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Author Topic: The Liberty Amendments: Restoring the American Republic
LetterRip
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I'm not sure what you are asking - your sentence doesn't make much sense or seem to relate to what I wrote.

If you are asking about externalities - pollution is a classic externality - water pollution; air pollution; dioxin; radiation; another classic externality is depletion of public resources (public water tables; or overgrazzing on public land; or over fishing of public waters). Long term externalities would be things like global warming or extreme weather events; toxic accumulation in ecosystems (ie mercury; dioxin).

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TomDavidson
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quote:
A far better method of regulating the free market is to let people vote with their pocketbooks and shop elsewhere...
I think one obvious lesson of history is that this approach, when not mixed with legal restrictions and safety regulations, is doomed to miserable failure. For very many reasons, people are not very good at voting with their pocketbooks.

quote:
What is a good that has no alternative that harms people who don't buy it and that is only sold or could only be acquired by one source?
Historical examples include whale blubber, oil, strip-mined copper, grazing cattle, railroads, and medical care. In some cases, those monopolies were propped up by governments; in others, all it took were recognized property rights.
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Pyrtolin
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quote:
Originally posted by Seneca:
I find it strange that progressives feel like they need laws to protect people from being abused by private economics, since any method of being harmed that way is purely voluntary. No one forces you to buy anything (except for Obama) and no one forces you to walk into a store.

Yeah, you can always just choose to starve to death instead of buying food. If there's only one store that sells food in town (or if all the stores the sell it collaborate with each other, as naturally happens without regulations to prevent it) then you can't effectively choose to shop anywhere else. Your claim here is completely ahistorical and profoundly ignorant of actual history in a way that only someone who is so acclimated to the benefits of a market kept free by a strong regulatory framework to prevent the deceptive and extortionary practices that naturally occur without active commnity intervention to prohibit them can express.

You're effectively parroting the exact same claims that the physiocrats and other mercantile apologists did when Adam Smith was shooting them down two and a half centuries ago, yo've just got it dressed up nicely to cover up its fundamentally plutocratic nature.

quote:
You cannot equivocate laws that punish people who murder and strike others to laws that regulate a free society where no one is forced into an economic relationship with someone else.
There is no such thing- by the very nature of being a society, by sharing the same common market and currency, everyone is by definition in an economic relationship with each other.

quote:
A far better method of regulating the free market is to let people vote with their pocketbooks and shop elsewhere if they are dissatisfied with a service or product, not to use the iron first of the government to mandate things.

That only works if they have the funds, information, and free choices amond competative options to do so. Without regulations and social supports to ensure those, then they're at mercy of the extortion, deception, and general anti-competative race to the bottom that naturally occurs thorugh monopolization and collusion by critical resource holders to secure as much power as possible.

You're recycling arguments that were designed to create and sustain a cheap, disposable, debt-enslaved workforce- to keep wages suppressed to the point that people would be willing to work for you for just a little less than the interest they owed you on the money that you loaned them that was only valid to buy the food you sold them and rent the houses you provided them at the rent your charged them (or the people you colluded with to maintain such a system), such that they were forced to keep working for you under threat that you'd have them punished for defaulting on their debts.

You've been so inured to the abuses that the progressive reforms that you're so didainful of have ensured your freedom from that you that you take that freedom for granted and are apparently completely blind to the fact that it only exists because of the regulatory framework that prevent the natural colllapse toward feudalism that occurs without it.

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Pyrtolin
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quote:
Originally posted by TomDavidson:
quote:
A far better method of regulating the free market is to let people vote with their pocketbooks and shop elsewhere...
I think one obvious lesson of history is that this approach, when not mixed with legal restrictions and safety regulations, is doomed to miserable failure. For very many reasons, people are not very good at voting with their pocketbooks.
Not the least of which is that, without such rules, they generally don't have pocketbooks to speak of to vote with.

quote:
quote:
What is a good that has no alternative that harms people who don't buy it and that is only sold or could only be acquired by one source?
Historical examples include whale blubber, oil, strip-mined copper, grazing cattle, railroads, and medical care. In some cases, those monopolies were propped up by governments; in others, all it took were recognized property rights.
You missed gold in that list. Its entire mythology comes from the fact that it was, for a significant period of time a very tightly controlled resource that the holders of could demand as the sole form of tax payment, such that everyone would have to buy gold from them to engage in any market transactions so that they could try to acquire enough to meet their tax obligations.
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KidTokyo
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This false dichotomy will never die. Someone needs to go back and read Adam Smith and John Locke. Both sides of the aisle do.

Capitalism requires far more "big" government "interference" than communitarianism. Our own history illustrates it. Capitalists need infrastructure. They need paper currency. They need credit. They need big banks. They need insurance companies. They need corporations.

None of these things can exist without very major government involvement and regulation. It is by definition impossible.

The growth of the federal government corresponds exactly with the introduction of "laissez-faire" theory into the American economy in the 19th century.

From the Reagan era onwards, the language of libertarianism has been completely immeshed into our political vernacular, and the size of the federal government has again grown in leaps and bounds. "De-regulating" big business has required more government support for the things big businesses do.

It's inevitable, but everyone believes the opposite, even thought the truth in hidden in plain view.

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Pyrtolin
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Adam Smith even very clearly and directly argued against the very laissez-faire concepts that his name and out of context remarks are used to try to justify these days. The invisible hand myth that stands in almost complete contradiction to his writing is so ground into people today that it flips our entire economic attitudes inside out and encourages the exact kind of perverse behvoirs that he tried to warn against.
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Seneca
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quote:
Originally posted by Pyrtolin:
quote:
Originally posted by Seneca:
I find it strange that progressives feel like they need laws to protect people from being abused by private economics, since any method of being harmed that way is purely voluntary. No one forces you to buy anything (except for Obama) and no one forces you to walk into a store.

Yeah, you can always just choose to starve to death instead of buying food. If there's only one store that sells food in town (or if all the stores the sell it collaborate with each other, as naturally happens without regulations to prevent it) then you can't effectively choose to shop anywhere else. Your claim here is completely ahistorical and profoundly ignorant of actual history in a way that only someone who is so acclimated to the benefits of a market kept free by a strong regulatory framework to prevent the deceptive and extortionary practices that naturally occur without active commnity intervention to prohibit them can express.

You're effectively parroting the exact same claims that the physiocrats and other mercantile apologists did when Adam Smith was shooting them down two and a half centuries ago, yo've just got it dressed up nicely to cover up its fundamentally plutocratic nature.

quote:
You cannot equivocate laws that punish people who murder and strike others to laws that regulate a free society where no one is forced into an economic relationship with someone else.
There is no such thing- by the very nature of being a society, by sharing the same common market and currency, everyone is by definition in an economic relationship with each other.

quote:
A far better method of regulating the free market is to let people vote with their pocketbooks and shop elsewhere if they are dissatisfied with a service or product, not to use the iron first of the government to mandate things.

That only works if they have the funds, information, and free choices amond competative options to do so. Without regulations and social supports to ensure those, then they're at mercy of the extortion, deception, and general anti-competative race to the bottom that naturally occurs thorugh monopolization and collusion by critical resource holders to secure as much power as possible.

You're recycling arguments that were designed to create and sustain a cheap, disposable, debt-enslaved workforce- to keep wages suppressed to the point that people would be willing to work for you for just a little less than the interest they owed you on the money that you loaned them that was only valid to buy the food you sold them and rent the houses you provided them at the rent your charged them (or the people you colluded with to maintain such a system), such that they were forced to keep working for you under threat that you'd have them punished for defaulting on their debts.

You've been so inured to the abuses that the progressive reforms that you're so didainful of have ensured your freedom from that you that you take that freedom for granted and are apparently completely blind to the fact that it only exists because of the regulatory framework that prevent the natural colllapse toward feudalism that occurs without it.

Because the USDA and FTC predates the Constitution right? [Roll Eyes]

Give me a break. Somehow we survived as a nation for a long time without all of this bureaucratic nonsense. Are you going to deny history? Where was the Department of Education in 1795? Where was the ATF in 1805? Oh my God, how did we ever survive without them? WHERE WAS THE FTC in 1835? How on earth did we ever have an economy before it?! How can anyone pretend that every single piece of our giant bloated bureaucratic leviathan is absolutely necessary when there is proof that we survived without them? We managed to thrive for quite a few periods as a nation without a debt-based currency that was managed by a central bank.

As for now, if you don't like somewhere don't shop there.
Don't want to shop anywhere at all for anything? There's plenty of places you can subsist ENTIRELY off of the land. I've done it myself a few times as a hobby. You can hunt, fish, grow your own food, make your own clothes, and believe it or not, there are still some native groups that do this in a few places.

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TomDavidson
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quote:
Somehow we survived as a nation for a long time without all of this bureaucratic nonsense.
We just had our third child. When my wife was hooked up to some monitors and on her way to an emergency C-section, she laughed that it was a miracle the human race was able to have babies on its own, without all this assistance and technology. And of course we could and did have babies on our own. But in the 1700s -- your period of reference above -- a third of them died, and when women my wife's age tried to have kids not only did half of the kids die, but one out of every ten women did, too.

quote:
As for now, if you don't like somewhere don't shop there.
How exactly would that address, say, the decision to strip-mine the national forest in the north woods of Wisconsin? Do you believe that it is feasible for the typical consumer to source the lead and copper in his electronics, or the natural gas used by factories to produce those electronics?
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KidTokyo
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quote:
Give me a break. Somehow we survived as a nation for a long time without all of this bureaucratic nonsense.
We didn't. The bureaucratic nonsense has always been there. It wasn't always federal bureaucracy, but there was always bureaucracy, unless you lived alone in the woods.

That's the horrible, depressing reality that so very many of us don't want to accept -- even though examples abound in our literature, as well as our law books.

To be clear, I'm not arguing in favor of the virtue of endless bureaucracy at all. My interest here is only that we proceed from correct premises.

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AI Wessex
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Seneca, Pyrtolin has also asked that you respond to my hypothetical scenarios. This is an opportunity for you to clear up a lot of ambiguity about how your organization will engage in actual situations that match the kinds of things your web site talks about.
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beefprime
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quote:
You're effectively parroting the exact same claims that the physiocrats and other mercantile apologists did when Adam Smith was shooting them down two and a half centuries ago
*Clicks on tape recorder*
Movie Idea: Bold young ace pilot Adam Smith takes to the skies in his bi-plane to shoot down dastardly free market apologists lead by the Red Robber Baron and save his beautiful girlfriend Columbia in a thrilling summer movie adventure.
*Clicks off recorder*

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DonaldD
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quote:
Originally posted by KidTokyo:
quote:
Give me a break. Somehow we survived as a nation for a long time without all of this bureaucratic nonsense.
We didn't. The bureaucratic nonsense has always been there. It wasn't always federal bureaucracy, but there was always bureaucracy, unless you lived alone in the woods.
I agree... but I disagree. It is clear that that, there was much bureaucratic nonsense that was missing and led to abuses in the early USA. But there was also slave labour, child labour and 80 hour work weeks; there was barely fettered collusion and monopolistic practices. Just because the young country did not immediately fail in the run up to the industrial revolution in a land with effectively unlimited natural resources does not mean that there has not been an increase in effective and valuable bureaucracy in the interim.
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KidTokyo
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Donald,

I think you're arguing against a point I haven't made. I don't support unconstrained freedom for corporations and monopolists.

I'm getting the idea that people on this forum sometimes have trouble separating what I assert only as a fact of history from what I assert as my own personal political beliefs.

I am probably the only self-described "left-libertarian" here so it probably not surprising that there is confusion on this matter. [Smile]

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Seriati
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quote:
Originally posted by AI Wessex:
Seneca, Pyrtolin has also asked that you respond to my hypothetical scenarios. This is an opportunity for you to clear up a lot of ambiguity about how your organization will engage in actual situations that match the kinds of things your web site talks about.

Take it back to your own thread.
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Seriati
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quote:
Originally posted by Wayward Son:
I see no reason Obamacare would have such a huge effect on the medical establishment. Well over 60 percent of the medical manufacturing companies are quite large and will easily weather the storm, assuming they don't easily adapt to it. There will be a higher demand for doctors and surgeons with more people covered, so there should be no shortage of such.

Well to be fair, if you saw the "reasons" you'd be on the other team. We're talking about predictions for what will happen, there's not clear and convincing evidence that can be trotted out to be absolute proof. And reading Pyrotolins absolutist dismissals of the possibilities won't change the future if Senaca's concerns turn out to be correct.

As to backing up the claims, the logical case is there and understandable, disagreeing with is a matter of opinion not fact.
quote:
quote:
You can not with intellectual honestly recast that to ignore today's stolen freedom to claim they aren't trusting people down the road to make a new decision to restore that freedom.
"Stolen freedom." Pfft.
You honestly think giving the federal government the power to force you into comercial transactions is not stolen freedom?

Like I said, it's a dishonest black is white argument. Nothing says you can't believe the other side is wrong and foolish, but playing this indignant game to twist their argument around is silly.
quote:
You think people will riot over having to have health care?
No. I think a lot of people are going to be hurt and poorer by being forced to pay for it. I think a lot of people are going to be hurt by being forced to pay more than they do today for coverage they don't need.

And I think end of day, an awful lot of people are going to end up paying a lot of money for plans with deductibles that are high enough that from the point of view of their own finances it will be functionally equivalent to not having insurance.

And the "best" response to this problem that seems to be put forward is that the federal government will be raising taxes on everyone and forcing the young and healthy to pay for insurance way beyond what they need to subsidize some of the premiums involved.

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Seriati
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quote:
Originally posted by LetterRip:
Also any doctor shortage in the US is trivial to rectify - just allow PAs and NPs to practice independently as primary care physicians and allow non doctors to do the roles that doctors in the US have made exclusiveto doctors (ie in most other countries a doctor isn't needed for many anesthetics that US doctors have lobbied only doctors be allowed to do).

So you're agreeing now that the standard of care needs to decline to meet the new demands for service.
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Pyrtolin
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quote:
You honestly think giving the federal government the power to force you into comercial transactions is not stolen freedom?
You have yet to justify the claim that people are going to be forced into any commercial transaction. The only difference is that there is not a price to attempting to shift your personal costs to the population at large. A price change is not direct force by any measure.

Heck, you're the one, elsewhere claiming that people should bear more of the direct price of their medical decisions, this is a small but important step in that direction on a level that the average person does, infact, have enough information to make a reasonably informed choice on.

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Pyrtolin
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quote:
No. I think a lot of people are going to be hurt and poorer by being forced to pay for it. I think a lot of people are going to be hurt by being forced to pay more than they do today for coverage they don't need.
Do you think fewer people will be hurt by a government shutdown or potential default?

The point wasn't to say that it's not valid to argue that people might be hurt by it, but rather that it's not a valid tactic to fight against that subjective perception of possible harm by threatening to inflict a much larger objective harm on everyone across the board.

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TomDavidson
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quote:
So you're agreeing now that the standard of care needs to decline...
I would be reluctant to confuse fewer certifications with a lower standard of care. I would prefer that standard of care be measured by outcome, and in countries where NPs and PAs have more authority we generally see better patient outcomes as well.
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Wayward Son
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quote:
Well to be fair, if you saw the "reasons" you'd be on the other team. We're talking about predictions for what will happen, there's not clear and convincing evidence that can be trotted out to be absolute proof.
Well, some proof would be helpful in seeing the reasons for the other "team." Just making a blanket statement doesn't do anything.

How about this, then: why do you predict that Obamacare will create such problems? What is your combination of facts and reasons?

quote:
You honestly think giving the federal government the power to force you into comercial transactions is not stolen freedom?
Of course not, since the government isn't forcing anyone into a commercial transaction.

Think of it, rather than a law requiring you to buy health insurance, as a tax reduction for people who have health insurance. (Sure, they first had to add the tax, but that's beside the point... [Smile] ). If you don't want health insurance, fine, pay the tax and be on your merry way. Your tax will go toward compensating hospitals for people who don't have health insurance (such as yourself).

See, you still have the freedom to choose. This isn't like slavery, where you have the choice of to work or to die. This isn't like imprisonment, where you are physically forced to do what you're told. This isn't banning free speech, or religion, or any of our other freedoms, where your freedom to move or do what you want would be curtailed if you don't toe the line. If you don't like health insurance, thumb your nose at the government, pay your tax, and go on your merry way.

That's why I said, "Pfft." There is so little freedom that is taken from you that it's a ridiculous comparison. And nothing to get emotional about.

quote:
No. I think a lot of people are going to be hurt and poorer by being forced to pay for it. I think a lot of people are going to be hurt by being forced to pay more than they do today for coverage they don't need.

And I think end of day, an awful lot of people are going to end up paying a lot of money for plans with deductibles that are high enough that from the point of view of their own finances it will be functionally equivalent to not having insurance.

And the "best" response to this problem that seems to be put forward is that the federal government will be raising taxes on everyone and forcing the young and healthy to pay for insurance way beyond what they need to subsidize some of the premiums involved.

OK, those are reasonable concerns.

Yes, this will be a hit for some people. They will be paying more for insurance they may never use. Of course, a few of them will discover that they really did need that insurance, which is why it doesn't seem so terrible to me. And, with the government subsidies and the (hopefully) reduction in the cost of (worthwhile) insurance rates, those in the situation you describe will be minimized.

But when you consider the increased number of people who want to be insured who can be insured; the number of those who were refused insurance who now can be insured; and the number of people who will have insurance when they need it when they didn't before, I think it is worth the cost.

But that is a concern, and I would love to hear ways to mitigate it, without throwing out all the benefits I described above.

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DonaldD
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quote:
Originally posted by KidTokyo:
Donald,

I think you're arguing against a point I haven't made. I don't support unconstrained freedom for corporations and monopolists.

I'm getting the idea that people on this forum sometimes have trouble separating what I assert only as a fact of history from what I assert as my own personal political beliefs.

I am probably the only self-described "left-libertarian" here so it probably not surprising that there is confusion on this matter. [Smile]

I wasn't suggesting that you do (support unconstrained freedom) just that your response glosses over the significant point of contention that bureaucracy as it exists today, including those things that I mentioned above, did not exist at the time of the USA gaining independence, and that growth in regulation was absolutely necessary in the growth of the country.
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Seriati
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quote:
Originally posted by Pyrtolin:

You have yet to justify the claim that people are going to be forced into any commercial transaction.[/quote]I find it bizarre that you pretend that a threat of an economic consequence is not force. Aren't you the same person that has repeatedly complained that the poor should not have to take on low wage jobs because they are being held as economic hostages? I'm not going to play a semantic game with you on this, this was a new twist on goverment power and loss of a freedom for the citizen.
quote:
The only difference is that there is not a price to attempting to shift your personal costs to the population at large. A price change is not direct force by any measure.
Nonsense, Obamacare will result in large amounts of personal costs being dumped on the population at large. Many of us will be paying higher taxes to subsidize it, many of us higher premiums for insurance, many of forced to pay out more with higher deductibles. All of us will pay with declining access to care and lowering standards.

And if you happen to be young and healthy you're going to paying for more than the benefit you're recieving.
quote:
Heck, you're the one, elsewhere claiming that people should bear more of the direct price of their medical decisions, this is a small but important step in that direction on a level that the average person does, infact, have enough information to make a reasonably informed choice on.
I've got no problem if people want to buy "insurance", though what it really is, is a medical expense installment payment plan when it covers things that aren't risks.

But forcing people to overpay for a service so those overpayments can be used to benefit others is in no way, shape or form causing them to bear the costs of their own care in a way that is designed to lead to efficient use of medical resources.
quote:
Do you think fewer people will be hurt by a government shutdown or potential default?
Yes to the shutdown both in raw numbers and magnitude. No to the default - but I've never been in favor of a default.
quote:
The point wasn't to say that it's not valid to argue that people might be hurt by it, but rather that it's not a valid tactic to fight against that subjective perception of possible harm by threatening to inflict a much larger objective harm on everyone across the board.
His point was to complain about hypocrasy by asserting a false equivalence. He didn't need to do that to make a substantive argument on the issue. That's what I posted about, not sure why you want to change the subject on it.
quote:
Originally posted by TomDavidson:

I would be reluctant to confuse fewer certifications with a lower standard of care. I would prefer that standard of care be measured by outcome, and in countries where NPs and PAs have more authority we generally see better patient outcomes as well.

I don't do it lightly. Objectively, switching from a professional with higher credentials, a longer training period and higher certification standards, would be expected to mean an inferior product.

However, I agree, for many of these situations seeing the doctor is overkill, so it may be that the lesser product is still more than enough. I'd be in favor of allowing a change as LR suggested - with or without ObamaCare. But, that doesn't change the fact that it represents a systemic quality drop, and in the demands in Obamacare both on medical resources and on price pressure will force this type of change.

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Pyrtolin
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quote:
I don't do it lightly. Objectively, switching from a professional with higher credentials, a longer training period and higher certification standards, would be expected to mean an inferior product.
If you have to put some finishing nails into a shelf, insist on a jack hammer; opting for a tack hammer is just settling for an inferior product.
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KidTokyo
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Donald

quote:
I wasn't suggesting that you do (support unconstrained freedom) just that your response glosses over the significant point of contention that bureaucracy as it exists today, including those things that I mentioned above, did not exist at the time of the USA gaining independence, and that growth in regulation was absolutely necessary in the growth of the country.
I'm actually not sure I get your exact meaning here, but I think you're conflating to distinct issues I raised about bureaucracy and federal power (distinct points).

Please read my initial post 5 or 6 from the top of this page and let me know if that addresses your concern.

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Seriati
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quote:
Originally posted by Wayward Son:

Well, some proof would be helpful in seeing the reasons for the other "team." Just making a blanket statement doesn't do anything.

How about this, then: why do you predict that Obamacare will create such problems? What is your combination of facts and reasons?

Why do I predict that Obamacare will lead to a doctor shortage, and that this will have a long term negative impact on the system even if repealed?

Well the second is obvious, if there is a doctor shortage created how could their not be a long term negative impact.

As to the first part, its really simple. The changes required to save "costs" in this system currently involve cutting reimbursements. If as I expect this system ends up costing far far more than advertised, there is going to be even more pressure to cut costs - while that might take the form of rationing it will also take the form of direct payment reductions and caps. Making the practice of medicine less lucrative for doctors means less interest - basic economics on that one.

But there's also a knock on quality of life issue here. Doctors have alreay walked far down a path away from personal relationships with patients towards fitting in as many as possible. As rates decline volume must go up, and while its possible that they will mitigate the increasing demands on each doctor (which new doctors won't mitigate because it will be economic necessity to see that many patients) with force mulitpliers like nurse practioners, its more than likely that the stress will get higher and the practice of medicine become less satisfying.
quote:
quote:
You honestly think giving the federal government the power to force you into comercial transactions is not stolen freedom?
Of course not, since the government isn't forcing anyone into a commercial transaction.
Wow, so notwithstanding the numerous threads about wage slavery and economic need, now monetary penalties are essentially meaningless. Write all you want on this, Pyrtolin as well, this is force applied by the government and its economic character doesn't change that. I suppose on this argument they'd have to add the death penalty for it to be considered force.

There are so so many awful things a government can do under this rubric its just baffling. What if they decide the tax should be $20K? What then? Still not force? What if its 50% of your income, still just a freely exercised choice?
quote:
That's why I said, "Pfft." There is so little freedom that is taken from you that it's a ridiculous comparison. And nothing to get emotional about.
That's why my first thought was just to write lol and walk away. This whole argument seems an exercise in tyring to pretend an ends justifies the means philosophy is something else.
quote:
Yes, this will be a hit for some people. They will be paying more for insurance they may never use. Of course, a few of them will discover that they really did need that insurance, which is why it doesn't seem so terrible to me. And, with the government subsidies and the (hopefully) reduction in the cost of (worthwhile) insurance rates, those in the situation you describe will be minimized.
Government subsidies DO NOT minimize this. They maximise the penalty everyone else is paying as they come from higher taxes on everyone esle. They are the hidden higher premiums that the left refuses to count in their analsis on what's happening to the costs.
quote:
But when you consider the increased number of people who want to be insured who can be insured; the number of those who were refused insurance who now can be insured; and the number of people who will have insurance when they need it when they didn't before, I think it is worth the cost.
When you consider that NOTHING in this plan creates money from nothing, and lots of things in this plan mandate massive additional costs, there is no real benefit here. It's shell game.
quote:
But that is a concern, and I would love to hear ways to mitigate it, without throwing out all the benefits I described above.
I honestly don't see those as benefits. Insurance is and was a broken model, this only doubles down on it.

[ October 16, 2013, 03:25 PM: Message edited by: Seriati ]

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Seriati
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quote:
Originally posted by Pyrtolin:
quote:
I don't do it lightly. Objectively, switching from a professional with higher credentials, a longer training period and higher certification standards, would be expected to mean an inferior product.
If you have to put some finishing nails into a shelf, insist on a jack hammer; opting for a tack hammer is just settling for an inferior product.
So your assertion that seeing a doctor is like using a jackhammer to nail in a shelf? Do you concede that a doctor will have more medical knowledge than the lesser trained substitute, and therefore be more likely to identify conditions that the lesser trained substitute may miss or misdiagnose? If you do, I think your argument is false, if you don't, I don't think you're being reasonable.
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TomDavidson
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quote:
Making the practice of medicine less lucrative for doctors means less interest - basic economics on that one.
It's worth noting that anyone attempting to cut medical costs should not -- and almost certainly will not -- start with salaries, but rather administrative overhead, pharmaceuticals, and equipment costs.
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NobleHunter
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quote:
Insurance is and was a broken model, this only doubles down on it.
Indeed. Pity that there doesn't seem to be any support to properly dismantle that model.
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Pyrtolin
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quote:
I find it bizarre that you pretend that a threat of an economic consequence is not force
How is assessing a price for a behavior that's somewhat congruent to the cost of that behavior a consequence?

quote:
Aren't you the same person that has repeatedly complained that the poor should not have to take on low wage jobs because they are being held as economic hostages?
I've said that they shouldn't be left in a position where their need can be used to extort them into accepting underpayment for the jobs in question- or, more to the point, that we should make sure that the price of their labor is congruent to the cost they incur to provide it.

quote:
I'm not going to play a semantic game with you on this, this was a new twist on government power and loss of a freedom for the citizen.
You consider the freedom to shift costs onto others one that's worthy of protection?

quote:
Obamacare will result in large amounts of personal costs being dumped on the population at large.
You say that as if our current system doesn't already do that. Pooling and subsidizing costs will help reduce the overall amount of costs dumped (especially where it prevents the compounded costs of neglected care, as well as the rampant price gouging that occurs because of the ability to lock people into what are essentially theft arrangements). The worst it can do is no better than what we have now because all of the costs that you speculate will be dumped are already being dumped- in fact more of them are because the current system forces people into actively long-term cost efficient decisions using adverse short term pricing.

quote:
And if you happen to be young and healthy you're going to paying for more than the benefit you're receiving.
No, you're just paying for more than your ill informed and misguided sense of immortality allows you to believe that you're receiving. Unless you're suggesting that the actuarial tables that are used to work out the price/cost relationship are somehow wrong.

quote:
But forcing people to overpay for a service so those overpayments can be used to benefit others is in no way, shape or form causing them to bear the costs of their own care in a way that is designed to lead to efficient use of medical resources.
They're not forced to overpay. If they thing that all of the available options to them are to expensive, they can opt for the default catastrophic coverage that they get by going without a plan, and just pay the associated price that they public would otherwise have to bear should their bet on being invincible go badly, never mind the long term costs of repairing the damage that years of neglect will eventually take on them in the absence of prompt and proper maintenance. Is it really better to make MEdicare pick up the tab for lingering conditions that would have been cheap to prevent if they had been caught in a timely fashion rather than being allowed to linger and compound themselves over decades of neglect?

quote:
Yes to the shutdown both in raw numbers and magnitude.
I can't imagine that the total collection of $100/person for opting to depend on ER guaranteed ER access instead of securing more useful coverage comes anywhere close to just the wages lost over the last two weeks, never mind the rippling effects from debt incurred and lost economic activity.
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LetterRip
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Seriati,

quote:
So you're agreeing now that the standard of care needs to decline to meet the new demands for service.
No, I'm not agreeing. Most of a doctors education is going to be fairly useless to providing primary care; and many practices that doctors have lobbied to get exclusive rights to perform can be performed by someone with a far shorter training time. Standard of care is only dependent on having proper training to perform the needed tasks.

Also I think the ACA will lead to a long term decreased demand for services, the driver of increased demand will be from population aging and from the historical choices of deliberate supply restrictions of doctors and now the decline due to retirements.

[ October 16, 2013, 03:40 PM: Message edited by: LetterRip ]

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kmbboots
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quote:
Originally posted by Seriati:

There are so so many awful things a government can do under this rubric its just baffling. What if they decide the tax should be $20K? What then? Still not force? What if its 50% of your income, still just a freely exercised choice?

For some people, that isn't an inappropriate tax rate. And here's the thing. If you don't agree, vote for people who will repeal it. I pay taxes for all sorts of things that I don't think we should buy. Welcome to life with other people.
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Pyrtolin
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quote:
Originally posted by Seriati:
quote:
Originally posted by Pyrtolin:
quote:
I don't do it lightly. Objectively, switching from a professional with higher credentials, a longer training period and higher certification standards, would be expected to mean an inferior product.
If you have to put some finishing nails into a shelf, insist on a jack hammer; opting for a tack hammer is just settling for an inferior product.
So your assertion that seeing a doctor is like using a jackhammer to nail in a shelf? Do you concede that a doctor will have more medical knowledge than the lesser trained substitute, and therefore be more likely to identify conditions that the lesser trained substitute may miss or misdiagnose? If you do, I think your argument is false, if you don't, I don't think you're being reasonable.
Seeing a highly trained ER doctor, who needs a wide range of experience in multiple areas, when all you need is a few quick stitches, or a prescription for antibiotics absolutely is. LR's specifics might not be right, but requiring credentialing well over the actual treatment needs (especially in the case of simple, acute complaints rather than general maintenance)
not only represents an increase in costs at no measurable benefit, but can, in fact, result in lower standards of care, as those with wider skill sets find their time occupied with issues they're overqualified to handle outside of the context of general health analysis- it directly contributes to that phenomenon you noted of trying to parcel as many patients through the door as possible rather than building better ongoing relationships.

But the other part of fixing that is helping more people become doctors. At no point is the solution denying a large segment access to doctors on the basis of the fact that they can't afford to bid enough to be worth the doctor's time a reasonable solution, though it's effectively what you imply when you suggest that our existing supply of doctors is already pressed to keep up with their patient loads and suggest that that's a problem with giving more people access to try to see them.

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Seriati
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quote:
Originally posted by Pyrtolin:
How is assessing a price for a behavior that's somewhat congruent to the cost of that behavior a consequence?

Have you looked at the definition of consequence recently?
quote:
You consider the freedom to shift costs onto others one that's worthy of protection?
No, which is why I'm opposed to Obamacare's shifing of costs onto others, if you're consistent on that philosophy you should switch sides.
quote:
quote:
Obamacare will result in large amounts of personal costs being dumped on the population at large.
You say that as if our current system doesn't already do that. Pooling and subsidizing costs will help reduce the overall amount of costs dumped (especially where it prevents the compounded costs of neglected care, as well as the rampant price gouging that occurs because of the ability to lock people into what are essentially theft arrangements). The worst it can do is no better than what we have now because all of the costs that you speculate will be dumped are already being dumped- in fact more of them are because the current system forces people into actively long-term cost efficient decisions using adverse short term pricing.
No I say it as if this new system isn't any better. Pooling and subsidizing DO NOT REDUCE COSTS they just spread them around, in fact more people using more medical services virtually by definition means more costs.

I will agree that there may be some savings on compound care, though its by no means certain. In fact with the deductibles being as high as they are it's entirely possible that less people will get early treatment.

It's actually false that all the costs are beind dumped into the current system. There are many people who are not seeking excessive amounts of medical aid because the current costs they bear lead them to efficient medical choices (and granted there are those for whom those costs force them to use less medical resources than they should).
quote:
quote:
And if you happen to be young and healthy you're going to paying for more than the benefit you're receiving.
No, you're just paying for more than your ill informed and misguided sense of immortality allows you to believe that you're receiving. Unless you're suggesting that the actuarial tables that are used to work out the price/cost relationship are somehow wrong.
An actuarial table for young people would set their insurance costs far lower than it will be under Obamacare. It's not rocket science, you can't have the administration claim this won't work without young people joining, and simultaneosly pretend that it isn't because they will be subsidizing the older and sicker patients because they will be over charged.
quote:
quote:
But forcing people to overpay for a service so those overpayments can be used to benefit others is in no way, shape or form causing them to bear the costs of their own care in a way that is designed to lead to efficient use of medical resources.
They're not forced to overpay. If they thing that all of the available options to them are to expensive, they can opt for the default catastrophic coverage that they get by going without a plan, and just pay the associated price that they public would otherwise have to bear should their bet on being invincible go badly, never mind the long term costs of repairing the damage that years of neglect will eventually take on them in the absence of prompt and proper maintenance. Is it really better to make MEdicare pick up the tab for lingering conditions that would have been cheap to prevent if they had been caught in a timely fashion rather than being allowed to linger and compound themselves over decades of neglect?
Lol. I think you're partially correct here. They will choose not to buy the insurance, because it won't be cost justified. You're waxing hyperbolic to conclude they will never become ensured. Especially since it flies in the face of what actaully occurs now.
quote:
quote:
Yes to the shutdown both in raw numbers and magnitude.
I can't imagine that the total collection of $100/person for opting to depend on ER guaranteed ER access instead of securing more useful coverage comes anywhere close to just the wages lost over the last two weeks, never mind the rippling effects from debt incurred and lost economic activity.
If that were the only cost you'd be correct, since its not remotely an accurate picture of cost you're not.
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Seriati
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quote:
Originally posted by kmbboots:
quote:
Originally posted by Seriati:

There are so so many awful things a government can do under this rubric its just baffling. What if they decide the tax should be $20K? What then? Still not force? What if its 50% of your income, still just a freely exercised choice?

For some people, that isn't an inappropriate tax rate. And here's the thing. If you don't agree, vote for people who will repeal it. I pay taxes for all sorts of things that I don't think we should buy. Welcome to life with other people.
What if they set it at 110% of income and force you to borrow to fund it? What if they set it at $100k. Still not force to you?

What if they decide to charge you a tax if you decide you don't want to have cable tv? What if after extensive lobbying by the auto industry you have to pay a tax if you don't own 4 cars manufactured in the last 4 years in the US? What if you have to step on a scale and pay a tax for every pound over optimal you weigh?

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LetterRip
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Something else to do is if a nation is know to have a good training program, then they should be able to forgo doing a US residency.
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kmbboots
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quote:
Originally posted by Seriati:
quote:
Originally posted by kmbboots:
quote:
Originally posted by Seriati:

There are so so many awful things a government can do under this rubric its just baffling. What if they decide the tax should be $20K? What then? Still not force? What if its 50% of your income, still just a freely exercised choice?

For some people, that isn't an inappropriate tax rate. And here's the thing. If you don't agree, vote for people who will repeal it. I pay taxes for all sorts of things that I don't think we should buy. Welcome to life with other people.
What if they set it at 110% of income and force you to borrow to fund it? What if they set it at $100k. Still not force to you?

What if they decide to charge you a tax if you decide you don't want to have cable tv? What if after extensive lobbying by the auto industry you have to pay a tax if you don't own 4 cars manufactured in the last 4 years in the US? What if you have to step on a scale and pay a tax for every pound over optimal you weigh?

What if they taxed me to subsidize oil companies? I would vote against people who campaigned on the laws you mentioned. I would probably be in the majority. See how that works?
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Pyrtolin
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quote:
No, which is why I'm opposed to Obamacare's shifing of costs onto others, if you're consistent on that philosophy you should switch sides.
You do not consider counting on effectively free ER access to be shifting costs on others?
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Pyrtolin
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quote:
Pooling and subsidizing DO NOT REDUCE COSTS they just spread them around, in fact more people using more medical services virtually by definition means more costs.
Pooling and subsidizing costs means that more people receive proper treatment in a more timely and coordinated fashion. That represents a significant cost savings over the total net costs of improper and even non-treatment of medical issues delivered haphazardly based on personal wealth rather than immediate need. Just about every other major country in the world has already figured this out, we're one of the few holdouts that is willing to keep suffering from the pathological effects of letting cash on hand, rather than need for treatment serve as the baseline for health.
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Pyrtolin
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quote:
There are many people who are not seeking excessive amounts of medical aid because the current costs they bear lead them to efficient medical choices (and granted there are those for whom those costs force them to use less medical resources than they should).
Only the latter exist to any significant degree. The fact that medical professionals gate access to treatment resources prevent all but the most wealthy from falling into the first category. There will be virtually no increase in those numbers unless the insurance companies completely throw their responsibilities and informed analysis out the window and start arbitrarily paying for unneeded care.
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Pyrtolin
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quote:
An actuarial table for young people would set their insurance costs far lower than it will be under Obamacare. It's not rocket science, you can't have the administration claim this won't work without young people joining, and simultaneosly pretend that it isn't because they will be subsidizing the older and sicker patients because they will be over charged.
You say that as if those young people won't be old some day. Again, playing to the same invincibility myth that warps their perception of what represents a reasonable price given their expected future needs at any given point, never mind the fact that their future costs will be much lower on the whole with the benefit of proper care at a point in their life when they falsely believe they don't need it because they haven't yet started to accrue the compound negative effects of neglected care.

Do you similarly suggest that young people shouldn't make allowances for other future costs, because they're not immediately bearing them at the moment?

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