Wednesday, August 1, 2007

From BibleGateway.com: The Sheep and The Goats

BibleGateway.com: From Matthew Chapter 25, The Parable of the Sheep and the Goats.:

"41'Then he will say to those on his left, 'Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. 42For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, 43I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.'
44'They also will answer, 'Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?'
45'He will reply, 'I tell you the truth, whatever you did not do for one of the least of these, you did not do for me.'
46'Then they will go away to eternal punishment, but the righteous to eternal life.'"

How bad can single payer be that Christians can walk away from this lesson so blithely? What evil in a government sponsored single payer system is so compelling to ignore these charges of Jesus? What principles have been teased and tortured out of Christianity to trump this parable so central to Christ's call for us to take care of each other?

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22 comments:

Anonymous said...

Profit over people; profit over planet; profit over truth; profit over Christ.

Anonymous said...

How one can leap from a Bible passage dealing with the treatment of God's people during the Tribulation to government controlled health care, is beyond me.

As for this Christian, I'll take to heart what God commands, but I will never force such a command upon an entire nation, nor shirk off my responsibility to government.

Of course, more government is not the solution to the heath care problem. Government involvement is a big part of the problem. The other part has to do with the nature of insurance and insurance companies. Do you prefer free-market socialism or a socialist government? Both are bad. Both play their role in the problems we see today.

Keep in mind that socialism itself is the problem - both from the government side and the private side. Socialize anything and you by nature will unbalance supply and demand. If you doubt this, ask most people if they'd go to the doctor's office for a mild health issue if it costs them nothing, then ask if they'd go for this very same problem if it cost them $50.

We do need to get back to a single payer system, but not the kind I see anyone pushing for. You and you alone should be responsible for your health costs. I believe this would ultimately lead to better prevention on the parts of individuals.

This leads us full circle to the comment relating to a Christian's responsibility to take care of others. Those who cannot afford health costs can be assisted by those good Christians (and other people who care about the plight of the poor) direct or charitable donations. This is far more efficient use of money, as you don't have the government sucking off 75% in overhead on one end or corporate insurance companies sucking off their overhead from the other side.

Keep in mind that on average, a private charity is going to be at least three times more efficient than a government program... just from a $$ perspective. Private organizations are also far more effective at actually helping the poor get out of their circumstance, as well. If we gave back all the government money spent on health care to the taxpayers, we'd have more than enough money in the hands of caring people to assist the poor in getting medical help - even if 2/3 of the people decided not to donate.

Medical care is not an entitlement. When we stop treating it like one and start treating it as the business (and let the market work), you'll start to see positive changes. Ultimately, the end user always determines the service and cost. If something is prices too high, and there is no government to subsidize it, the price will come down or the company will go out of business. Competition for $$ has the uncanny ability to produce creativity in bringing costs down, as well as weeding out the bad providers.

Christopher M. Hughes, MD said...

This is Jesus command on how to treat each other all the time, not at the tribuation. His point is that how we behave towards others determines our fitness to sit with the father.

It would be swell if healthcare could be handled on a village level, but it can't. Therefore it MUST be resolved on a large scale. As I said in my original post, this ideological fear of "creeping socialism" should not overturn our duty to the least among us.

And this is not a "Christian" thing, this is a "human" thing and we are all in this life together. Wishing that charities could do this just leaves millions suffering. At the end of the day, do you think Jesus will think of those "socialists" in Canada or France more or less kindly than us who let this wrteched system continue. I know what I think.

Your comments about government involvement in healthcare are clearly ill informed. Go ask a few nurses and physicians and then we'll talk. If you find someone who agrees with you, it is pure ideology speaking, not based upon medical ethics nor the good of the patient nor society.

Medical care is an entitlement in every sense. We will be judged by how we treat the least among us. Your comments about efficiency and "end-users" are also not well informed. Please feel free to root around the blog for more information.

I have been trying to tag the posts so that you can research more by topic.

Cheers

antiliberalism said...
This comment has been removed by the author.
antiliberalism said...

[My previous comment was removed by me due to typos... hopefully I got 'em all ;) ]

That passage takes place right after the Tribulation is concluded and Jesus comes back in glory. The immediate judgement is not for everyone of all time, it's for those who are left alive when he returns. But this is really not the point. I'm not going to argue that Jesus does not want us taking care of one another. I will argue that this is a command to individuals. YOU must help a person in need. There is a big difference between YOU helping, and you PUSHING FOR A GOVERNMENT PROGRAM you feel will help.

If you want to help, give of your own time and money to a worthy cause. Tithe to your church so it has funds to help those in your community. Do not force your view of charity onto everyone else via the federal government - which has no Constitutional power to spend money on wealth redistribution programs (see Article 1, Section 8 for alloted expenditures).

After 80 years of Welfare, it is crystal clear that it is not just a failure, but an unmitigated national disaster. It started with New Deal as a $10 million/year safety net, and has grown to be the single largest form of expenditure in the federal budget (by far). Centralizing such power and money opens everything up to corruption (politicians now buy votes with your tax $$), makes it incredibly inefficient, and also makes it very difficult to change.

Why do you feel that this problem must be resolved by the federal government (I'm assuming this is what you mean by "large scale")? We already spend well over $1 Trillion (yes, that's trillion - more like 1.2T) in wealth redistribution programs. The end result is that the biggest programs are going insolvent soon. It's going to cost us all an arm and a leg just to keep SS and Medicare limping along (plus a cut in benefits, and Medicade is in bad shape as well). It's clear to me that the federal government has completely failed as a charitable organization.

On the other hand, charity cannot go insolvent. They can close their doors if people decide it is no longer worthwhile giving to it, but it cannot force tax hikes or create economic havok on this country as a whole.

Give this $1.2T in tax money back to those who earned it, and you'll have all the money you'll ever need in circulation to help the poor. A charity at 90% efficiency is 3x as effective as the government's efficiency of 30% (actually, less than this for some programs) in the arena of wealth redistribution. So, you have 3x the efficieny by converting it from government tax and spend to private charity. Even if only 1/3 of this money was given as charitable contributions, you still have the same effective amount of money going to those in need... and they'll likely be helped a lot more in the process. In addition, you have the added benefit of not creating entire inner city government-sponsored slums.

I have talked with health care providers. I have family and friends that work in hospitals as doctors and administrators. The biggest problem they have arises from dealing with government agencies. A close second is dealing with insurance companies. If you feel that I'm completely off-base about government being a part of the problem, please bring some information to the table to show where I'm wrong. I'm always open for factual correction. But please, don't just state 'I'm misinformed'.

There is no question that if you remove government and insurance companies from the mix, the cost of health care would go down. With these elements out of the arena, free market efficiencies will take over. It won't happen overnight, but it will happen (we didn't get into this mess overnight, either).

I will pick out one of your sentences and challenge you on it before signing off today. You state, "Wishing that charities could do this just leaves millions suffering." First, this shows a complete lack of faith in your fellow man. It tells me that you feel we all must be forced by government to do what you feel is the right thing. From my perspective, America is the most charitable country in the world. I've seen people stand up time and time again giving to those in need, and in great times of need. There is no reason to beleive that if Americans were allowed to keep their own money - rather than having huge chunks taken by the fed - that much of this money would not be directed at problems that people see in their communities. Second, you have nothing to base such a statement upon. I've already posted numbers on federal efficiency vs. a good private charity, clearly showing that a private charity would get far more of the same $$ to those who need it. Third, you're missing the point that millions already suffer even though we spend over a trillion/year. How much is enough? How many more decades of failure must we endure before you and others come to their senses and realize that these programs - no matter how much money you throw at them - are not effective or efficient at what they are supposed to do.

Having the government take over health care, given its current and past track record in other "entitlement" programs, is not just a bad idea, its foolhardy.

I admire your passion to help the needy. I share in your desire to assist the poor. However, Jesus' commands are not to force everyone in your community to help the poor. He does not command you to vote money out of someone else's wallet to help someone down on their luck. His command is for you and me, _personally_, to help the poor, as well as to treat others as we'd like to be treated. This means that we, as individuals, must give our OWN money, if that is how we feel the poor can best be helped. It means we must give of OUR time, if that is where we can most help. It has always been a personal thing, not a command for socialization. In fact, given the poor track record of government in this arena, I'd argue that Jesus would prefer a better, more efficient, far more personal approach to helping others... like having the churches step up and do more (which they could with more money).

Here are three questions to consider before handing everything over to the federal government.

(1) If the W-4 forms were revamped to include a line-item where you could contribute to the government for socialized health care, would you contribute? Keep in mind that this is completely voluntary for everyone.

(2) Given the choice, when looking to help the poor, would you rather donate extra money in taxes on that same W-4 for Welfare, or would you rather donate money to your church (assuming your church helps the poor)?

(3) How much do you trust the federal government? Do you feel they are efficient? Are they responsible in managing money?

Thanks for the lively conversation. Hopefully, I haven't offended too much. I tend to come across rather strong... passion does that, and I'm very passionate about this country and its well being.

Christopher M. Hughes, MD said...

Unfortunately, I do have little faith in my fellow man to actively participate in a massive national charity program. My goodness, most people don't even vote let alone participate in community life or charity! To be fair, many if not most families are living paycheck to paychek and don't have the wherewithall to act as you suggest.

My interpretation of doing my part to help the least among is is to push my government to do the right thing and implement a universal healthcare program. And I suppose that you think everything the government does is "forced" on us? I confess, I've felt this way for the past 6 and a half years as I watch us disastrously invade the wrong country, but this is a democracy. The ship is being righted. We are only forced in the sense that as citizens we are forced to participate in our national life, even if one chooses to only pay taxes and do nothing else.

I think your aversion to government action are well founded based upon this administration's performance. But it can be done right. Most countries do get it right. It is our selfishness [and active mismanagement of government since the Republicans have been in charge] that keeps us from getting it right.

And regarding government being the problem in healthcare, go ask again. I know of nobody in healthcare that thinks that. I am a trustee of my state medical society and I talk about this stuff with professionals all the time. The private insurance industry is far and away the biggest problem. State and federal regulations are sometimes annoying, but they rarely impact on healthcare negatively.

And depending upon where you live, Medicare may be your best reimbursement source. It is certainly the most hassle free and the most efficient. [BTW, where do you get the 90% vs 30% efficiency thing- Medicare is far and away the most efficient health insurance provider in the country]

I don't have time to reply to everything right now, so, my apologies.

Cheers.

antiliberalism said...
This comment has been removed by the author.
antiliberalism said...

If you are successful in convincing people to pay for the universal health care via government taxation, why do you feel it is so farfetched to suggest that a majority would be charitable if they weren’t forced? Either way, they are choosing to contribute. And again, given the HUGE tax savings from having government separated from our paychecks, you’d have more than enough money in the hands of charitable people to help the poor.

My aversion to turning over health care to government crosses party lines. All I need to do is look at 80 years of wealth redistribution history to see that our government makes for a very poor charitable organization. It is plagued by corruption, and suffers from abject monetary and budgetary mismanagement/incompetence. If they can even balance the budget, it’s a rare and newsworthy event. It simply cannot be trusted with our money. Look at Social Security if you have any doubt as to the veracity of my statement. It was originally set up as an off-budget trust fund (i.e., could not be used to fund any other government program), but this pool of money proved to be too much a temptation for Congressmen of any stripe. It didn’t take long before this “lock box” became an ATM, and all the savings were replaced with IOUs. The end result is that there is no SS trust fund, and a program that could have remained viable (even if I disagree with the program itself, it could have remained viable if the original intent and rules were kept) was turned into a ponzie scheme… one that will come crashing down as the Boomers retire en mass. This is the way government works, and at the end of the day we will all pay in spades for our trust in government, rather than ourselves. With its abysmal track record, how can you rationalize that somehow they will get this one right?

The most basic and critical freedom to self determination is the ability to control your own earnings. The power to tax is the power to control. If you fear anything from government, you should fear this most basic economic/governmental reality. At least with private insurance I can opt out, and it matters somewhat if I keep myself in good health, when it comes to how much I pay. I have no such option with federalized health care, nor will my tax bill be adjusted because I keep myself in good health and rarely visit the doctor. I pay the same as a morbidly obese person with multiple expensive health care issues. This is not fair by any standard.

I truly believe you are missing the point of Jesus’ command when you abdicate your responsibility and place it onto government authority. Such a system is the epitome of unfairness and forced charity. You are only seeing one side of the story. You rightly feel for the poor and those who cannot afford health care. But you wrongly believe that federalizing it will bring about fairness and equity. The opposite is true. There is far more to this equation than helping the poor.

With regards to government being a part of the problem, I’m speaking of the added expense and red tape inserted into medical costs by federal involvement. I’m also talking about the negative impact on costs Medicare and Medicade present to the public coffers. As long as the federal government inserts itself into the medical realm, the rules of economics will continue to be pushed aside. Supply and demand, for one, is artificially thrown off kilter by both government and private insurance. Combine the two into a federal program and you create a mess that we’ll never be able to extract ourselves from.


The 90% efficiency figure is about what a good charity (churches can go even higher) can provide for your contribution. 90 cents out of every dollar goes directly to the individual who needs it, 10% goes to running the organization. The 30% (actually 24%) figure represents the basic Welfare program (AFDC, I believe). Out of every tax dollar collected for this program, only 24 cents actually makes it to the recipient. I highly doubt, due to natural government overhead, oversight, manpower, and general bureaucracy involved, that other wealth redistribution programs are much more efficient than this. It is a simple fact – regardless of the actual numbers today (the 24% figure is from about 10 years ago, maybe more) for government inefficiency - that there is no way for the government to be as efficient as private charity with your dollars; nor can a one size fits all approach work for all communities, or address specific needs within a community as well as a local church or charity.

I think you need to limit the scope to your own community. Focus on helping those in need closest to you. Get your church and others involved directly. Give of your time and money to help the helpless. If we each did this in our own communities (and many do already, but could do far more if we didn’t have half or more of our paychecks taken from us in taxation), you’d find that the needs of the poor would be met far better than any government program could ever hope to. What would Jesus rather you do – take personal action to help someone, or petition government to help someone? Think about it.

Christopher M. Hughes, MD said...

Here goes...

If you are successful in convincing people to pay for the universal health care via government taxation, why do you feel it is so farfetched to suggest that a majority would be charitable if they weren't forced?

I suppose one could commission on poll to see if that could happen, but on the fairness side, I think we should all contribute and all benefit as a community. And frankly, I just think it's silly. You seem to be averse to this idea out-of-hand, while I dismiss letting citizens out of our social contract ouot-of-hand. And certainly there are many polls showing large majorities of Americans are willing to accept the trade off of higher taxes for universal healthcare. And I assume that they don't even realize it would cost us all less when payroll deductions, private insurance profit, inefficiencies due to a patchwork of systems, etc. are factored in.

Either way, they are choosing to contribute. And again, given the HUGE tax savings from having government separated from our paychecks, you'd have more than enough money in the hands of charitable people to help the poor.

I'm not aware of the huge savings to which you refer, so you'll have to give me some data.

My aversion to turning over health care to government crosses party lines. All I need to do is look at 80 years of wealth redistribution history to see that our government makes for a very poor charitable organization.

I don't consider health care charity any more than I do public education, Social Security, Medicare, roads and bridges, the courts or any other part of our civilized society. And I rarely hear free-marketeers crying about wealth redistribution when it goes low to high, such as when Wal-mart uses it's size to keep wages and benefits low, or when oil and pharmaceutical companies "petition the Government" for favors allowing for higher profits and higher executive salaries.

It is plagued by corruption, and suffers from abject monetary and budgetary mismanagement/incompetence.If they can even balance the budget, it's a rare and newsworthy event. It simply cannot be trusted with our money.

If it does, that is our fault and our job to fix it. I think if there is one major recurring theme in our dialogue it is this one: You think government is "them,' and I think our government is "us.' Sure it screws up with great regularity, but so does even the best run free-market business. Our job is to hold our government accountable.

Look at Social Security if you have any doubt as to the veracity of my statement. It was originally set up as an off-budget trust fund (i.e., could not be used to fund any other government program), but this pool of money proved to be too much a temptation for Congressmen of any stripe. It didn't take long before this “lock box” became an ATM, and all the savings were replaced with IOUs. The end result is that there is no SS trust fund, and a program that could have remained viable (even if I disagree with the program itself, it could have remained viable if the original intent and rules were kept) was turned into a ponzie scheme… one that will come crashing down as the Boomers retire en mass.

I'm not an actuary, but this is sort of how I understand it: http://www.msnbc.msn.com/id/7080681/

Further, my understanding is that social security was in serious trouble until the mid-80's when the system was revamped to account for the big change in demographics.

This is the way government works, and at the end of the day we will all pay in spades for our trust in government, rather than ourselves. With its abysmal track record, how can you rationalize that somehow they will get this one right?

Because, most every other western nation in the world has gotten it (at least mostly) right. Or at lease better than we have it. You're not one of those "hate America" people who don't think America can do anything right, are you?

The most basic and critical freedom to self determination is the ability to control your own earnings. The power to tax is the power to control. If you fear anything from government, you should fear this most basic economic/governmental reality.

No, I think the most basic are the ones in the Bill of Rights. And some of those are in a bit of jeopardy at the moment.

At least with private insurance I can opt out, and it matters somewhat if I keep myself in good health, when it comes to how much I pay. I have no such option with federalized health care, nor will my tax bill be adjusted because I keep myself in good health and rarely visit the doctor. I pay the same as a morbidly obese person with multiple expensive health care issues. This is not fair by any standard..

This is the argument that really appalls me in this debate. As if a child coming down with childhood leukemia or autism or an adult coming down with multiple sclerosis is morally inferior and of the undeserving class. And are you so confident in your genetics that you are sure you won't have some illness you didn't "deserve?" That your kids won't develop manic depressive illness or schizophrenia? Or get in a serious accident? And have you ever tried to buy private health insurance with a condition you didn't "deserve"? Then tell me about fairness. I want to be helped when I need it, don't you?

I truly believe you are missing the point of Jesus' command when you abdicate your responsibility and place it onto government authority. Such a system is the epitome of unfairness and forced charity. You are only seeing one side of the story. You rightly feel for the poor and those who cannot afford health care. But you wrongly believe that federalizing it will bring about fairness and equity. The opposite is true. There is far more to this equation than helping the poor.

See my earlier point. We are our government. I want to not send my tax dollars to Halliburton and Lockheed Martin and GE, but this is the society in which we live. Even the Amish have to pay taxes.

With regards to government being a part of the problem, I'm speaking of the added expense and red tape inserted into medical costs by federal involvement. I'm also talking about the negative impact on costs Medicare and Medicaid present to the public coffers. As long as the federal government inserts itself into the medical realm, the rules of economics will continue to be pushed aside. Supply and demand, for one, is artificially thrown off kilter by both government and private insurance. Combine the two into a federal program and you create a mess that we'll never be able to extract ourselves from.

Medicare, Medicaid, the VA are all part of our healthcare spending. As pointed out earlier, virtually every other nation on earth has created this type of federal program and haven't wanted to "extract" themselves.

The 90% efficiency figure is about what a good charity (churches can go even higher) can provide for your contribution. 90 cents out of every dollar goes directly to the individual who needs it, 10% goes to running the organization.

Well some are good, some not so good: http://www.charitynavigator.org/index.cfm/bay/topten.detail/listid/20.htm

The 30% (actually 24%) figure represents the basic Welfare program (AFDC, I believe). Out of every tax dollar collected for this program, only 24 cents actually makes it to the recipient.

Can you spot me a reference here?

I highly doubt, due to natural government overhead, oversight, manpower, and general bureaucracy involved, that other wealth redistribution programs are much more efficient than this. It is a simple fact - regardless of the actual numbers today (the 24% figure is from about 10 years ago, maybe more) for government inefficiency - that there is no way for the government to be as efficient as private charity with your dollars; nor can a one size fits all approach work for all communities, or address specific needs within a community as well as a local church or charity.

From the PNHP web site: "Private insurers take, on average, 13% of premium dollars for overhead and profit. Overhead/profits are even higher, about 30%, in big managed care plans like U.S. Healthcare. In contrast, overhead consumes less than 2% of funds in the fee-for-service Medicare program, and less than 1% in Canada's program."

I think you need to limit the scope to your own community. Focus on helping those in need closest to you. Get your church and others involved directly. Give of your time and money to help the helpless. If we each did this in our own communities (and many do already, but could do far more if we didn't have half or more of our paychecks taken from us in taxation), you'd find that the needs of the poor would be met far better than any government program could ever hope to. What would Jesus rather you do - take personal action to help someone, or petition government to help someone? Think about it.

Why not do both? As a physician, I provide lots of free care, and I do a lot of work for my community. You can try to fool yourself, but this will never get done on less than a federal level. And frankly, why should I have to justify it? We think nothing of our tax dollars going to roads and bridges and our court system, largely to promote commerce. Why should something as basic to human dignity as healthcare, helping the sick, go begging?

I'll part with one final thought: Who do you think is more likely to be advocating for Medicare for all/single payer: The physician who goes on around the world to provide charity care with Doctors Without Borders or in a hospital in Haiti; or the doctor who doesn't? I don't think Jesus intended us not to do both, do you? http://www.beliefnet.com/story/132/story_13245_1.html

Cheers,

antiliberalism said...

I suppose one could commission on poll to see if that could happen, but on the fairness side, I think we should all contribute and all benefit as a community. And frankly, I just think it's silly. You seem to be averse to this idea out-of-hand, while I dismiss letting citizens out of our social contract ouot-of-hand. And certainly there are many polls showing large majorities of Americans are willing to accept the trade off of higher taxes for universal healthcare. And I assume that they don't even realize it would cost us all less when payroll deductions, private insurance profit, inefficiencies due to a patchwork of systems, etc. are factored in.

There’s the rub. We don’t, nor will we, all contribute. True fairness is everyone paying their own medical expenses. Fairness is not forcing me to pay for someone else’s medical bills. It’s not fair that I (for example) contribute $5000/yr into a system for $500 worth of medical expenses every year. It’s not fair that I pay the same (or more, depending on income level) into a system than someone who lives in an unhealthy manner. At least with insurance, they take risk factors into account. A government run system would not, as the ACLU would cry “discrimination” from the rooftops if they made any attempt to do so.
As far as a social contract, what are you talking about? The Constitution says nothing about providing a minimum comfort/financial level for citizens via taxpayer money, nor anything about providing health care for all. In fact, it can be easily argued that such socialist programs are unconstitutional.

I'm not aware of the huge savings to which you refer, so you'll have to give me some data.

We spend approx. 1.2 Trillion on wealth redistribution programs alone. Imagine having all this money back into people’s paychecks, then think of how many people could be helped with that windfall of extra cash. Imagine how much more efficient your church is than the Welfare system. That extra money in your wallet goes a lot farther in the private sector, with the added benefit of more people being able to lend a direct hand to help his neighbor and experience the joy of giving. There is no joy in wealth redistribution – regardless of what the money is used for, as you remove choice and true compassion from the equation.
I don't consider health care charity any more than I do public education, Social Security, Medicare, roads and bridges, the courts or any other part of our civilized society. And I rarely hear free-marketeers crying about wealth redistribution when it goes low to high, such as when Wal-mart uses it's size to keep wages and benefits low, or when oil and pharmaceutical companies "petition the Government" for favors allowing for higher profits and higher executive salaries.

If I pay a poor person’s medical bills, it is charity. If government pays for them, it isn’t? Why? Public education is most certainly charity for the poor, who pay no taxes to support the schools. The fact is that Welfare programs started as a way to help the poor (charity by definition… whether its government, private organization, or personal contribution).
Going over your list, above, I notice that you throw in disparate ideas and programs as if they were all equivalent. SS and Medicare is federal forced wealth redistribution – government forcibly taking money from you and giving to someone else. These programs are not found in Article 1, Section 8 of the US Constitution as lawful expenditures. Roads and bridges are infrastructure, which are lawful federal expenditures when dealing with inter-state roads and bridges (states are responsible for their own roads beyond that, or should be). Courts similarly fall under two categories, but a federal court structure is outlined in the US Constitution. In order to discuss this, you have to first understand what the Constitution allows for and what it does not.
I’m interested in what form of wealth redistribution you’re talking about in the free market. I was unaware that the free market system was able to take money directly from your pay and give it to someone else. I’m no fan of Wal-Mart, but at least the free market (that’s you and me) can choose whether or not to shop or work there.

If it does, that is our fault and our job to fix it. I think if there is one major recurring theme in our dialogue it is this one: You think government is "them,' and I think our government is "us.' Sure it screws up with great regularity, but so does even the best run free-market business. Our job is to hold our government accountable.

If government is ‘us’, why are you against letting ‘us’ take care of the poor without being forced to? Why do you feel that ‘we’ can’t do the job without government controlling the money?

I'm not an actuary, but this is sort of how I understand it: http://www.msnbc.msn.com/id/7080681/

I wouldn’t take this guy’s word for it. He completely ignores the fact that the tax cuts Bush pushed through have generated _more_ revenue for the federal government (just as they always have in the past), all the while counting on treasury bills that do not exist. The lock box is full of IOUs. When the ratio of workers to retirees hits 3/1 (which it will in about 10-15 years) we’re in big trouble. Congress, which always waits until things are an emergency before acting, has just now starting its chicken-little routine. End result? More taxes, less benefits. Do you know how much extra I could have back for retirement if I could have controlled my own SS contributions (plus the 6+% my employer pays)? Can you say ‘early retirement’?

Because, most every other western nation in the world has gotten it (at least mostly) right. Or at lease better than we have it. You're not one of those "hate America" people who don't think America can do anything right, are you?

Hardly. My passion on this and other political topics comes out of a deep love for the nation our founders created. I’m saddened and angered by what some have done to this country and the Constitution.
If most every other western nation has gotten it right, why are there now two-tiered systems for health care – government and private (the private being the best tier)? Apparently, it isn’t working nearly as well as you believe.

No, I think the most basic are the ones in the Bill of Rights. And some of those are in a bit of jeopardy at the moment.

I agree, some of the Bill or Rights are definitely in jeopardy. But getting back to my previous comment, if everyone else controls your money, you are not free in any real sense. You are reduced to a tax slave whose income becomes the property of government, and ultimately the government will decide how much of your earnings you can keep. If you reduce everything to a vote, ignoring what the Constitution says on these matters, our form of government is reduced to a pure Democracy (i.e., mob rule), rather than what we were created as.
The power to tax is the power to control. Our founders understood this well, which is why they were so specific in controlling what the federal government can tax for (see Article 1, Section 8 of the US Constitution).

This is the argument that really appalls me in this debate. As if a child coming down with childhood leukemia or autism or an adult coming down with multiple sclerosis is morally inferior and of the undeserving class. And are you so confident in your genetics that you are sure you won't have some illness you didn't "deserve?" That your kids won't develop manic depressive illness or schizophrenia? Or get in a serious accident? And have you ever tried to buy private health insurance with a condition you didn't "deserve"? Then tell me about fairness. I want to be helped when I need it, don't you?

You’re twisting my words. I give a valid example of what will happen (which you ignore), then you go on about a sick child. I made no moral judgments, as you suggest. I made a very well documented observation. As a doctor, you have to realize that obesity causes many health problems. With that in mind, someone who is obese will cost the health care system far more in a government controlled system than I will. This is a simple fact. Yet, in your world, it’s okay if I’m charged (potentially, depending on income) the same or even more in taxation than this person. How is this fair? Remember, we’re talking fairness and not compassion… it seems these two concepts are getting mixed up.
It is fair that I am responsible to pay for any illness I come down with. It is fair that you have to pay for any illness you come down with. It is compassion to help someone who can’t afford to pay for their medical bills, and I’m all for that… as long as it is a personal choice to do so.
Personal responsibility was once the core of American culture. What happened to change this?

See my earlier point. We are our government. I want to not send my tax dollars to Halliburton and Lockheed Martin and GE, but this is the society in which we live. Even the Amish have to pay taxes.

Your tax dollars do not go to a company directly, except when it comes to buying military equipment and similar things government purchases. They also purchase toilet paper for government buildings and such… I’m not sure how this can be stopped and still have government be able to do anything. The fundamental difference is that these things are constitutional expenditures, which translates into a product we receive that helps keep us safe (in the case of your examples).

Why not do both? As a physician, I provide lots of free care, and I do a lot of work for my community. You can try to fool yourself, but this will never get done on less than a federal level. And frankly, why should I have to justify it?

You have to justify it because you are trying to force others into funding such programs. You need not justify what you do on your own time with your own money. In fact, I applaud you for your community efforts.
I guess it comes down to this. You don’t trust people to help. I do. You trust the government to take over health care for everyone. I most definitely do not.

We think nothing of our tax dollars going to roads and bridges and our court system, largely to promote commerce. Why should something as basic to human dignity as healthcare, helping the sick, go begging?

Again, the difference is constitutional expenditure vs. non-constitutional expenditure. One of the core principles of our founding was limited federal government, which is the main reason for the shopping list in Article 1, Section 8.

I'll part with one final thought: Who do you think is more likely to be advocating for Medicare for all/single payer: The physician who goes on around the world to provide charity care with Doctors Without Borders or in a hospital in Haiti; or the doctor who doesn't? I don't think Jesus intended us not to do both, do you?
It’s irrelevant. When Jesus returns to rule (which would mean a just government without corruption), the reasons for limiting federal powers goes away. In fact, the reason for borders goes away with it. Until then, given the staggering amount of corruption in man’s government, we’re far better off limiting what government controls. The founders knew this well, and went to great lengths to limit federal powers. Ignore their wisdom at your own peril.

antiliberalism said...
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antiliberalism said...

Sorry, my formatting didn't take on the last one...

Christopher M. Hughes, MD said...

True fairness is everyone paying their own medical expenses. Fairness is not forcing me to pay for someone else’s medical bills. It’s not fair that I (for example) contribute $5000/yr into a system for $500 worth of medical expenses every year. It’s not fair that I pay the same (or more, depending on income level) into a system than someone who lives in an unhealthy manner. At least with insurance, they take risk factors into account. A government run system would not, as the ACLU would cry “discrimination” from the rooftops if they made any attempt to do so.

The world is not fair, as I am sure you are aware. Yes, you might have to pay for someone who smokes and drinks and overeats, but the bargain is that if your child gets into an accident, society steps up and helps them. So it's not fair for you to pay for the "undeserving", but it's not "fair" for me to pay for your kid's accident. That seems like a reasonable price, a reasonable social contract.
I am reminded of the school boards that go to great length to avoid providing good services for the autistic or other disbled kids. No, it's not "fair", to ask taxpayers to pay extra, because it's not their kid, but for God's sake, we are in this together. ANd frankly, I am not prepared to let off the scumbags who don't give a rat's ass about other peoples misfortunes. Because you know they would whine the loudest if it were them or their family.


In fact, it can be easily argued that such socialist programs are unconstitutional.
I'm prepared to have that argument. Public schools are not in the Constitution either, yet here we are. The founding fathers wanted no standing army, yet here we are. Alexander Hamilton expected that the Constitution would need to be updated or even totally revisited every generation to adjust to changing times.

And this is not about a "level of comfort," unless you consider relief of suffering from illness a luxury.


$1.2 trillion

can you give me a reference or just tell me which programs bother you the most? Agriculture subsidies? Tax breaks for businesses moving from one state to another? The use of our military to secure revenue for Exxon?

If government is ‘us’, why are you against letting ‘us’ take care of the poor without being forced to? Why do you feel that ‘we’ can’t do the job without government controlling the money?

It's not that I don't "feel" we can't, it's that we aren't. No feeling about it. Do you think Medicare and Social Security were some grand scheme to cheat charitibale people out of the joy of helping the destitute elderly? It wasn't getting done for them, then, and it isn't getting done for us now.

tax cuts Bush pushed through have generated _more_ revenue for the federal government

This has been shown to be false many times over. Follow the trail here:
http://economistsview.typepad.com/economistsview/2007/09/uh-no-your-tax-.html

And talk about wealth redistribution: Shouldn't we be deeply ashamed of passing on these massive deficits to our kids? Not to worry, the next President will try to fix it, then get blamed for doing the responsible thing.


If most every other western nation has gotten it right, why are there now two-tiered systems for health care – government and private (the private being the best tier)? Apparently, it isn’t working nearly as well as you believe.

How did you decide the private was the best? What makes you think this is happening in the countries that do it well?
I think there are two tiers because if you are rich, you want to jump line in healthcare, as you do with everything else in life. That's fine, go ahead, I see no reason we can't have a hybrid system.


"tax slave "
If you have a preexisting condition, you are an "insurance slave." If you are low income, you are a "wage slave." So I'll risk being a tax slave.
BTW, Sicko, has a great section about this: the fear that people live in that keeps them sheepishly compliant.


Personal responsibility was once the core of American culture. What happened to change this?

I don't know about that, but:
And for the support of this Declaration, with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our Lives, our Fortunes, and our sacred Honor.

and here:

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare , and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.


Until then, given the staggering amount of corruption in man’s government, we’re far better off limiting what government controls. The founders knew this well, and went to great lengths to limit federal powers. Ignore their wisdom at your own peril.

Well, I don't think I am ignoring them, I just don't see the connection of their concerns about over-reaching government and this argument.
And the corruption in government I worry about is not the corruption of graft, but the corruption of the abuse of power. That was what the founders were far and away most concerned about. Graft is easy, send them to jail, vote them out of office, no biggie.
And for my money, governemt corruption is chump change compared to what private insurers, drug companies, military contracters and the like get in return for their dollars.

Cheers,

antiliberalism said...
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antiliberalism said...

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare , and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

I don't have time to address everything at the moment, but I will address the above. "Promote the gneral welfare" is not a blank check for the federal government. If it were, we would not have Article 1, Section 8, which strictly limits the WHAT it can lawfully spend money on.

I guess we should discuss the Constitutionality of socialized health care before going further. This is at the heart of the problem I have with it.

I also think we have two distinct views on what is fair. Again, it looks to me like you are confusing fairness with compassion.

Christopher M. Hughes, MD said...

Section 8: The Congress shall have power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States; but all duties, imposts and excises shall be uniform throughout the United States;

From wikipedia on appropriations for the general welfare:
http://en.wikipedia.org/wiki/General_Welfare_Clause

I am not a constitutional scholar, but it seems to me we've stretched the general welfare clause pretty far. You know, the horse is out of the barn and 3 counties away. So you can choose to fight that battle, but I think it's been decided already.

My confusion of fairness and compassion are muddled by the original subject of this post: doing for the least among us, including taking care of the sick part. And I am not preapred to let anybody who benefits from the bounty of this country off the hook when it comes to taking care of all of us in a humane fashion, and this includes universal access to healthcare.

Cheers,

Christopher M. Hughes, MD said...

Sorry, i missed this part:

Why the federal government? I guess I'm trying to understand this mentality that all things need to be federalized - particularly when the federal government does such a crap job of nearly everything else it handles.

Well, first, because other countries seem to be able to manage to do it. (Admittedly, some much better than others.)

Second, I know the Bush administration has screwed up everything it has tried, but this does not have to be. America used to be a country where we could do a good job. We still do. Look at the NIH, the military, NASA, and, pre-Bush, FEMA.


For goodness sake, if Belgium and France can do this, why can't we?

Cheers,

antiliberalism said...

I understand your desire for everyone to have access to healthcare. In truth, everyone does. Hospitals are not allowed to turn anyone away. While this is far from the ideal way for many to access health care, it is worth noting because it dispels the myth that not everyone has access to care, if needed. Even illegal aliens have figured this out and are abusing our system to high heaven, forcing the closing of many border hospitals.

http://archive.newsmax.com/archives/articles/2005/12/26/170334.shtml

I’m glad you understand that the “general welfare” clause has been stretched beyond recognition of its original intent. But doesn’t this recognition that our Constitution is being abused come with a responsibility to fight against further erosion? Rather than give up and push for further abuses, why not fight to bring back Constitutional intent and standards? If all patriotic Americans understood this and fought it, we’d have a chance of turning the tide.

You’ve said that everyone should pay into the system for health care, but the reality of your position is that many will not pay a dime, while collecting many more benefits than you or I will ever receive (all the while continually voting themselves more of your money for their personal benefit). The economic reality is that you cannot continually tax the producers in a society to subsidize those who do not produce, nor can you continue to go into debt to fund such programs. You will drain the economy dry, which is exactly what is happening already (see figures at the bottom of this post). This is a recipe for economic disaster, and one we’ve been cooking up for far too long. Adding universal health care to the government’s list of entitlement programs will, without a doubt, increase the burden on every taxpayer dramatically in the future. There is simply no argument based that can suggest otherwise, given the nearly eight decades of wealth-redistribution history. It is the way of every single federal “entitlement” program ever enacted. The predictable end result will be higher costs and less care for all of us (with the exception of those who won’t be paying any taxes in the first place to support it). You can argue based on what other countries do until you turn blue, but there is simply too much history that tells an undeniable tale of what will happen HERE.

2 Thessalonians 3 comes to mind in this discussion.

I’m getting the impression that you believe that we are all somehow entitled to the fruits of the labor of others. I respectfully disagree. Early settlers found out that socialism doesn’t even work well even on a small scale. They created a system where everyone was “entitled” to necessities. Some quickly figured out that they no longer had to work for their keep, and began living off the hard work of others. The work force was reduced to the point where the leader of the settlement was forced to make a proclamation that mirrored the above verses (basically: if you don’t work, you don’t eat). Now, with the threat of starvation looming, these lazy folk had new motivation to work… and they did. This is human nature in a nut shell.

The only thing any of us are “entitled” to is the right to succeed or fail on our own merits… without limit in either direction. By placing artificial limits with retributive taxation on the wealthy or a safety net for the poor, you remove motivation in both directions and alter the natural equilibrium on both the economic and social level. This does not mean you cannot help the poor. Far from it! But such help is rightly called charity, which is not the purview of the federal government nor should it be.

There are other ways to address the problems in health care besides handing over a huge chunk of our economy to the federal government, which can’t even balance its own ridiculous-sized budget. You don’t throw money at a drunken sailor and expect a positive result. [My apologies to drunken sailors… you’re far more restrained in spending than Congress has been for decades. I need to come up with a better analogy.]

There are times when a handout is not the appropriate way to help someone. Money is not the cure all, nor is government cradle to grave care.

Since I’ve been throwing around figures on entitlement expenditures, I decided to look up the numbers. Here are a few interesting tallies from the 2007 US budget:

Total receipts: $2.4 Trillion

Total spending: $2.8 Trillion

Total entitlement spending: $1.6 Trillion – or roughly 68% of all tax dollars collected. [I underestimated in previous posts… by quite a bit.]

Between entitlements and servicing our debt (which is mainly due to the ever-escalating costs of the social welfare programs which make up most of the budget), we spend $2 Trillion annually. This leaves a mere $400 billion left to do things that government is mandated to do in the Constitution. No wonder we’re in constant deficit spending mode. Also note that COLAs built into most welfare programs far exceed annual cost of living increases, based on published inflation levels.

How much is enough? I’m amazed the economy still functions with such an upside down spending structure. Out of all the major line items, I’d estimate that only 30-35% are spent on things that would fall (loosely, even) in the ‘Constitutional expenditures’ column. This is unsustainable economic insanity.

I’ll close with a question I posed a while back that still remains unanswered:

Given the choice, would you voluntarily donate money to the federal welfare system to do more to help the poor, or would you donate money to a good charity of your choosing?

I’ve asked this same question to many who support government welfare programs. The result is that my question is either ignored (most of the time), or the answer is that they would not donate more money to government-run social-welfare programs.

The fact is that there is no such thing as a social welfare contract. What we have is forced participation in a federally run series of charity programs. This not only makes life rougher on the hard-working, but gives the politicians more money with which to buy votes. It also limits total dollars, choice, and efficiency in the money people would like to use to help the poor.

The answer to our ills is not more of the same. It is not to kill the working class with more taxes
(nor "stick it to the rich"), but to allow people to keep what they’ve earned and let then decide how best to help their neighbor. And yes, some will decide not to help, which is not the end of the world nor doom for the impoverished.

Christopher M. Hughes, MD said...

Access to emergency care is not access to healthcare. Not even close. Plus it costs us all more to pay for expensive ER and hospital care rather than good ongoing healthcare. click on Access or Rationing subjects on my blog for more information.

I recognize "general welfare" has been stretched, but my point is that we, as a people, have accepted that for the most part. Anti-New Dealers, excepted, of course. So you can be consistent like some and not only oppose single payer, but Medicare, Medicaid, Social security, etc as well. I think that is a small minority opinion.

And as far as erosion of the constitution is concerned, I'm way more concerned with the Bill of Rights at this point than the general Welfare provision.

I have faith that responsible leaders in the US can do this at least as well as half of the european Union nations.

Why do you so worry about people getting more health care than they pay for? Do you think people seek out more health care because it's free? Click on the Moral Hazard Myth in the must read section on my links.

I worry about wealth redistribution, too, but the opposite of you. I see the wealthy using the wheels of government to suck the poor and middle class into economically marginalized people. I'll bet almost everyne you know would be financially devastated by a major illness or a loss of just 2 or 3 paychecks. That is extraordinary power over employees.

>Early settlers found out that socialism doesn’t even work well even on a small scale. <
So Jesus was wrong?

Retributive taxation, really? You think the wealthy put more in than they get out? Remember, other than criminal courts, our court system, paid for by all of us, is for the wealthy. How about the FAA? Who flies most? Roads? Who do those truckers work for? The military? Why are we in Iraq again? I could go on, but they get far more out of it than they put in, except perhaps for the welthies 100 or so.

>Given the choice, would you voluntarily donate money to the federal welfare system to do more to help the poor, or would you donate money to a good charity of your choosing?<

False choice. If this were a real choice, wouldn't it already be done? Is there a charity hospital and free clinic in every city? How many doctors and nurses would work for half of what their peers make to do this? Besides, Medicare runs more efficiently than any charity, so for the purposes of our discussion, I choose medicare for all: Single payer, not socialized medicine.

Finally, quit worrying about the rich getting a raw deal. If i get rich, I hope to emulate Warren Buffet, and worry about not being taxed enough and my employees being taxed too much, and not some whiny assed country club Republican worrying about my tax bills. And if you can find someone who didn't start a business because their tax bracket was going to be too hig, you'd better show him or her to the Republicans- they'll have him up on the RNC convention podium next year!

Cheers,

antiliberalism said...

[[False choice. If this were a real choice, wouldn't it already be done? Is there a charity hospital and free clinic in every city? How many doctors and nurses would work for half of what their peers make to do this? Besides, Medicare runs more efficiently than any charity, so for the purposes of our discussion, I choose Medicare for all: Single payer, not socialized medicine.]]

How is it a false choice? It's a simple question that shows what one really believes about federal programs. Most who support socialistic policies would not donate their money to these programs they feel so passionately about. Why not? I have no problem volunteering my money to church and charities who do God’s work, without feeling the need to force everyone else to give money to the charity or program of my choice.

Besides, there are free clinics all over the country even WITH the semi-socialized system we have now. Remove the federal government and more would pop up. You mentioned you give free care, I don’t see why many other doctors wouldn’t follow suit. Give them a tax break for charity work and you may enlist even more who normally wouldn’t do this. Create initiatives for new doctors out of medical school to volunteer in free clinics as a part of their residency.

I’m not too surprised with your answer, though. Most people dodge or deflect from it as they realize they would not volunteer their own money to a federal government over a good charity. This realization shows a fundamental flaw in their logic for supporting federal socialistic programs in general. They’d only “donate” the money if everyone else was forced to do so as well. So much for freedom, liberty, and choice. Think about this for a moment, in light of previous comments on freedoms and liberties being in jeopardy, as well as your recognition that welfare policies are not Constitutional, if one were to read the document as it was intended. Think about those, like me, who would be able to do far more in their communities if they didn’t have large chunks of their wages confiscated by the federal government. We’re out there, and we would do more if we were allowed to keep more of the money we work so hard to bring home. Most of us simply don’t have the extra money because we are being over-taxed. We outnumber the Scrooges, and could do far more than any federal program to actually help people and resolve some of the core problems leading to poverty, rather than handing them a check and sending them on their way, trapping them into a system that only multiplies poverty in the end. Finally, think about the $1.6 TRILLION dollars already spend on socialistic programs. Again I ask… how much is enough?

I’ll do some research on Medicare. I have a hard time believing your efficiency numbers on this. I’ll check this blog site first to see where the numbers come from and see if I can confirm this elsewhere. In any case, Medicare IS a form of socialized medicine. Medicare for all IS socialized medicine, regardless of what name you give it.

As a side note, I get the idea that you think I’m a rich Republican. Let me put this notion to rest. Given my family size and income, I’m barely middle class. We are a single income family, and took a 40% hit in income in order to do the right thing when our first son was born. God has provided, though. I belong to no political party, which makes me an independent. I generally vote for anyone who isn’t a Democrat or Republican, if given a valid third choice. I’ll vote for anyone who understands and will protect the Constitution of the US, regardless of party affiliation. There are some Democrats that seem okay and some Republicans that seem okay, but both parties, in general, have gone in a direction that is very bad for America. I have gone for lengths of time without any health insurance at all due to circumstances beyond my control. I’m the type of person who’s always being brought up in the arguments for socialized medicine. You already have my opinion on this… I don’t want it. The price to the country is simply too high, even if there are plenty of benefits for me, personally.

I have much to gain by supporting the system you propose. I’d have more money in my paycheck, and most of the tax nastiness would hit higher tax brackets (until later), most likely. But I can’t support something that is constitutionally wrong; nor can I support something that will clearly balloon out of control, causing rationing and higher costs in the end. There is simply too much history surrounding federal programs of this sort to think this one will be any different in this country. Heck, even with insurance (another form of socialization of medicine, and another part of the problem), there is rationing. If I want to see my doctor for some non-emergency, it takes weeks. The reason? There are many, but it comes down to simple supply and demand. Insurance (like federal socialization) artificially skews the most fundamental economic principle (supply and demand). $15 trips to the doctor equates to higher demand, longer waits, and higher costs (supply can’t keep up). Make this $50 and my wait would go down from weeks to days. Make it an “entitlement” and my wait will likely increase from weeks to months, and then the government will decide what it will and won’t treat me for. No thanks.

Your heart is in the right place, but your solution is not.

Christopher M. Hughes, MD said...

Let me see if I can summarize your argument:

If you can't afford healthcare you shouldn't get it unless you are lucky enough to get a charity or charitable person to provide it.

Do you beleive in the undeserving poor concept, then?

Cheers

antiliberalism said...

Here are a few links regarding the efficiency of Medicare:

http://healthcare-economist.com/2006/07/27/medicares-true-administrative-costs/

http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf


There are more, but these are good for starters. Another factor (already calculated into private insurance costs) is fraud. One figure I ran across for Medicare fraud suggested 10% total dollars spent are gobbled up in fraud. See:
http://www.aapsonline.org/fraud/medfraud.htm


Since we're playing the summation of argument game, here's what I see:
...

Forget the facts, history, and expansion rate of costs for every federalized social welfare program, somehow THIS time it will be different. I'm willing to take the chance of ruining it (and the economy) for everyone to potentially help a few people who already have access to medical care if they really want it.

...


The difference between our views isn't about a desire to help others, it's one of philosophy. This is where are fundamental differences lie. You believe that everyone in America is owed a living (and medical care) regardless of circumstances. This is a dangerous philosophical road to take, and is the very thing that is slowly (well, not so slowly in reality) crippling our economy. Ironically, economic recession/depression hit the poor the hardest.


The best way to help others is to do things that will strengthen the economy. Without a strong economy, there is no money left over to help the poor, and you can only deficit spend so much before some really nasty economic consequences come home to roost.

I am unwilling to throw everyone overboard in order to hopefully help a few people. However, I am willing to privately help those few by giving to church and charities that are set up properly to help.