to the next immediately after a year in which there was a decline in revenue. R&D decisions, against which I've personally been involved in, are not decisions you make on a year-to-year basis. The people in charge of R&D are different from the people in charge of strategy. Declines in revenue necessitates longer-term restructuring of the company's financial outlays and that restructuring manifests in more long-term changes in spending. For instance, I would expect to see less R&D spending over a period of 1 to 3 years after a period of 3+ years of consistent revenue decline from my experience in the industry. Companies typically don't make spending budgets based on just one or two years of revenue declines. They prefer to look at longer-term market trends. The main shortcoming of this study is that it focuses on a very specific time frame because it's looking for a specific answer that the authors set out to look for. I would vet your studies more before citing them.
While you may argue that decreases in revenue are not adjusted for in periods of time under 3 years, to quote this same study "As a group over the decade, these companies grew their investment in R&D (compound annual growth rate (CAGR) of 1.76%) and cut SG&A (−1.12% CAGR), even as revenues remained essentially flat (−0.01% CAGR) (Fig. 1a). Individually, R&D growth rates exceeded revenue growth rates for 8 out of 10 companies over this 10-year period, and exceeded SG&A growth rates for 9 out of 10 companies (Fig. 1a). Individually, R&D growth rates exceeded revenue growth rates for 8 out of 10 companies over this 10-year period, and exceeded SG&A growth rates for 9 out of 10 companies (Fig. 1a)." This doesn't mean that the growth in R&D is insensitive to revenue, but that it doesn't necessarily correspond in strategy or funding. As for whether your experience is generalizable, it's worth mentioning that one of the authors was director of strategy of AstraZeneca's "Oncology Innovative Medicines unit" (I'm going to assume this means cancer drugs, if I'm wrong in doing so, please correct me,) and currently runs a healthcare investment bank. Either the author is being intentionally disingenuous given that he would understand how strategic choices in R&D budget are not identifiable on a year-to-year basis, or his experience is different from yours.

Again, I do not argue that it would halt research. It just alters the financial incentives (reduces) for research. Yet again, you're ignoring the fact that causing big structural changes to the system changes that system itself in such a way that previous assumptions no longer necessarily hold. That is, your study is basically a cross-sectional one. It shows what's happening at some set point in time. It makes no observations about what would happen if big structural changes happen. In other words, just because another country can operate on a single payer system and negotiate down prices without affecting pharma R&D overall doesn't mean that the U.S. can suddenly do that too because that changes the system and you would have to expect structural changes in response. Find a longitudinal study that measures the effect of a large, global market changing from a free market to one that negotiates down pharma prices on pharma R&D spending. That'll make you more believable.
Not for lack of trying (and probably because data about the market in the 1940s, 50s and 60s when most of these programs were implemented in Europe is not necessarily translatable to the present day) I cannot come up with such a study. How radical is a reduction of, say, 30% in the price of medications that the global pharmaceutical market changes structure? Given that the United States is about 33% of this market per your earlier source, this means a 10% global reduction, which may be of significance but isn't market or R&D shattering, even assuming that Europe does not adjust its prices to provide a more equitable share of, and save the market that we all benefit from (which they should, if this turns out to be an issue.)


I'll address (2) here. What functional difference is there between legislating a price ceiling and a single-payer government saying "No, we won't pay you a price above this"? Who defines reasonable? In both cases, it's the government that defines reasonable. So the difference is a legal and not functional one.
That the "no, we won't pay you a price above this" that falls under the negotiating power of public and private sectors alike does not exclude the rest of the market and is adjustable for negotiation (because the public insurance providers, as was the case with the NHS and Palbociclib, also have an interest in providing those medications, particularly when they offer significant therapeutic advantages) whereas a price control is just that, a price control, and may be entirely unilateral is the difference.


As I already stated above, with evidence, that number is much likely much much less than 1/5. It is reasonable that pharma invests more given that they profit more. But that's not the point of the argument. You made the argument that a significant amount of R&D funding comes from the taxpayer. It does not.
This is another semantic argument we're stuck in. I chose my words well enough. This is how Merriam-Webster defines significant

1 : having meaning; especially : suggestive
  • a significant glance
2 a : having or likely to have influence or effect : important
  • a significant piece of legislation
; also : of a noticeably or measurably large amount
  • a significant number of layoffs
  • producing significant profits
b : probably caused by something other than mere chance
  • statistically significant correlation between vitamin deficiency and disease


Perhaps the term "Beveridge model" should enter into your vocabulary.
It has. And, though it doesn't include single-payer in its definition, the Physicians for a National Health Program page on basic healthcare system models refers, when speaking of the multi-payer Bismarck model, to "the single-payer Beveridge Model," and adds a note at the end:"Reid’s “Beveridge” model corresponds to what PNHP would call a single payer national health service (UK); “Bismark” model refers to countries that PNHP would say use non-profit “sickness funds” or..."...Reflecting that this isn't some misuse I've made out of thin air, but what may be the admittedly commonly ambiguous use of the word


Nobody is arguing that it's desirable. In an ideal world, everybody would have everything they could possibly want and not have to work. Too bad I don't live in that world. As long as you can accept that the public option and the private options will compete and let the chips fall where they may, then that's fine with me.
Didn't say you were arguing this, you asked me for my opinion.


It offers what you define to be adequate coverage at an actuarially fair price for that coverage. Is there another sense of community rating that I am not aware of?
There are pure and adjusted community rating, where the latter establishes some demographic guidelines on which premium costs may be raised (for instance, the 3:1 ratio on the basis of age and 5:1 on the basis of tobacco use in the ACA.) While I'm a tad ambivalent on tobacco-based adjustments, the former seems like burdening our elderly and aging population on the basis of age, which is no more controllable than health history (which does not permit premium adjustments)

Edit: Fixed quote brackets
 
The threat of them showing up at gun point....which they will totally do....is how taxes get paid.
The threat of showing up "at gunpoint" is how the gentlemen with the guns and the blue uniforms have their salary paid. Should we not have those either, or should those be paid for only by those who voluntarily choose to do so? Because any alternative would necessitate those gentlemen showing up.
It's also worth noting that the threat of being prosecuted by law enforcement is how any law enforcement whatsoever works. This doesn't mean that we're always awaiting for the moment when law enforcement shows up and pulls a gun on us, because law (as taxation, which is the effect of a law) is not arbitrarily enforced and does not resort to the use of actual threat of violence or seizures where it can avoid it, unlike your common neighborhood burglar. To therefore say that because it can happen to those who violate the law means that we are abiding by laws at the threat of gunpoint is inaccurate and hyperbolic. (Also, my earlier question remains ignored)
 
The threat of showing up "at gunpoint" is how the gentlemen with the guns and the blue uniforms have their salary paid. Should we not have those either, or should those be paid for only by those who voluntarily choose to do so? Because any alternative would necessitate those gentlemen showing up.
It's also worth noting that the threat of being prosecuted by law enforcement is how any law enforcement whatsoever works. This doesn't mean that we're always awaiting for the moment when law enforcement shows up and pulls a gun on us, because law (as taxation, which is the effect of a law) is not arbitrarily enforced and does not resort to the use of actual threat of violence or seizures where it can avoid it, unlike your common neighborhood burglar. To therefore say that because it can happen to those who violate the law means that we are abiding by laws at the threat of gunpoint is inaccurate and hyperbolic. (Also, my earlier question remains ignored)
We had a country and a govt and police for decades with no federal income tax.

And the threat of the guys with guns taking your stuff and taking you to jail is 100% the only reason most people pay those taxes. To pretend that gun point enforcement isn’t how we take up to 1/3 of someone’s earnings is dishonest

I don’t like to have 4 rebuttal topics going in one post so I’ll go back and find your other question
 
ould I decline paying for representative government, armies for basic self defense, and the basic functions of government and law enforcement (i.e. stopping burglars and murderers,) provided for in the constitution because I disagree with or am indifferent to them? Or does the end of this taxation being likely in my self interest trump my consent?
Someone thinking something is in your best interest isn’t enough reason to have a law and tax you for it (I’m looking at you bloomberg with your stupid big soda regulations)

I’m fine with a useage fees for the few legitimate uses of govt....but for the general structure of govt there should be no free ride, and the reason for that is to encourage the populace to insist on a minimal govt. it is never a legitimate function of govt to be a proxy for one person taking another person’s stuff without a their consent
 
We had a country and a govt and police for decades with no federal income tax.
Someone thinking something is in your best interest isn’t enough reason to have a law and tax you for it (I’m looking at you bloomberg with your stupid big soda regulations)

I’m fine with a useage fees for the few legitimate uses of govt....but for the general structure of govt there should be no free ride, and the reason for that is to encourage the populace to insist on a minimal govt. it is never a legitimate function of govt to be a proxy for one person taking another person’s stuff without a their consent
This wasn't my question. My question is, in these years, was the levying of taxes to finance that government and police not also "theft" by your definition, regardless of its merits? Given that the threat of armed law enforcement is no less real when it comes for paying government and law enforcement, does it stop being theft when it comes to those institutions that you think are valuable? (bear in mind, I'm talking about your argument, not insinuating that law enforcement agencies are not valuable)

And the threat of the guys with guns taking your stuff and taking you to jail is 100% the only reason most people pay those taxes. To pretend that gun point enforcement isn’t how we take up to 1/3 of someone’s earnings is dishonest
No, it's realistic. How many people are actually pointed guns at in the process of tax collection?
Probably very few. That it lies within the capacity of the government to use guns against those violating laws does not mean we have a Waco siege every other week or that the go-to for tax evaders is gunpoint. Again, that it can happen does not mean that it is happening. The government relies, first, on its authority as a representative of the will of Americans as a collective and the understanding that this entails abiding by those laws passed by the representatives we elect. This is the same authority by which it justifies its most basic functions, and what separates it from your everyday feudal lord that takes your wealth for protection.
 
This wasn't my question. My question is, in these years, was the levying of taxes to finance that government and police not also "theft" by your definition, regardless of its merits? Given that the threat of armed law enforcement is no less real when it comes for paying government and law enforcement, does it stop being theft when it comes to those institutions that you think are valuable? (bear in mind, I'm talking about your argument, not insinuating that law enforcement agencies are not valuable)


No, it's realistic. How many people are actually pointed guns at in the process of tax collection?
Probably very few. That it lies within the capacity of the government to use guns against those violating laws does not mean we have a Waco siege every other week or that the go-to for tax evaders is gunpoint. Again, that it can happen does not mean that it is happening. The government relies, first, on its authority as a representative of the will of Americans as a collective and the understanding that this entails abiding by those laws passed by the representatives we elect. This is the same authority by which it justifies its most basic functions, and what separates it from your everyday feudal lord that takes your wealth for protection.
You put way too much trust in the motivation of citizens. Openly announce that taxes won’t be enforced. That you still have to pay but literally nothing happens to you if you don’t...no seizure, no court, no jail, no criminal record....and everyone stops paying

People pay because of the threat of men with guns coming
 
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I don't wanna hog the conversation, but I've been meaning to ask you and this is a good chance. What do you think makes a right?
A natural right is something that would exist in nature as long as someone else did not take it away. "Healthcare" aka other people's labor to take care of you is not something you would have.
 
The poster above me said Medicare for everyone was the best plan to support. My post is not snark, it’s a fact. Take away private insurance and substitute Medicare for everyone and watch what happens. You will be in trouble if you’re the one responsible for keeping the lights on and paying the ancillary staff. Nurses and techs don’t bill and equipment doesn’t pay for itself. Go look what Medicaid pays for some procedures. What you get vs Private Insurance. What the facility fees are. There’s a reason many physicians don’t accept Medicaid/Medicare patients, or limit their census.


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Il Destriero

It actually might be difficult to find that information, particularly the private reimbursement, so an easier to identify proxy of the financial health of a Medicare/Medicaid for all system vs a mixed Private payer system would be looking at inner city community hospitals vs ones just across the border in the suburbs. People come out of the city to the nice suburban hospital, but the private insurance suburbanites don’t go into the city to the community hospital.
One has the newest equipment, centers of excellence, new ambulatory surgery centers, a gleaming campus, etc., etc. and one looks like it’s ready for the wrecking ball and hasn’t had a refresh in 50 years.


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Il Destriero
 
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You put way too much trust in the motivation of citizens. Openly announce that taxes won’t be enforced. That you still have to pay but literally nothing happens to you if you don’t...no seizure, no court, no jail, no criminal record....and everyone stops paying

People pay because of the threat of men with guns coming
That if the government decided it would no longer enforce the law people would not abide by it does not a threat of gunpoint yet make. People pay because they don't want their assets seized and to violate the law, and because they have been abiding by laws their entire life, which does not mean that they've always lived in fear of uniformed gunmen. That I can perform a crime of enough magnitude that a van full of SWAT men may storm my home doesn't mean I live in fear of SWAT men, and this separates it from the naked and arbitrary threat of violence that is actual theft.

Also, you didn't answer my first question, are involuntary taxes for law enforcement and government not also theft? If the government started taxing only the salaries of its elected representatives and law enforcement officials, and I refused from lack of sympathy or indifference to the rule of law, would those men and women be stealing from me when they collect their taxes?

A natural right is something that would exist in nature as long as someone else did not take it away. "Healthcare" aka other people's labor to take care of you is not something you would have.
The actual state of nature in which humans lived a few tens of thousands of years was violent and miserable. The only right present in this environment was, evidently, survival of those with the best means. And, whether it exists unless someone takes it away from "a state of nature," does not automatically make it a right or not a right. We still need to resort to a value judgment to ascertain how much of a right we want it to be, even if we make a coherent distinction of what we mean by "natural rights." Which, to reiterate my earlier point, that other people make those value judgments to consider "artificial" rights worthy of being protected as such is no surprise, especially when it comes to the right to healthcare.
 
That if the government decided it would no longer enforce the law people would not abide by it does not a threat of gunpoint yet make. People pay because they don't want their assets seized and to violate the law, and because they have been abiding by laws their entire life, which does not mean that they've always lived in fear of uniformed gunmen. That I can perform a crime of enough magnitude that a van full of SWAT men may storm my home doesn't mean I live in fear of SWAT men, and this separates it from the naked and arbitrary threat of violence that is actual theft.

Also, you didn't answer my first question, are involuntary taxes for law enforcement and government not also theft? If the government started taxing only the salaries of its elected representatives and law enforcement officials, and I refused from lack of sympathy or indifference to the rule of law, would those men and women be stealing from me when they collect their taxes?


The actual state of nature in which humans lived a few tens of thousands of years was violent and miserable. The only right present in this environment was, evidently, survival of those with the best means. And, whether it exists unless someone takes it away from "a state of nature," does not automatically make it a right or not a right. We still need to resort to a value judgment to ascertain how much of a right we want it to be, even if we make a coherent distinction of what we mean by "natural rights." Which, to reiterate my earlier point, that other people make those value judgments to consider "artificial" rights worthy of being protected as such is no surprise, especially when it comes to the right to healthcare.
Taxes are absolutely enforced by threat of violence and seizure, it’s silly for you to pretend that isn’t why they get paid

I feel like this is a good place for a “it’s always sunny in Philadelphia “ meme here about ‘because of the implication’....
 
Taxes are absolutely enforced by threat of violence and seizure, it’s silly for you to pretend that isn’t why they get paid

I feel like this is a good place for a “it’s always sunny in Philadelphia “ meme here about ‘because of the implication’....
Taxes are enforced by 1098 forms (among others.) It's silly and alarmist of you to say that because nonobservance of tax law entails law enforcement that we're under constant threat of gunpoint.

But, assuming that this is the case, let me insert my question again, because I'm repeating myself too much, An answer is appreciated:
Are involuntary taxes for law enforcement and government not also theft? If the government started taxing only the salaries of its elected representatives and law enforcement officials, and I refused from lack of sympathy or indifference to the rule of law, would those men and women be stealing from me when they collect their taxes?
Edited the beginning of my second sentence so the two points don't seem so disjointed
 
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Taxes are enforced by 1098 forms (among others.) It's silly and alarmist of you to say that because nonobservance of tax law entails law enforcement that we're under constant threat of gunpoint.

But, assuming that this is the case, let me insert my question again, because I'm repeating myself too much, An answer is appreciated:

Edited the beginning of my second sentence so the two points don't seem so disjointed
Any income tax is theft. (And again, we had govt for quite some time without income tax) And yes, we absolutely only get to collect it via 1098 because people know the eventual consequence of not paying is guys with guns coming to put you in a cage....we literallygive people the option of pay or prison/get shot. We’ve sanitized it by not saying it loud everytime because people know that’s the deal
 
Taxes are enforced by 1098 forms (among others.) It's silly and alarmist of you to say that because nonobservance of tax law entails law enforcement that we're under constant threat of gunpoint.

And let me insert my question again, because I'm repeating myself too much, An answer is appreciated:
Any income tax is theft. (And again, we had govt for quite some time without income tax) And yes, we absolutely only get to collect it via 1098 because people know the eventual consequence of not paying is guys with guns coming to put you in a cage....we literallygive people the option of pay or prison/get shot. We’ve sanitized it by not saying it loud everytime because people know that’s the deal
You qualified your answer here in a way I think is inconsistent with your earlier description of taxes as theft, why is only income tax that is theft when involuntarily given? Does circumventing tariffs or excise taxes of old not entail law enforcement and the involuntary seizure of those taxes? The Nullification Crisis would suggest otherwise.
 
You qualified your answer here in a way I think is inconsistent with your earlier description of taxes as theft, why is only income tax that is theft when involuntarily given? Does circumventing tariffs or excise taxes of old not entail law enforcement and the involuntary seizure of those taxes? The Nullification Crisis would suggest otherwise.
things like tariffs would qualify as a useage fee.....the same thing for items like gas taxes that are designated for local road upkeep.
 
You can change what you call tariffs and excise taxes, this doesn't change that they're delegated by a governing body and their nonobservance is responded to by law enforcement. If I start selling gas and not collecting taxes because I wanna be more competitive or I'm apathetic to the upkeep of roads, am I not targeted by the uniformed men with guns?


Let me wrap this one up with an earlier quote of yours.

QUOTE="sb247, post: 19882091, member: 480308"]It’s irrelevant how many people take my money at the threat of gun point when discussing theft’s morality.

Is the threat of gunpoint less real now? Or does the end of roads and representative government justify the means of threat?[/QUOTE]

Edit: Punctuation
 
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You can change what you call tariffs and excise taxes, this doesn't change that they're delegated by a governing body and their nonobservance is responded to by law enforcement. If I start selling gas and not collecting taxes because I wanna be more competitive or I'm apathetic to the upkeep of roads, am I not targeted by the uniformed men with guns?


Let me wrap this one up with an earlier quote of yours.

QUOTE="sb247, post: 19882091, member: 480308"]It’s irrelevant how many people take my money at the threat of gun point when discussing theft’s morality.

QUOTE="goatmed, post: 19883858, member: 877823"]Is the threat of gunpoint less real now? Or does the end of roads and representative government justify the means of threat?

Edit: Punctuation

There is definitely a difference between taking money from half the country just because everyone else thinks they make too much to get to keep it and the notion of chargin individual useage fees (i.e. gas surcharges for road upkeep, or impact fees on new construction, or even the per gallon charges on public utiliities)

Many municipalities pay for things like law enforcement (which is largely about protection of property) via a line item property tax which at least has the justification factor of all property owners contributing (minus the nonprofit sector which I think should have to pay as well)
 
There is definitely a difference between taking money from half the country just because everyone else thinks they make too much to get to keep it and the notion of chargin individual useage fees (i.e. gas surcharges for road upkeep, or impact fees on new construction, or even the per gallon charges on public utiliities)

Many municipalities pay for things like law enforcement (which is largely about protection of property) via a line item property tax which at least has the justification factor of all property owners contributing (minus the nonprofit sector which I think should have to pay as well)
You're adding a lot of conditions as to when it is reasonable to tax (but we're charging on things people are buying, but it's the property owners who pay) and missing the point you made and stressed earlier, that no matter the conditions it is sustained on authority or threat of violence. I hope from this we can agree that there are conditions in which the involuntary payment of taxes is justifiable and that dismissing taxation as theft entails nothing short of some form of anarchism (lest the government is made up of volunteers.)
Where you think that the line of ethically justifiable taxes should be drawn is simply a matter of your values. Yes, there is a difference between income taxes and taxes on commodities. They're both taxes, however.
As to taxes being the result of "everyone thinking they make too much to get to keep it," that's a strawman you've built yourself. Though I'm sure to you it seems like a punishment, the intention behind them, far from being punitive, is to make the burden of taxation proportional to different wealth levels. This doesn't mean you have to support it or like it, although the majority of our representatives and their constituents evidently agree on some extent of it. As is the case with property taxes and taxes on gas, your disagreement with it does not excuse you from abiding by it.
 
You're adding a lot of conditions as to when it is reasonable to tax (but we're charging on things people are buying, but it's the property owners who pay) and missing the point you made and stressed earlier, that no matter the conditions it is sustained on authority or threat of violence. I hope from this we can agree that there are conditions in which the involuntary payment of taxes is justifiable and that dismissing taxation as theft entails nothing short of some form of anarchism (lest the government is made up of volunteers.)
Where you think that the line of ethically justifiable taxes should be drawn is simply a matter of your values. Yes, there is a difference between income taxes and taxes on commodities. They're both taxes, however.
As to taxes being the result of "everyone thinking they make too much to get to keep it," that's a strawman you've built yourself. Though I'm sure to you it seems like a punishment, the intention behind them, far from being punitive, is to make the burden of taxation proportional to different wealth levels. This doesn't mean you have to support it or like it, although the majority of our representatives and their constituents evidently agree on some extent of it. As is the case with property taxes and taxes on gas, your disagreement with it does not excuse you from abiding by it.
Yeah, we don’t agree at all on your impression of the situation. I guess we can just leave it at that
 
As voluntaryist as I am, and I get your point of taxation with and without representation sb, but goat is also correct that your values are the dividing line. Not some solid principle.

Something to think about
If a thief breaks into my house and steals my wallet, but leaves me a cheese burger, is it okay? What about if he leaves me a diamond necklace? That he stole from someone else?

My point is either you’re okay with taxes or you believe it is theft. You cannot justify theft based on the results.
 
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Go look what Medicaid pays for some procedures. What you get vs Private Insurance. What the facility fees are. There’s a reason many physicians don’t accept Medicaid/Medicare patients, or limit their census.

Note that Medicare and Medicaid have very different models of compensation. The Medicare fee schedule is the gold standard that other schedules are based off of and usually is pretty reasonable. Private insurance will use that and compensate physicians some percentage over that, say, 125% of Medicare fee schedule. It's usually Medicaid that pays them a whole lot less and that's why they don't take Medicaid patients. Medicare patients generally get along just fine.
 
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