Embracing Orwell


Nancy Pelosi epitomizes the ethics illness that has been gradually infecting our public discourse for decades now. She suffers from, and indeed wants to spread, the George Orwell Disease, epitomized in his classic “1984,” which causes political leaders to seek to control the public and hold power by controlling what the population is capable of thinking and saying. Such cynical and sinister use of language to hide the truth and then keep it hidden by insisting on vernacular that throws the brain off the track was once primarily the realm of the military, but in recent decades the American liberal establishment has found the approach—“War is Peace,” as George would have put it—extremely useful, indeed, indispensable. Pelosi’s tactics—it isn’t just her, of course, but the Democrats are accountable for their leadership—include many of those that Big Brother was adept at in Orwell’s book—repetition, for example.

Yesterday, Pelosi explained how the Affordable Care Act was a “winner” for Democrats going into the 2014 elections—or, as Big Brother would say, “Losers are Winners”—and instructed the public and the media that the law isn’t “Obamacare.”  “It’s called the Affordable Care Act. It’s called the Affordable Care Act, ” she insisted. “Affordable. Affordable. There’s a reason. Affordable. Affordable. Affordable. Affordable. Affordable.”

Pelosi, like the fictional uber-dictator who casts a permanent shadow over George Orwell’s dystopian alternate 1984, knows that if you pound descriptions into the minds of human sheep relentlessly enough, then you can control them. In the totalitarian mindset that leaders like Pelosi endorse, it isn’t the truth that matters but the language  used to hide it. “Fifty-one times the Republicans have voted to repeal this freedom and opportunity for the American people,” she said yesterday. Freedom! Funny, in my dictionary, freedom would seem to mean that I should be able to buy or not buy whatever health insurance plan I want, and be able to keep going to a doctor whom I trust and know. Oh no! Government mandates are Freedom. Just ask Nancy Pelosi.

The problem with the Affordable Care Act is that for a great many, indeed for the nation itself,  it may not be affordable….although the President and the Democrats are the ones who decide what “affordable” means. Unaffordable is Affordable, after all.  As the President told a young audience this month, your health care is affordable, it’s just that you might have to give up buying some things you enjoy. Wait, make that ‘you now have the freedom to give up some things you enjoy.’ See, Nancy, I’m getting the hang of it! I can be taught to love Big Brother!

What Americans need to start paying attention to is what kind of character and values their leaders display when they nakedly distort the truth like this. Lies are Truth. The President lied for four years about what the new law would do to our health care choices, and the supporters of Obamacare have spent the months since this was revealed excusing it, denying it, and spinning it, because, after all Big Brother knows best.

Rep. Pelosi is doing us a favor, I think: she doesn’t even try to hide her admiration for Big Brother tactics and thought control. She likes it; she admires it; she practices it.  A major city and a great political party treat her as a respected and trusted leader, which means—which must mean—that they endorse her methods and philosophy, which is that allowing the public to see, say and think the truth is dangerous. She gives Americans, at least those who are paying attention (“Look over there! Missing airplane!!!), a clear choice. Do we love Big Brother?

“Affordable. Affordable. Affordable. Affordable. Affordable.”

214 thoughts on “Embracing Orwell

  1. Well, TECHNICALLY it’s not a lie… sure you may have to give up on other purchases and spend more money, but they didn’t call it the “more affordable than the health care you had before” care act, or the “comfortably affordable” care act, so I guess as long as those naughty millenials will just stop being so selfish and go back to propping up the boomers like we should, we technically DO have enough money in the bank to afford it…

  2. FYI, the coverage I bought on the NY exchange is about $70 month less expensive and covers far more than the plan I had before.

    Before I paid 25% of a hospital bill which led to a $4000 bill for four days of hospitalization. Under my new Obamacare plan, my liability is capped at $500, no matter how long the hospitalization.

    Just sayin’.

    • I would like some more information about your coverage. I can only think of three possible ways for your coverage/costs to work out as you say.
      1.You are being heavily subsidized by your fellow citizens. Either through Medicare or tax “credits”.
      2. You have a nasty, long horizon pre-existing condition, and have had it long enough for your previous insurance to raise your rates over a period of years.
      3. You are lying.
      Perhaps we both would have been better off if I had simply given you half of the additional $6k a year that my individual policy now costs, for coverage inferior to that which I had before.

      • 4th option: he only believed the top line sweeteners used to advertise specific insurance plans , and has failed to read the details that would demonstrate the hidden out of pocket costs if he seeks medical treatment.

          • However, if it turns out that your #1 is the actual reason his costs are low, then I officially declare it unethical for anyone so benefitted to brag about how awesomely low their costs are.

      • I have no pre-existing condition. I don’t even see how I could be subsidized by Medicare or by taxes so that part of your argument seems a nonsequitur. This is still a private insurance pool where the premiums of the healthy (and I am relatively healthy and don’t use my coverage very much) subsidize the pay-outs for the sick, which is the way it has always worked in the private marketplace.

        I think your bias against Obamacare is so great that you can’t accept anyone could possibly have a good experience, hence the ad hominem attack at the end. I don’t personally accuse people of lying until I know them a whole lot better.

        • What don’t you understand about being subsidized? It’s when other people pay for your stuff. Or, in the case of a risk pool, you pay less than your share of the risk.
          I absolutely understand that people who are getting free stuff from Obamacare are having a good experience, on the backs of their fellow citizens. I also accept that slave owners thought that whole human bondage thing had a big upside.
          Excellent use of : bias; ad hominem (might want to look that up); accuse. Always make your arguments emotional, and those are great ‘word triggers’.
          I will pay you $500, if you can produce your before and after policies, with any personal information removed, and I am incorrect about this. So, as they say in poker: I’ll pay to see ’em.

          • Per Wikipedia, you may be right about ad hominem. “Mere verbal abuse in the absence of an argument, however, is not ad hominem nor any kind of logical fallacy”.

            As far as subsidies are concerned, people without insurance freely using emergency rooms for their gunshot and stab wounds and heart attacks are being subsidized by the rest of us, as all our premiums and our taxes may get hit as a consequence. However, I am still confused the model for your taxes subsidizing my insurance premium–could you please spell that out for me? How do you maintain the government is charging you to subsidize me?

            You want to analyze my before and after insurance policies why, exactly? To see if I’m lying or see if I’m missing something about my own policy?
            We can probably work something out, though it will probably involve your placing that $500 in escrow with a third party.

            • As of this writing, your paragraphs 1 and 2 have been well answered by others below. As to your questions, I want you to prove to me that you have purchased an individual insurance policy from a private company, through the Obamacare exchange in your state that offers both lower prices and better coverage than what you had before. That these are “apples to apples” differences; that you are not subsidized in any way; that you were not paying your previous insurer a rate based on a pre-existing condition (including covering a dependent who is now not on your policy). In short, that your current monthly cost, and deductible, and percentage coverage of claims are all better than they were, and that this is due to Obamacare. I don’t think you can. If you do, let me know, and we will arrange to trade dollars for proof.

              • That’s exactly what I’m saying, so this is an easy $500. Lets figure out a process for appointing a neutral third party who will hold your money and then give it to me when I show the evidence.

                • In my world, the guy getting paid does the work, so figure out what you want to do. As far as I’m concerned you can post a link to a pdf file right here. Think hard about the word ‘subsidy’, as it includes any government commitment to reimburse your insurance company for losses or premium shortfall, or any other tax payer dollars given to the company as an inducement, or reward, for participating.

                  • Is that subsidy thing tripping you up? It should. If you decide to go ahead, Jonathon, I can think of no one I would rather have hold my $500 than a man of steely integrity, erudition, wisdom and forbearance, as well as a unique felicity for language…if, of course, he is willing to undertake such a task, I speak of course, of Scott Jacobs.

                    • I would be honored to act as escrow for this challenge.

                      Though perhaps it would be more expedious if I simply acted as arbitor, and if this be the case then I fear I must confess to being unequal to that task. I would advise the adjudication be placed in the hands of our magnanimous host.

                    • As I expected, Jonathon has failed to follow through on the challenge he accepted. My $500 will have to stay in my pocket, and we now know that he was lying from his very first post.

          • Joe, just saw your post that you thought I ran away from a challenge. No, I thought you had dropped it after my follow up post where I told you what kind of insurance I had, details of my premiums, hospitalizations etc.

            Glad to take your money. If you’ve been on my website, you know my email address, so send me an email.

            This is what I think the deal is, just to be clear. We identify someone (respectfully, its not going to be Scott or even Jack) who holds your money. I show you, and that person, a cancelled check or invoice showing my old and new premiums, and details from my old plan that it had a 25% deductible on hospitalization and that my new plan has a $500 cap. One I have established this, the third party releases your $500 to me. Right?

            You really think its impossible that even one person has better terms under Obamacare? Chris Marschner said, and so have others that quite a few people could be doing better at the outset anyway and the plan could still be flawed/ immoral/sure to fail/fattening. Others have said that the plan could be a bait and switch, that I will discover other things I thought were covered were not, and that my premiums will go up radically. I agreed with those people that until I have been on the new plan a while, I won’t know for sure what else it does or doesn’t do and that it would not surprise me if my premiums kept going up.

            I will tell you that in my first excursion under my new plan yesterday, I saw a really great specialist who I first was referred to under my old, non-Obamacare coverage and who takes both. So far so good.

                • In response to Jonathan’s comments and all the replies is –

                  Bottom line: ACA is a net negative for *most* people. The handful of folks that truly receive a net benefit are easily washed out by those that are screwed over by the *same public policy”. Now, Jonathan’s situation would be FINE if everything else, for everyone else, stayed the same, but it didn’t.

                  A good allegory would be killing 10 people to save 1. Yes, great for the one, totally sucky for the 10.

                  • What is your evidence its a net negative for “most” people? I don’t mean anecdotal, Fox News “evidence”. I believe with its flaws Obamacare has done more good than harm.

                    One thing I’m not hearing here, by the way, is any kind of a reasoned defense of the existing system. I worked on NYC ambulances in the 911 system for four years and about a third of the hospitals I used to take patients to back then (I retired in 2007) are now closed because they could no longer afford to treat the uninsured. Those of you who see a right not to buy health insurance as a liberty interest can only be consistent if you also think hospitals should have the right to turn away the uninsured. Anyone who simultaneously maintains a right not to be insured AND a right to be treated for a serious wound or heart attack at the ER has issues.

                    • Ah, now that you’ve read up on “ad hominem,” try “poisoning the well” on for size. “Anecdotal Fox News ‘evidence…'” You have nothing to base a supposition on that anything Bill says comes from Fox News, but you know you dislike Fox News and you know that you disagree with Bill, so you throw that out there. In doing so you seek to make the implied connection that Fox News is untrustworthy, and Fox News may also dislike the ACA, so people who dislike the ACA must be making untrustworthy arguments they got from Fox News.

                    • OK, you can have that one. Let’s just say “anecdotal evidence”. I don’t really care if it comes from the water cooler, MSNBC, Fox or personal experience. Someone said “most” people are hurt by the ACA. What’s the back up to that?

                    • I never watch Fox News, but it appears you do… how about you tell me all about it?

                      Look, champ: I don’t have to prove it DOESN’T work… YOU have to prove that it does. Get it? Your individual case, in a nation of THREE HUNDRED MILLION, does not mean SQUAT.

                      So, stop talking about how great you have it and PROVE that ACA is, or is going to be, beneficial to at least 50% of the population.

                      You can’t because there is NOTHING in this legislation that makes it more affordable for most people, or for the nation in general. If it WERE beneficial for most, participation would NOT be mandatory. If it WERE beneficial for most, people would not be seeking exemptions or finding other ways to get out from under it. If it WERE beneficial to most people, the DEMOCRATS would not be shitting their pants over the implementation of it. Get it, yet?

                    • Gee, thanks for saying I can have that one. It’s so generous of you to concede the perfectly correct calling out of your dishonest argument tactic.

                    • Of course not—that would be a violation of the professional mission of doctors. However, they should be able to take the uninsured and charge the reasonable cost of their treatment, or some agreed upon version thereof, and be able to force sales of property and garnish wages to pay for as much of it as possible. And if someone has to work in indentured servitude to pay for their bypass or their son’s operation, that’s life, or rather, the rice of saving one. Then people will be a bit more careful about overuse of the medical system.

                    • Jack,

                      How dare you apply concepts of incentives and personal responsibility to the free market! Don’t you know this is America! We can have our cake AND eat it too!!!

                    • You’re retired? And purchasing an individual plan, from a private company, through a state exchange? Sorta makes me wonder if what you said before is true. You’ve been retired for 7 years? And choose NOT to use Medicare?

                    • That’s the reason I complimented the one guy who acknowledged I might have had a good experience under Obamacare, even though he believes most people have not. I think people who are capable of conceding a point occasionally are more likely to be willing to engage in an actual discussion with a goal of seeking the truth together. People who refuse ever to acknowledge that an adversary might be right even on a trivial or subsidiary point and who instead start making personal accusations (regardless of whether correctly labeled “ad hominem” or not) strike me as starting from a rigid ideological framework which must stay 100% intact. Just sayin’.

                    • Whether one individual or a hundred thousand have had a good experience with the ACA is irrelevant to the question of whether it is a competent and responsible program. Is it what it was sold as and represented to be? (NO.) Were the costs fairly and honestly estimated? (NO.) Are the costs to those whose position is made worse worth the benefits to others? (UNKNOWN) Is it fair? (ARGUABLE) Will it in fact add to the deficit and the debt? (PROBABLY) Most of all, does the evidence suggest that the government is capable of delivering on the administration of the complex system in place? (ABSOLUTELY NOT.)

                      I hear defenses that 1) the law had good intentions 2) it does some good things and 3) some people, maybe a lot, are benefiting from it. 1) means nothing with out competence and honesty. 2) Lots of bad laws do good things—this is not an argument by itself, and 3) again, so what? How many aren’t benefiting, or are being hurt? What are the unintended consequences? Does the fact that individual freedom is being infringed matter at all? How bad will the budget be busted?

                      In high school guy talk, you are telling us that the stupid fat girl has nice eyes and doesn’t sweat much.

                    • So the fact that the other networks who are demonstrably pro-Obama and won’t report something that is deeply embarrassing to him means that the one outlet willing to do is tainted and unusable?

                      How astonishingly convenient. It must be easy to claim that there is no evidence to counter your bullshit claims when you dismiss any evidence that runs counter to your ignorant, bullshit claim is “biased”.

                      Much like “They are funded by BigOil” is used to dismiss arguments against AGW.

                      I think I’m willing to guess how you vote on election day…

                    • Yes, I voted for Obama twice.

                      I corrected my statement to reject anecdotal evidence from anyone, including MSNBC and my own. Just hoping we could search for MIltonian truth together.

                    • Just hoping we could search for MIltonian truth together.


                      An Obama voter interested in “the Miltonian truth”…


                      Jesus man, you should do fucking standup. You’re fucking killing me here.

                    • “That’s the reason I complimented the one guy who acknowledged I might have had a good experience under Obamacare, even though he believes most people have not. I think people who are capable of conceding a point occasionally are more likely to be willing to engage in an actual discussion with a goal of seeking the truth together. People who refuse ever to acknowledge that an adversary might be right even on a trivial or subsidiary point and who instead start making personal accusations (regardless of whether correctly labeled “ad hominem” or not) strike me as starting from a rigid ideological framework which must stay 100% intact. Just sayin’.”

                      Quit establishing the conditions necessary to claim martyrdom when people vehemently disagree with you.

    • Jonathan, your experience is just one of many. I am not denying the missteps and confusion of the implementation of the ACA, and I know that some will have a negative experience, including changing doctors, higher premiums or changing plans. I have talked to people who have actually used their new coverage and are very happy. The Act is helping a lot of people and in the end the good stories will outweigh the bad.

      • Jan, your propaganda statement is just one of many. I am not denying that the talking points inevitably address the roll out, and not the actual program, and I know that many Democrats will have a negative experience, including not being re-elected, higher levels of obfuscation and double-talk, and Orwell-speak. I have talked to people who have actually been rat-fucked financially and medically, and they are assuredly not very happy. The Act is helping a lot of people understand the term ‘government overreach’, and in the end will collapse of it’s own weight.

      • I know that some people are getting screwed, but fuck ’em! After all, isn’t it the government’s job to force people to change their health care to something shitty and expensive so the people it likes more get a better deal?

      • And there are over 5 million people who had their coverage canceled. So even if we assume the White House’s numbers on “enrollments” is accurate (and ignore the whole “how many are actually paying the premiums?” question), That leaves about a million who have no coverage where once there was coverage.

        And when you subtract out those who went on Medicaid (and thus not actually in the exchanges), you get an even bigger difference.

        The ACA is a shit law, written by shit people, and supported by shit brains.

        Anyone who still thinks the ACA is a good law or a positive thing is a moron, without exception.

        If it was a good thing, why would large parts of it be put off (without Congressional input, via Executive – and unconstitutional – fiat) time and time again? Why would groups that pushed for it be seeking to be exempt?

        If it was good, the bumbling fucktard that people like you put into the Oval Office would not seek to make sure it didn’t go into effect until after the next elections.

        • RIght. ANOTHER reason this thing is a turkey – if it is so great, why not put the whole thing in place RIGHT NOW?

          They don’t because the whole thing is a big shit sandwich (that THEY made!) and they do NOT want to take a bite!

          This POS law is going to simply fade away.

    • OK, a few more details for anyone open minded enough to evaluate my veracity…..

      Circa 2008, my COBRA coverage from my ambulance job was running out and I started looking for a NY group I could join as a self employed person. I found one via a nonprofit called Fractured Atlas. It was an Emblem Health/HIP plan which went up 10-20% per year. By the end of 2013, I was paying $720 approx for my coverage (I am away for the weekend but will provide exact amounts when I get home).

      I was 59 on my last birthday, too young for Medicare. I am generally healthy, exercise,don’t smoke, am not obese and had no pre-existing conditions. I have been hospitalized twice, once in 2010 or so for a transient infection and once last August after a fall. Both times, I was in for four nights, the total bill came to more than $20,000 and my share was $4,000 approx.

      Last fall, I got a letter that Emblem/Hip was discontinuing my plan due to Obamacare. I think that Obamacare, erroneously in my opinion, made no provision for groups like mine, in which every participant paid the full price of coverage and Fractured Atlas, the plan sponsor but not our employer, made no contribution.

      I got onto the NY exchange, which like the federal one was seriously farkled, and after 30+ attempts set up an account, reviewed coverage and bought the second highest level of plan, It is also an Emblem/HIP plan, and the premium is about $80/mo. less than my old plan. The online prospectus says that for any length hospitalization, my participation will be capped at $500.

      So strangely enough I agree with the following proposition: “Obamacare is complex, problematic legislation with some unforeseen side effects, which may eventually fall under its own weight”. I stand by the foregoing description of my personal experience, and will be happy to accept the offer one of you made to pay me $500 to see copies of plans, hospital bills,the prospectus and cancelled checks.

      • You are HEAVILY subsidized. You have to be.

        To start with, you basically went from a plant that had no subsidy – had you had an employer, a similar plan would have cost you about half what you were paying (because an employer would contribute to your premiums for reasons that have nothing to do with caring about you), and sorry but 1/5 the cost of a 4 night hospital stay doesn’t sound too bad.

        For any plan to be both cheaper and cap hospital stays at $500 is impossible unless the actual cost is much, much higher.

        It simply isn’t possible otherwise. It just isn’t.

        But having taken the opportunity to wander about your site, I’m hardly shocked you don’t grasp this. You seem fairly taken with the socialist model, which by definition means you can’t have any grasp on actual economics.

        And your premiums for next year?

        Yeah, they aren’t shaping up to be nearly as nice for you. Have fun with that.

        • Time will tell. I also will not be surprised if my premiums go up radically.

          As I have said in various posts, I am not actually arguing Obamacare is a panacea, or even that it wont fail. I am saying it was an attempt to solve a real problem, which various Congresses since Roosevelt refused to address, perpetuating a badly broken system for additional decades. The purest form of the “Repeal Obamacare” movement and literature seems to seek to restore the status quo ante with no changes. I have yet to hear an acknowledgement from anyone promoting that effort that there was a problem or a proposal for an alternate solution.

          Your statement that being responsible for $1000 a day is not so bad is interesting. It seems to me to follow from that that being financially completely ruined by a chronic illness or trauma which is not caused by lifestyle choices is acceptable, possibly the price we pay for liberty?

          I am pleased you took a look at my website, http://www.spectacle.org. You will also find my bio there. I have created and helped to run businesses, made jobs for people and provided employer benefits, and am proud of that. I don’t actually believe the workers should own the means of production, which is my (old fashioned) understanding of “socialist”. I do believe in some legitimate roles for government which are different than those you believe in.

          • It seems to me to follow from that that being financially completely ruined by a chronic illness or trauma which is not caused by lifestyle choices is acceptable, possibly the price we pay for liberty?

            It is the price you pay for poorly-made choices. People who opt to have no coverage are gambling they won’t need the coverage. Such is life. If they choose a plan that doesn’t cover what they need, that too is a gamble.

            It is neither my desire nor duty to save people from their bad choices, and I will cut down any man who dares to suggest I am somehow obligated to sacrifice my life or lifestyle simply because it will make someone else’s more comfortable.

            • People who opt to have no coverage are assuming you and I will pay for their treatment.

              Submitted for your consideration: the car insurance analogy. Most states require you to have insurance to drive a car on roads. Suppose Obamacare were recharacterized only to require you to have insurance to be treated at a hospital. What is the legal or moral difference? The argument about mandates as an infringement of liberty seems identical: in both cases the state is forcing you to buy insurance in order to be able to do something. In either case, you can then opt out by giving up that thing.

              People who choose not to have health insurance but insist on their right to be treated at a hospital seem morally identical to people insisting on a right NOT to buy car insurance but to drive on roads, making the rest of us cover the costs of accidents.

              • No, they are assuming they won’t need coverage.

                I don’t have insurance because, barring a couple of minor complaints, I am in generally good health. This means that insurance is an expense I don’t need.

                And guess what – people without insurance still get billed. And they are, in fact, expected to pay.

                But please, tell me about this magical world where things don’t cost. It sounds lovely.

            • Its interesting I haven’t yet found anyone willing to say that hospitals should be able to refuse treatment to the uninsured. Why doesn’t anyone care about the liberty of private hospital owners who are forced by government to treat people they know will never pay? If I owned a grocery, would you be comfortable with a government mandate that forced me to give groceries to people who couldn’t pay?

              Back in the day, “unfunded mandates” were a big Republican talking point. Forcing hospitals to treat people without payment seems like one of the biggest, and it is actually driving hospitals like St. Vincent’s in NYC out of business.

              • By the way, a world in which hospitals could actually refuse to treat people has some interesting implications. Every ER would have people dying on the sidewalk outside of gunshots and heart attacks who couldn’t pay.

                Jesus fuck will you fucking get over the God Damn “turn away the uninsured” shit, you cunt.

                If you don’t have insurance, you pay. Period. If you can’t pay, your property gets taken to sell off to cover the bill. Period.

                Your costs shouldn’t come out of my pocket, you fucking whore.

        • One more thought. Various people here have said my premiums must be subsidized. Please elaborate on the subsidy model? I am not getting a tax break from the government. Is my insurer? How do you see everyone else paying for my health care?

          I do understand that those of us paying premiums in my plan who are not using health services are subsidizing those who use them more, but that’s the way private insurance has always operated.

          • One more thought. Various people here have said my premiums must be subsidized. Please elaborate on the subsidy model? I am not getting a tax break from the government. Is my insurer? How do you see everyone else paying for my health care?

            It is impossible for your current plan to be more expansive and have far, far lower out-of-pocket costs and have lower premiums. It simply isn’t possible.

            Think of it like this – there are two car insurance plans. Plan A has a premium of $100 a month, and has coverage that consists of $10,000 for property damage for a single accident, $25,000 for bodily injury and $50,000 for death for a person involved in an accident, $50,000 for bodily injury and $100,000 for death for two or more people in an accident, all with a $750 deductible.

            Plan B, however, costs $65 a month, and has coverage that consists of $20,000 for property damage for a single accident, $35,000 for bodily injury and $70,000 for death for a person involved in an accident, $70,000 for bodily injury and $150,000 for death for two or more people in an accident, with a deductible of $250.

            Who in their right mind would ever pick option A? No one would. Unless Plan B is cost-effective and profitable (and if it is, the Plan A must REALLY be profitable) on it’s own, that insurance company will never survive.

            Your current plan is like Plan B – too good for the cost. Someone (the government) is helping pay part of a much higher premium, the remainder of which you see as $660-something.

            There is no other possible way your plan could ever be possible.

            Unless somehow the range of places you can get covered care is so small as to be worthless. But you say that isn’t the case.

            Someone is paying money towards your premiums besides you, and that means the government is paying the money. Which means I am paying.

            And I don’t know you, and I don’t like you – why should I be required to pay for you?

            • I understand. Your argument is “there MUST be a man behind the curtain to explain this”. I was waiting for you or Chris to tell me about an actual subsidy I didn’t know about: some objective flow of dollars spelled out in the ACA which I didn’t know existed.

              How about this as the man behind the curtain: my old coverage was worse because only people who needed insurance bought it. The new insurance is better because there are (expected to be) more healthy people in the pool. I understand you still don’t think healthy people should be required to buy insurance they don’t want, but why doesn’t this work as an economic model/ explanation of the “curtain man”?

              • Uh, they’ve been saying this the entire time. You’ve just admitted your prices are lower because the government has compelled other people to surrender their property into market action they otherwise would not take.

                Subsidies don’t have to come DIRECTLY from the government.

                That you don’t realize that is telling. But yes, you are quite happy to have lower prices because others have been compelled to surrender their property and value to you. I hope you thank them on a daily basis.

                • I knew someone would characterize that as a subsidy. But, as I’ve said in several posts now, those people who are being “forced” and who want to decline coverage still expect to be treated at the hospital. I suggested a model above in which in exchange for the right to refuse insurance, they would waive the right to be treated at the hospital for any problem for which they were unable to pay cash.

                  Otherwise, anyone who wants no insurance but expects to be treated is a free rider, like anyone who claims an equivalent right not to buy car insurance but insists on driving on roads.

                  • We’ve already stated, multiple times, that those who are brought in for treatment they MUST have RIGHT now, should be compelled to pay for it if they don’t decline the treatment.

                    We’ve already been sitting on that hill, don’t pretend like you’ve just clambered to the top of it, dusty and sweaty and exclaimed “Glad We’ve made it here, together, I’ve done most of the climbing though!”

                • By the way, a world in which hospitals could actually refuse to treat people has some interesting implications. Every ER would have people dying on the sidewalk outside of gunshots and heart attacks who couldn’t pay.

                  Making the decision in a split second as to who can pay or not is also non-trivial, when people come in unconscious and/or without their insurance card. I think we would all have to have microchips implanted somewhere. Mine would have my Emblemhealth insurance number imprinted. Yours would contain a Google Wallet with $1,000,000 in it. But suppose a trauma which sent us both to the hospital also eliminated or fried the microchips?

                  Personally, I think its a whole lot easier to have a system in which 1. hospitals can immediately rush to treat everyone who comes in with a severe condition without worrying about whether they have insurance AND 2. know they will always be paid by someone. I wonder what kind of system might fit those criteria?

                  • We’ve already noted that those who come in for treatment who do not decline treatment are the one’s who must pay.

                    On the flipside, if their injury is the result of an assault, then the assaulter would technically be the one who owes.

              • This is why I think you are a fucking moron…

                There are not enough non-sick signing up for coverage to spread the risk. There isn’t. Only 4.2 Million or so (if you assume the government is telling the truth and that each sign-up has paid their premiums, which only the truly stupid do) NATION WIDE have signed up. More people than that lost their coverage.

                It might be that the premium you pay is set at a level that assumed greater enrollment, but that just means your rate will increase by well more than 10% next year in order to make up the gap.

                But hey, that would never happen to you. After all, you’re one of the people who benefited from the law. Surely it will never turn around and bite you in the ass.

                Jesus you’re dumb. You’re like some kind of perverse science experiment…

                • So you agree with me regarding the economic model. We don’t have to look for the man behind the curtain elsewhere.

                  I never actually said Obamacare will work. I don’t know it will. My premiums have always gone up 10-20% per year before and it wouldn’t surprise me if they still did. The ACA could wind up a misguided effort to solve a real problem, just what some of you are saying. We don’t actually disagree quite as much as you think.

                  Most of my efforts here have been to figure out whether or not most of you agree there is a real problem to be solved. I have asked why people who want to decline coverage while insisting on treatment are not free riders. I have asked why government should force private hospitals to treat people who don’t have coverage.

                  I have told you that I am one of those people whose coverage dropped because of Obamacare, and also that I had to make about 50 attempts to buy coverage on the exchange. I haven’t said anywhere that Obamacare is perfect or won’t fail or is better than sliced bread.

                  I told you that after my other coverage unexpectedly dropped, I was able to buy what APPEARS to be a better plan for somewhat less money. I don’t know there won’t be other problems. I do have the perception that reimbursements are low and that some doctors are unwilling to take the new plans.

                  At times you are talking past me to your IDEA of a liberal or socialist. When I referenced Miltonian truth, part of the reason was I came here hoping to learn somethjing, which I have (from Chris Marschner).

  3. Part of the problem is that we, who are fed this on a regular basis, rarely ever question how the terms are defined.

    If we define affordable as that which is within our means to buy, is something that we need to purchase so as to avoid placing an economic burden on another, and we have no higher priorities then I would have to conclude that members of Congress, the Executive branch and the Judiciary can afford to fully fund their own health care from their personal resources, fully fund their own retirement plans and fully fund their non-business travel expenditures.

    If we require a taxpayer supported subsidy to acquire such a product, it is by definition unaffordable to the individual and society unless we are willing to preclude that subsidized individual from purchasing other goods that are of a lower social priority such as cigarettes and lotto tickets. You cannot make something affordable simply by shifting costs from one person to another.

    • But you could play all kinds of semantics games with that. Leaving aside the ACA, why do you buy health insurance? It’s to make your health care affordable. How does insurance do that? by shifting costs around among the pool. It’s all in how you define the word “affordable,” and it can be made to do the job for anyone who wants to argue the point.

      This is why I don’t like lawmakers assigning propagandistic names to laws. “Patriot Act,” “No Child Left Behind,” “Affordable Care Act.” All are meant to tie the law to feel-good words and phrases, so the law’s supporters can use them as a weapon. Aren’t you a patriot? Don’t you want health care to be affordable? Don’t you care about children?

        • Depends what you mean. By “poor substitute” do you mean that it obfuscates the real issues and hurts the cause of good governance? Then I agree. On the other hand, it does a dandy job of substituting rhetoric and shoutable slogans for boring old reasoning… 😀

    • Chris, a thought experiment I like to try is, imagine that a region of space is discovered that has a thousand or more uninhabited Earth-like worlds which a government bureaucracy then assigns to people who wish to start their own world. One group establishes the Libertarian planet, another the Palestinian planet, and so forth. You and I and 10,000 of our closest friends sign up for a world and the first week, are sitting together on a hilltop we have named the Pnyx forming our constitution.

      I will argue that taking care of all our health is a very useful function of government, and propose a tax paid by healthy and ill alike to pay for all of our health care. We could offest by avoiding some other expenditures,,refraining from paying for total surveillance of each other all the time for example. Anyway, in our Pnyx discussion, you would have to try to persuade me that government health care is immoral/fattening/could never work.

      A lot of the arguments I hear are “Obamacare isn’t working”, so naturally given my goals I would naturally respond, “How can we do better?” As an American voter, even though I live in a fat terrorist target, my chances of being bankrupted by hospital bills is far greater than that of being killed by a suicide bomber. I really don’t see why, in our conversation on the Pnyx hill on our new planet, a government run health care system is obviously not a topic for discussion, or a problem we could solve by the mutual application of good faith, compassion and ingenuity.

      • I will argue that taking care of all our health is a very useful function of government, and propose a tax paid by healthy and ill alike to pay for all of our health care. We could offest by avoiding some other expenditures,,refraining from paying for total surveillance of each other all the time for example.

        Well at least you said it out loud.

        To start with, you dolt, for a guy that bitches about “free riders” you sure seem to favor a system that does nothing but encourage it. Why do anything to maintain my health when I pay no cost for my medical care save a fairly fixed tax that everyone else pays?

        What care would I have what lung cancer treatment would cost? I certainly would never pay it, so why not smoke as much as I like?

        Blood pressure and medications to fight high cholesterol are insanely expensive, but not that I would ever know it! I’ll just eat every fattening food I could dream of, because it isn’t like it will cost me anything, right?

        And this assumes that the government could be anything remotely like competent about the whole thing, which it has never (especially lately) show to be the case.

        The only way your system works is if, in addition to the power to tax me to make sure Johnny Sonofabitch has the same coverage I do, you also allow the government to force me to not engage in certain activity and/or outlaw certain foods, and cigarettes, and alcohol, etc. That is the only way that system works.

        And no, it wouldn’t actually work.

        Anyway, in our Pnyx discussion, you would have to try to persuade me that government health care is immoral/fattening/could never work.

        It can never work because it has never worked anywhere it is done. Not only do the places that have see ever increasing government expenditures, but they systems don’t actually provide good, efficient, or effective care – care is rationed either by weight times or by deciding who is “worth” a particular treatment.

        Not to mention, these countries don’t tend to have the full range of modern medicine. Montreal has hospitals with less ability to handle premature infants than Bloomington, Illinois.

        As an added “bonus”, these countries have, effectively, no military. That’s a fine plan, but only because we in the US still have (or had, I guess) a robust military capable of picking up the slack. Germany, for example, doesn’t have an army that could effectively stall the Russians for even a week, let alone the two it would take for use to get our forces over there to be NATO for NATO. Nor does the UK. Or France. Or anyone. The entire EU couldn’t even handle fucking Bosnia, ffs.

        And that ignores the fact that what will REALLY get cut is our navy which is the reason you can get fresh fruit and veg in February – shipping. We are the reason ocean piracy is pretty much a thing of the past. You take away us, and all you are left with are smaller regional powers like China who will not be as kind as we are when it comes to letting commerce take place.

        Not to mention, out “broken” system is responsible for over 80% of all medical innovation. France sees lower costs because private enterprise in the U.S. shoulders the cost. When was the last time any new treatment or medication came from anywhere that wasn’t in the U.S.?

        But please, tell me more about this magical place where government isn’t incompetent. I love a good fantasy tale.

        • “The only way your system works is if, in addition to the power to tax me to make sure Johnny Sonofabitch has the same coverage I do, you also allow the government to force me to not engage in certain activity and/or outlaw certain foods, and cigarettes, and alcohol, etc. That is the only way that system works.”

          Don’t think for once that that wasn’t part of the ultimate objective.

        • I was waiting for the Canadian example to come up. I have only anecdotal evidence, but its worth mentioning. A French friend who lived in Canada for many years said two things: that the wait times for tests are indeed distressing, but that once you’ve been diagnosed and are in the system, you are completely taken care of. She once came to the US and paid $1000 for a test rather than wait four months. But once a problem was diagnosed, she was very pleased with the care she received in the Canadian system at no cost to herself. More recently, a Canadian client who lost his father praised the care his dad received in his final hospitalizations and the intervals in between and contrasted the terrible financial hit he believed his family would have taken in the US.

          I believe that many of those reviling the “Socialist” Canadian system may never have spoken to an actual Canadian. In any event, private doctors also exist in Canada so anyone choosing to can go outside the system.

          One thing which strikes me about everyone vaunting the increased innovation in the American system seems to be overlooking the fact that it is innovative treatment many of us will have no access to, if we do not have good insurance that covers it. People who make this argument tend to be arguing for a complete repeal of Obamacare and putting nothing in its place, so that they seem to be saying the status quo ante should be restored. I don’t agree because I think that system was badly broken.

          I was also interested by your linkage of health care expense to armies and fresh produce. As I said in another post, since my chances of being bankrupted by a serious illness (my unlucky father had a series of heart attacks, then lymphoma) are greater than of being killed by a terrorist bomb, I would in a vote on the Pnyx personally trade off a smaller army and a substantial chunk of our surveillance expense for better health care. I am not sure I believe we would have no fresh produce but I would even trade off some dietary choices for health care.

          A related point (since we seem at last to be having a conversation here) is that if I stand up on the Pnyx Hill and argue for a smaller army, or for nationalized health care, it seems to me in a democracy the best way to get business done is for you to say “I completely disagree” and give your reasons. Then we put it to a vote. The tactic I encountered here last week is to call me names until I shut up. Not that its written anywhere this board has to engage in open discussion, but I came here thinking it would due to the neutral-sounding name and the reasoned nature of Jack’s postings.

          • In any event, private doctors also exist in Canada so anyone choosing to can go outside the system.

            Yes, they exist now. Canada has been pulling back from it’s universal system for years now because it was entirely unaffordable.

            The client who was happy with the care at the end of their father’s life might have preferred the cost of still having the father around, had he been in the US. I dunno, I don’t know the guy.

            But My grandfather was around for almost a decade longer than he should have been thanks to our “broken” system. I assure you, higher cost came with far superior results. There is a reason those who can afford it don’t get their heart surgeries or transplants done in Canada – they come here.

          • “One thing which strikes me about everyone vaunting the increased innovation in the American system seems to be overlooking the fact that it is innovative treatment many of us will have no access to, if we do not have good insurance that covers it.”

            That’s the way innovation and technological advancement work. Throughout all history, new things, better things, more advanced things have always been expensive upon release to the market. there is a ton of research and development and capital overhead costs per good to recover. As the particular good/service continues on the market and efficiencies are developed, more people can afford it down the line. This is historically undeniable.

            You seem bent on believing medical care to be a right. It is not, and you’ll never demonstrate that it is. Medical care is just one more good/service created by market forces to meet a demand generated by market forces.

            The national government has no business imposing itself on the market in any way that subsidizes people’s private choices that cause the confiscation of someone else’s property. Nope.

            “I was also interested by your linkage of health care expense to armies and fresh produce. As I said in another post, since my chances of being bankrupted by a serious illness (my unlucky father had a series of heart attacks, then lymphoma) are greater than of being killed by a terrorist bomb, I would in a vote on the Pnyx personally trade off a smaller army and a substantial chunk of our surveillance expense for better health care. I am not sure I believe we would have no fresh produce but I would even trade off some dietary choices for health care.”

            Uh, the link is pretty clear: program X and Y cost money that adds up to Z dollars the government has to spend. We now add program W, which costs money. Now where does that money come from if the government only has Z dollars to spend? either you sacrifice X or Y to pay for W, or you raise the hell out of taxes, decelerating the economy, or you debt spend. I don’t doubt in your economic ignorance you think those last two options are fine and dandy.

            However, why is sacrificing military expenditure a bad thing? Because the military isn’t only watching out for Mr jihadi-self-guided-bomb. Our military is the ONLY thing keeping any regional powers from arising that could disrupt global commerce. Global commerce by the way that is protected (read as ‘kept inexpensive’) because the world’s shipping lanes are guarded by the Navy of the world’s strongest commercial republic. Diminish that and the regional monsters that rush to fill the void will be far less interested in global peace or international trade.

            Your Pnyx thought experiment is ludicrous for that reason, it attempts to set a society in a vacuum in which there are no other external concerns to worry about, and presumably an infinite set of resources to work with. That is utopian blather. Try again.

            • I think our disagreements are now pretty well spelled out by both of us, so I just want to clarify one thing. I don’t think health care is a “right”. In fact, I don’t believe in natural rights at all. I think humans get together in groups to decide the rulesets they live under, and what we call rights are simply the rules they decide.

              I said if we were sitting on the Pnyx hill on our new planet, I would argue pretty hard for including single payer health care in our rule set, even if it meant having a smaller army. I perfectly understand you think that would be madness.

              For those recounting stories about grandpa living ten years longer than he would have in Canada, I assume Medicare paid for everything, OR you had a million dollars lying around you didn’t need for something else to cover the extra expense, OR your family took a pretty big hit along the way.

              • If you insist on arguing your point backed up by your fantasy-land that has no other external concerns and an infinite set of resources, I don’t think we can continue this discussion in good faith.

                • Either you haven’t read my responses or you are playing a fool, but all your assertions have been answered. You continue to fall back on this fanciful thought experiment in which your fantasy-land exists with nothing else to worry about spending money on than universal healthcare.

                  When I see you continue to drum out dreamworld as a reason to take you seriously, it becomes increasingly impossible to take you seriously.

    • Chris, I find many of your economic concerns persuasive or at least thought provoking, but what is your prescription? Or do you think there is nothing to be done?

      I am reminded of a conversation I had with a dogmatic Libertarian, in which after seeming to deny human-induced climate change, then its magnitude, he ended by saying there is nothing to be done about it any way.

      Some human problems may not be solvable. As I said in another post, I believe Obamacare may fail. But I radically disagree with anyone who says either of two things:

      1. The status quo ante was not broken.

      2. The problem of pricing of and access to health care can be entirely solved by the free market if government just didn’t intervene.

      By the way, I once found an apparently straight-faced article arguing that there would be no violence in Somalia if there wasn’t even a vestige of a government (not 100% sure it wasn’t a spoof). Even Hayek acknowledged that certain problems are best solved by government (he gave an environmental example). When I quoted that to the dogmatic Libertarian I mentiooned above, he said “That’s what I hate about Hayek”.

      • <blockquote<The problem of pricing of and access to health care can be entirely solved by the free market if government just didn’t intervene.Prior to the ACA, how much government intervention do you think there was or was not in the medical marketplace?

        • Who is willing to bet that the day the law was passed compelling hospitals to accept all patients with serious issues, without also ensuring those accepted are responsible for the payment of service, is the day the prices started to climb.

          Combine that also with the lack of interstate competition…

        • I know there was a lot of government regulation in the pre-ACA market.

          I am waiting for the modern Libertarian argument to be made by you or someone that a perfectly free market would result in the distribution of affordable health care to everyone who needs it.

          Even Hayek admitted there are areas of human concern which require government intervention.

          • Uh, I’ve already posited that the Free Market historically does lower costs while simultaneously increasing quality for everyone. Maybe not EVERYONE immediately in the case of new procedures or new products, but those costs go down over time to become affordable, and certainly available should individuals choose to purchase a particular service. Again, unless it is a right however (which it isn’t, and you even admit so), then there is no logical argument to be made to ensure anyone can buy a particular item from the market.

            The government’s business is

            1) providing the means to address external needs that threaten the ability of the market to function freely and that develop so rapidly that the market cannot generate a solution to the problem quickly enough.

            2) providing the means to promote the general welfare. A vague concept that lefties often erroneously conflate with specific welfare (read as redistribution of wealth).

            3) related to #1, provide fair and measured action to disperse or counter internal aggregations of power that could threaten the ability of the market to operate freely.

  4. I am very curious whether anyone here believes hospitals should have the right to turn away the uninsured (except for those able of course to pay cash). I am waiting for someone to explain why anyone resisting a health insurance mandate but claiming a right to free hospital treatment is not a free rider.

    • You’ll be waiting a while on that, for most here recognize it as the obfuscation it is. There were problems with health care before the ACA. The ACA was pitched as solving those problems (actually for the most part, it was pitched as solving an entirely tangential set of problems – altering insurance does little to change high costs of health care.) But hand-waving aside legitimate problems with the proposed solution to insist on focusing on the original problems is the hallmark of an apologist at best, a propogandist at worst.

      tldr: Admitting that there used to be a problem has zero bearing on whether or not this solution is effective.

      • Aaron, I am not at all sure personally whether Obamacare will be effective to fix a broken system. We do agree “There were problems with health care before the ACA”, and I think they were pretty severe. I am not hearing a lot of acknowledgment from others here that the system was broken.

        I think the cost of health care has made it unaffordable for most of us, even with insurance. The fact that it cost me $5000 a day to be in a New York hospital, $1000/day of which was not covered by my insurance is a case in point. I think the profession contributes to driving up prices and premiums by recommending a fair number of unnecessary tests and procedures. For example, my mother in law, who already had stage IV breast cancer, was prescribed and took a $3500 test to determine if she had the gene for breast cancer. In other cases, women (Angelina Jolie) have undergone preventive mastectomies due to a test which was not actually determinative of whether they would have cancer one day.

        Since you agree the prior system was broken, what is your recommended solution? If you wouild repeal Obamacare, what would you do in its place?

        • The fact that the system didn’t work in a way that makes you feel good doesn’t mean it was broken, and didn’t mean that it didn’t work.

          You seem ignorant (a shock, that) of the fact that costs have risen as a result of the insertion of third party payers. When you never see the true cost, you don’t act in a way to minimize costs. If you only pay $500 for a hospital stay, regardless of how long it is, why not stay a week instead of 5 days? Those two days you stay extra cost the hospital, and cost someone who could be better served in that bed, but what do you care?

          You seem utterly uninformed at every. Single. Step. Are you just playing at the role, or are you actually this stupid?

          • So you think we should revert to a system in which we all pay cash for everything? No health insurance at all?

            1. Doesn’t that infringe the liberty interests of people who want to be in the health insurance business? Aren’t we eliminating a whole area of privatecommerce by banning third party payers?

            2. So you think if there were no third party payers that prices would come down?

            3. Just curious, but do you also think that if no-one was trying to form a government in Somalia that the place would be peaceful?

    • The problem is, as I see it is that uninsured people go to hospitals for all sorts of reason. No, I don’t think hospitals should be allowed to turn people away for life threatening illnesses. However, I see too many people in emergency departments seeking treatment for their kid’s colds or for maternity care who are uninsured and frequently undocumented aliens. Perhaps we should look at a system that offers “skilled birth attendants” providing care at county hospitals for these women. A doctor could be called in if they are experiencing a difficult birth. Routine care could be offered at clinics for kid’s colds and such. We had a system in California that offered indigent medical care in clinics.

    • Considering that was illegal, it wasn’t much of a problem.

      Though folks like Michelle Obama became adept at getting their hospitals around it by shipping patients to other facilities as fast as possible.

      • Not quite true, emergency rooms and hospitals which could treat a condition couldn’t turn patients away because they couldn’t pay, but specialty hospitals which weren’t capable of treating a patient were legally allowed to turn away that patient. Mind you, I’m not sure it is an improvement to have alcohol abuse counselors treating broken legs and heart attacks, which I am assuming M. Wallace is saying the ACA requires.

  5. After reading some of the preceding comments about a positive experience I will acknowledge that there will be cases in which some find the exchanges a benefit to them. This is especially true in NY where premiums were high to begin with. That does not mean that social benefits will rise. The idea that what is good for me is good for all is faulty reasoning. There may also be an equal or greater number that the opposite is true. If some are getting better rates now my only question is that why did they not shop plans before? Nothing in the ACA requires reductions in premiums. The proponents of the ACA say cost savings come from increased competition.

    This too is Orwellian speak because the insurers are only competing for the newly required persons to purchase insurance and those that were dropped because of the law. There has been no increase in the number of insurers. Quite the opposite is true. Exactly what new competitive pressure exists than before? Competition exists when many sellers are vying for the consumer’s dollars not the other way around. It seems to me that only when consumers have the right to not buy a product can real competition exist. The ACA does not give the individual the right to opt out of a cost (paying into the risk pool) for the benefit of keeping costs down for others. Thus, rate reductions cannot come from increased competition but may come when a much larger group exists from whom insurers can extract resources to offset the costs of providing the service. Many of newly insured are heavily subsidized by others who must pay full freight of their insurance and the extra cost of the governmentally provided subsidy. Is this fair and socially just? How is it any more fair than when all the insured and the uninsured taxpayers shared the burden of helping the uninsured?

    All that is happening is that the mandates increase the amount of money flowing into the health care system which reduces the per capita benefit ratio and requires more money to be paid out in the benefit payout ratio. Example: If 90% of the population or 18 people paid premiums of $100 and 3 get sick resulting in a payout of $1600. then the benefit payout ratio is 89.9%. If we require the remaining population (2) to buy coverage and both are healthy then the payout ratio falls to 80%. By capping the payout ratio to no less than 80% then adding more healthy bodies to the mix would theoretically cause rates for all to fall. By adding covered benefits that could/should be absorbed by the individual the benefit ratio remains above 80%. Conversely, if both are sickly then the payout ratio rises to an unsustainable level ($2166/$2000 or 108.3%) or more and prices must rise or be offset by additional government expenditures to the insurers. Making something more affordable for another by requiring one to make a purchase of insurance that precludes the purchase of something more satisfying/beneficial reduces the theoretical total social benefit.

    Orwellian speak is thought control and is effective because it controls the message by redefining terms used and includes not telling the entire truth or the entire plan for its citizens. The underlying assumption of the ACA is that supply prices charged for actual health care will not rise. The only way that can happen is if price controls are imposed on medical practitioners, researchers and device makers; or we begin to legislate what unhealthy activities are prohibited or limited – smoking, skateboard riding, sugar, salt, caloric intake, sports, driving, gun ownership, being too old to benefit, etc. Do we wanted to be treated by government in the same way we manage beef stocks to produce veal stocks? Should we have socially mandated calisthenics every morning at six AM prior to our daily activities? It is not that far fetched when the ACA legislation fines wage earners 1% of their pay for failing to buy a mandated product.

    For all those that are benefitting from the ACA I ask you – How will we force practitioners to provide services when the reimbursements fall so low that fewer doctors are available to treat the increasing population of consumers demanding more health care services?

    • Chris, congratulations on a truly thought out and interesting post. I will reply at length when I have time later, but I will tell you that yours is the kind of discussion I hoped to find here. Catch you later.

        • No, I would rather call it what it is.


          Your “when I have time later” looks a lot like “never, I hope you forget about this so I don’t have to try to counter these points”.

      • Thank you for your comment. I cannot make the claim that most people be harmed by the ACA just as you cannot say that there are net positive benefits. I can say that between 2000 and 2010 there was 326 billion dollars spent in uncompensated care for the uninsured, underinsured or bad debt among the reporting 5000 hospitals. Source: American Hospital Association. The most recent amounts for 2009 and 2010 was $32B or about 5.8% of all costs. http://www.aha.org/content/12/11-uncompensated-care-fact-sheet.pdf

        Right now, the CBO predicts the ACA to cost $1.675T in public funding by over the next ten years. This is more than 500% higher than the costs absorbed by taxpayers and the other insured who indirectly fund the costs of the uninsured. Without getting into the financial calculation of the inflation rate I can estimate that to be about a 35% per year increase in public cost and that does not include the amounts paid to insurers for services that are not used by the insured.

        The natural price limiters for actual medical services is what people are ready willing and able to buy given their available resources. Third party payers disconnect the consumer from the transaction. Consequently the consumer has little reason to NOT take advantage of a medical service that imposes only a fraction of the cost to them. Insurers on the other hand have greater bargaining power which allows them to negotiate more favorable pricing on the insured’s behalf with the additional understanding that they can decide to what level they are willing to pay on your behalf. It is part of the transaction between the insured and the insurer. By interjecting unlimited amounts of public funding into the demand equation, because the subsidies are an entitlement, then there is no effective limit on price, short of governmentally mandated price controls that will affect everyone. Such price controls reduce supplies and therefore may have a substantially negative effect on all persons who are prevented from receiving care in a timely fashion.

        I would have less of a problem with the ACA if it simply permitted the creation of a taxpayer subsidized high risk pool where people with preexisting conditions paid a premium equal to the median premium paid by the non-high risk pool. I do not see any reason to create program that mandates everyone to pay a private firm for a product or face a fine. Furthermore, most insurance today is not used for catastrophic health care; it is used for health maintenance and routine medical services that will not force people into bankruptcy. This creates the problem of moral hazard in which people use the doctor to help them manage their own less than healthy choices. This is what drives the demand for health care services. If most people had to pay the costs for accidents of their own making, or the costs of prescriptions to ameliorate the costs of lifestyle and dietary choices maybe people would take fewer health risks and reduce the amount of damage they inflict upon themselves. This would lower the costs of lost wages and productivity far more than having health insurance.

        One final point on your example of gun shot wounds. The fastest way to reduce the cost of GSW’s is for citizens in the neighborhoods to work with the police to get the perpetrators off the streets. The need to hold candlelight vigils for innocent victims of gun violence will be reduced if people chose to get involved in making their own streets safer by identifying the known perpetrators.

        • “If most people had to pay the costs for accidents of their own making, or the costs of prescriptions to ameliorate the costs of lifestyle and dietary choices maybe people would take fewer health risks and reduce the amount of damage they inflict upon themselves. This would lower the costs of lost wages and productivity far more than having health insurance.”
          In a truly perverse Big Brother move Obama Care advertises to young people that they can behave completely irresponsibly now that insurance is so readily and affordably available. Sure, go out and get your party on ’cause big bro’s got your back.

          Is it any wonder they’re cynical? If you can’t trust dear old granny Pelosi who can you trust?

          • How odd, indeed: The most politically powerful supporters of a law (including the president who proposed it as the single most significant legislative initiative of his two terms), so aggressively campaigning to instill into the minds of all people a name for that law which is utterly dissociated from its chief advocates at its time of enactment.

            We have Dodd-Frank. We have Sarbanes-Oxley. We had Reaganomics (THAT “Trojan horse”). We had Gramm-Rudman.

            The Spin Machine answers readily: “Not odd at all. These great leaders are humbly foregoing personal credit for their historic achievement. It’s not THEIR law; it’s EVERYBODY’s law” (except for the great leaders who exempt themselves and for any cronies they deem worthy).

            So for health care, we have ONLY the “Affordable Care Act.” No other names, please. No. Other. Names, DAMMIT! Use ANY other name, and YOU are a CRIMINAL! RACIST! HATER! ENEMY OF HEALTH, AND ENEMY OF HUMANITY!

            What do you bet? The day is coming when anyone who dares to characterize the new, historic, altruism-perfecting law of nationwide, bureaucrat-controlled health care delivery as “medical malpractice gone viral” or “Chronic Oppressive Politicians’ Disease” will be stalked and harassed by the IRS and FBI until they rot in jail and die of pneumonia.

            By golly, when the history books all get re-written in the next couple of years, I fully expect it’ll be called Romneycare. (And the “failure” to enact it nationwide before 2009 will be the “fault” of President George W. Bush and Republicans in Congress.)

        • Chris, on ambulances I worked in four of NY’s five boroughs. There are one or more hospitals in the Bronx, Manhattan, Brooklyn and Queens which no longer exist a few years later, and the principal reason is their being forced to provide health care for which nobody was paying. The people who suffer the majority of shot and stab wounds tend not to have insurance and each of them requires hundreds of thousands of dollars worth of care, if not millions over time. A government mandate which forces hospitals to treat people who can’t pay at the hospital’s own expense seems more like socialism to me than some of the other mandates we are discussing. Jack’s point, that the hospital could sue, seize assets etc is not realistic, as many of these people are completely judgment proof. A mandate which forced any other kind of private entity to provide services for which there was a reasonable expectation they wouldn’t get paid would cause a lot of screaming on this board.

          This is a gross imbalance in the system, and I think the only way to resolve it is either to allowhospitals to leave unfunded victims dying on the sidewalk or find a way to pay them for their services.

        • Also, could you please comment on the following proposition: “Medicare is single payer for people over 65 which works fairly well.”

          If you agree, please explain why you wouldn’t expand it to the rest of the population. If you think we can’t afford to, I understand that argument; but if you think that would be immoral,illegal or fattening, please explain.

          To the Fatigued Ones: please speak up if you would like to repeal Medicare, or plan to reject it when you turn 65.

          • It won’t exist in 30 years when I am 65. It simply won’t. The cost of the system, which provides shitty coverage, will cause it to collapse under it’s own weight.

            That you think it will be around forever is kinda cute.

              • This “if” bullshit is the root of your problem – you don’t interact with reality, you interact with a dream world. you wish to know what would happen and how we would react if the world was not as it were.

                That is the hallmark of the insane. It doesn’t matter “if”. It won’t be there. Period. It won’t make with past 2025, and frankly I don’t think it will last that long.

                When you are willing to deal with reality instead of the world as you wish it to be, you feel free to open your dick holster again, ok?

                Until such time, shut it.

                • So you will use Medicare if its available, right?

                  Shades of John Stossel, who wrote an essay about how he bought heavily subsidized federal flood insurance for his Hamptons mansion but didn’t think it should exist.

                  • He bought the insurance because he was required by law to do so you ignorant shitcunt.

                    Fine, I’ll fucking answer you so you will shut your cock holster – assuming Medicare still exists, I will absolutely use it because my money has been taken by government force to pay for it. Just like people will take social security (again, it won’t actually exist because it isn’t sustainable either, but since you will fucking hump that corpse we will again assume the impossible) because their money has been taken their whole working life. It is money the government fucking stole from you, so of course you want it back.

                    • Read the Stossel article.http://abcnews.go.com/Business/Insurance/story?id=94181&singlePage=true

                      Stossel’s point is that big daddy govt suckered him into building a house where he shouldn’t by making insurance available. He never complains of being required to buy it; he was glad to have it and wouldn’t have made a decision to own so close to the ocean without it.

                      I have purchased flood insurance for years, never saw anything saying its mandatory and know people who dropped it, so when you said, “He bought the insurance because he was required by law to do so you ignorant shitcunt”, I went and researched this. Which is what people might do when they’re actually having a conversation and not just snapping four-letter words together while exercising a Dread Certainty which may itself be quite ignorant.

                      Here is the actual description from the government’s web site of when flood insurance is required: “Homes and buildings in high-risk flood areas with mortgages from federally regulated or insured lenders are required to have flood insurance.”

                      So you are right that Stossell was probably required to buy it, even though he never says so.

                      Raise your hand if you think banks wouldn’t require flood insurance anyway to give you a mortgage in a high risk area, just as they require homeowners. If we were actually talking, we might discuss other issues, such as whether FDIC insurance should exist, or whether the requirement to buy flood insurance to get a mortgage in a high risk area actually infringes on some liberty interest of banks or homeowners.

                      Lesser risk areas= no requirement. No mortgage= no requirement. So the argument is not over the proposition “Should government force you to buy something you don’t want?” but the more complicated one, “Should government require a federally regulated institution, which receives the benefits of certain federal protections, to condition a mortgage loan for a home in a high risk area on the purchase of flood insurance?” Keeping in mind that no bank in its right mind regardless of federal law would lend money to John Stossell to buy or build a home on the ocean if he didn’t have insurance (his home did wash away in the end). Also that the insurance is so heavily subsidized that its ridiculously inexpensive, though that will probably end this year.

          • Medicare works as single payer because EVERY tax payer is funding it, but only a subset of society is benefitting from it. That math problem works out. Open single payer to cover EVERYONE and now the math problem is a little more lopsided and it doesn’t work.

            • It SORT of works…without politically difficult fixes, Medicare, like SS, is a debt bomb. There is rampant fraud and waste, too. But kick the can down the road, and because that works so well, add another can or two. That’s Jonathan’s logic. I don’t know if Milton would have bought it or not…

              • Well right, without getting into the deeper problems, I merely hoped to demonstrate to Jonathan why single payer in Medicare’s case is not analogous to single payer in a national case.

                • I understand the difference between Medicare and single payer for everybody. That leads to an interesting question. If we were forming a system tomorrow (my Pnyx Hill thought experiment) I would be interested in examining ways we could make single payer work for everybody on our new planet.

                  If you were against it, I would want to know whether

                  1. You think it can never work economically. This is the kind of practical problem I think of as a binary switch: one of us is right but it may take a hundred years or so for us to know which.

                  2. Regardless of whether it works economically, you think we shouldn’t do it because its immoral. This is a much mushier territory and involves subjective considerations and its much harder to know who is right (with some such arguments we will never find out during lifetime but only based on whether we wake up in heaven or hell (or nowhere) after).

                  One thing which has always interested me is how people mix practical and moral arguments without noticing, or use the practical as a cover for the moral. “I am against the death penalty because it is immoral and too expensive” mixes the moral and practical, for example. On this board, we have a similar mixture (“Obamacare can never work financially and it infringes liberty:”)

                  I think its useful in a conversation to separate the moral and practical arguments because they are really two completely different types of discourse.

                  For what its worth, I think Obamacare is moral but am not sure it will work financially.

                  • Or expecting people to invest and save for their own retirement is an awesome, time tested system, that has the added benefit of not siphoning money through a fiscally incompetent mass of government workers (who take their cut) so each individual actually has MORE during retirement of what they put into it.

                    • I agree that personal retirement savings is an awesome idea. I just don’t think it has worked in practice for most people, for a lot of reasons. For example, I had a nice 401(k) when I left the corporate world in 2000, but about 30% of it vanished in 2008 even though I was invested only in the very conservative end of the money market spectrum.

        • By the way, it was great seeing an actual number in a post here, your reference to the AHA numbers on unreimbursed expense of hospital treatment. As an EMT, I carried shooting and stabbing victims to St. Vincent’s ER, which is now closed because the hospital was legally mandated to treat them but nobody was paying. The real world impact is that anyone shot or stabbed in the Village, even a billionaire who can pay cash for treatment, has to be rushed twenty blocks further uptown to Bellevue, which means some folk will die who could have been saved if the ER was closer. There are communities in Brooklyn who risk no longer have a local hospital (Interfaith and Long Island College Hospital, http://www.nydailynews.com/new-york/brooklyn/financially-ailing-brooklyn-hospitals-needed-saved-article-1.1717203)

          I am not hearing anything from the “Repeal Obamacare” contingent that would address this problem; the implication seems to be the status quo works fine, or that somehow, vaguely, the free markets will take care of it. Chris, do you have a proposed solution? All I got from your post is that Obamacare is much more expensive than the current cost, but you don’t seem to take into account the cost or social impact of continuing to lose hospitals.

          • Huh. What a shock…

            This fiscal condition was predictable: more than 60% of Interfaith’s patients are enrolled in Medicaid, which translates to low reimbursements to hospitals.

            So it is unable to support itself because it has as the majority payer a government system which underpays.

            And your solution is to make more people a part of this quality system? Really? Are they going to make up for the loss by volume?

            Good plan! They can fail twice as fast now!


          • Oh, by the way…

            I am not hearing anything from the “Repeal Obamacare” contingent that would address this problem

            Now I know you’re a lying fuck – the “repeal Obamacare” folks have given a litany of suggestions. I have personally listed the most likely to actually reduce costs on this blog countless times.

            I seem to recall promising violence on the next ignorant fuck who said anything akin to “well, you don’t like Obamacare, but you haven’t offered a solution!”.

            Come here, cock-wipe. I don’t feel like straining to reach.

            • Questions for Jack:
              1. What are your goals in maintaining a discussion area on your blog? I assumed when I came here you were seeking reasoned discussion of the ideas you presented. Its not written anywhere this has to be your goal, of course. It could be “Operate a forum where my friends and I can agree with each other” or “where we can enjoy the spectacle of Scott Jacobs”.

              2. Do you acknowledge that Scott appears actually to be driving people like Jan Chapman off your list? I am still here because I am very stubborn and also because I am learning some interesting things from people like Chris Marschner. If you perceive Scott is actually causing other people to stop posting, does that actually suit your goals for the “Ethics Alarms” blog?

              Back in the day, I was a member of various email lists and forums which failed, in a classic Tragedy of the (Unmoderated) Commons model. For example, I belonged to a freedom of speech list, which at the outset included many law professors and other experts. At the end, due to lack of effective moderation, there was nobody left except trolls posting statements like “Come here, cock-wipe”, and the moderator finally closed it and substituted an announce-only list.

              Scott presents a very interesting ethical dilemma. My strategy of ignoring the insults and simply responding to whatever substantive ideas he presents is not succeeding in getting him to stick to ideas. I briefly thought we had gotten past the insults, but now I think my failure to engage on that level (which I refuse to do) is sending the wrong message, that I accept being insulted and threatened. If I simply ignore him and stop responding to his posts, I may be creating a false impression his arguments are unanswerable. In the end, I respectfully submit that I only have this problem because you are not performing your role as moderator.

              By the way, I will be happy to stop posting if you, Jack, ask me to, for example if I am wrong about your goals in maintaining this discussion area.

              • 1. I know a small percentage of the commenters here, and it is self-selecting. Although those on the extreme left can’t detect it, this a politically balanced blog, and has no partisan objectives whatsoever. To their undying shame, a recent exodus of the more liberal commenters was prompted, by my accounting, by their being unwilling to be honest and objective in assessing the Obama administration blatant unethical conduct regarding the Affordable Care Act, and their efforts at spin and rationalization were properly and harshly rebuffed. Scott, in my view, is a scapegoat.

                Yes, the goal here is open and contentious debate. The mix ebbs and flows. Sometimes I succeed in driving off the conservatives too. The blog is balanced, as any fair accounting will show. I work hard at it.

                2. Regarding the rough and tumble here: rather than rehash the arguments pro and con, I recommend that you read this post and this one in response to it, as well as the threads they generated.

                3. Scott occasionally—too often, in my view, and he knows that—resorts to pure abuse. I have explained why I allow it in his case. I know the blog pays a steep price for that, and I remain an advocate for respect and civility. I have concluded that the assault, almost entirely from the left, on free speech and open discussion compels me to reject political correctness and allow intense expression of emotional reactions to what a commenter feels is a dishonest argument. Is a gender neutral use of the word “cunt” less valid than a naked rationalization of dishonest conduct? On what basis? I allow both,up to a point, and one sometimes sparks the other.

                4. When did I ever suggest that you weren’t welcome here? Why would you be asked to leave?

                • 1) their emotional stance on the Zimmerman fiasco didn’t help, nor did the constant reminder on the abortion debate that they ultimately value comfort and convenience over the right to life, nor did their constant knee jerk genuflection towards their Savior Obama’s fiscal attitudes, nor did their almost robotic defense of his malicious handling of the shut down, nor did their religious adherence to believing his “foreign policy” was actually helpful

                  • It was the Zimmerman rationalizations that led to Barry’s exit… the atrociously dishonest “I’m not saying I personally agree that Zimmerman should have been convicted but you should understand why blacks feel that way and you have no standing to say they are wrong” crap. Thanks for reminding me, but it makes me angry all over again. There are valid diametrically opposed positions on most issues discussed here. Not that one.

                  • Right—well, what I meant was “Why would you be asked to leave?” And there is this, which is perpetually forgotten:
                    You want to talk about the health care policy, which isn’t, on the whole, an ethics issue, nor was it what I wrote about in the post in question. Obviously, major health care reform is needed in the US: costs are out of control, and the pre-existing condition problem needs a solution. Health care reform, whatever its specifics, would have been passed with transparency and honesty; its true costs should have been revealed rather than hidden, competent administrators should have readied it for launch, the public should have been told the truth about what to expect, those who performed poorly in setting up systems should be held accountable, the news media’s role should be making sure this occurs rather than playing partisan wingman…and so on, especially: LEGISLATORS WHO VOTED FOR SUCH A MASSIVE BILL SHOULD HAVE READ IT AND KNOWN EXACTLY WHAT THEY WERE DOING. That is what the vast majority of the commentary from me has been about, not politics or even health care. And at least from my perspective, my objection to protests of “but peopele are being helped!”; “it’s not all bad!” “Bush invaded Iraq!”, “they meant well!” and similar denials is also unethical, because they are efforts to obscure the truth, avoid accountability, and assert standards for evaluating government performance that are based on wishes and loyalty rather than survival and common sense.

                • I will wind this down now by summarizing what I learned here.

                  Chris Marschner got me thinking about some economic issues of supply, demand and competition with words such as the following: ” Competition exists when many sellers are vying for the consumer’s dollars not the other way around. It seems to me that only when consumers have the right to not buy a product can real competition exist.” Don’t know what I make of this yet, but am thinking about it.

                  Chris, you can easily find my email on my web site, http://www.spectacle.org. Contact me if you’re interested in writing something for The Ethical Spectacle about why you think Obamacare won’t work, or another topic.

                  On the other hand, as I expected, nobody gave me a really good explanation of why:

                  1. someone who declines insurance but expects to be treated though he cant pay is not a free rider and

                  2. why an unfunded government mandate forcing private hospitals to treat such people invades no liberty interest.

                  I won’t be back very often because of a paucity of actual civil discussion and the tediousness of the abuse. (Chris hasn’t been back in a while either, I am curious why).

                  Jack, your reactions to Scott’s abuse are like an indulgent father who thinks its adorable when his child smears….you get the drift. You tolerate the immediate expulsion of people like Jan Chapman who try to get a conversation going. And, respectfully, the following words don’t pass the straight face test:

                  “To their undying shame, a recent exodus of the more liberal commenters was prompted, by my accounting, by their being unwilling to be honest and objective….”

                  That might be true if they were received with respect, couldn’t stand to be disagreed with in civil language, blew up and engaged in expletives. But saying it had nothing to do with Scott’s abuse, really? I find it hard to believe that you really believe that.

                  Anyway, its your board, and you’re entitled to run it as you please. But you can’t both have Scott’s antics and a fair and open forum where people feel comfortable expressing opposing views. Seriously.

                  “When did I ever suggest that you weren’t welcome here? Why would you be?” You meant “Why wouldn’t you be”, right?

                  • On the other hand, as I expected, nobody gave me a really good explanation of why:

                    1. someone who declines insurance but expects to be treated though he cant pay is not a free rider and

                    2. why an unfunded government mandate forcing private hospitals to treat such people invades no liberty interest.

                    1.) Because they can still be billed, you thundering moron. Much like the idiots who think that if an employer, for religious reasons, declines to provide coverage for birth control then there is no other means to pay for it, you seem to think the only people allowed to give money to hospitals are insurance companies.

                    2.) Because “treat everyone” is just good policy, dipshit. Again, they can be billed later. Also, charities exist to help pay for outstanding medical bills. I know this to be true because my sister once needed their assistance.

                    That might be true if they were received with respect

                    This is going to surprise you, but you aren’t actually owed anything. Being a feckless, pedantic shit-for-brains should cause people to treat you like shit. It would probably discourage such idiocy in the future.

                  • “On the other hand, as I expected, nobody gave me a really good explanation of why:

                    1. someone who declines insurance but expects to be treated though he cant pay is not a free rider and

                    2. why an unfunded government mandate forcing private hospitals to treat such people invades no liberty interest.”

                    And with that, you’ve shown yourself to be
                    1) Illiterate
                    2) Unwilling to read

                    Either way, you pretend like those topics have not been addressed time and again so you can play the victim or play the arrogant leftist who can say “Ah ha! They don’t have answers”.

                    I’ve tried to be civil with you, but I’m afraid Scott is accurate, you are an idiot.

                    • Tex, I have watched this whole series of comment and counter comment with some interest and think now that I would like to share my observations and beliefs stemming from Mr. Wallace’s diatribes. My belief, and it is only a belief, generated by his apparent lack of ability to look at, read or digest articles that do not agree with his stance, is that he came to this site, possibly at someone else’s instigation, specifically to agitate and eventually provoke just the kind of response he got from Scott. I can think of several scenarios in which he could benefit either monetarily or ideologically from doing so and, frankly, given Jack’s statement that liberals have been abandoning the blog in droves, none of them would surprise me. That is also why I have jumped to this conclusion, as I don’t have any problem with someone in the liberal camp saying “We have to do something about this site. It’s members are too well informed”. And certainly in Jack’s case, “too logical and ethical for us”. Unfortunately, I do not think we have seen the last of Mr. Wallace, so I think we need to give Scott all of the support we can to stay on this guy’s case. Scott does not suffer fools gladly, and I for one, am glad he does not.

                    • I’m willing to bet he was half legitimate discourse half seeking material to take back to his socialist blog to develop an exposé on how the Right / believers in liberty / believers in the free market don’t have answers to his questions. I guess that based on his constant repetition of the “just looking for answers to question X, Y, and Z” when those questions had been answered several times.

                    • That is a distinct possibility, but it does not excuse his willful disregard of 1) the original blog article or 2) multiple postings of links to answer his questions which were ignored. As a matter of fact, that reinforces my contention that he provoked the reaction he got in order to promote an ideological gain, if not monetary. So, Jonathan, if you are reading, yes, I am questioning your ethics, your honesty and what passes for your principals. Admittedly without any objective proof, but with a great deal of circumstantial evidence. I believe Jack, an attorney, will be able to define a conviction based on circumstantial evidence. I have checked out Mr. Wallace’s (see, I got it right that time) web site, and it contains articles such as this one…
                      http://www.spectacle.org/0314/causation.html (which, for some reason, will not post as a hyperlink.)

                    • Not at all surprised that you got there before me, but I was aghast at that blog. Unfortunately, I had heard the exact arguments just 2 nights before from my brother-in-law, who is also an idiot.

                • I would like to speak for myself as to why I rarely post (I appreciate your concern, Jon, and enjoy your posts).

                  I respect Jack’s rules of moderation–it’s his blog and he should be able to have the blog he wants. He is wrong in my case that I don’t post because I am unwilling to look at the Obama administration honestly. I have been working to enroll people in the ACA, and believe me, I have seen the incompetence up close. His unequivocal statement that if you like your plan you can keep it period is indefensible. I do believe, however, that the law will help people. It’s better than what we had before. And don’t bother going through all your arguments as to why it’s a shitty law and will bring the downfall of the insurance industry and end civilization as we know it. I’ve read your opinions, and to tell the truth, I don’t think anyone knows what the ultimate outcome will be. You could be right, but I don’t think so and I certainly hope not.

                  I am very disappointed in a lot of things that Obama has done. The drones, the NSA, immigration, I could go on and on. Jack is right–a lot of my liberal friends are in total denial. But I am glad every day that Mitt Romney is not our President, or that John McCain is not our President. There are a host of issues that I care about that they are on the wrong side of, and on balance I’ll take Obama.

                  I don’t post much anymore, because I don’t care for the tone that usually takes over when a liberal pitches in. I’m a wimp, and I’ll admit it. I don’t like being called a fuckwit and a shitwipe, even if it’s from a thousand miles away in somebody’s basement. Take it as a complement that when I do say something, I make damn sure I have facts to back it up. You all have taught me that.

                  I continue to “lurk,” as I like to put it, and when an issue that is important to me comes up I’ll stick my neck out and take my punishment.

                  • I have no idea why my post appeared where it did. It was meant as a response to Jack’s response to Jon later in the thread.

                    • Excellent post, though, Jan, wherever it came up. Thanks. I’d love to delve someday into why being called a fuckwit and a shitwipe are more upsetting than substantive accusations. I don’t like being called a tea partier, a right wing zealot, a liar, a hypocrite, an Obama apologist, an ideologue, and a “so-called” or “self-styled” ethicist, and I get one of these about every day. You’ve been adding to discussions here, often injecting your perspective in some melees where rocks are flying, for a long time, and I know I’ve been harsh to you on occasion. , Your participation enhances the discussion, and I am grateful for it.

                  • Jan, nice, warm caring people like yourself enable ruthless statists, because you believe their pretty stories and propaganda. Those who oppose the collectivism of the left, and it’s inevitable destruction of individual freedom are pissed at your naivete, and complicity.

            • Question for everyone: I actually don’t know what counterproposals the GOP, Tea Party, or Koch Brothers have made for fixing the health care system. I think the Cato Institute would say that a fully free market would solve the problem of distributing affordable care to everyone who needs it.

              If anyone would care to engage me on this by letting me know details, or pointing me to resources (rather than just threatening to hurt me) I would greatly appreciate the civility.

              • So no, you still haven’t looked at those links that texagg gave you…

                In at least three of them I personally detail the most useful measures that could be taken that would have direct and nearly immediate effect on costs.

                FYI, I used to go by “AblativMeatshld” or “AblativeMeatshield”.

              • I think it’s irrelevant to the topic. I’m pretty sure anyone can be assumed to be ready to propose that a health care law should be honestly described to the public, voted on by legislators who actually know what they are voting for, not sold with lies, and administered competently. We call that “a low bar.”

        • Another thought for Chris: health care expense as an equality issue. Do you agree with the reports that the middle class is declining in this country in terms of its share of wealth, actual income, cost of living, financial security, perception of itself and America, and degree of optimism? If yes, isn’t the fact that even people like myself who always had health insurance can expect to be bankrupted by any kind of extensive hospitalization a contributing factor to that insecurity? Imagine if I had been hospitalized 100 days instead of four at $1000/day.

          By the way, another problem I personally experienced (which so far as I know is not solved by Obamacare) was that of being treated in a covered circumstance by an additional doctor who didn’t take my insurance: a routine colonoscopy of the kind we are advised to have every five years was 100% covered but the anesthesiologist’s $1600 charge was not. It also can easily happen that on a visit to the ER where you are not admitted to the hospital, your insurance covers the ER charge but not that of an attending physician.

          If you agree with the proposition that the middle class is in trouble, do you also agree there are implications for our democracy? I am not aware of any country in history that thrived for long while the middle class dwindled. If you agree with both propositions, what would you do to solve the problem?

    • Chris, the issue I have is that most people who want to opt out of Obamacare don’t think they are opting out of being treated at the ER, they are just opting out of paying for it. It would only be a consistent and ethical position (for those unable to pay cash) if they said, “I don’t want to participate in your health care system as a payor OR recipient. If I am brought in to the ER with a stab wound or cardiac arrest, I hereby authorize you to leave me on the sidewalk.” Short of agreeing to waive receiving services, anyone who wants merely to opt out of paying is a free rider, and anyone presenting the Obamacare mandate as a liberty issue without discussing the recipient end the of the equation is encouraging free riders.

      Its like opting out of contributing to a 401k plan but expecting employer contributions anyway. In fact, sounds kind of like socialism to me 😉

      • Short of agreeing to waive receiving services, anyone who wants merely to opt out of paying is a free rider

        Except they still get billed, and in fact will be billed more, and for worse care because everyone will be using the ER and so the cost will have to go up.

        So you are actually costing people more money by trying to make shit free, an outcome you would have seen coming if you weren’t fucking retarded.ts like opting out of contributing to a 401k plan but expecting employer contributions anyway. In fact, sounds kind of like socialism to me 😉No, because the only person hurt by not contributing to a 401(k) is the person. Your beloved ACA is causing huge premium increases (next year is going to be a doozey because no one is signing up for the shitty, too-expensive premiums), and will increase wait times and costs.

        Because that’s what happens when you increase demand without increasing supply.

        Maybe if the system the Democrats created wasn’t incompetent (but what do you expect from people who are incompetent) and designed to be “fair”, maybe it wouldn’t appeal to only fuckwitted asstards like you…

        But that’s a hope most rational people gave up long ago.

        Not to mention, your hypothetical is bullshit anyways because hospitals never could (and never will be allowed to) turn away people. Which you have been told. Repeatedly. But refuse to accept. Because you are fucking retarded.

    • Obamacare doesn’t require any practitioner to accept insurance. I agree that given rising prices and low reimbursements, there is a problem in the system which Obamacare may not solve.

      However, I would be interested in knowing if the Fatigued Ones here think the status quo is perfect and cannot be improved. If not, what’s your favored solution?

    • Chris, check out my web site at http://www.spectacle.org, look for my email there and get in touch if you’d like to write something (or submit something already published nonexclusively elsewhere). In the months to come I would like to publish a variety of views on whether Obamacare can work or not. Anyway, thanks again for your posts here.

      • It’s safe to assume you have still blinded yourself to the plethora of links I sent you, where EVERYONE who posted on this thread, have given exhaustive expositions in the other places.

        If you really are interested in expanding and learning, you’d actually bother to read those discussions, it’s about an hour’s worth of reading.

  6. I wonder what would happen if a Republican President told citizens they should cut off their cable TV or internet access in order to better afford food….

    Any takers?

    • We would be called uncaring mean people. No different than what we are called now when we point out well meaning but faulty policy.

  7. Hey…I just got back after having to give two ethics courses this morning, and see that 1) you all managed to have a lively discussion without me. Good; 2) I managed to leave out some words when I typed the post, which I have finally inserted; I apologize for being rushed and sloppy, and 3) the ad hominem problem surfaced again. Remember: calling someone an idiot because of what they say is not an ad hominem attack (though it is not nice, and may not be fair ). Saying that what someone says is wrong BECAUSE he or she is an idiot IS an ad hominem attack—you attack the opinion holder as a substitute for rebutting the opinion..

    • The gentleman in question has never offered any proof as to how this law benefits most people or that nation in general.

      Instead, this person fired off all sorts of insults directed at specific individuals and “proved” the law is great by submitting his one-off benefit.

      Essentially, proving your point (although that was not the intent, I’m sure).

  8. I have been called a liar, dishonest, disingenuous, and accused of insulting people, all in about 36 hours.

    I haven’t claimed to have “proved” anything yet. Just thought we might engage in a search for Miltonian truth together. Just sayin’.

  9. Wonder if I could get someone to define for me what “Miltonian Truth” actually is? Reason I ask, John Milton wrote for the English government under Oliver Cromwell…and was, here’s a surprise, a republican. Note the lack or capitalization, so I’m not referring to the current political party.

    • Truth obtained by open debate leading to consensus. Milton quoted St. Paul, “Prove all things, hold fast that which is good.” So far, the process here is not well customized; its more like, “Reinforce the ideological beliefs we already hold, and use a lot of four letter words to make sure those who would debate with us stop posting here.”

      • Unfortunately, Jonathan, the “Prove all things” part seems to be an area where you are a little weak. You have been asked several times to provide proof of your assertions and so far as I can see, you have simply made more assertions. Proof does not include “You’ll just have to take my word for it”.

      • It is not ideology, you fucking cunt, to see that a law (written by incompetents, enacted by incompetents, and enforced in a manner that gives “random” a bad name) is utter shit and beyond repair. A monstrosity of 20,000 pages can not be spot edited into functionality.

        The only ideology that is attempting to be re-enforced are by the likes of you and Jan.

        We don’t like your “I’m just a truth seeker” bullshit because a) we sought this truth ages ago and found already b) it is a term used by idiots, partisans, and assholes for ages as a way of pretending to be objective when in fact your agenda is anything but honest.

        Alex Jones “seeks the truth”, but that doesn’t make him less stark raving mad.

            • OK, commenting on two ideas advanced by multiple people on the board. I had sort of decided not to bother answering Scott any more but one of the peculiarities of the software is that you have to reply first to the person whose post generated the email you clicked on to bet to the site.

              1. “Everyone has to pay for medical care”. Nobody who has said this can possibly believe it. Numerous hospitals in this country have closed, such as St. Vincent’s, because they were not getting paid for acute and trauma care. You are saying that anyone who goes to the ER expecting free treatment is not a free rider because they have a legal obligation to pay, yet the world is full of judgment proof people. You are being ingenuous here. In no other field, such as hotels or groceries, is anyone required to provide you a good or service regardless of whether you can pay for it. If the government passed a law saying that Marriott or Whole Foods had to take a shot on you and hope to get paid, you guys would be up in arms. The reason you keep insisting there’s no free riding problem is that nobody wants to say either that hospitals should be able to leave dying people on the sidewalk or that an insurance mandate, or even single payer, might make some sense as a solution.

              Again, in most states, “want to drive on roads” = “must buy car insurance”. “Want to be treated at hospital” =”must buy health insurance” is the same equation.

              Anyone insisting that you should have a right to refuse insurance is only taking a morally and logically consistent position if that is understood to imply “and the hospital then has a right not to treat you”. Anyone encouraging people to refuse coverage while expecting treatment for which they can’t pay is encouraging free riders. Period.

              2. “Obamacare encourages careless/risky lifestyle choices”. We’ve also heard this one a lot. So people with cheap or free government health insurance are saying “I will eat anything I want and become obese and get a heart attack or diabetes because I know I can get treatment”? Anybody risking cardiac arrest in particular on the assumption the doctors will be able to revive them is making a choice so foolish you would have to be insane to make it. A very tiny % of cardiac arrest victims ever come back, and even fewer of those who regain a heartbeat actually live more than a week or so, or emerge with with their brain intact. People with diabetes don’t get cured but have to maintain with medication, and fear imbalances, the rest of their lives, and so forth.

              I have always had car insurance but have a safe driving record. I have always had health insurance, but exercise and eat carefully. So you are assuming a link which may not exist, or if it does, may exist for a small percentage of the population. But its being presented here as a universal.

  10. I fear that currently in the USA were are caught between “the devil and the deep blue sea.” The devil being ‘Obamacare’ and the deep blue sea being big pharmaceutical corporations price gouging on new drug approved for serious medical conditions.

  11. I dk exactly. I do know that Bayer Pharmaceutical has been around since 1863 and in 2004 acquired the OTC Pharmaceutical Division of Roche Pharmaceuticals. Pfizer Pharmaceutical has been around since 1849. These are damn big companies and they can quash lawsuit very effectively.

  12. One more comment for Jack. I posted a message in which I quoted some of Scott’s obscenities and saw that it was being held for moderation. Until then, I thought you just weren’t moderating enough, but you’re actually pre-reviewing any of Scott’s abusive and threatening posts that contain certain words and then approving them, aren’t you?

    Scott became curiously quiet at times, He doesn’t seem to have responded to my latest posts to you about him, for example. Have you in fact reviewed and *rejected* posts of Scott’s addressed to me or to that issue?

    Just curious about how things work here.

      • I gotta tell you, this guy is even starting to piss ME off. How is it any of his business how Jack runs the site…IT’S JACK’S SITE, NOT HIS. Of all the gall…not to mention arrogance. I’m back to my original thought…he’s here to stir up controversy and/or trouble, but now I’m almost certain it’s at somebody else’s instigation. He doesn’t seem bright enough to have thought of it on his own.

    • Once any commenter is approved with one comment, his or her posts automatically go on the blog. An approved poster will sometimes have a comment held for approval or caught in spam if it has a lot of links. I often do not see a comment for as much as a day if I’m traveling, which I was this week, or doing a lot of speaking, or being with my wife in the hospital. Glad that Scott is getting under your skin, though.

  13. Also saw various posts suggesting I am paid to be here, which is laughable, and that I am planning to write something for the Ethical Spectacle, http://www.spectacle.org.

    I am a self employed attorney in NYC and my views are my own. Jonathan Wallace is my real name and I don’t feel personally threatened by the NSA because what I say on the phone= what I write for my web site. I am a registered independent, don’t particularly like or trust Democrats, and as I’ve said all along, I came here to have a conversation. Jack can verify I’ve been following the blog for a while, and I had previously posted two or three times on other topics, though didn’t come back to follow the whole thread.

    As for writing something about my experience here, I’ve thought of it. The question is whether you guys are representative enough of anything to be worth writing about. I have a lack of background or context for you. If you represent a small corner of the Internet and the public sphere, you’re not essay material. If you are emblematic of the way public discourse has broken down and we can’t talk about issues any more without Scott Jacobs-style threats and abuse, you might be worth writing about. But since I don’t know who anybody is its hard to tell.

    By the way, you might want to take a look at the life of Richard Cobden. He was a nineteenth century British businessman who figured out that the Corn Laws which propped up prices were causing starvation. He was elected to Parliament and championed this issue for some years so persuasively that his greatest adversaries including sir Robert Peel finally acknowledged he was right and repealed the law. Ask yourself whether its possible for anything similar to happen today or whether both sides are so locked into ideological and political constraints that there’s no way to meet. Personally I always ask whether an adversary is capable ever of conceding a point. I’ve done it twice in this conversation I can remember, Chris Marschner did it, but most of you seem very stuck in that “Obama is evil. All fruits of Obama are therefore evil” lockstep thing which forces you into absurd positions such as

    “Not one person can possibly be having a good experience under Obamacare”.

    “Nobody who refuses coverage yet expects to be treated at the ER is a free rider.”

    After visiting here to look at follow ups once a day for a while, I waited two days this time. I am interested in what people have to say about this post, and will be back, so save yourself the “Jonathan hasn’t been back in x hours, therefore he ran away” posts.

    • Nope, I’m banning you, Jonathan. You begged for it.

      You’re a narcissistic jerk. Ethics Alarms isn’t your research project, and your characterization of the commentary here is factually false. I have never written, nor suggested, nor asserted, nor believed, that “Obama is evil,” and I challenge you to quote any section from any post that suggests that. He’s a weak incompetent leader that’s all. It’s a tough job. I can’t say I would do any better. But this is not a partisan blog. (Bush was a stronger incompetent leader.) Commenters are quite correct that you have ducked their arguments, and I already told you that your threads are unrelated to ethics, which is the topic here.

      I did not write about the relative virtues of the ACA, and don’t care about them, at least not in posts. I ask commenters, especially new ones, for a modicum of respect for the forum I provide, and I am not required to read ad nauseum snotty comments about how the blog that you inflict with your logorrhia isn’t worth your time. Frankly, as I do read all the comments and do moderate them (the ones moderated don’t appear at all, as I e-mail the authors), you are wasting my valuable time.

      Like any other exile, you are free to email me off site, acknowledge your misuse of the forum, apologize sincerely, and get a second chance. I don’t expect that, as you fall into the category of commenters who are habitually obnoxious in tone and attitude and either don’t realize it or don’t care.

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