Although one law professor in particular at FPLC would vehemently disagree, health care is NOT a human right, and was never contemplated as such by our Founding Fathers. All legitimate rights have one thing in common: they are rights to action, not to rewards from others.
The rights we have been endowed with include life, liberty, and the pursuit of happiness. Notice that these American rights impose no obligations on others, but are negative obligations that allow you to be left alone.
Also, it is the "pursuit" of happiness that we have been endowed with, not happiness itself. Happiness was never guaranteed.
The right to life doesn't mean your neighbors have to feed and clothe you; it means you have the right to earn your food and clothes for yourself, and no one can forcibly stop your pursuit of these things or take them when you have achieved them.
And no, health care rights do not stem from the "penumbras" of the Bill of Rights. It always irked me to learn of new penumbras judges found during law school.
It isn't a right. But I don't think it is a "privilege" technically.
Privilege connotes something that someone is allowing you to do. I.e. that the gov't permits it.
It is not my privilege to be able to buy food. I just get to do it. The gov't doesn't have the power (or shouldn't have it if we assume they do) to tell me that I can't buy my own food, the same holds for health insurance.
Maybe a better way to say it is that our gov't wasn't designed to give us rights. It doesn't have the power. It was designed to prevent a gov't body from taking our God-given rights.
We have the right to pursue what we want (within reason), which can include health insurance. That is why I wouldn't call it a privilege either...they don't authorize our ability to get it. It is that they can't prohibit us from getting it.
Since when are all rights defined by and limited to the American founding fathers? Even *they* weren't so arrogant as that, and recognized that rights come from God. They also noted that "life, liberty, and the pursuit of happiness" were AMONG the rights granted by God, and are not limited to those few, great as they are.
Health care is a precursor, in all too many cases, to life itself, and to liberty (in the sense that a crippled, weak body can be a prison preventing the exercise of anything that makes life worthwhile), and to the pursuit of happiness (surely even Jeremy will acknowledge that pain -- especially when the knowledge is present that proper care could alleviate that pain -- is a stumbling block to the pursuit of happiness).
I just despise the tendency of too many of us toward gifts of the spirit and the joy God intends us to have, limiting them solely to the political rights of the United States. Religion should inform your politics; politics should not constrict your religion.
Let's assume that the 5th and 14th amendments don't exist and that we are not dealing with original intent of the founders. Or even just from the narrow look at what we want for public policy. Would you argue that government should have zero role in providing various levels of medical/fiscal assistance? For example and just for this hypothetical, would you prefer Social Security, Medicare and Medicaid, WIC, or other programs to be eliminated? If not, where would you draw the line as being a program that we support tax money going to and one that doesn't?
I am not being confrontational, I am just trying to find where we would draw a line. Jer and Nate know that I am a strict constructionist as much as the next white, middle class male, but I like defined lines of where we would be comfortable and not. Just a thought experiment.
One additional note, the Constitution does not guarantee the right to happiness, only the Declaration of Independence. I don't believe that the Constitution guarantees healthcare as a right, but I wonder if the country as a people wants to make it one.
Anon, you may have missed the point of my comment. The rights given to us by our Founding Fathers, and ALSO from our Creator, are rights to action - not rights to receive stuff from others (especially the government). In other words, the rights we have allow us to choose and act as we will, but never do they entitle us to a free meal.
I echo Nate's comments. We were given a republic where the people decide how much power the government has; not the other way around. Because the government is "of the people, for the people, and by the people," it cannot possibly perform any action that the people do not allow. We literally lend our rights to the government for a short period so that it may act on our behalf.
Sadly, this original idea has been mutated into the idea that the government lends the people rights, and we have to petition the government to allow us to pursue happiness. This is a complete 180 from the original intent.
In view of this, your argument about pain necessarily fails. While the onset of pain my cast a stumblingblock on your pursuit of happiness, you nonetheless retain that right. The purpose of our government was not to pursue that happiness for us (i.e., remove all stumblingblocks from us and deliver the end result) but it is a framework of laws and regulations that afford the people a playing field to enjoy and practice those rights.
"Religion should inform your politics; politics should not constrict your religion."
I don't see anyone doing either. Referring to rights as God-given is just to say they are inherent in being human. That doesn't have anything to do with religion.
I want healthcare for my family. I therefore work for it and pay for insurance. If I couldn't afford insurance, I would cut other things (dirrectv, gym membership, size of house, etc.) to get it. I don't have the right to inhibit anyone else's pursuit of happiness to take their money in order for me to keep some of these things. And gov't should not have the power to do it.
Many of the people that are without insurance can pay for it and they choose not to.
As for the others, we can discuss solutions for them (hopefully these wouldn't cost a trillion dollars).
The prescription drug solution was just as stupid. Something like 6% of the population over 65 had a problem. But now I will pay for Bill Gates's drugs when he's old. Is that a good solution?
Health insurance for a family of 4 costs about $12K/year. If rent is another $12K/year, and utilities and food are another $12K/year (surely there are other expenses beyond this), what suggestions would you have for someone who only makes $25K/year? This person works for $12/hr, 40 hours/wk, 52 weeks a year (with no vacation).
I couldn't vote because I needed a spot for neither. It's a slippery slope trying to say something is a "right". Where would you stop. For example, what about car insurance. With this logic, the gov't would need to pay for that also. I mean, it's expensive and everyone needs it. As of two weeks ago, my family of six lost the employer provided health insurance. Yes, it sucks. No, the gov't doesn't need to give it to me. We will work harder, cut expenses and come up with a way to pay for it.
As a society, we will never be able to afford unlimited health care, but we can afford a better level of health care than most individuals with significant problems would be able to pay for on their own. A significant minority of the nations in our current world already have succeeded in creating a right to health care. This is a moral good and a positive accomplishment.
From one extreme point of view, everything that we earn as individuals is ours alone to use as we see fit. From the opposite point of view, the government has the right to take and redistribute everything we earn as it sees fit. Instead of insisting on either of these extremes, we ought to seek a fair balance that rewards hard work and success without forgetting the needs of people who would be helpless without our help.
Many people can't get health coverage for hook or for crook. If you have a preexisting condition, then you're simply out of luck. No insurance for you, unless you can get an employer-based plan. So, you get sick & lose your job. Now what? You cannot buy insurance to cover that disease that made you lose your job in the first place.
This is why healthcare costs are the leading cause of bankruptcy in the U.S. right now.
I do not believe that if someone gets sick they should lose everything, which is where things stand right now in the US.
Not only that, but there's been tremendous consolidation in the health insurance market. When there's only one or two providers, they get to set the prices. This is why health insurance premiums have been skyrocketing, while benefits have been plummeting. The proceeds of those premiums are going into the pockets of the insurance companies. Monopoly power--that the insurance companies now have--is not a free market. It's the opposite.
America's healthcare system is the best in the world, and no one can dispute this. That is why leaders and wealthy people from around the world (even Norway) enter our borders for American healthcare services. In "Sicko," Michael Moore conveniently failed to mention this fact.
And why is it the best healthcare system in the world? Capitalism. Capitalism provides the incentive to work hard and earn as much money as you want.
I agree that healthcare in the U.S. needs an overhaul. But, do you really think putting the government in charge of our healthcare is going to make it more efficient? The only program that the government runs efficiently is the military; every other government program is riddled with needless red tape, and healthcare will certainly suffer a similar fate.
Djinn wrote:
"When there's only one or two providers, they get to set the prices. This is why health insurance premiums have been skyrocketing, while benefits have been plummeting."
This is just not accurate. There are hundreds of providers in the U.S. today, and competition is a good thing. However, the reason premiums are so high is a direct result of ever-increasing tort litigation. Providers cannot afford to lower their prices when our courts continuously dole out billion dollar healthcare judgments.
A start to the solution lies in massive tort reform legislation to cap the dollar amounts in healthcare-related lawsuits. Unfortunately, most of the members of Congress and the Senate are lawyers and therefore will refuse to eliminate a profitable branch of their profession in the event they don't become mainstay politicians.
SmallAxe, Your premise is flawed. A family of four making 25K/yr would automatically get $5,028 welfare check (called "earned income tax credit") without even having to apply.
My health insurance costs ~10K a year through my employer. I can get the same Aetna plan minus coverage for maternity for $4300/yr in TX. Under this Hypo, your poor family can afford it.
Regardless, a family of 4 with that income probably already qualifies for medicaid (certainly at least for their children). So expenses would be even lower.
The people I am discussing are the ones who make 40K/yr. The ones who don't qualify for medicaid, and can afford to pay their own way. (note, these people would also get the $5K EIC after taking standard deductions). When I was in this position...I bought my own. I wouldn't have felt a right to your money, or even the richest person in the world's money.
I would also bet that many housholds making 40K own HDTV's, have gym memberships, etc. (I did) Do you want to work 1 month out of the year to pay for them?
djinn: I couldn't disagree more. If people get sick and lose everything, we as a society don't allow them to hit bottom. Even our bankruptcy laws don't allow for a total liquidation. Medicaid picks them up, social security disability kicks in, food stamps, etc. If someone can't work, they will lose a substantial amount no matter what. BK kicks in as soon as you're insolvent (even if you make a ton of money)...so you don't have to dig a hole until you lose your house and everything.
I know BK sounds bad, but it is a very merciful law which was set forth in the constitution by our founders. The philosophy was that an honest debtor should get a fresh start if everything fails.
The bigger problem is that people can't possibly understand each of those programs due to inherent gov't complexity. Adding another complex program won't help the people that are unable to get help now.
BTW: Good discussion all....thanks for stopping by.
Many that advocate your position do not realize how much money they are taking.
Do you think it is fair that I work 3-4 months/yr full time for the gov't? At what point am I enslaved? I already only see my kids ~1hr/day.
But hey, I'm glad my portion of tax money (that took several hundred hours to earn, and that much time from my family) could almost pay to fly in a pizza chef and food that was ordered special for a white house party last month.
Much more thought should be given before you take even a single dollars worth of product of a person's labor. They already take too much by double.
And as a side note: I don't think this is only the Democrats' fault. They're only doing exactly what Bush did times 4. What our gov't is, and has been doing, is immoral.
The people I am discussing are the ones who make 40K/yr.
If your point is that people who can't afford healthcare should be provided it, and those who can afford it should purchase it, I'm not sure we're at odds with each other. But where do you propose the money should come from in order to provide for those who cannot afford it (especially given that we're talking about the nearly 40% of households in the country that make less than $40K)?
Wow! With no offense due those who have a different opinion, I have to say that considering health care a right is an absolute mockery of rights! I can explain this in many ways, but the religious argument is very simple:
D&C 101 77 According to the laws and constitution of the people, which I have suffered to be established, and should be maintained for the rights and protection of all flesh, according to just and holy principles; 78 That every man may act in doctrine and principle pertaining to futurity, according to the moral agency which I have given unto him, that every man may be accountable for his own sins in the day of judgment.
What a perfect summary of the idea of rights with the perfect constitutional context!
Here's the idea simplified: in order to fulfill God's will concerning the plan of salvation we need to make moral choices individually concerning ourselves and others. Government exists to preserve our ability to do so (against the infringement of others).
There is some debate about what sort of economic responsibilities the government has in terms of protecting people from others' choices and so forth, but the question of health care is beyond debate.
If healthcare is a 'right' then the government must enforce its completely equal and maximally beneficial in society.
There are problems with this: not everyone has the same health needs, and health care itself is by no means a perfected practice.
Hence, if healthcare is a 'right' the government must make a stupendous amount of choices. These choices range from basic health treatment decisions to the very distribution of resources and even labor in society.
There is no defensible way you could argue that a government could engage in this without unreasonably infringing on important moral choices on the part of its citizens.
I'm not necessarily talking about universal/single payer healthcare, I'm talking about what it would mean if healthcare was a 'right'. So if you disagree with me on this point, then you aren't talking about rights, maybe you're talking about 'everyone being covered' being a good idea, but rights aren't involved.
Of course, I shouldn't even have to go here. Really 'government hands off!' should be all my argument needs to be. Nevertheless, I have indulged the other side because this issue seems so clear to me - that of 'rights'.
Look, Marx invented the whole idea that economic factors determine all history and society and macro human decisions and then overplayed it in order to win an argument in favor of socialism. There's this idea that the 'invisible hand' of capitalism will ravage people who are helpless before it unless they band together and support a common morality embodied in a social contract which is a government that enforces 'positive rights' or rights to food, healthcare, whatever.
The problem is that we are individuals and GOD inspired the Constitution so that individual moral decisions could be protected from outside coercion. The 'invisible hand' is the product of society's moral decisions. History and life and even economics can be the product of moral decisions, not the other way around.
Government has a role, there's a good debate about exactly what, but at two ends there are two opposing visions. One's from God, I have a firm conviction of the originator of the other philosophy.
In 2006, the Congressional Budget Office published a comprehensive report on the correlation of legal medical malpractice limits of various types to health care costs and couldn't find any statistical correlation. Won't help.
There were some counter-intuitive findings, though. One was that total medical expenditures went up in some markets when malpractice caps were implemented.
I think all this talk of rights is just nuts. Do we have a right to clean water? Roads? A sewer system? Ambulances? A standing army? If these are not rights, do we have any right to them? Whatever happened to the greater good?
We do not have the greatest health system in the world, not even close. According to the WHO, we're 37th. Behind Costa Rica and, yes, Cuba. Plus, for this bad health care we pay about twice as much as anyone else.
Oh, as to monopoly power, according to the AMA, 92% of health care markets are monopolies (bad for us) and monopsonies (bad for the doctors), as a single entity sets the price--whatever they want--for everyone.
This is why the AMA is suddenly for the private option (after years of taking the opposite position), because the rapid consolidation of health insurance in the last few years has seriously cut into doctor's profits.
If you have a preexisting condition, you simply cannot get insurance to cover it. This is not a difficult point. Why should a rational for-profit entity give you coverage? This is why it makes no sense (to me) to have our health care rationed by for-profit institutions. You get sick, they get busy finding a way to deny you coverage. The worse they treat you, the more money they make.
Remember, these institutions have monopolistic power in 92% of all areas. So, if they don't like you, you're out of luck.
The AMA report is called "Competition in health insurance:A comprehensive study of U.S. markets | 2007 update."
American businesses are getting clobbered in the international market because health care costs for their workers are so much higher than what similarly-situated companies in other countries have to pay (nothing).
So for pragmatic reasons alone, good businessmen should be for some sort of universal health care, and in my admittedly small sample, those who have to deal with actual health care costs very much are. No matter their politics otherwise. We spend twice as much on health care as anywhere else. And we get crap. Why does anyone find this to be a good thing? Because of some sentimental attachment to the phrase "the invisible hand?"
djinn said "We do not have the greatest health system in the world, not even close. According to the WHO, we're 37th. Behind Costa Rica and, yes, Cuba."
Would you rather get cancer treatment in Cuba than here? Next time you are in a serious accident, do you hope they take you to a trauma unit in Costa Rica? Of course not. We are by far the best system in the world. We cost more because we develop more. For every 1 breakthrough there are 10 failures, the cost of which must be absorbed.
And you should note that if a poor person gets hit by a car, the ER doesn't turn them away. Illegal aliens come here to have babies...and we pay for it. You make it sound like most Americans don't get sufficient help, but that is simply false.
Our system is what has fostered innovation Do you value that for nothing? The WHO ratings do.
"Whatever happened to the greater good?" By that argument, a person making 20K/yr here is in the richest 5-10% in the world and should have to cut back and distribute to the world. Do you think it is okay to cut down their living standards too?
That is the problem with your logic. The greater good is better served if you allow individuals to be free to excel on their own. They create, advance, etc., and everyone benefits from it.
Whereas blind populism tends to bring down standards of living equally. That is why we're the wealthiest country in the world and why France would be the 5th poorest state in our union.
I also like how in those enlightened countries they kidnap bosses, burn 500 cars in one night, etc...must be a great utopia.
"American businesses are getting clobbered in the international market because health care costs"
The proposed solutions will help big business. That is why they're on board. Doesn't that scare you? Do you think big business has your best interest at heart?
The proposals will hurt small business; i.e. the people who employ 70%+ of the population (and big business knows it). My sister's business would have to lay off at least 2 people because of the penalties of the current proposals (her employees are all moms whose husbands have health care with their work). Are they better off having their job or not? Hurting small business will have a much worse impact on our system, and cause a strain that we can't afford right now.
"Do we have a right to clean water? Roads? A sewer system? Ambulances? A standing army? If these are not rights, do we have any right to them?" Clearly No.
To say we have a right these days is to say the gov't owes it to us. These things take care of themselves (yes the invisible hand may help). When the west was getting settled...did the gov't come in and dig waterways and make roads? People would naturally organize for their purposes. (you should read Thomas Paine's "Common Sense" it explains these principles very well and how gov't role is best served)
Your advocating Marxism plain and simple. I agree that in theory Marxism is the way that good people could live together and maximize happiness. However, our world experiences show us that these principles simply don't work.
--I don't mean to sound hostile...I am enjoying this.
djinn, you are correct, I mispoke when I said that the U.S. has the best health care "system" in the world. That is probably not true, and thank-you for actually backing up your point with facts.
The point I was trying to make is that it is not the "system" that is the best, for we can all agree that something needs to be done, but the U.S. offers by far the best health care services in the world.
Insterestingly, last night 20/20 did a piece on Canadian healthcare and showed how animals get better treatment than humans do there. Every day Canadians cross the border into states like Washington and Montana to receive medical treatment that is just not available in Canada, or the government is unwilling to pay for, or the wait is too long and the person would die in the meantime.
I agree with Nate, the innovation of the free-market is what makes our current health care system bearable. I would like to see a list of all the medical innovations that came from single-payer systems. My bet is that it's quite short-if not non-existent. For that matter, name one great invention that came from a non-capitalist society. It has been this evil capitalism that has brought us the jet engine, air conditioning, the automobile, nuclear fusion, etc.
I understand the angst some have when trying to find insurance with an existing condition. But, hospitals that receive Medicaid/Medicare funding from the govt are required to treat anyone that comes through their door, regardless of insurability. In that sense we already have a universal health care system.
Last point, also brought up in the 20/20 report. We already have a great example of how our healthcare system would be under total government control - that of the Native Americans. These people are not thriving as some may assume our country would be. In fact, the government gives them everything, and what has that done for them?
For that matter, name one great invention that came from a non-capitalist society.
Democracy.
the Native Americans. These people are not thriving as some may assume our country would be. In fact, the government gives them everything, and what has that done for them?
My hunch is that the unfortunate situation of many Native Americans has less to do with the government providing healthcare and more to do with the seizure of their land which then became the means of production fueling the American capitalist economy.
Jeremy, I know that you believe that Canadians go across the border every day to get health care that they can't get in Canada, but that is not correct. If canada cannot provide timely care, especially in extremely time-sensitive cases, they outsource to the US.
As far as I can tell, this has happened twice in the last three years, going on the reports given in the news--it's always the same two cases. Plus, the care was paid for by the Canadian government. No rationing at all. The system worked just fine.
There is also a woman who had a brain cyst who has been appearing on various outlets with her problem rebranded a brain tumor. Canada doesn't ration care. It just doesn't.
If you have ever lived in Utah, you should know that babies don't always decide to be born at even intervals. I had a friend give birth on a gurney in the hallway with insufficient medical care due to overcrowding in the maternity ward. She had serious complications due to lack of proper medical supervision. It would certainly have been better for her if she could have been flown to Canada.
I double dog dare you to show me a case in Canada where someone died because of a wait for healthcare. In contrast, 22,000 people a year, A YEAR, die here due to lack of medical services. 22,000 people a year die here. Right now. Bad luck, it could be you or someone near and dear to you.
Again, not difficult to determine which system works better.
Plus that native american example? I see you that, and raise you the medical care given to members of congress and provided by your favorite boogyman, the US gov't.
Jeremy, I haven't noticed any lack of innovation on the part of the WHOLE REST OF THE FIRST WORLD in spite of the fact that they provide health care for their citizens.
Jeremy, you said that hospitals are required to treat anyone, but that's not true. They're required to treat anyone with a life-threatening condition.
This is defined as:
“A condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health ... in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs.”
Further, the condition only needs to be stabilized, not cured. So, no athsma treatment, no diabetes treatment, no chronic type of treatment at all unless you're on death's door. And then, they only treat you until you're just slightly through the doorway.
Plus, unless you have no possessions at all, essentially, you're responsible for inflated medical bills--insurance companies bargain for cheaper rates with hospitals. Uninsured people have no such luck. It's really bad. Trust me.
Even more fun, more and more hospitals are closing their emergency rooms, or making them for-profit only, so they don't even have to treat dying people.
From what I have heard from actual Canadians, is that the healthcare is neither as dire as the US opponents make it out to be, but nor is it nearly as nice as its supporters claim. I think both sides are being a bit starry eyed. In general, I think it is unfair to get the govt to fix a problem that it has aggravated in the first place.
"22,000 people a year, A YEAR, die here due to lack of medical services. 22,000 people a year die here."
I was going to call you out on this for a source because it is clearly false on its face.
But I went to the source instead. I have never seen a more ridiculous calculation.
Isn't it funny that the obvious calculation would be to take the number of insured vs uninsured. (e.g. 80/20). Then take the number of deaths in an age group and see if there is disproportionate representation. That would still be an incorrect # because there would be so many other factors that can't be controlled. But at least it would be an honest start.
Instead, this report makes fun assumptions, throws in extra factors, etc.
And you couldn't have looked at the news too long...you can't listen to conservative talk radio for 30 minutes without hearing at least 10 headlines from a Canadian newspaper about dangerous wait times, poor response, etc. The stories are there.
Zen is probably right. At some point people are just trying to hear what they want to hear (myself included).
There have been numerous studies that show roughly a 25% increase in death rates for the uninsured. The article above summarizes some of the findings. Interestingly enough, when some studies looked at confounding factors, the number of deaths went up.
That is the source I read. And there is an amazing amount of missing data in the report. Why would they do that?
No matter how non-partisan they say they are...it is clearly not the case. There are also impossible factors that are not said to be controlled. For example, what amount of uninsured vs insured people are smokers?
This institute has also come out for taxing sugar snacks, etc.
That is why I don't want gov't health care. It used to be that liberals opposed the gov't being in on decisions with your Dr.s and lifestyle.
Even if I granted your entire premise to be true (i.e. US is the worst place to get care, we're all going to die, etc) I still don't want gov't to control what they would define as "health." What power would they not have?
Nate, but the insurance companies now control what gets treated, and they certainly don't have your best interests in mind, rather the opposite. No one is suggesting Great Britain -style socialized medicine here. No one is saying the Gov't alone will make the decisions. No one. Actually, the Gov't does pay for Medicare and Medicaid and they currently don't seem to be making any of those bad decisions.
I realized I never answered the original question. Modern-style medicine didn't exist when the constitution was written. However, the preamble to the constitution includes the phrase "promote the general welfare." Health care is certainly promoting the general welfare. Places like Russia and the former Soviet Republics that have seen the quality of healthcare seriously deteriorate are having outbreaks of typhoid fever and diphtheria; certainly not promoting the general welfare. Oh, and it looks like TB may reach epidemic levels soon. This isn't good for anyone, especially with the new antibiotic-resistant strains that keep showing up.
Keeping the population healthy promotes everyone's welfare.
So, yes. Health care is a right granted under the constitution.
"However, the preamble to the constitution includes the phrase 'promote the general welfare.'"
"So, yes. Health care is a right granted under the constitution."
Yes, and it is so obvious that general welfare means healthcare as a right that it took 222 years to implement it.
Look, I would like everyone to have healthcare. Maybe it will happen and maybe it won't. But reading things in to the Constitution is dangerous because when the people voted to accept the Constitution in 1787-1791 they ceded powers to the government as delineated in the Constitution. It is clear that healthcare was never intended. But reading into the Constitution what suits us best today, the so-called living Constitution, is dangerous because it no longer is the document that the people voted on.
That doesn't mean that healthcare can't be passed under other clauses giving power to the legislative branch, the commerce clause comes to mind as the obvious one, but that does not mean that the Constitution confers a right for healthcare. I could easily say that everyone in the country receiving $10,000 a year from the government is also good for the general welfare, but that doesn't mean that it is a right.
As to controlling for tobacco use, two studies cited in the report did so. "Hadley and Waidmann controlled for alcohol use, tobacco use, disability, self-reported health status, and chronic health conditions." (They looked at people between 55 and 64). After controlling for all these variables, they found the biggest difference in uninsured vs. insured outcomes: the mortality reduction reached 42%. Their cite is below.
Hadley, J., and T. Waidmann. (2006). “Health Insurance and Health at Age 65: Implications for Medical Care Spending on New Medicare Beneficiaries.” Health Services Research 41(2): 429–51.
The other study that controlled for tobacco, alcohol, wealth, and a host of other confounding factors, McWilliams, (which also looked at people between 55 and 64) found that 13,000 near-elderly people a year die as a result of being uninsured. "This estimate would place uninsurance third on a list of leading causes of death for this age group, below only heart disease and cancer."
McWilliams, J.M., A.M. Zaslavsky, E. Meara, and J.Z. Ayanian. (2004). “Health Insurance Coverage and Mortality among the Near-Elderly.” Health Affairs 23(2): 221–33.
Both of these articles are in peer-reviewed journals.
I just realized that everyone here (except me) is a patent attorney. You all should comment on cool things like "originality" and that case where the guy made a road out of wood and was testing it for something like 20 years.
Promoting the general welfare does not mean bypassing the God-given right and responsibility we have to earn what we receive. That is counterintuituve to the freedom that our Founding Fathers earned through their hard work and sacrifice.
Instead, promoting the general welfare means that Congress must provide laws that are in keeping with the principles of the self-governed; that Congress may provide legislation that acts in the general best interests of a nation. It does not mean that Congress should create legislation that plunders the people in order to redistribute wealth. It certainly does not provide for any entitlements, for the rights under the Constitution are but negative rights, or rights to action.
We can all agree that something must be done to remedy the failings of our system. More government is not the answer and never has been.
Nate is probably right that many of us take more than we realize. Governments provide many services and fill many roles that are easy to take for granted. As I stop to think about it, I am really thankful for the services that government workers at all levels provide. I am glad that my wife was able to borrow a book from a public library yesterday. I am grateful for the airport security worker who recently took the time to examine my shoes. I am glad that I can drive on public roads or walk on public sidewalks instead of having to negotiate with my neighbors for the right to pass through their property. At the same time, I am glad that we have a mixed economy where private enterprise plays a major role, and I think that it would be a major loss to have the balance shift too far from the private to the public side.
Although I fortunately work for a private employer that provides good health insurance, I don't have to look very far to find people without the same opportunity. I am not surprised to read that the working poor are more generous with their limited means than the middle class. Just as African Americans in our society have a reason to understand that any of us can be arrested without cause under the wrong circumstances, poor people have a reason to understand that any of us can become unable to take care of ourselves under the wrong circumstances.
At least among my acquaintances, it has seemed to me that advocates of a libertarian point of view believe that they will come out on the top of the heap when put to the test and that less successful people deserve their less desirable fates. As long as it is within my power, I agree with the self-proclaimed libertarians that the responsibility to take care of my own needs is primarily mine, but I also believe that I have a duty to help in taking care of the needs of my neighbors. I am not sure about where I fit on the spectrum between liberal and conservative, although my dread of the idea of listening to a conservative talk show for a whole half hour may be a relevant clue, but I believe that one thing to be said for conservatives is that are much more willing than liberals to contribute to charity. If we collectively recognized the extent of the need, perhaps we would be able to organize a national program that provided health insurance for everyone through voluntary means, but we would have to look for answers to questions such as how to provide for people with pre-existing conditions, how to find the right balance between helping others and working to meet our own needs, and how to discourage free riding without neglecting the genuinely needy. A solution organized or mandated by government would have to include answers to many of the same questions but would have the advantage or disadvantage of the coercive power of the government, depending on how you look at it. If you have a strong ability to succeed in our competitive world, and if you also have strong feelings about the importance of keeping government from meddling in health care, maybe you can help by applying your abilities to finding a better solution.
Sometimes more government really is the answer, but not always. It will always be that way.
"I agree with the self-proclaimed libertarians that the responsibility to take care of my own needs is primarily mine, but I also believe that I have a duty to help in taking care of the needs of my neighbors."
I completely agree. The issue I take is that I work hard for what I have and I will share it with who I want to. Government cannot force me to be charitable.
George Washington once said: "It is not everyone who asketh that deserveth charity; all however, are worth of the inquiry or the deserving may suffer."
On average, conservatives do give more to charitable organizations because they live by principles like those espoused by George Washington.
Mormonism has only been associated with the sort of extreme capitalism that Jeremy espouses since about the 1950's with the plitical ideas of Cleon Skousen and Ezra Taft Benson. Remember that in Missouri and Utah communitarianism was the ideal.
Also, Jeremy, as I previously asked, are you upset about having to pay for roads? Clean water? A standing army? None of these are mentioned in the Constitution
Come on djinn, you took Con Law. No mention of a standing army? Article 1 Clause 8:
[Congrees has the power] "to raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years;
To provide and maintain a Navy."
Regulate roads?
"To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes"
Even if I didn't like the government spending money on these programs, they are explicity mentioned in the Constitution, which the people ratified. I think water is a regulated at a state level, which is exactly the point of the 10th amendment. We gave the government the power to do these things. We are not given the right to healthcare unless you take a convoluted view of the general welfare clause. Perhaps this is what Congress will argue that it has the power, but it is not a right. That was the point of the poll, whether it is a right or not. I think that Congress will turn it into a right, but up until now, I could not sue a government office for denying me the right to healthcare.
"Remember that in Missouri and Utah communitarianism was the ideal."
Right, but who was running the show there? The Saints trusted their government leaders since they shared common interests and moral values. However, once greed and apathy began to take hold upon the Saints, this form of government ultimately failed. I personally do not trust our government, nor do I beleive that its members share the same moral values as I.
Moreover, let us not forget that the United Order did not reward laziness or entitle its members to the personal property of others. Instead, each entered into a binding covenant with the Lord and the members that each would work for his/her keep. Each deeded their personal property to the Bishop, who in turn, returned that exact property to the Saint for his/her personal use. Any "surplus" was to go to the building up of the Kingdom of God, but was not forcefully taken.
Evgenii, there was no standing army when the constitution was ratified. That was the whole point of the 2nd amendment. Plus, the explicit mention of only two years funding for an army indicates that the army was meant to be temporary.
And, as to roads, many of the major roads in the 1789 time frame were toll roads. Regulating interstate commerce = roads in exactly the same way that the general welfare clause = health care.
Wait a minute...aren't I "commanded" to pay tithing so that others can enjoy the "privileges" of charity? Isn't the concept of providing healthcare for all, even those that can't aford it, moving closer to the law of consecration?
From a Kantian perspective, doesn't it seem imperative to provide some equality of access to services necessary to persue live and happines? The Church provides access to food and emergency care to those in need, all at the expense of the tithe-payer. In my mind, the only reason the church doesn't provide access to health services for members is that it would cause a financial and logistical nightmare. Otherwise, it fits directly in line with the Churches teachings regarding the law of consecration.
That brings me to my next point. This issue is really more about logistics issue not morals. The only reason people start screaming about the issue is because they are cheap and don't want to pay more taxes for the benefit of others. Of course they bring religion into it, they have to feel that they are on the moral high ground of the issue. But, Obama is not "evil" because he is proposing universal healthcare. He has identified a financial and logistical problem for many Americans, and he is trying to address that issue. Anyone who has been self-employed will agree that the healthcare system is in need of reform. The only real question is: which of the various options is financially and logistically most feasible?
Well, what option is most feasible? The insurance companies only suck up massive amounts of money themselves while also requiring the health care givers of various stripes to expend massive amounts of money to get reimbursed. It's pretty easy to determine what to do to save money. Don't forget that Medicaid has a 3% overhead, while private (and non-profit--i'm looking at you Blue Cross--) insurers have overheads of 20% to 50%.
djinn, Medicaid has a 3% overhead? I'm not sure if that's accurate but does it even matter when they are tens of trillions of dollars in the hole? Trillions! The same can be said of Social Security.
There is no way that government-run healthcare is going to turn a profit as the President believes. Instead, we are going to find our country even deeper in debt and unable to undo the things of the past since entitlements are the hardest thing to reverse.
What's going to happen with government-run healthcare is the same thing that has happened with all other government-run institutions - they will go bankrupt. As we have seen, the government can't even run its own Senate cafeteria or this ridiculous "Cash for Clunkers" program without completely losing their shirts. This scenario would be no different.
Jeremy, there's many wonderful Government-run institutions. We are the government. The military is run by the government, and is pretty socialist, what with free health care, base housing, subsidized supermarkets and the like. Starting with Ronald Reagan, government institutions started to be mismanaged, but they still, pretty much, hung on. Government contractors, now; you've got an argument.
Besides, every other first world country manages to provide health care for its citizens at rougly half the price of the US, except for Switzerland (which, strangely enough, relies on actual health insurance companies), but still manages to ensure all of its citizens.
Switzerland still only spends 11% of GDP compared to the 15% of GDP for the US with somewhere around 18% (in 2007, Census Bureau numbers, certainly up to 20% now, at least, that's one in five.)
If health care reform (including covering all) would save you money would you be for it or against it?
djinn, no one here is saying that healthcare reform is a bad thing, just that the health care reform that is being forced on America is bad. We have politicians that laugh at the prospect of even reading the 1,000+pg bill (John Conyers). And when people openly oppose a public option, they are automatically assumed racists.
Saving money through health care reform is meaningless if you sell out your freedoms. I would gladly pay triple what I pay now if that ensured that I and my children would be free from govt control of how I live my life. If the government runs things, they will dictate how you live and what treatments you will get - this ultimately leads to healthcare rationing.
A good example of this is the VA. Sure, our veterans may have free health care, but the government continuously rations what treatments and medications they can obtain. It will be no different if it is placed on a universal scale.
Reform starts with tort reform and allowing insurers to cross state lines. Right now the govt has tied the hands of insurers in not letting competition cross interstate borders. True capitalism would inherently drive healthcare costs down dramatically.
So, I ask you, what would you be willing to pay for healthcare so as to ensure your freedoms?
Can I just add a point here? djinn mentions Switzerland as an example of successful healthcare management. I only add that we be careful of such statistics as countries like Swtizerland and the the Scandinavian countries have relatively low immigration rates compared to the US. Switzerland has actually been in the news quite recently due to the success of racist/anti-immigrant parties.
While not all immigrants add to overall healthcare costs per se, using the US as an example to these countries does not work because their population density, immigration rates, and health of their populations are too dissimilar to the US.
djinn also says that these countries can offer medical services at half the price of the US. This is of course a trade off of paying higher taxes. In Sweden, one can pay up to 69% on income taxes and 25% on VAT (Value added tax, effectively a sales tax on goods). So if you make $200,000, you come home with no more than $60,000 and then if you buy a $1 hotdog, you will have to pay $.25 in taxes. That is a great way to fund social programs. It also helps to have little to no military expenditures for a global navy to protect shipping lanes or other UN hotspots. In Norway, income tax is at about 47% (lower than Sweden thanks to gas fields) and the VAT is 25%. In Denmark, income tax can be as high as 63%. VAT is 25%. In Germany, income taxes cap at 45% and VAT is 19%. So in the end, either way we are going to pay for it. But remember than in these countries, even the people classified as the poor are still paying as much taxes (percentage wise) as people in the upper tax brackets do here. When people qualify under poverty provisions here in the US, they pay only FICA and Medicare/Medicaid.
Perhaps if the tax level was raised across the board so that even the poor contributed like they do in Scandinavia, I would be more on board with this.
My comment just got eated. But, Sweden has an "all-in" tax (all taxes paid by everyone with various corrections taken) of 62%; In comparison, Utah has an "all-in" tax of about 48%. For that extra 14%, Swedes get free college for their kids, free healthcare, guaranteed pensions, guaranteed disability pay, and the list goes on. I think your 65% Tax rate was probably arrived at by someone not realizing that the separate pension tax is offset by other taxes, and so no one (or almost no one) actually pays it.
The all-in tax includes the Swedish vat, as well as the sales tax in, say, Utah, and so the comparison is apples to apples.
Plus, can't you think it's at least a tiny bit admirable that Norway's north sea oil reserves benefit the masses rather than a tiny elite?
54 comments:
Although one law professor in particular at FPLC would vehemently disagree, health care is NOT a human right, and was never contemplated as such by our Founding Fathers. All legitimate rights have one thing in common: they are rights to action, not to rewards from others.
The rights we have been endowed with include life, liberty, and the pursuit of happiness. Notice that these American rights impose no obligations on others, but are negative obligations that allow you to be left alone.
Also, it is the "pursuit" of happiness that we have been endowed with, not happiness itself. Happiness was never guaranteed.
The right to life doesn't mean your neighbors have to feed and clothe you; it means you have the right to earn your food and clothes for yourself, and no one can forcibly stop your pursuit of these things or take them when you have achieved them.
And no, health care rights do not stem from the "penumbras" of the Bill of Rights. It always irked me to learn of new penumbras judges found during law school.
is that law professor named after a famous NHL goalie and make ape like sounds when you spoke to him?
It isn't a right. But I don't think it is a "privilege" technically.
Privilege connotes something that someone is allowing you to do. I.e. that the gov't permits it.
It is not my privilege to be able to buy food. I just get to do it. The gov't doesn't have the power (or shouldn't have it if we assume they do) to tell me that I can't buy my own food, the same holds for health insurance.
I don't like my first comment...
Maybe a better way to say it is that our gov't wasn't designed to give us rights. It doesn't have the power. It was designed to prevent a gov't body from taking our God-given rights.
We have the right to pursue what we want (within reason), which can include health insurance. That is why I wouldn't call it a privilege either...they don't authorize our ability to get it. It is that they can't prohibit us from getting it.
Since when are all rights defined by and limited to the American founding fathers? Even *they* weren't so arrogant as that, and recognized that rights come from God. They also noted that "life, liberty, and the pursuit of happiness" were AMONG the rights granted by God, and are not limited to those few, great as they are.
Health care is a precursor, in all too many cases, to life itself, and to liberty (in the sense that a crippled, weak body can be a prison preventing the exercise of anything that makes life worthwhile), and to the pursuit of happiness (surely even Jeremy will acknowledge that pain -- especially when the knowledge is present that proper care could alleviate that pain -- is a stumbling block to the pursuit of happiness).
I just despise the tendency of too many of us toward gifts of the spirit and the joy God intends us to have, limiting them solely to the political rights of the United States. Religion should inform your politics; politics should not constrict your religion.
Let's assume that the 5th and 14th amendments don't exist and that we are not dealing with original intent of the founders. Or even just from the narrow look at what we want for public policy. Would you argue that government should have zero role in providing various levels of medical/fiscal assistance? For example and just for this hypothetical, would you prefer Social Security, Medicare and Medicaid, WIC, or other programs to be eliminated? If not, where would you draw the line as being a program that we support tax money going to and one that doesn't?
I am not being confrontational, I am just trying to find where we would draw a line. Jer and Nate know that I am a strict constructionist as much as the next white, middle class male, but I like defined lines of where we would be comfortable and not. Just a thought experiment.
One additional note, the Constitution does not guarantee the right to happiness, only the Declaration of Independence. I don't believe that the Constitution guarantees healthcare as a right, but I wonder if the country as a people wants to make it one.
Anon, you may have missed the point of my comment. The rights given to us by our Founding Fathers, and ALSO from our Creator, are rights to action - not rights to receive stuff from others (especially the government).
In other words, the rights we have allow us to choose and act as we will, but never do they entitle us to a free meal.
I echo Nate's comments. We were given a republic where the people decide how much power the government has; not the other way around. Because the government is "of the people, for the people, and by the people," it cannot possibly perform any action that the people do not allow. We literally lend our rights to the government for a short period so that it may act on our behalf.
Sadly, this original idea has been mutated into the idea that the government lends the people rights, and we have to petition the government to allow us to pursue happiness. This is a complete 180 from the original intent.
In view of this, your argument about pain necessarily fails. While the onset of pain my cast a stumblingblock on your pursuit of happiness, you nonetheless retain that right. The purpose of our government was not to pursue that happiness for us (i.e., remove all stumblingblocks from us and deliver the end result) but it is a framework of laws and regulations that afford the people a playing field to enjoy and practice those rights.
Anon said:
"Religion should inform your politics; politics should not constrict your religion."
I don't see anyone doing either. Referring to rights as God-given is just to say they are inherent in being human. That doesn't have anything to do with religion.
I want healthcare for my family. I therefore work for it and pay for insurance. If I couldn't afford insurance, I would cut other things (dirrectv, gym membership, size of house, etc.) to get it. I don't have the right to inhibit anyone else's pursuit of happiness to take their money in order for me to keep some of these things. And gov't should not have the power to do it.
Many of the people that are without insurance can pay for it and they choose not to.
As for the others, we can discuss solutions for them (hopefully these wouldn't cost a trillion dollars).
The prescription drug solution was just as stupid. Something like 6% of the population over 65 had a problem. But now I will pay for Bill Gates's drugs when he's old. Is that a good solution?
Health insurance for a family of 4 costs about $12K/year. If rent is another $12K/year, and utilities and food are another $12K/year (surely there are other expenses beyond this), what suggestions would you have for someone who only makes $25K/year? This person works for $12/hr, 40 hours/wk, 52 weeks a year (with no vacation).
I couldn't vote because I needed a spot for neither.
It's a slippery slope trying to say something is a "right". Where would you stop. For example, what about car insurance. With this logic, the gov't would need to pay for that also. I mean, it's expensive and everyone needs it.
As of two weeks ago, my family of six lost the employer provided health insurance. Yes, it sucks. No, the gov't doesn't need to give it to me. We will work harder, cut expenses and come up with a way to pay for it.
As a society, we will never be able to afford unlimited health care, but we can afford a better level of health care than most individuals with significant problems would be able to pay for on their own. A significant minority of the nations in our current world already have succeeded in creating a right to health care. This is a moral good and a positive accomplishment.
From one extreme point of view, everything that we earn as individuals is ours alone to use as we see fit. From the opposite point of view, the government has the right to take and redistribute everything we earn as it sees fit. Instead of insisting on either of these extremes, we ought to seek a fair balance that rewards hard work and success without forgetting the needs of people who would be helpless without our help.
Many people can't get health coverage for hook or for crook. If you have a preexisting condition, then you're simply out of luck. No insurance for you, unless you can get an employer-based plan. So, you get sick & lose your job. Now what? You cannot buy insurance to cover that disease that made you lose your job in the first place.
This is why healthcare costs are the leading cause of bankruptcy in the U.S. right now.
I do not believe that if someone gets sick they should lose everything, which is where things stand right now in the US.
Not only that, but there's been tremendous consolidation in the health insurance market. When there's only one or two providers, they get to set the prices. This is why health insurance premiums have been skyrocketing, while benefits have been plummeting. The proceeds of those premiums are going into the pockets of the insurance companies. Monopoly power--that the insurance companies now have--is not a free market. It's the opposite.
America's healthcare system is the best in the world, and no one can dispute this. That is why leaders and wealthy people from around the world (even Norway) enter our borders for American healthcare services. In "Sicko," Michael Moore conveniently failed to mention this fact.
And why is it the best healthcare system in the world? Capitalism. Capitalism provides the incentive to work hard and earn as much money as you want.
I agree that healthcare in the U.S. needs an overhaul. But, do you really think putting the government in charge of our healthcare is going to make it more efficient? The only program that the government runs efficiently is the military; every other government program is riddled with needless red tape, and healthcare will certainly suffer a similar fate.
Djinn wrote:
"When there's only one or two providers, they get to set the prices. This is why health insurance premiums have been skyrocketing, while benefits have been plummeting."
This is just not accurate. There are hundreds of providers in the U.S. today, and competition is a good thing. However, the reason premiums are so high is a direct result of ever-increasing tort litigation. Providers cannot afford to lower their prices when our courts continuously dole out billion dollar healthcare judgments.
A start to the solution lies in massive tort reform legislation to cap the dollar amounts in healthcare-related lawsuits. Unfortunately, most of the members of Congress and the Senate are lawyers and therefore will refuse to eliminate a profitable branch of their profession in the event they don't become mainstay politicians.
SmallAxe, Your premise is flawed. A family of four making 25K/yr would automatically get $5,028 welfare check (called "earned income tax credit") without even having to apply.
My health insurance costs ~10K a year through my employer. I can get the same Aetna plan minus coverage for maternity for $4300/yr in TX. Under this Hypo, your poor family can afford it.
Regardless, a family of 4 with that income probably already qualifies for medicaid (certainly at least for their children). So expenses would be even lower.
The people I am discussing are the ones who make 40K/yr. The ones who don't qualify for medicaid, and can afford to pay their own way. (note, these people would also get the $5K EIC after taking standard deductions). When I was in this position...I bought my own. I wouldn't have felt a right to your money, or even the richest person in the world's money.
I would also bet that many housholds making 40K own HDTV's, have gym memberships, etc. (I did) Do you want to work 1 month out of the year to pay for them?
djinn: I couldn't disagree more. If people get sick and lose everything, we as a society don't allow them to hit bottom. Even our bankruptcy laws don't allow for a total liquidation. Medicaid picks them up, social security disability kicks in, food stamps, etc. If someone can't work, they will lose a substantial amount no matter what. BK kicks in as soon as you're insolvent (even if you make a ton of money)...so you don't have to dig a hole until you lose your house and everything.
I know BK sounds bad, but it is a very merciful law which was set forth in the constitution by our founders. The philosophy was that an honest debtor should get a fresh start if everything fails.
The bigger problem is that people can't possibly understand each of those programs due to inherent gov't complexity. Adding another complex program won't help the people that are unable to get help now.
BTW: Good discussion all....thanks for stopping by.
kamschron:
Many that advocate your position do not realize how much money they are taking.
Do you think it is fair that I work 3-4 months/yr full time for the gov't? At what point am I enslaved? I already only see my kids ~1hr/day.
But hey, I'm glad my portion of tax money (that took several hundred hours to earn, and that much time from my family) could almost pay to fly in a pizza chef and food that was ordered special for a white house party last month.
Much more thought should be given before you take even a single dollars worth of product of a person's labor. They already take too much by double.
And as a side note: I don't think this is only the Democrats' fault. They're only doing exactly what Bush did times 4. What our gov't is, and has been doing, is immoral.
The people I am discussing are the ones who make 40K/yr.
If your point is that people who can't afford healthcare should be provided it, and those who can afford it should purchase it, I'm not sure we're at odds with each other. But where do you propose the money should come from in order to provide for those who cannot afford it (especially given that we're talking about the nearly 40% of households in the country that make less than $40K)?
Wow! With no offense due those who have a different opinion, I have to say that considering health care a right is an absolute mockery of rights! I can explain this in many ways, but the religious argument is very simple:
D&C 101
77 According to the laws and constitution of the people, which I have suffered to be established, and should be maintained for the rights and protection of all flesh, according to just and holy principles;
78 That every man may act in doctrine and principle pertaining to futurity, according to the moral agency which I have given unto him, that every man may be accountable for his own sins in the day of judgment.
What a perfect summary of the idea of rights with the perfect constitutional context!
Here's the idea simplified: in order to fulfill God's will concerning the plan of salvation we need to make moral choices individually concerning ourselves and others. Government exists to preserve our ability to do so (against the infringement of others).
There is some debate about what sort of economic responsibilities the government has in terms of protecting people from others' choices and so forth, but the question of health care is beyond debate.
If healthcare is a 'right' then the government must enforce its completely equal and maximally beneficial in society.
There are problems with this: not everyone has the same health needs, and health care itself is by no means a perfected practice.
Hence, if healthcare is a 'right' the government must make a stupendous amount of choices. These choices range from basic health treatment decisions to the very distribution of resources and even labor in society.
There is no defensible way you could argue that a government could engage in this without unreasonably infringing on important moral choices on the part of its citizens.
I'm not necessarily talking about universal/single payer healthcare, I'm talking about what it would mean if healthcare was a 'right'. So if you disagree with me on this point, then you aren't talking about rights, maybe you're talking about 'everyone being covered' being a good idea, but rights aren't involved.
Of course, I shouldn't even have to go here. Really 'government hands off!' should be all my argument needs to be. Nevertheless, I have indulged the other side because this issue seems so clear to me - that of 'rights'.
Look, Marx invented the whole idea that economic factors determine all history and society and macro human decisions and then overplayed it in order to win an argument in favor of socialism.
There's this idea that the 'invisible hand' of capitalism will ravage people who are helpless before it unless they band together and support a common morality embodied in a social contract which is a government that enforces 'positive rights' or rights to food, healthcare, whatever.
The problem is that we are individuals and GOD inspired the Constitution so that individual moral decisions could be protected from outside coercion. The 'invisible hand' is the product of society's moral decisions. History and life and even economics can be the product of moral decisions, not the other way around.
Government has a role, there's a good debate about exactly what, but at two ends there are two opposing visions. One's from God, I have a firm conviction of the originator of the other philosophy.
Be careful about 'rights'.
In 2006, the Congressional Budget Office published a comprehensive report on the correlation of legal medical malpractice limits of various types to health care costs and couldn't find any statistical correlation. Won't help.
There were some counter-intuitive findings, though. One was that total medical expenditures went up in some markets when malpractice caps were implemented.
I think all this talk of rights is just nuts. Do we have a right to clean water? Roads? A sewer system? Ambulances? A standing army? If these are not rights, do we have any right to them? Whatever happened to the greater good?
We do not have the greatest health system in the world, not even close. According to the WHO, we're 37th. Behind Costa Rica and, yes, Cuba. Plus, for this bad health care we pay about twice as much as anyone else.
Oh, as to monopoly power, according to the AMA, 92% of health care markets are monopolies (bad for us) and monopsonies (bad for the doctors), as a single entity sets the price--whatever they want--for everyone.
This is why the AMA is suddenly for the private option (after years of taking the opposite position), because the rapid consolidation of health insurance in the last few years has seriously cut into doctor's profits.
If you have a preexisting condition, you simply cannot get insurance to cover it. This is not a difficult point. Why should a rational for-profit entity give you coverage? This is why it makes no sense (to me) to have our health care rationed by for-profit institutions. You get sick, they get busy finding a way to deny you coverage. The worse they treat you, the more money they make.
Remember, these institutions have monopolistic power in 92% of all areas. So, if they don't like you, you're out of luck.
The AMA report is called "Competition in health insurance:A comprehensive study of U.S. markets | 2007 update."
American businesses are getting clobbered in the international market because health care costs for their workers are so much higher than what similarly-situated companies in other countries have to pay (nothing).
So for pragmatic reasons alone, good businessmen should be for some sort of universal health care, and in my admittedly small sample, those who have to deal with actual health care costs very much are. No matter their politics otherwise. We spend twice as much on health care as anywhere else. And we get crap. Why does anyone find this to be a good thing? Because of some sentimental attachment to the phrase "the invisible hand?"
djinn said "We do not have the greatest health system in the world, not even close. According to the WHO, we're 37th. Behind Costa Rica and, yes, Cuba."
Would you rather get cancer treatment in Cuba than here? Next time you are in a serious accident, do you hope they take you to a trauma unit in Costa Rica? Of course not. We are by far the best system in the world. We cost more because we develop more. For every 1 breakthrough there are 10 failures, the cost of which must be absorbed.
And you should note that if a poor person gets hit by a car, the ER doesn't turn them away. Illegal aliens come here to have babies...and we pay for it. You make it sound like most Americans don't get sufficient help, but that is simply false.
Our system is what has fostered innovation Do you value that for nothing? The WHO ratings do.
"Whatever happened to the greater good?" By that argument, a person making 20K/yr here is in the richest 5-10% in the world and should have to cut back and distribute to the world. Do you think it is okay to cut down their living standards too?
That is the problem with your logic. The greater good is better served if you allow individuals to be free to excel on their own. They create, advance, etc., and everyone benefits from it.
Whereas blind populism tends to bring down standards of living equally. That is why we're the wealthiest country in the world and why France would be the 5th poorest state in our union.
I also like how in those enlightened countries they kidnap bosses, burn 500 cars in one night, etc...must be a great utopia.
"American businesses are getting clobbered in the international market because health care costs"
The proposed solutions will help big business. That is why they're on board. Doesn't that scare you? Do you think big business has your best interest at heart?
The proposals will hurt small business; i.e. the people who employ 70%+ of the population (and big business knows it). My sister's business would have to lay off at least 2 people because of the penalties of the current proposals (her employees are all moms whose husbands have health care with their work). Are they better off having their job or not? Hurting small business will have a much worse impact on our system, and cause a strain that we can't afford right now.
"Do we have a right to clean water? Roads? A sewer system? Ambulances? A standing army? If these are not rights, do we have any right to them?" Clearly No.
To say we have a right these days is to say the gov't owes it to us. These things take care of themselves (yes the invisible hand may help). When the west was getting settled...did the gov't come in and dig waterways and make roads? People would naturally organize for their purposes. (you should read Thomas Paine's "Common Sense" it explains these principles very well and how gov't role is best served)
Your advocating Marxism plain and simple. I agree that in theory Marxism is the way that good people could live together and maximize happiness. However, our world experiences show us that these principles simply don't work.
--I don't mean to sound hostile...I am enjoying this.
djinn, you are correct, I mispoke when I said that the U.S. has the best health care "system" in the world. That is probably not true, and thank-you for actually backing up your point with facts.
The point I was trying to make is that it is not the "system" that is the best, for we can all agree that something needs to be done, but the U.S. offers by far the best health care services in the world.
Insterestingly, last night 20/20 did a piece on Canadian healthcare and showed how animals get better treatment than humans do there. Every day Canadians cross the border into states like Washington and Montana to receive medical treatment that is just not available in Canada, or the government is unwilling to pay for, or the wait is too long and the person would die in the meantime.
I agree with Nate, the innovation of the free-market is what makes our current health care system bearable. I would like to see a list of all the medical innovations that came from single-payer systems. My bet is that it's quite short-if not non-existent. For that matter, name one great invention that came from a non-capitalist society. It has been this evil capitalism that has brought us the jet engine, air conditioning, the automobile, nuclear fusion, etc.
I understand the angst some have when trying to find insurance with an existing condition. But, hospitals that receive Medicaid/Medicare funding from the govt are required to treat anyone that comes through their door, regardless of insurability. In that sense we already have a universal health care system.
Last point, also brought up in the 20/20 report. We already have a great example of how our healthcare system would be under total government control - that of the Native Americans. These people are not thriving as some may assume our country would be. In fact, the government gives them everything, and what has that done for them?
For that matter, name one great invention that came from a non-capitalist society.
Democracy.
the Native Americans. These people are not thriving as some may assume our country would be. In fact, the government gives them everything, and what has that done for them?
My hunch is that the unfortunate situation of many Native Americans has less to do with the government providing healthcare and more to do with the seizure of their land which then became the means of production fueling the American capitalist economy.
The Rights we have been given are freedom to do certain things - not things we are given - a chicken in every pot or 40 acres and a mule.
Our system needs improvement - but not replacing.
Jeremy, I know that you believe that Canadians go across the border every day to get health care that they can't get in Canada, but that is not correct. If canada cannot provide timely care, especially in extremely time-sensitive cases, they outsource to the US.
As far as I can tell, this has happened twice in the last three years, going on the reports given in the news--it's always the same two cases. Plus, the care was paid for by the Canadian government. No rationing at all. The system worked just fine.
There is also a woman who had a brain cyst who has been appearing on various outlets with her problem rebranded a brain tumor. Canada doesn't ration care. It just doesn't.
If you have ever lived in Utah, you should know that babies don't always decide to be born at even intervals. I had a friend give birth on a gurney in the hallway with insufficient medical care due to overcrowding in the maternity ward. She had serious complications due to lack of proper medical supervision. It would certainly have been better for her if she could have been flown to Canada.
I double dog dare you to show me a case in Canada where someone died because of a wait for healthcare. In contrast, 22,000 people a year, A YEAR, die here due to lack of medical services. 22,000 people a year die here. Right now. Bad luck, it could be you or someone near and dear to you.
Again, not difficult to determine which system works better.
Plus that native american example? I see you that, and raise you the medical care given to members of congress and provided by your favorite boogyman, the US gov't.
Sorry, that last comment was djinn. Shared computer.
Jeremy, I haven't noticed any lack of innovation on the part of the WHOLE REST OF THE FIRST WORLD in spite of the fact that they provide health care for their citizens.
Jeremy, you said that hospitals are required to treat anyone, but that's not true. They're required to treat anyone with a life-threatening condition.
This is defined as:
“A condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health ... in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs.”
Further, the condition only needs to be stabilized, not cured. So, no athsma treatment, no diabetes treatment, no chronic type of treatment at all unless you're on death's door. And then, they only treat you until you're just slightly through the doorway.
Plus, unless you have no possessions at all, essentially, you're responsible for inflated medical bills--insurance companies bargain for cheaper rates with hospitals. Uninsured people have no such luck. It's really bad. Trust me.
Even more fun, more and more hospitals are closing their emergency rooms, or making them for-profit only, so they don't even have to treat dying people.
Oh, as to that list of inventions?
The jet engine was created by an Englishman (pretty socialist) and a German under Naziism (fascist.)
The automobile was invented in the 1800's in a number of locations: England, the US, Scotland, Switzerland.
Air conditioning was invented in 1902 by an american.
Nuclear fusion was discovered by a whole host of characters, British, Australia, Italian, and German-American.
From what I have heard from actual Canadians, is that the healthcare is neither as dire as the US opponents make it out to be, but nor is it nearly as nice as its supporters claim. I think both sides are being a bit starry eyed. In general, I think it is unfair to get the govt to fix a problem that it has aggravated in the first place.
"22,000 people a year, A YEAR, die here due to lack of medical services. 22,000 people a year die here."
I was going to call you out on this for a source because it is clearly false on its face.
But I went to the source instead. I have never seen a more ridiculous calculation.
Isn't it funny that the obvious calculation would be to take the number of insured vs uninsured. (e.g. 80/20). Then take the number of deaths in an age group and see if there is disproportionate representation. That would still be an incorrect # because there would be so many other factors that can't be controlled. But at least it would be an honest start.
Instead, this report makes fun assumptions, throws in extra factors, etc.
And you couldn't have looked at the news too long...you can't listen to conservative talk radio for 30 minutes without hearing at least 10 headlines from a Canadian newspaper about dangerous wait times, poor response, etc. The stories are there.
Zen is probably right. At some point people are just trying to hear what they want to hear (myself included).
http://www.workplacebullying.org/docs/uninsured_dying.pdf
There have been numerous studies that show roughly a 25% increase in death rates for the uninsured. The article above summarizes some of the findings. Interestingly enough, when some studies looked at confounding factors, the number of deaths went up.
That is the source I read. And there is an amazing amount of missing data in the report. Why would they do that?
No matter how non-partisan they say they are...it is clearly not the case. There are also impossible factors that are not said to be controlled. For example, what amount of uninsured vs insured people are smokers?
This institute has also come out for taxing sugar snacks, etc.
That is why I don't want gov't health care. It used to be that liberals opposed the gov't being in on decisions with your Dr.s and lifestyle.
Even if I granted your entire premise to be true (i.e. US is the worst place to get care, we're all going to die, etc) I still don't want gov't to control what they would define as "health." What power would they not have?
Nate, but the insurance companies now control what gets treated, and they certainly don't have your best interests in mind, rather the opposite. No one is suggesting Great Britain -style socialized medicine here. No one is saying the Gov't alone will make the decisions. No one. Actually, the Gov't does pay for Medicare and Medicaid and they currently don't seem to be making any of those bad decisions.
I realized I never answered the original question. Modern-style medicine didn't exist when the constitution was written. However, the preamble to the constitution includes the phrase "promote the general welfare." Health care is certainly promoting the general welfare. Places like Russia and the former Soviet Republics that have seen the quality of healthcare seriously deteriorate are having outbreaks of typhoid fever and diphtheria; certainly not promoting the general welfare. Oh, and it looks like TB may reach epidemic levels soon. This isn't good for anyone, especially with the new antibiotic-resistant strains that keep showing up.
Keeping the population healthy promotes everyone's welfare.
So, yes. Health care is a right granted under the constitution.
"However, the preamble to the constitution includes the phrase 'promote the general welfare.'"
"So, yes. Health care is a right granted under the constitution."
Yes, and it is so obvious that general welfare means healthcare as a right that it took 222 years to implement it.
Look, I would like everyone to have healthcare. Maybe it will happen and maybe it won't. But reading things in to the Constitution is dangerous because when the people voted to accept the Constitution in 1787-1791 they ceded powers to the government as delineated in the Constitution. It is clear that healthcare was never intended. But reading into the Constitution what suits us best today, the so-called living Constitution, is dangerous because it no longer is the document that the people voted on.
That doesn't mean that healthcare can't be passed under other clauses giving power to the legislative branch, the commerce clause comes to mind as the obvious one, but that does not mean that the Constitution confers a right for healthcare. I could easily say that everyone in the country receiving $10,000 a year from the government is also good for the general welfare, but that doesn't mean that it is a right.
As to controlling for tobacco use, two studies cited in the report did so.
"Hadley and Waidmann controlled for alcohol
use, tobacco use, disability, self-reported
health status, and chronic health
conditions." (They looked at people between 55 and 64). After controlling for all these variables, they found the biggest difference in uninsured vs. insured outcomes: the mortality reduction reached 42%. Their cite is below.
Hadley, J., and T. Waidmann. (2006).
“Health Insurance and Health at Age 65:
Implications for Medical Care Spending
on New Medicare Beneficiaries.” Health
Services Research 41(2): 429–51.
The other study that controlled for tobacco, alcohol, wealth, and a host of other confounding factors, McWilliams, (which also looked at people between 55 and 64) found that 13,000 near-elderly people a year die as a result of being uninsured. "This estimate would place uninsurance third on a list of leading causes of death for this age group, below only heart disease and cancer."
McWilliams, J.M., A.M. Zaslavsky, E.
Meara, and J.Z. Ayanian. (2004). “Health
Insurance Coverage and Mortality
among the Near-Elderly.” Health Affairs
23(2): 221–33.
Both of these articles are in peer-reviewed journals.
I just realized that everyone here (except me) is a patent attorney. You all should comment on cool things like "originality" and that case where the guy made a road out of wood and was testing it for something like 20 years.
Promoting the general welfare does not mean bypassing the God-given right and responsibility we have to earn what we receive. That is counterintuituve to the freedom that our Founding Fathers earned through their hard work and sacrifice.
Instead, promoting the general welfare means that Congress must provide laws that are in keeping with the principles of the self-governed; that Congress may provide legislation that acts in the general best interests of a nation. It does not mean that Congress should create legislation that plunders the people in order to redistribute wealth. It certainly does not provide for any entitlements, for the rights under the Constitution are but negative rights, or rights to action.
We can all agree that something must be done to remedy the failings of our system. More government is not the answer and never has been.
Nate is probably right that many of us take more than we realize. Governments provide many services and fill many roles that are easy to take for granted. As I stop to think about it, I am really thankful for the services that government workers at all levels provide. I am glad that my wife was able to borrow a book from a public library yesterday. I am grateful for the airport security worker who recently took the time to examine my shoes. I am glad that I can drive on public roads or walk on public sidewalks instead of having to negotiate with my neighbors for the right to pass through their property. At the same time, I am glad that we have a mixed economy where private enterprise plays a major role, and I think that it would be a major loss to have the balance shift too far from the private to the public side.
Although I fortunately work for a private employer that provides good health insurance, I don't have to look very far to find people without the same opportunity. I am not surprised to read that the working poor are more generous with their limited means than the middle class. Just as African Americans in our society have a reason to understand that any of us can be arrested without cause under the wrong circumstances, poor people have a reason to understand that any of us can become unable to take care of ourselves under the wrong circumstances.
At least among my acquaintances, it has seemed to me that advocates of a libertarian point of view believe that they will come out on the top of the heap when put to the test and that less successful people deserve their less desirable fates. As long as it is within my power, I agree with the self-proclaimed libertarians that the responsibility to take care of my own needs is primarily mine, but I also believe that I have a duty to help in taking care of the needs of my neighbors. I am not sure about where I fit on the spectrum between liberal and conservative, although my dread of the idea of listening to a conservative talk show for a whole half hour may be a relevant clue, but I believe that one thing to be said for conservatives is that are much more willing than liberals to contribute to charity. If we collectively recognized the extent of the need, perhaps we would be able to organize a national program that provided health insurance for everyone through voluntary means, but we would have to look for answers to questions such as how to provide for people with pre-existing conditions, how to find the right balance between helping others and working to meet our own needs, and how to discourage free riding without neglecting the genuinely needy. A solution organized or mandated by government would have to include answers to many of the same questions but would have the advantage or disadvantage of the coercive power of the government, depending on how you look at it. If you have a strong ability to succeed in our competitive world, and if you also have strong feelings about the importance of keeping government from meddling in health care, maybe you can help by applying your abilities to finding a better solution.
Sometimes more government really is the answer, but not always. It will always be that way.
kamschron wrote:
"I agree with the self-proclaimed libertarians that the responsibility to take care of my own needs is primarily mine, but I also believe that I have a duty to help in taking care of the needs of my neighbors."
I completely agree. The issue I take is that I work hard for what I have and I will share it with who I want to. Government cannot force me to be charitable.
George Washington once said: "It is not everyone who asketh that deserveth charity; all however, are worth of the inquiry or the deserving may suffer."
On average, conservatives do give more to charitable organizations because they live by principles like those espoused by George Washington.
http://squaretwo.org/Sq2ArticleBushmanIllAtEase.html
Mormonism has only been associated with the sort of extreme capitalism that Jeremy espouses since about the 1950's with the plitical ideas of Cleon Skousen and Ezra Taft Benson. Remember that in Missouri and Utah communitarianism was the ideal.
Also, Jeremy, as I previously asked, are you upset about having to pay for roads? Clean water? A standing army? None of these are mentioned in the Constitution
Part of the question that has to be asked is, regardless of rights, do you really trust the Government to do a better job?
I find the idea of additional layers of weavers of redtape making things cheaper to be nonsense.
Come on djinn, you took Con Law. No mention of a standing army? Article 1 Clause 8:
[Congrees has the power] "to raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years;
To provide and maintain a Navy."
Regulate roads?
"To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes"
Even if I didn't like the government spending money on these programs, they are explicity mentioned in the Constitution, which the people ratified. I think water is a regulated at a state level, which is exactly the point of the 10th amendment. We gave the government the power to do these things. We are not given the right to healthcare unless you take a convoluted view of the general welfare clause. Perhaps this is what Congress will argue that it has the power, but it is not a right. That was the point of the poll, whether it is a right or not. I think that Congress will turn it into a right, but up until now, I could not sue a government office for denying me the right to healthcare.
"Remember that in Missouri and Utah communitarianism was the ideal."
Right, but who was running the show there? The Saints trusted their government leaders since they shared common interests and moral values. However, once greed and apathy began to take hold upon the Saints, this form of government ultimately failed. I personally do not trust our government, nor do I beleive that its members share the same moral values as I.
Moreover, let us not forget that the United Order did not reward laziness or entitle its members to the personal property of others. Instead, each entered into a binding covenant with the Lord and the members that each would work for his/her keep. Each deeded their personal property to the Bishop, who in turn, returned that exact property to the Saint for his/her personal use. Any "surplus" was to go to the building up of the Kingdom of God, but was not forcefully taken.
Evgenii, there was no standing army when the constitution was ratified. That was the whole point of the 2nd amendment. Plus, the explicit mention of only two years funding for an army indicates that the army was meant to be temporary.
And, as to roads, many of the major roads in the 1789 time frame were toll roads. Regulating interstate commerce = roads in exactly the same way that the general welfare clause = health care.
Wait a minute...aren't I "commanded" to pay tithing so that others can enjoy the "privileges" of charity? Isn't the concept of providing healthcare for all, even those that can't aford it, moving closer to the law of consecration?
From a Kantian perspective, doesn't it seem imperative to provide some equality of access to services necessary to persue live and happines? The Church provides access to food and emergency care to those in need, all at the expense of the tithe-payer. In my mind, the only reason the church doesn't provide access to health services for members is that it would cause a financial and logistical nightmare. Otherwise, it fits directly in line with the Churches teachings regarding the law of consecration.
That brings me to my next point. This issue is really more about logistics issue not morals. The only reason people start screaming about the issue is because they are cheap and don't want to pay more taxes for the benefit of others. Of course they bring religion into it, they have to feel that they are on the moral high ground of the issue. But, Obama is not "evil" because he is proposing universal healthcare. He has identified a financial and logistical problem for many Americans, and he is trying to address that issue. Anyone who has been self-employed will agree that the healthcare system is in need of reform. The only real question is: which of the various options is financially and logistically most feasible?
Well, what option is most feasible? The insurance companies only suck up massive amounts of money themselves while also requiring the health care givers of various stripes to expend massive amounts of money to get reimbursed. It's pretty easy to determine what to do to save money. Don't forget that Medicaid has a 3% overhead, while private (and non-profit--i'm looking at you Blue Cross--) insurers have overheads of 20% to 50%.
djinn, Medicaid has a 3% overhead? I'm not sure if that's accurate but does it even matter when they are tens of trillions of dollars in the hole? Trillions! The same can be said of Social Security.
There is no way that government-run healthcare is going to turn a profit as the President believes. Instead, we are going to find our country even deeper in debt and unable to undo the things of the past since entitlements are the hardest thing to reverse.
What's going to happen with government-run healthcare is the same thing that has happened with all other government-run institutions - they will go bankrupt. As we have seen, the government can't even run its own Senate cafeteria or this ridiculous "Cash for Clunkers" program without completely losing their shirts. This scenario would be no different.
Jeremy, there's many wonderful Government-run institutions. We are the government. The military is run by the government, and is pretty socialist, what with free health care, base housing, subsidized supermarkets and the like. Starting with Ronald Reagan, government institutions started to be mismanaged, but they still, pretty much, hung on. Government contractors, now; you've got an argument.
Besides, every other first world country manages to provide health care for its citizens at rougly half the price of the US, except for Switzerland (which, strangely enough, relies on actual health insurance companies), but still manages to ensure all of its citizens.
Switzerland still only spends 11% of GDP compared to the 15% of GDP for the US with somewhere around 18% (in 2007, Census Bureau numbers, certainly up to 20% now, at least, that's one in five.)
If health care reform (including covering all) would save you money would you be for it or against it?
djinn, no one here is saying that healthcare reform is a bad thing, just that the health care reform that is being forced on America is bad. We have politicians that laugh at the prospect of even reading the 1,000+pg bill (John Conyers). And when people openly oppose a public option, they are automatically assumed racists.
Saving money through health care reform is meaningless if you sell out your freedoms. I would gladly pay triple what I pay now if that ensured that I and my children would be free from govt control of how I live my life. If the government runs things, they will dictate how you live and what treatments you will get - this ultimately leads to healthcare rationing.
A good example of this is the VA. Sure, our veterans may have free health care, but the government continuously rations what treatments and medications they can obtain. It will be no different if it is placed on a universal scale.
Reform starts with tort reform and allowing insurers to cross state lines. Right now the govt has tied the hands of insurers in not letting competition cross interstate borders. True capitalism would inherently drive healthcare costs down dramatically.
So, I ask you, what would you be willing to pay for healthcare so as to ensure your freedoms?
Can I just add a point here? djinn mentions Switzerland as an example of successful healthcare management. I only add that we be careful of such statistics as countries like Swtizerland and the the Scandinavian countries have relatively low immigration rates compared to the US. Switzerland has actually been in the news quite recently due to the success of racist/anti-immigrant parties.
While not all immigrants add to overall healthcare costs per se, using the US as an example to these countries does not work because their population density, immigration rates, and health of their populations are too dissimilar to the US.
djinn also says that these countries can offer medical services at half the price of the US. This is of course a trade off of paying higher taxes. In Sweden, one can pay up to 69% on income taxes and 25% on VAT (Value added tax, effectively a sales tax on goods). So if you make $200,000, you come home with no more than $60,000 and then if you buy a $1 hotdog, you will have to pay $.25 in taxes. That is a great way to fund social programs. It also helps to have little to no military expenditures for a global navy to protect shipping lanes or other UN hotspots. In Norway, income tax is at about 47% (lower than Sweden thanks to gas fields) and the VAT is 25%. In Denmark, income tax can be as high as 63%. VAT is 25%. In Germany, income taxes cap at 45% and VAT is 19%. So in the end, either way we are going to pay for it. But remember than in these countries, even the people classified as the poor are still paying as much taxes (percentage wise) as people in the upper tax brackets do here. When people qualify under poverty provisions here in the US, they pay only FICA and Medicare/Medicaid.
Perhaps if the tax level was raised across the board so that even the poor contributed like they do in Scandinavia, I would be more on board with this.
Apologies, my hotdog example in Sweden was not very good. Food and hotel rental rates have a separate VAT level of 12%.
My comment just got eated. But, Sweden has an "all-in" tax (all taxes paid by everyone with various corrections taken) of 62%; In comparison, Utah has an "all-in" tax of about 48%. For that extra 14%, Swedes get free college for their kids, free healthcare, guaranteed pensions, guaranteed disability pay, and the list goes on.
I think your 65% Tax rate was probably arrived at by someone not realizing that the separate pension tax is offset by other taxes, and so no one (or almost no one) actually pays it.
The all-in tax includes the Swedish vat, as well as the sales tax in, say, Utah, and so the comparison is apples to apples.
Plus, can't you think it's at least a tiny bit admirable that Norway's north sea oil reserves benefit the masses rather than a tiny elite?
We already have health care monopolies and monopsonies in 92% of markets, Jeremy. Why would making the existing monopolies bigger help anything?
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