Monday, October 22, 2012

Huffington Post Reply

A few days ago egdot replied to one of my comments at the Huffington Post.  We've already looked at how egdot's comment compares to the typical liberal's comment, as described by Dilbert Blog commenter Hankfu.
Me:

How is ACA supposed to help balance the budget?

With it the government will be paying for more peoples' healthcare, and many more bureaucrats will be hired, whose salaries need to be paid.
egdot

So you should just leave these people without healthcare? Which bureaucrats? It's still a private insurance system by and large - not a government takeover. And even if it were - at least you'll be creating jobs which will increase demand which will stimulate the economy.  Healthcare costs money. You will never get away from that. Not insuring people is immoral as well as costly too.  Conservatives don't get it - even in the face of all the evidence from countries where they do cover all their people and have strong economies - Germany, Australia, France...Sweden, Norway, Denmark..
I said that I would describe why his/her comment is wrong.

1) more government always means people are worse off

2) socialized healthcare has not worked well in the places that it has been tried

3) egdot has called me "immoral" for not wanting to insure everyone.  I will point out why his position is immoral.  And even more so.

What egdot seems to support is the Patient Protection and Affordable Care Act (ACA, Obamacare).  ACA is clearly the socializing of America's Healthcare.  At least in part.

Calling something "socialist" is not an insult.  It is merely describing what it is.  It is no different from calling a "car" a "car."  If you are going to describe something to someone, one way to make the explanation simple is to use words that both parties know the meanings of.

Which is easier to understand: 1) I just bought one of those large metal things with four wheels, a motor, some seats, etc., or 2) I just bought a car?

It is the same thing with calling something socialist or anarchist or conservative or liberal.  Which is easier to understand: 1) My political beliefs are that the government always makes things worse, but some laws are necessary, like no injuring others, and a case can be made for paying for the people who are unable to provide for themselves, or 2) I'm a libertarian?

If a word, or term, has a negative feeling about it, then that is probably becasue the things that have been described by that word, or term, has often been bad.  But that does not make the use of that word, or term, any less accurate.

Definition of socialism: "Any of various theories or systems of social organization in which the means of producing and distributing goods is owned collectively or by a centralized government that often plans and controls the economy."

Let's look at ACA:
Key Features of the Law
The health care law offers clear choices for consumers and provides new ways to hold insurance companies accountable. The most important parts of the law are broken into groups below. We’ll highlight new features of the law here as they roll out between now and 2014.
Rights and Protections
Insurance Choices
Insurance Costs
65 or Older
Employers
If you need help dealing with your insurance, finding insurance, or getting answers to questions about how the health care system works, visit the Get Help Using Insurance section. Use our interactive FAQ tool at answers.healthcare.gov to find answers to your questions about health care and insurance.
Thanks to healthcare.gov we can see what the "Key Features of the Law" are.  This law contains these rules about: insurance costs, pre-existing conditions, which healthcare services must be provided to you "at no cost," etc.  How are all of these rules not "planning
and controlling this segment of the economy"?

To sum up: ACA is socialist because with it the government is planning and controlling what you, doctors, and insurance companies may, or may not, do and how much of it we can, and cannot, do.  ACA also includes new Medicare rules and regulations.  And Medicare is a "systems of social organization in which the means of producing and distributing goods is owned collectively or by a centralized government."

So, ACA is socialist, but that's not necessarily a bad thing.

***

1) more government always means people are worse off

By "more government" I mean more rules and regulations from the government.  We should all agree that ACA is "more rules and regulations from the government."

When the government has controlled all or most of a country millions of people have died as a result.

According to "The Black Book of Communism" the death tolls from the various countries that have tried communism are:
These deaths have been the result of these communist countries':
To this we can add, at least, the Nazi's 25 million deaths.  The Nazis being, of course, the "National Socialist" party.

Perhaps this is why socialism currently has a negative connotation to many people?

Sure, not all socialist or communist countries have resulted in the deaths of millions.  In many places it has only meant that people have lived in extreme poverty. 

India was socialist from its independence in 1947 at least until 1991.  This meant poor economic growth and tens of millions in poverty.
The low annual growth rate of the economy of India before 1980, which stagnated around 3.5% from 1950s to 1980s, while per capita income averaged 1.3%.[18] At the same time, Pakistan grew by 5%, Indonesia by 9%, Thailand by 9%, South Korea by 10% and in Taiwan by 12%.[19]
And since 1991 and more economic freedoms (less socialism):
The Indian economy is the world's tenth-largest by nominal GDP and third-largest by purchasing power parity (PPP).[7] Following market-based economic reforms in 1991, India became one of the fastest-growing major economies; it is considered a newly industrialised country.
The reduction in socialism in China has also resulted in great gains in the quality of the Chinese.

A picture speaks a thousand words (Shanghai, China 20 years ago/ Shanghai now):

 

The same is also true in Vietnam: "Less Government = More Prosperity, Vietnamese Example."

And there are many other examples from around the world where less government equals more prosperity.

But many of you on the left claim that many countries in Europe are socialist and not awful places to live.  This is true.  But I doubt that you are thinking of Portugal, Ireland, Italy, Greece, and Spain at present, or are you?

No, many of you on the left like to point to the Scandinavian countries, and Sweden in particular, as examples of places where socialism is not awful.

Some facts about Sweden
(The Politically Incorrect Guide to Socialism by Kevin Williamson, reviewed by me here):
  • Poverty rate for Swedish Americans: 6.7% (page 101)
  • Poverty rate in Sweden: 6.7% (page 102)
  • 60% of Somali immigrants to Minneapolis, MN have a job (page 105)
  • 30% of Somali immigrants to Sweden have a job (page 105)
  • Average income in Sweden: $36,600 (page 106)
  • Average income in America $56,900 (page 106)
  • In 1970 Sweden had the fourth-highest average income in the world (page 106)
  • In 2000 Sweden had the fourteenth-highest average income in the world (page 106)
  • 1 in 5 working age Swedes call in sick on any given Monday (page 107)
  • 20% "of working age Swedes receive some sort of unemployment benefit" (page 108)
  • IKEA was designed as "do it yourself" to "minimize state-imposed labor costs" (page 110)
So Sweden, that great model of more government, is poorer than the poorest state in America (page 106).

In summary:  Countries are socialist kill tens of millions, force tens of millions to live in poverty, and the lives of those people improve dramatically when the government reduces its involvement in its peoples' lives (see the economic history of: China, India, and Vietnam).

Since adding more government has worked out so well for those other countries (and our public education), why would you want to add more government to any part of our economy, including healthcare?

If you still think that more government will improve our lives, then perhaps we should have an economic experiment to see if that is true? 
I propose an experiment in order to see weather more government improves peoples' lives.  I suggest that we divide several countries into halves with more government and into halves with less government.  Then we will wait several decades and see which halves performed "better."...
2) socialized healthcare has not worked well in the places that it has been tried

In my previous point I showed that when whole countries are socialized the results are disastrous.  

Now let's look at only the issue of healthcare.

The countries that you, egdot, listed for examples of success were: "Germany, Australia, France...Sweden, Norway, Denmark.."

You also said that these countries "have strong economies". 

France's lowest unemployment rate since 1999 was 7.4%.  Its unemployment rate has been over 9% for 9 of those 12 years.  

Is that what you mean by having a "strong" economy?

Denmark is still struggling to recover from the current economic slowdown.

The German "labor market is, slowly but surely, losing steam and all forward-looking indicators also don't bode well," said ING economist Carsten Brzeski.

Norway is doing well, largely thanks to its selling of oil.  How can some other country repeat the selling of oil to lessen the bad effects of our current economy?

 Australia's economy is doing well.  Largely thanks to its natural resources.  And that can be reproduced elsewhere right?

 Estonia's economy is doing better than its neighbors.  Wait! They did it by reducing the size of their government, not by adding more rules and regulations.

But, let's assume that you meant instead of having a "strong" economy you actually meant that these are places with socialized healthcare and they are not awful places to live.  This is true.  (Except, maybe, for France.)

I noticed that you neglected to mention the healthcare of Great Britain or Canada.  Is this because you know that waiting times, the quality of care, and the healthcare tourism of English people are bad indicators of its healthcare system?  Or could it be that more Canadians are going to private healthcare providers rather than their public options?

(BTW, America's healthcare system was heavily regulated by the government before ACA, see doctor's licensees, not being allowed to buy insurance across state lines, insurance being required to cover things that the insured may, or may not want, etc.)

You said that there is evidence that several countries have good economies and cover all of there citizens' healthcare.  Would you care to show that evidence?

When we try to compare the differences in healthcare results we often look at the infant mortality numbers and life expectancy numbers.  A problem with this is that different countries measure these things differently.  For example the life expectancy in America includes the deaths at birth in our life expectancy numbers, other countries do not.  This skews the numbers in their favor.

We also have more technology in our hospitals than other countries, is the added cost bad?

From US health care: A reality check on cross-country comparisons
The combination of higher delivery costs because of greater NICU use and the unique way the United States counts live briths could lead one to erroneously conclude that the United States is highly inefficient compared to other industrialized nations.
  Another quote:
Teenage mothers are more likely to have preterm, low-birth-weight babies. The mortality rate for infants born to US teenage mothers is 1.5 to 3.5 times as high as the rate for infants born to mothers ages twenty-five to twenty-nine.[12] The US rate of births for teenage mothers is very high—2.8 times that of Canada and 7.0 times that of Sweden and Japan. If the United States had the same birth weights as Canada, its infant mortality rate—adjusting for this variable alone—would be slightly lower than Canada’s (5.4 versus 5.5 per one thousand births).[13]
Turning to gestational age, MacDorman and  Mathews calculate that if the United States had the same distribution of gestational ages as Sweden, its recorded infant mortality rate would drop by 33 percent,  tying it with France as the fifth lowest rate out of twenty-one developed countries.[14] Moreover, in the United States, mortality rates for infants born to unwed mothers were about twice as high as for infants born to married women.[15]
Overall, these lifestyle and socioeconomic factors may reflect poorly on some aspects of society in the United States in comparison to other countries. It is inappropriate, however, to conclude that the root cause is the US health care system rather than societal factors in a dynamic heterogeneous society. Infant mortality is a particularly misleading metric by which to grade country-specific health system performance and to make international comparisons.
A quote on life expectancy:
As a result of the problems with infant mortality (as well as mortality due to violence and accidents), the difference between US life expectancy and that of other countries is reduced at later ages. This is demonstrated in empirical studies of the production of health, including in the OECD report itself and also in the raw data. For example, in 2000, female life expectancy at birth was 79.3 years in the United States, 80.3 in the United Kingdom and 81.2 in Germany. Female life expectancy at sixty-five was 19.0 years in the United States, 19.0 years in the United Kingdom and 19.6 years in Germany.[17] The differences decline from 1.0 and 1.9 to 0.0 and 0.6.
 This paper's conclusion:
The OECD report raises important questions on how to determine the efficiency of health care in producing positive health outcomes and how to compare and contrast efficiency of systems among different countries. The OECD staff concludes that health care is highly productive in improving health outcomes and that efficiency varies greatly across countries. It provides country-specific estimates of that efficiency.

Unfortunately, major problems in OECD’s analysis render their conclusions—especially the country-specific conclusions—unreliable. Many external factors that influence health outcomes are either omitted or poorly measured. The net effect is to underweight the role that non-health care factors play in determining health. And since the United States scores relatively poorly on most of these external measures, omitting them or not adequately controlling for them increases the apparent relative inefficiency of the US health care system and probably biases the estimated productivity of health care as well. The OECD report controls to a limited extent for some lifestyle differences by gross measures (for example, consumption of alcohol, tobacco, fruits, and vegetables). It adjusts one health measure—PYLL—for violence and accidents, but does not use that measure for country-specific efficiency numbers. As explained above, we believe that these controls and adjustments are inadequate.

It is overreaching to interpret country-specific variation in health outcomes as a measure of health care system productivity. In reality, the country-specific estimates reflect all differences in country-level influences, whatever their source and measurement issues. As econometrician William Greene stated in a similar context, there are considerable differences among countries that masquerade as inefficiency. More carefully calibrated research is necessary to identify these differences.[25]
There are problems comparing the healthcare systems based on just raw numbers.  The countries measurements and lifestyles are incomparable.  There is not a good way to measure health objectivity; there are too many variables.

Here are some thoughts:

"Close to 25 percent of U.S. doctors are foreign-born."  Doctors come here to work.  Doctors, and everyone else, will move to where they get higher pay, better living conditions, and better jobs.

How Does The Quality Of Care Compare In Five Countries?

This study shows mixed results for comparing the quality of care between countries (here is a bigger version).

http://content.healthaffairs.org/content/23/3/89/T1.large.jpg

One note from this study (England has socialized healthcare, fyi):
On these indicators, the range in performance was usually small. On most survival rates, the countries are within 10 percent of each other. One pattern that does stand out is that England is consistently at the low end of the distribution for cancer survival. This is consistent with previous comparisons of cancer survival between the United Kingdom and other European countries.10
 art of the Summary:
The comparisons on this initial set of quality indicators show that each country performs well in some areas and poorly in others compared with other countries. Each country could improve the quality of care. 

Australia performed well on many of the indicators. In particular, cancer survival rates were generally high (excepting childhood leukemia); breast cancer screening rates were high; asthma mortality was relatively low; and influenza and polio vaccination rates were high. However, the incidence of pertussis was much higher than elsewhere, suggesting an opportunity for improvement.
 American Heathcare in the summary:
In the United States, breast cancer survival rates were higher than in the other countries. Cervical cancer screening rates were very high. One area for concern is that asthma mortality rates were increasing in the United States but decreasing in the other countries. Transplant survival rates were also relatively low in the United States.
 Overall, mixed results between the various countries.

Other than in England and Canada(which you did not mention), I have failed to show that healthcare is worse when socialized. 

If you would show"the evidence from countries where they do cover all their people and have strong economies", I would like to see it.  But, please remember that the plain data is questionable between different countries thanks to differing lifestyles and differing measurements.

If we are interested in how well ACA's predecessor in Massachusetts has worked, then let's consider these five lessons:
Lesson 1: The Massachusetts plan does not control costs.

When Massachusetts launched its reform program in 2006, it already had the highest medical costs in the nation. Today, the burden is still rising far faster than wages or inflation, from those already lofty levels. A report from that state attorney general in March -- remember, this is a Democratic administration -- asked rhetorically "Can we expect the existing health-care market in Massachusetts to successfully contain health-care costs?" The report concluded, "To date, the answer is an unequivocal 'no.'"

Costs are rising relentlessly for both families and for the state government. The median annual premium for family plans jumped 10% from 2007 to 2009 to $14,300 -- again, that's a substantial rise on top of an already enormous number. For small businesses, the increase was 12%. In 2006, the state spent around $1 billion on Medicaid, subsidies for medium-to-lower earners, and other health-care programs. Today, the figure is $1.75 billion. The federal government absorbed half of the increase.

Hence reform's proponents boast that expenses have risen only $354 million or around 6% a year. But the real increase is double that, including the federal share. And it's highly possible that given the current budget pressures, the U.S. will reduce the contribution that has encouraged the state to spend so lavishly.

Lesson 2: Community rating, guaranteed issue and mandated benefits swell costs.

How did costs in Massachusetts get so big to begin with? A major reason is the adoption of guaranteed issue and community rating in the mid-1990s. The new federal bill would expand those rules to the entire nation. Under guaranteed issue, insurers must accept all enrollees regardless of their medical condition; under community rating, they must charge all customers similar premiums, even if their costs are far different. The result is that prices rise steeply for young, healthy customers, who must pay far more than their actual costs. It also give them a strong incentive to drop insurance; then they can "game the system" by signing up any time they need surgery or get diabetes.

Hence the pool of insured people gets older and sicker as the healthy drop out. That's what happened in Massachusetts, and it contributed to soaring premiums. The 2006 reform plan was supposed to solve the problem by requiring that everyone buy coverage or pay a fine of around $1,000. It worked, but only in part: Of the 600,000 uninsured in 2005, around 450,000 are now covered. But a large share of 150,000 who still lack coverage are young residents who choose to pay the fine instead of high premiums. Insurers are also getting socked by people who sign up for insurance to get expensive care mandated under state law, including hospitalization for childbirth or hip replacements, and then depart once the procedure is completed.

In the federal bill, the fines for going uninsured are even lower than in Massachusetts -- and anyone who can't find an inexpensive plan is exempted from all penalties. Hence the "adverse selection" problem could prove far worse.

Lesson 3: Huge subsidies for low-to-medium earners could prove extremely expensive.

One of the most fascinating features of the Massachusetts plan is that it introduced a system of subsidized policies, sold through an insurance "exchange" that's extremely similar to the one in the new federal plan. Under Commonwealth Care, the state subsidizes plans -- offered by private carriers -- for residents who earn up to $66,150 who are not covered by employers. The aid is extremely generous. At $44,000, families pay around $1,000 a year in premiums. At the $66,150 maximum, they contribute around $3,000.

The problem is that the actual annual cost of these plans is around $10,000, so the subsides are enormous -- that's 90% for families earning $44,000. And while the costs keep going up, the share paid by the enrollee barely budges. Says Michael Tanner, an economist at the conservative Cato Institute: "It's a situation where the entire escalation in costs is paid by the government, not the people receiving the care."

The federal plan also subsidizes care provided through state-run exchanges. The patients' contributions are bigger than in the Mass. plan: A family earning $66,000 would pay $6,300 a year. But the federal plan offers subsidies far higher along the income scale, aiding families of four making up to $88,200. And surprisingly, the federal plans would probably prove a lot more costly than the ones in Massachusetts, where the state prides itself on restraining what they pay by squeezing providers, who then shift the added costs to private customers.

The big problem arises if far more people sign up for these exchange-offered plans than anticipated. That's been the case in Massachusetts. And as we'll see in a moment, it could still get a lot worse there. A potential disaster threatens the federal plan if employers staring dropping coverage, since a flood of newcomers would rush into the state-funded pools.

Lesson 4: The exchanges reward people for working less and earning less.

Data is lacking on how damaging these perverse incentives are in practice. But it's clear in Massachusetts that low-to-medium earning families often suffer financially if they get a raise, work overtime, move to a higher paying job -- or if a spouse rejoins the workforce. For example, a family earning $33,000 pays no premium at all under Commonwealth Care. But if their pay goes to $46,000, they're obligated to contribute about $2,400. That's an effective tax rate of 18.5% on that $13,000 raise. A pay increase of $44,000 to $46,000 is mostly erased by higher premiums alone.

The federal bill is plagued by the same weakness. For example, a $55,000 earner contributes $4,400 a year towards insurance. At $65,000, the bill is $6300; so the family is paying a "tax" of $1,900 or 19% on that $10,000 raise. After payroll taxes, those Americans would face a marginal rate of around 35%, a number that's heretofore been the territory strictly for high-earners.

Lesson 5: The generous plans and added mandates give employers an incentive to drop health insurance.

In charting the future of health-care costs, the biggest danger by far is that companies will drop their coverage. It's also the one that's the most difficult to handicap, both for Massachusetts and the entire nation. The problem is simple: If employers stop paying for health care, employees will flood into the government-subsidized programs, enormously raising the cost to already fragile budgets.

Surprisingly, health reform in Massachusetts has actually increased the number of workers covered by employers. Over 100,000 more employees are covered by corporate plans today than when the program debuted in 2006. The main reason is that the plan imposed a $1,000 fine on employees who refused their employers' plans. Then, families were paying around $3,600 a year towards their company policies. Many decided that, when faced with a fine, the better choice was paying the extra $2,600 for full coverage. The plan was shrewdly calibrated by the administration of then-governor Mitt Romney to tilt the market towards company-provided care.

The Massachusetts plan also bans any employee from getting coverage from Commonwealth Care if his or her company offers coverage. Hence it would appear that corporate coverage is solidly entrenched. But that's by no means certain, either in Massachusetts or under the Obama plan. The reason is the fast escalation in costs, for both companies and employees. From 2007 to 2009, the employee contribution for family policies rose a steep 17%, or $624 a year, to $4,200.

Employees can only move into Commonwealth Care if their employers drop their plans. The danger is that the incentives are tilting in that direction as the costs of coverage for employer, and the price of premiums to employees, keep climbing. The point is rapidly approaching where both will pocket big savings if employers drop their plans and workers buy their policies through the heavily subsidized exchanges.

In Massachusetts, the state government is pushing toward that tilt point by adding heavy mandates to a list of more than 40 already on the books. In 2009, it required insurers to cover prescription drugs. An expensive autism mandate is now being debated in the state legislature. The list of mandates under the federal plan is bound to mirror the ones in Massachusetts, and once again, the added expense severely weakens companies' incentive for providing coverage.

Cracks are already starting to appear. Part-time workers can get coverage under Commonwealth Care for a fraction of what they'd pay as full-timers. So they "game the system" by working ten or fifteen hours a week for two or three companies. Or they find that it pays to switch from full- to part-time work. PHI, an organization that represents home health-care workers, states that one-fourth of the home care agencies in Massachusetts are reducing workers' hours so they're eligible for state-subsidized care.

The federal plan will encounter the same problem -- perhaps a more acute one since its penalties are lower and its subsidies go much higher on the income scale.

Starting in 2017, the states will have the option of allowing companies that drop their plans to shift workers into the subsidized, state-run exchanges. That choice doesn't exist now in Massachusetts. It's not that employers are likely to dump their plans en masse. What's far more probable is a progressive erosion that relentlessly and systematically raises government spending.

The incentives are there, both in the federal plan, and its prototype in the Bay State. And when the incentives are that big -- and when subsidies inevitably get bigger, not smaller -- no amount of regulatory tinkering can stop America's employers and employees from taking the government's money, and saving their own.
3) egdot has called me "immoral" for not wanting to insure everyone.  I will point out why his position is immoral.  And even more so.

You have called me "immoral" for not wanting to insure everyone. You have even said, "So you should just leave these people without healthcare?" when I have said nothing of the sort.

Morality is an objective, not subjective idea.  I may very well be immoral in your vision of morality.  But you are immoral in mine.  Neither is right or wrong.  But which preferred healthcare system is more likely to be "better" for the currently uninsured?

You claim that if I don't "help" (by subsidizing healthcare insurance) someone who is hurt, that I am "immoral."

I claim that your preferred policy of taking from one American to give to another is theft.

From Walter Williams' column Bogus Rights:
Do people have a right to medical treatment whether or not they can pay? What about a right to food or decent housing? Would a U.S. Supreme Court justice hold that these are rights just like those enumerated in our Bill of Rights? In order to have any hope of coherently answering these questions, we have to decide what is a right. The way our Constitution's framers used the term, a right is something that exists simultaneously among people and imposes no obligation on another. For example, the right to free speech, or freedom to travel, is something we all simultaneously possess. My right to free speech or freedom to travel imposes no obligation upon another except that of non-interference. In other words, my exercising my right to speech or travel requires absolutely nothing from you and in no way diminishes any of your rights.
 and:
Three-fifths to two-thirds of the federal budget consists of taking property from one American and giving it to another. Were a private person to do the same thing, we'd call it theft. When government does it, we euphemistically call it income redistribution, but that's exactly what thieves do -- redistribute income. Income redistribution not only betrays the founders' vision, it's a sin in the eyes of God. I'm guessing that when God gave Moses the Eighth Commandment, "Thou shalt not steal," I'm sure he didn't mean "thou shalt not steal unless there was a majority vote in Congress."
From Bryan Fischer's column Obama's Platform: breaking the 8th and 10th commandments":
President Obama's entire re-election campaign platform can be summed up in two words: greed and theft.

Despite God's command against lusting for the possessions of others — "You shall not covet...anything that is your neighbor's" (Exodus 20:17) — the president seems animated by a twitching, trembling greed for the wealth of others.

And he is determined to use the coercive power of government to take it from them by force, despite God's clear command, "You shall not steal" (Exodus 20:15).

The president's approach to public policy is predicated on one premise alone: the involuntary transfer of wealth. But taking money from one citizen by force and giving it to another is robbery, and doing it under color of law does not make it right.

Even doing it with the consent of Congress does not make it right. Paraphrasing Walter Williams, God did not say "Thou shalt not steal — unless you can get a majority vote in Congress."

As Frederic Bastiat observed 160 years ago, when government engages in the involuntary transfer of wealth, that's nothing more than legalized plunder. There is nothing noble or laudatory about it. It is contemptible, evil and profoundly wrong.
If I steal your wallet, then that is wrong. If I steal your wallet and give it to a poor person then that is also wrong.

You claim that it is immoral to not help an injured person.

I claim that forcing one American to pay for another is theft.  And, therefore, socializing healthcare, or anything else, is theft.  Theft is causing harm to another person.

I would argue that not helping an injured person is not as bad as harming someone in the first place.
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