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Was Ayn Rand too much of an optimist?

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You can try to argue it all you want about private healthcare being better, but America was defined as pursuit of life, liberty, and the right to happiness.

You should probably read up on the Declaration of Independence, the document you are attempting to quote there. You'll find that your made up version is embarrassingly different from the original.

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You should probably read up on the Declaration of Independence, the document you are attempting to quote there. You'll find that your made up version is embarrassingly different from the original.

You mean happiness and the pursuit of happiness are not the same thing? Darn it, I guess I have to actually do something to achieve that =(

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Hey, thanks for correcting some of my posts guys. I will apologize that I was tired and wasn't forming the words correctly. Since it looks like I can't edit stuff after people have posted, so I'll repost some of what I said earlier here.

Which we need. You can try to argue it all you want about private healthcare being better, but America was defined as pursuit of life, liberty, and the pursuit of happiness. Individual responsibility is key, but a universal, easily accessible healthcare system is necessary for long run health for Americans. Point is, there's a lot of fundamental waste by design in the current for profit healthcare system, and the extent to which it's broken is proof.

I will say that people should have the right to opt out of the above system, but that they should sign a waiver when they opt out that they will not try to check into the public plan hospitals.

Interesting judgment given that Obama is drastically over-spending Bush. In this respect, he is making the previous administration look like amateurs. If you respond to pictures better here is a good visual.

Wow, that's something retardedly expensive. Thanks for making my goal of saving $20 million in taxes / year look inconsequential in comparison. ;)

But in all seriousness, I think that Obama is trying to control the cost. I will concede this point though, because the numbers (assuming they are valid) speak the truth.

Those two are a contradiction.

Again, I would recommend educating yourself. In terms of health care here is a good start.

I think that there is a differentiation that needs to be made. There are two separate groups of thoughts:

1. What is a fundamental consideration about healthcare

2. What is a practical consideration about healthcare

For #1, questions like is healthcare a right? Should we have Medicaid / Medicare? Who deserves to be covered? should be considered.

For #2, questions like what makes sense to save money on the program but keeping it the same? What can we streamline to get the same results while keeping the overall configuration the same? should be considered.

And I will apologize that I kinda mashed the two together. For #1 above, I think that healthcare is a right (I think the risks of not having a public option are too great), but that people should also have the right to opt out. For #2, I think the means to get to whatever end healthcare result want to land on will reduce the overall costs in the long run.

Which we clearly see by your example.

My feelings noooooooo! ;(

Elysium, I'm sorry, but I have to ask, why are you on this Forum? You do not subscribe to the principles that members of this board agree to. It is asked that you have some understanding and acceptance of Objectivism to participate. You don't. Your say in your comments that you are a government employee (not necessarily bad in and of itself) who is pro Obama and socialism. You do not support freedom, let alone reason. You did understand the basis of Leibniz's view of the world, so you accept religion and really silly ideas. Okay, that's alright, lots of people do. I'm not going to kick you. I just wish that you would go off and play somewhere other than our Forum. We deserve that respect.

I tried to go the whole "not having to explain what my background is and for people to judge me based on the content of my message" route but I guess I didn't do a good enough job. I'm still a fervent believer in O'ism for the large majority of life, societal structure, and public policy. Of recent though I have noticed that healthcare is one area in which I just can't apply O'ism. I worked in management consulting for pharma manufacturers, worked with drug wholesalers, learned the product life cycles, supply chains, etc, of the industry, and government's involvement. I agree that a lot of the programs the government runs need fixing or removal altogether. However, I still stand firm on the need for a single, streamlined, public insurance program that people can opt out of.

I say this because I'd like to keep all the configurations for the product suppliers (drugs, equipment) and healthcare providers (hospitals, doctors, etc) unchanged (which, upon removal of some ill-conceived government pricing would actually increase overall revenue for those companies), but just replace the middleman with government insurance. Thing to keep in mind is I have no problems with people making a ton of money. I'm convinced that the insurance industry is just a predatory industry writ large.

You should probably read up on the Declaration of Independence, the document you are attempting to quote there. You'll find that your made up version is embarrassingly different from the original.

Yup, sorry, thanks for pointing it up.

You mean happiness and the pursuit of happiness are not the same thing? Darn it, I guess I have to actually do something to achieve that =(

Yeah man, we gotta all work hard to get what we want in life. ;)

*EDIT* I just got a notice that I'm veering off topic from the purpose of the Philosophy forum. For the sake of continuing this, let's limit scope of discussion away from "what's the deal with Ely?" to back on topic please.

Edited by Elysium
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I'm still a fervent believer in O'ism for the large majority of life, societal structure, and public policy. Of recent though I have noticed that healthcare is one area in which I just can't apply O'ism. I worked in management consulting for pharma manufacturers, worked with drug wholesalers, learned the product life cycles, supply chains, etc, of the industry, and government's involvement. I agree that a lot of the programs the government runs need fixing or removal altogether. However, I still stand firm on the need for a single, streamlined, public insurance program that people can opt out of.
A free market can most definitely work for medicine. History offers ample proof. The government should have no role in this, except for its standard police and court role.
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A free market can most definitely work for medicine. History offers ample proof. The government should have no role in this, except for its standard police and court role.

To say nothing of the fact that one can't be pragmatic with principles: they work for all applications or none.

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For #1 above, I think that healthcare is a right (I think the risks of not having a public option are too great), but that people should also have the right to opt out.

Rights have one thing in common - they are rights to action and not to rewards from other people. The concept of rights arises because life requires us to have the chance to work for what we need to survive. There are no rights to the actions or products of others. Health care is certainly not a right (neither is food, or shelter).

For #2, I think the means to get to whatever end health care result want to land on will reduce the overall costs in the long run.

This is also not true. I live in Canada and you should read some about our system. Monopoly on health care does not lead to reduction of overall cost (government can not and does not run things more efficiently than business) but it does result in a drastic reduction of the quality and accessibility of health care and halts innovation and new technologies.

Here is a good article explaining US leadership in health care technology and how that relates to cost.

My feelings noooooooo! ;(

Given that you are showing understanding of the importance of facts, I apologize.

Edited by ~Sophia~
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A free market can most definitely work for medicine. History offers ample proof. The government should have no role in this, except for its standard police and court role.

Medicine =/= healthcare. See below.

Rights have one thing in common - they are rights to action and not to rewards from other people. The concept of rights arises because life requires us to have the chance to work for what we need to survive. There are no rights to the actions or products of others. Health care is certainly not a right (neither is food, or shelter).

We have the right to life, meaning that when we are born, we have the unfettered right to live our lives and not impinge on other people's rights to do the same. The question for me comes down to does "healthcare" get bundled into the same category as "life," and I say yes. With the option to opt out.

Now, does that right to "life" impinge on other people's rights to do the same? I say no, to the same extent that law enforcement; it is a preservation of life.

As for whether taxation should be mandatory or voluntary to do that (e.g. the vehicle of funding), that's a separate discussion.

This is also not true. I live in Canada and you should read some about our system. Monopoly on health care does not lead to reduction of overall cost (government can not and does not run things more efficiently than business) but it does result in a drastic reduction of the quality and accessibility of health care and halts innovation and new technologies.

I completely agree innovation + new technologies are only paved in a capitalist system, and I'm glad for those components. It's the insurance industry specifically I disagree with...

Here is a good article explaining US leadership in health care technology and how that relates to cost.

OH HEY thanks for the article, and it just validates what I've lived and breathed for the last 3 years. ;) I'm all for innovations; I think that the US is by far the best in its ability to create new solutions to people's problems. I don't mind patent exclusivity for new drugs to make huge profits, because that directly feeds in principle to new pipelines in R&D, and hence more innovator drugs (btw patent law is a government construct, but besides the point).

Again, my issue with US healthcare is the reimbursement nature of our care and the pencil pusher decision makers at an insurance company. You and your doctor are waiting on insurance to release money before you can get an operation, or you choose to pay it out of pocket, or the hospital does the procedure, and then tries to chase down payments. In the above 3 cases, the first is one that slows the delivery of healthcare (which was the purpose of buying insurance to begin with), the 2nd negates insurance altogether, and the 3rd just adds to your operating costs because you're paying a doctor's salary to file papers and fill out forms (hospitals can afford to hire assistants, but I hope you get my point).

I understand that Canada and other countries have issues with their healthcare systems. However, the source of the problem isn't the public healthcare itself; the source of the problem is that they don't have the innovation dollars incentivizing growth as they do in the US. Imagine a US with the same incentive structure, but with less overhead cost, fewer pencil pushers, and faster delivery of care. That's the healthcare system I want.

Given that you are showing understanding of the importance of facts, I apologize.

Hahaha I wonder what else I'm misconstrued as, but that's off topic.

Edited by Elysium
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We have the right to life, meaning that when we are born, we have the unfettered right to live our lives and not impinge on other people's rights to do the same.

And herein lies the contradiction of your position. While claiming one person's unfettered right to his life through provided healthcare, you fetter the life of the man you take the money from to pay for this healthcare. A man has a right to his life, but he does not have a right to have his life PROVIDED FOR HIM at the expense of another man's life.

Edited by RationalBiker
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Hey man I think I was editing my post while you posted yours. I said:

The question for me comes down to does "healthcare" get bundled into the same category as "life," and I say yes. With the option to opt out.

Now, does that right to "life" impinge on other people's rights to do the same? I say no, to the same extent that law enforcement; it is a preservation of life.

As for whether taxation should be mandatory or voluntary to do that (e.g. the vehicle of funding), that's a separate discussion.

From a practical perspective, I would prefer an automatic enrollment system at the national level, and you have to specifically choose to opt out. Upon enrollment, you're locked in for a 5 year period, and if you chose to opt out, you can't get yourself back in for the full 5 years.

Would I prefer a mandatory system? Yes, because I know there's going to be more administrative headache with allowing people to opt out and back in, which would drive up the overall program costs. However, to acknowledge the full definition of a "right" as not impinging 100% at all on any other person's right, I will have to acknowledge that you must on principle have the right to opt out.

I guess also the word "mandatory" around here hits some nerves, so I'll avoid it in the future. ;)

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It does not matter whether its opt out or not. By the nature of it being government funded I have to pay for it whether I opt out or not. Even if the costs are low directly, the indirect costs i pay through taxes make it worse. Additionally letting the government compete with private companies is not fair as it allows a companyw ith no limits and the ability to go into debt to tax its competitors who have those limits.

Also it has been said several times but the Declaration of Independence says life, liberty and the pursuit of happiness. All of these are actions, not provided by others. Universal Healthcare requires the funding of others and the work of others, two forced seizures of life. Rights are not contradictions; ie a right cannot violate another right at the same time, rights are absolute.

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Let's define everything!

"Opt out" to me means you can choose to not go with the government program, and can elect to pursue whatever other insurance methods you want. The government program covers only those who did not opt out, and is funded only by those who do not opt out. You are essentially choosing to buy a government bond or not, only your annuities throughout are in the form of healthcare.

Of course this is all in "Ely's Fantasy America" where I get exactly what I want. I also want a unicorn but I probably won't get that in real life America either.

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So if everyone is perfectly happy with their healthcare but the poor, how do you fund your program?

Not to mention how far this program must extend for it to be completely voluntary; government medical research; government produced medicine and medical supplies, government employed doctors, government built hospitals and facilities, etc. etc. etc.

Also, the government becomes competition for medical services in the "free" market.

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Also, what you describe is just another company that can only do as much as any other private company because it doesnt use tax revenues at all. The only way it could differentiate itself is by charging more to the rich as the government loves to do but then they can just opt out and the program fails

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^ Selective reading? Naw...

I wrote earlier:

Medicine =/= healthcare. See below.

I completely agree innovation + new technologies are only paved in a capitalist system, and I'm glad for those components. It's the insurance industry specifically I disagree with...

I'm all for innovations; I think that the US is by far the best in its ability to create new solutions to people's problems. I don't mind patent exclusivity for new drugs to make huge profits, because that directly feeds in principle to new pipelines in R&D, and hence more innovator drugs (btw patent law is a government construct, but besides the point).

Again, my issue with US healthcare is the reimbursement nature of our care and the pencil pusher decision makers at an insurance company. You and your doctor are waiting on insurance to release money before you can get an operation, or you choose to pay it out of pocket, or the hospital does the procedure, and then tries to chase down payments. In the above 3 cases, the first is one that slows the delivery of healthcare (which was the purpose of buying insurance to begin with), the 2nd negates insurance altogether, and the 3rd just adds to your operating costs because you're paying a doctor's salary to file papers and fill out forms (hospitals can afford to hire assistants, but I hope you get my point).

I understand that Canada and other countries have issues with their healthcare systems. However, the source of the problem isn't the public healthcare itself; the source of the problem is that they don't have the innovation dollars incentivizing growth as they do in the US. Imagine a US with the same incentive structure, but with less overhead cost, fewer pencil pushers, and faster delivery of care. That's the healthcare system I want.

To summarize again what I said above: nothing changes except insurance. Not medicine, not medical research, not doctors, not hospitals / facilities, etc. That all stays the same. I'm not sure how much clearer I can make it.

So if everyone is perfectly happy with their healthcare but the poor, how do you fund your program?

Not everyone is happy with their healthcare right now. If you think all the rich people are, you clearly haven't seen the numbers: http://www.commonwealthfund.org/Content/Ne...19-Percent.aspx

Are you happy paying paying more than double what you paid a year ago (after accounting for inflation)? Ya looking forward to paying double again in 10 years? I'm not, and I'm not even rich!

In fact how do you fund any system by the government when over 90% of taxes are payed by the top 10% in income?

By incentivizing them to a cheaper annual insurance premium?

Also, what you describe is just another company that can only do as much as any other private company because it doesnt use tax revenues at all.

DING DING DING WE HAVE A WINNER.

The only way it could differentiate itself is by charging more to the rich as the government loves to do but then they can just opt out and the program fails

Yes, because it will choose to differentiate itself. And it loves to do that! And all the rich people will be unhappy with the government and will opt out!

For my next act, I have a gut feeling I need to explain how the US healthcare system works.

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Why cant any private company do exactly what you want the government insurance company to do since there is no real difference?

Also government has never run a business well. See USPS, Amtrak, Public Schools, etc

Edited by fountainhead777
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Why cant any private company do exactly what you want the government insurance company to do since there is no real difference?

Size, influence, and accessibility. Like I said earlier, I think insurance companies by design in the US are fundamentally broken. Their business model is to take your money and not pay for your care. That's what drives up their profits. And they are for profit companies, and their upper management gets paid a lot more than government workers. Take away all those factors and put in place a rock solid SOP for healthcare payment issuance and you have a cheaper system overall.

Similar models exist in the private sector; local individuals like NJ Motor Corp (I think was the name) form non-profit insurance organizations (it's a car insurance company, not a health insurance one, but work with me here). They're fewer and farther between, they have a very rigorous review process of who gets in based on driving history, and their premiums are substantially lower than Geico, etc.

The challenge is that you don't always have them in your local area. You don't always get in. And even if you get in, you have limitations of where you're covered.

I fully recognize the faults of the US government; it's no secret that we have a lot of problems. I could tell you about the barriers upon barriers that prevent us from firing underperforming employees quickly, but I'm preaching to the choir.

But yeah, I intend to spend time working for fed govt and learn its ins and outs to see how I can change it for the better.

Also government has never run a business well. See USPS, Amtrak, Public Schools, etc

USPS and Amtrak I agree with.

Public schools? Nope. There were just as many public school students in my home town who went to ivy league schools as those from private high schools. I'm one of the former. Statistically their performance may be lower than private schools, but there's also a number of reasons for that: contracts between private high schools and ivy league universities, harder to attract talented teachers (speaks to government's lax incentive structure), and underfunding for developmental programs for the students (again, a money management issue).

Edited by Elysium
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Lastly, I'd just like to say that in this topic I feel like Dagny.

Everyone else: "YOU'RE STUPID YOU'RE STUPID NEENER NEENER"

Dagny: "NO THE WORLD IS STILL WORTH SAVING I WILL DO IT JUST BELIEEEEEEVE IN LIFE AFTER LOOOOOOOVE"

Let my... optimism run its course. :P Either I'll wise up and realize the US isn't worth saving, or I'll fix it. In either case, you win.

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To summarize again what I said above: nothing changes except insurance.

Except that ignores reality. Insurance costs are based on all those factors I described. Making insurance costs lower requires those things to be different than they are. Private insurance rates right now are based on all those factors.

For my next act, I have a gut feeling I need to explain how the US healthcare system works.

Actually you still need to explain how health insurance is a 'right' in the first place. Then you need to explain why it is a proper function of government.

I'd pass on you gut feeling if I were you. There are a number of very well-informed people on this forum. Most of them wouldn't appreciate a little dig like this thrown their way. They might be far less likely to seriously entertain your position.

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Except that ignores reality. Insurance costs are based on all those factors I described. Making insurance costs lower requires those things to be different than they are. Private insurance rates right now are based on all those factors.

You are right that insurance pricing includes the costs of those other factors you described, such as medicine, hospital infrastructure, doctors' salaries. However, those are on a contractual basis between whatever insurance company they have in the private sector with the respective drug manufacturers, hospitals, doctors, etc. That information is essentially fed to insurance companies and negotiated over; those services are not rendered by the insurance company unless you're in an HMO (or similar construct where delivery of healthcare and insurance for it are under 1 roof).

Insurance ultimately just boils down to what price you pay for what service when. In that sense, the only thing that changes from a private industry -> my version of public one is the prices you're paying (lower) and who you're paying it to (the government acting as a private entity), and thus all those other elements such as what hospitals, what drugs, what doctors, (except for pricing) stay the same (excluding HMOs of course).

I re-read what you said and realized that you and I were saying the same thing. Insurance IS about pricing. Either you choose to pay for treatment upfront (or take out a loan for it) or you get insurance to pay for it. Which insurance you pick comes down to pricing. If your concern is around how certain HMOs, PPOs, etc, have their own exclusive network of doctors / hospitals that are its members, my answer is that those are part of the "hook up" process by which my ideal insurance system is established. Payments to the doctors, pricing on drugs, etc remain the same. All that would change is how much you would pay and who you would pay to. In preserving the payment structures to those drug companies, hospitals, and doctors, changes to which ones you would get to see would be minimized, because those entities would not be incentivized to turn you down if they get paid the same in the end.

Actually you still need to explain how health insurance is a 'right' in the first place. Then you need to explain why it is a proper function of government.

I thought I... did? To me, insurance = healthcare = being healthy = life. Life is granted to us, we can all agree. And if the means by which we can continue that health is an opt-out system, that does not infringe on others' right to life. I feel like I'm repeating myself.

As for why it's a proper function of government, I thought I... did too. I see it in the same vein as national defense, and payment being voluntary. Only in this case, it's more enforceable that if you opted out, you don't get access to the care, whereas in a voluntary payment military, the military will still pay for your protection (unless you wear a big flashing sign saying that you didn't donate or something).

I'd pass on you gut feeling if I were you. There are a number of very well-informed people on this forum. Most of them wouldn't appreciate a little dig like this thrown their way. They might be far less likely to seriously entertain your position.

In respect of this, I didn't elect to illustrate my point above by walking through the US healthcare supply cycle step by step. Do let me know if you want me to though.

Edited by Elysium
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I understand that Canada and other countries have issues with their healthcare systems. However, the source of the problem isn't the public health care itself; the source of the problem is that they don't have the innovation dollars incentivizing growth as they do in the US.

There is no money for innovation but that is not the major source of the problem.

When medical insurance is guaranteed and other people pay for your health care - there is no incentive to first take care of your health (in order to prevent medical expenses) and second to use the system prudently (to limit the expenses). Those are some of the factors which drive the cost UP. To control cost the government restricts access to medical services (rationing - long waiting lists), limits acquisition of new innovative products (decline in quality) and limits health professionals wages (drives best talent away) while making it difficult or impossible to obtain medical services outside of the public system.

Imagine a US with the same incentive structure, but with less overhead cost, fewer pencil pushers, and faster delivery of care. That's the health care system I want.

Yes you have problems with your current set up. But the solution lies with free market reforms that allow more competition and reduce costs (for example, by eliminating laws that forbid purchasing health insurance across state lines, by eliminating mandates of what has to be covered) and reward individual responsibility (for example, by eliminating mandatory insurance benefits and allowing discounts/increases based on lifestyle).

I personally would like to be able to decline coverage for routine doctor's visits, routine tests, and even lower cost procedures (and pay for those outside of insurance from my savings on per use bases) and only purchase coverage for major conditions I personally may be at risk for (after consulting with my doctor) with a deductible set at a % of the actual cost (I would have set it as high as I could manage). Such options would lower costs drastically.

Edited by ~Sophia~
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