Single Payer rears its ugly head again.

A fellow I’ve known slightly for many years is editor of the Alpha Omega Alpha medical honorary society magazine, The Pharos. He has a lead editorial in The current issue It is titled “Now is the time to enact a US Healthcare System.

Now, don’t get me wrong. Dick has had a more successful career than I have. Many years ago I knew him and he read his acceptance letter to USC medical school in my apartment. He did well in medical school, almost as well as I did, but his wife agreed to go to New York for a high status internship and residency, setting him on a path to great success. He became a Professor of Medicine and eventually President of the University of Colorado. I have not seen him in years and suspect very little of his time has been spent in the delivery of primary health care “in the trenches” so to speak.

My wife refused to leave Los Angeles and I have, as a result, had a less prestigious career but satisfactory as anyone who has read my Memoir will see. I did harbor some resentment and the marriage ended in divorce after 18 years.

Now let us consider what this academic authority proposes. First, we are now ten years after Obamacare and some level of practicality has crept in.

The “federalism” response to the COVID-19 pandemic, medicine, health care, and the profession of medicine is not working well and needs to change. A serious societal and public review and plan of action for change is needed with regard to why and how the U.S. must improve overall health care and create a new health care system for all Americans. The U.S. is the only developed country in the world that has not determined that health care is a fundamental human right. Universal health care should be considered by all as a social good and a national priority.

There is, of course, no such promise in the US Constitution of a “right” to healthcare although we do have an Amendment forbidding involuntary servitude. Section 1

All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

Shall the federal government have the right to compel doctors and healthcare providers to provide services ? Right now Medicare pays about 13% of billed charges. This produces ridiculous fees on paper but what is the uninsured to do ? Pay 87% higher prices ? At my last understanding, a doctor may not offer a service for less than his/her/xir Medicare price. Anyway, let us see what is proposed.

The long-standing federalism approach to health care is associated with a lack of leadership, the absence of a solid plan, setup, or organization to manage our national health care. Also it is slow to respond to national and international issues. It has not worked well and leaves the country’s health care system disjointed, confusing, and expensive. The federalism approach, in which all 50 states and five territories each have their own rules, regulations, and financing, has been a barrier to providing health care for every U.S. citizen, regardless of where they reside.

I frankly don’t see the Federalism handicap but suspect nationalization appeals to some. Those darned Red States again.

One option that is often discussed is a single payor system in which the government is the only payor through tax and other revenues and manages health care as a public and social good. Currently in the U.S., the Military Health Care System, Indian Health Services, Veterans Health Administration, and Medicare are all government single payor systems. Medicaid and the Child Health Insurance Program (CHIP) are jointly funded by the federal govern-ment and state governments. All totaled, these government funded programs provide health care coverage for nearly 50 percent of the U.S. population.4

The success of the VA and the Indian Health Service is doubted by many. Both have seen repeated scandals.

The other half of the population is covered under their employer-sponsored health plan; is self-insured; or receives coverage through individual market health plans, including ACA-compliant plans; or completely lack any type of health insurance. Through the private health insurance programs, private insurance companies are re-sponsible for paying claims for their members. Hospitals, physicians, pharmacies, and other health care providers each file claims independently. Obamacare is responsible for a significant segment of the uninsured as small group plans were devastated by Obamacare.

According to Jerry Bonenberger of Babb Insurance in Pittsburgh Pennsylvania, “small employer groups with less than 50 full-time employees are experiencing an extraordinary increase in their insurance premiums for 2015. In one case, a professional services firm with 42 full-time employees received an 87% increase in their premiums for next year.”

Through the development of the quasi-independent, apolitical National Health Reserve System (NHRS) pro-posed in the Summer 2020 issue of The Pharos,(1) the U.S. would have a health care system modeled after the Federal Reserve System, allowing for government funded care for half, and private insurance for half. The role of the NHRS would be to govern, integrate, coordinate, and manage a nationwide system of health care, both private and governmental. It would be far more extensive operationally than the Federal Reserve and would be governed and managed by experts, including physicians, health professionals, and others using data, experience, evidence, and planning to operate a national health care system independently with transparency and quasi- independence from politics.

Does anyone really believe that ? At least he wants to get rid of Obamacare although it is too late, as I have repeatedly pointed out. Doctors are no longer small business people but employees with the psychology of employees. Those that are opting out to go to a cash practice are a small minority but that seems the only realistic option. I submitted a rebuttal letter to the journal but doubt it will see the light of day. In it I suggested some reforms on the lines of the French system that I described in multiple blog posts ten years ago. I think the French system would have been a better reform but I doubt that will appeal to the academics who want control. When I was at Dartmouth in 1994-95 I met many of the people who designed Hillarycare, and they were also all academics. Pelosi and Reid who wrote Obamacare (I doubt Obama had anything to do with it) at least learned to include the insurance companies in their plan. In fact, I am sure it was written by insurance lobbyists and 25 year old staff lawyers.

The abysmal implementation of Obamacare suggests that big national scale programming projects are not the federal government’s strong suit. The federalism that my former friend, Dr Byyny, opposes allows for incremental reform and some level of experimentation. A national one-fits-all program failed spectacularly. Another one is likely to fail, as well.

That was 2015.

39 thoughts on “Single Payer rears its ugly head again.”

  1. From all I have read, the Indian Health Service has been pretty much a disaster. Partly this is probably due to the fact that so many reservations are in out-of-the-way places, but I doubt that this is the only or even the primary factor.

    VA appears to have greatly improved under Trump, but how long will this last?

  2. I’m still confident that it’s too late for single payer in the US, since the government is undeniably completely broke. If Bill Clinton has been smarter he would have put someone sensible from Congress in charge of implementing some sort of system-sabotaging plan similar to Obamacare and paid for it with the “peace dividend” but thankfully he blew it. The Dems seem far more eager at this point to destroy the energy industry than do anything else with health care…

  3. Just like Obamacare & HillaryCare, Dr. Byyny’s proposal is not about providing heath treatment — this is about paying for health treatment — or more specifically, about getting other people to pay for one’s health treatment.

    Someday, someone will come up with a plan that focuses first on the effective provision of realistic health services, and then bases the funding system on the self-evident truth that the average person over the course of his life will have to pay the full costs of his own lifetime health treatment.

    Let’s note two points:

    One is that half the cost of the average person’s lifetime health care expenditures are incurred in the last 6 months of life. Are we trying too hard to extend the easily measured length of life instead of focusing on improving the harder-for-bureaucrats-to-quantify quality of life? We need a moral revolution to accept the inevitability of human mortality.

    A second point would be to look at the health care system in the only significant international competitor to the US — China. As best I understand the system in “Communist” China, patients pay a significant part of their health care costs out of pocket. If that approach were married to the religious-based charity hospitals which used to be common in the US, we might have the best practicable system possible in this imperfect world.

    Brian is right — our bankrupt FedGov does not have any funds to pay for more health care. The Political Class can certainly make promises — but they cannot fulfill them.

  4. What I think, is you should be thankful to your then wife. If not for her resistance, you might have had Dr.B career, and ended up like him – a hopeless bureaucrat, far removed from his nominally noble profession; a socialist with anti-American, anti-Constitutional tendencies, a bootlicker to our Dem overlords.

  5. Tatyana, I should tell her that. She still is unwilling to consider anything she did was wrong or unhelpful. She would love your support.

  6. Any government organization that purports to have as its reason for existing the helping of the general population will be part of the political system overall. The real highest priority will be the accumulation of power and money at the expense of the governed by the government. It is the goal of those seeking single payer to enslave all of us and those providing care.

    Subotai Bahadur

  7. Ridiculous. Go ahead keep paying twice as much, for a less that universal health care system.

    It amazes me that a supposedly Christian country cares so little for the poor. A short and painful life from lack of health care, and prison as a solution, defines your priorities.

    Democracy is a crock. Its a way to retain power by keeping your people stupid and feeding them lies. Very effective indeed as it turns out. More authoritarian systems should take note.

  8. Ridiculous. Go ahead keep paying twice as much, for a less that universal health care system.

    Natasha Richardson could not be reached for comment on the troll’s assertion.

  9. Predictable PenGun: “Go ahead keep paying twice as much, for a less than universal health care system.”

    You are missing the point, Mr. P. The US effectively has “universal” health care. That is why Canadians sneak over the border to get the CovidScam vaccinations that are free — but unavailable — in their own country.

    Personal observation — I was once at the scene of a Multiple Casualty Incident, a winter night freeway accident involving a coyote running an overloaded van packed full of illegal aliens. Three Counties diverted all their ambulances to the scene. Medevac helicopters made multiple trips taking the most seriously injured to hospital operating rooms. Every one of the injured got better prompter medical treatment in a rural part of the US than Princess Di got in Paris after her accident. None of the illegal aliens paid a penny.

    The health treatment delivered to patients in the US is near-universal — but the politically-driven bureaucracy, cost-shifting, and litigation are financially extremely burdensome.

  10. COVID showed the federal system actually works pretty well if you’re measuring by practical response as opposed to measuring whether your preferred non-medical intervention was uniformly established and enforced nationwide. The primary response of the Feds was Warp Speed, a function which the Federal government is uniquely positioned to perform. It also provided a backstop for emergency funding since it can, unlike most states, run a deficit as well as providing some material resources. Across the country, each state was able to respond according to the needs, wishes, and unique circumstances of their people and geography. The primary failures in the states were issues of governance and policy that had nothing to do with the structure of the federal system. Federalism provided a firewall that prevented policies like requiring nursing homes to take COVID positive patients from being implemented nationwide.

  11. Gavin brings up an excellent point. Obamacare worked out the way it did in part because our major argument is over health care financing, not health care provision. The piece that nobody wants to tackle is the distortions caused by tax incentives to provide employer-paid health insurance, an antiquated patchwork over another government-caused distortion. As this benefit has become a larger and larger portion of employee compensation, beneficiaries have become more insistent on unlocking that portion of their pay by expanding usage of medical services. In some ways this is good since it provides an income stream to offset Medicaid and Medicare deficits at the provider level but it still distorts service usage and overall medical spending. The creation of universal HSAs that work similarly to the various self-funded but government- or employer-supported retirement accounts might be a better solution, and offer a way to wean ourselves off the accidental adoption this benefit.

  12. It amazes me that a supposedly Christian country cares so little for the poor. A short and painful life from lack of health care, and prison as a solution, defines your priorities.

    Once again you demonstrate appalling ignorance of how things actually work in the United States, as opposed to the fantasy construct the leftist grifters who rule Canada lyingly describe to you.

    The poor, the sacred poor- every welfare parasite in the US gets free free free healthcare sans restraint, no matter what the cost. I recall a story about a dialysis patient from a few years ago, who not only received free dialysis, along with bounteous free medications, but also a free ride to the clinic by a personal chauffer. That is, the government paid for a ride for this blessed poor person who couldn’t arrange a ride by themselves.

    But that isn’t even what ****es me off. What gets me is that in this particular story, the dialysis patient couldn’t even be bothered to be awake when the free free free ride to the lifesaving treatment showed up. Nope, the driver had to go and pound on the door to the free free free apartment the dialysis patient was provided, by the country you fantasize cares little about the poor, to get the patient to go and get their life saved. If the driver had failed to get the welfare recipient to go to their lifesaving dialysis appointment, the driver could be punished. And as a mere wage slave, I bet that driver had much worse health insurance than that sacred poor person.

    Democracy is a crock. Its a way to retain power by keeping your people stupid and feeding them lies. Very effective indeed as it turns out. More authoritarian systems should take note.

    You are describing the government of Canada, and how it manages to keep people like you willing to tolerate its relentless treason against you. That is, by attacking the large foreign country right next door that you and your fellow subjects know essentially nothing about, while importing vast swarms of foreigners to replace you. Your ruling class hates you and wants you erased.

    I think this is roughly the same situation Americans are in- but at least we noticed and elected Donald Trump.

    Canuckistanis? Nope, still clueless. Worry about your own vanishing country, stop fantasizing about the United States.

  13. I believe I have commented here before on this regarding my own experiences.

    THANK GOD WE DON’T HAVE (yet) A HEALTHCARE SYSTEM BASED ON THE Canadian/Brit model. 6 9 17 22

    Mon Nov 6 I went in for a routine colonoscopy (I’d had polyps 3y before, so I was on a 3y rather than 5y schedule).

    They found a lump too large to remove short of surgery.

    By Thurs Nov 9 I was in to see a surgeon and discuss options. We set Friday, Nov 17 as the surgical date. Surgery was successful and without any complications (duh, I’m writing this)

    I was released from the hospital on Nov 22, just before Thanksgiving. Not the best TDay I’ve ever had, mealwise, but it was still A Good Day. :-P

    If I’d’ve been in Canada, all the surgeons would have performed their alotted surgeries for the year, and I would have had to wait until the next year to even SEE a surgeon about having the lump removed. It probably would have been February before I got to see the surgeon, and things are always backed up there, so probably another month or more to schedule the surgery.

    So, March instead of November. 4 months for the cancer to metastasize (yes, it was cancer).

    My November prognosis? Stage 1 — no need for further treatment.

    Who knows what a hypothetical March prognosis might have been? Would it have been as benign a final outcome? I’m glad I did not need to find out.

    The USA has FAR better survival rates than the UK or Canada, for a reason.

    FUCK SINGLE PAYER.

    I’d rather trust to the charity of those around me than the charity of a government bureaucrat.

    Anyone who does otherwise is a total and complete fool.

  14. If the poor paid for the care they got, including illegals, I would be much more comfortably retired. The troll is just ignorant and resentful. Many a long night I spent operating on people who would never pay a penny. My favorite, an illegal walking on the train tracks on Memorial Day 1986, listening to his Walkman, did not hear the train. After I saved his life, I learned he worked for his brother in a gardening business. I suggested he could repay me by cutting my grass for a few months. Nope. Too busy. Later he tried to sue Amtrak.

  15. }}} If Bill Clinton has been smarter he would have put someone sensible from Congress in charge of implementing some sort of system-sabotaging plan similar to Obamacare and paid for it with the “peace dividend” but thankfully he blew it.

    It helped a lot that the GOP was strongly in charge of Congress under him, and there was no way he could ram single payer down America’s throat with them standing there rejecting it.

    }}} Are we trying too hard to extend the easily measured length of life instead of focusing on improving the harder-for-bureaucrats-to-quantify quality of life? We need a moral revolution to accept the inevitability of human mortality.

    Exploring length-increasing techniques should be encouraged, but not a central feature. As far as the cost of expensive treatments go, that should be a lottery kind of thing with the goal of using the “winners” to find ways to lower the cost to make them practical for all.

    }}} Brian is right — our bankrupt FedGov does not have any funds to pay for more health care. The Political Class can certainly make promises — but they cannot fulfill them.

    Destroying the government, financially, by overburdening it with promises is not a problem, it’s a feature. PostModern Liberalism has been implementing a Cloward-Piven strategy to that end for over half a century, now.

    }}} You are missing the point, Mr. P.

    No, his point is where it has always been. On top of his head. Zippy The Pengun.

    }}} That is why Canadians sneak over the border to get the CovidScam vaccinations that are free — but unavailable — in their own country.

    A hell of a lot more than just vaxes.

    I recall some years back when some significant basketball player in Canada got bumped waaaaay forwards on the knee surgery lists… because, “Equal care” is a myth.

    BTW, I will note, I recall, back when HillaryCare was being pushed, discovering that the entire nation of Canada, with (then) 30m people, had all of four CAT scan machines.

    The marginally poor State of Tennessee, with (then) only 5m people, ALSO had… four CAT scan machines….

    PART of the solution is to remember what the system was for handling this kind of thing before Der Uber Stat took over and provided Single Payer Welfare:
    Mutual Aid societies, which most Americans not only no longer have any part in, but have no memory of.

    *I* certainly had never heard of them in my (then) 40y of life until I encountered this American Heritage piece:

    From Mutual Aid to Welfare State: How Fraternal Societies Fought Poverty and Taught Character
    https://www.heritage.org/political-process/report/mutual-aid-welfare-state-how-fraternal-societies-fought-poverty-and-taught

    There is, or was, prior to ObamaCare, exactly one significant one left in the USA.

    Time we went back to a system that worked, and worked well, and stopped funneling 40% (and more!) of our income to Der Uber Stat.

    I’m personally pretty sure we’re going to need a Civil War to right this. I don’t want it, and I’m probably not going to survive it, but I suspect that is now the only remaining way to Fix Things.

    But we need inculcated in an entire generation that The Government Way is the way of last resort, not the be-all-end-all-solution-to-all-things.

  16. The analogy with the Federal Reserve seems a little far-fetched. And when he says “It would be far more extensive operationally than the Federal Reserve and would be governed and managed by experts, including physicians, health professionals, and others using data, experience, evidence, and planning to operate a national health care system independently with transparency and quasi- independence from politics.”…I’m reminded of something former Fed employee Danielle DiMartino wrote in her book ‘Fed Up.’ She said she didn’t encounter any discrimination on account of being a woman, but encountered *a lot* of discrimination on account of having practical experience in the financial markets as opposed to an academic background.

  17. “It helped a lot that the GOP was strongly in charge of Congress under him, and there was no way he could ram single payer down America’s throat with them standing there rejecting it.”
    I didn’t say anything about single payer at that point. Clinton could have easily picked some GOPe Congresscretins to help pass a proto-Obamacare I bet, if his wife hadn’t insisted to take point.

    “Destroying the government, financially, by overburdening it with promises is not a problem, it’s a feature.”
    Indeed, but they have to at least sort-of pretend to mostly pay for things, and they can’t take away benefits that their new base of white suburban women value so desperately.

  18. }}} }}}“It helped a lot that the GOP was strongly in charge of Congress under him, and there was no way he could ram single payer down America’s throat with them standing there rejecting it.”
    }}} I didn’t say anything about single payer at that point. Clinton could have easily picked some GOPe Congresscretins to help pass a proto-Obamacare I bet, if his wife hadn’t insisted to take point.

    Didn’t need to. They WANTED single-payer, they were AIMING for single payer. I remember the arguments at the time. The GOP had enough power that there was no way in hell it was happening.

    }}} }}} “Destroying the government, financially, by overburdening it with promises is not a problem, it’s a feature.”
    }}} Indeed, but they have to at least sort-of pretend to mostly pay for things, and they can’t take away benefits that their new base of white suburban women value so desperately.

    They are writing checks they can’t cash. If anyone OTHER than a government was doing this, they’d be in jail so fast there would be a very loud POP!! as the air rushed in to fill the vacuum. More critically, they are writing checks faster than the ink is dry on the pre-printed part of the checks. :-/

    It’s pretending only in the sense of me bringing along my copy of Monopoly to the bank, the electric company, the phone company, etc., and leaving my wallet at home.

    And no, I don’t think it’s the “white suburban base” they’re playing to. This is all the ne’er do wells — the grasshoppers — who are being bought off — the kids getting paid to stay at home, as well as other urban types who don’t contribute anything a horses rear end could not contribute just as effectively.

  19. “I don’t think it’s the “white suburban base” they’re playing to”
    Oh it absolutely is. White suburban women control their party now. They’re the reason why mask mandates still exist anywhere. They, not racial minorities, love that stuff, along with electric cars, “free” day care and college, etc.

  20. It helped a lot that the GOP was strongly in charge of Congress under him, and there was no way he could ram single payer down America’s throat with them standing there rejecting it.

    Remember Hillarycare was the reason for the 1994 landslide. After the GOP took Congress, I got an idea. I was just finishing a year at Dartmouth learning how to measure quality in healthcare. I went down to DC and offered my services for free to a committee to work on reform. The NH Senator, Gregg, was a big help getting me interviews. I was told that the GOP was not interested in providers, even those with a health policy degrees and 40 years of experience in private practice. All they wanted were tax lawyers,. The GOP is no better.

    Also, I found that NOBODY was interested in medical quality. Eventually, I spent 15 years teaching medical students to listen to hearts and feel livers.

  21. It’s not about health care. It’s not about health care financing. It’s not about anything they say it is.

    It is about power.

    You get control over people’s health care, they’ll do anything, anything at all that you want them to. Look at the UK and Canada; two of the greatest proponents of individual liberty and economic freedom in the world, circa 1900. Where are they today? Happily ensconced in a situation where they allow unelected bureaucrats the decision over whether you live or die, all in the name of “free, universal health care”.

    News flash, folks: Ain’t nothing comes for free. If it did, it would be worth exactly what you paid for it–Nothing.

    I don’t know how to fix health care after the last 70+ years of mismanagement and politicalization, but I’m pretty sure I know one thing: I do not want my health care managed by the likes of the people you meet down at the DMV or most other government agencies. The sort of personality attracted to the low-prestige jobs in government here in the US are not the sort of people you want making life-and-death decisions every single day. Fauci is a perfect example–How’d you like to look up from the operating table and see his repugnant and entirely incompetent face looking down at you, as the mask covers your face?

    If you’re a government bureaucrat in America, that is to know truly unfettered and utter lack of accountability. You think things are bad when they grant “qualified immunity” to the cops and prosecutors, wait until you find out what we in the military have put up with for years, with the Feres doctrine. Think that’s gonna remain something unusual, once Uncle Sugar takes over? It’s gonna be a lot easier to “save healthcare dollars” by cutting out the ability to sue the incompetent government quacks than it will be to fix anything, and it’ll also have the salutary side-effect of cutting out the cancer of unhealthy people at the same time. It’s a twofer–They’ll save money no matter what.

    You want to know why I loathe the idea of “free public health care”? Feres. I’ve watched them screw over so many military personnel and their family members for years that I find it entirely unbelievable that anyone who has even the slightest idea about what that “free military medical care” really looks like could possibly hold up either that or the VA as a good idea.

    Government-run health care might work in some other country. Not America, because we don’t have saints and competent people working in government. Not even remotely…

    That’s the thing people don’t get–You want German health care? You best start importing yourself some Germans to run it, along with a German population to participate in it as patients. Otherwise, a German solution in the US is just going to turn into a disaster.

    It’s a cultural thing–Americans don’t do government or hierarchies at all well. Look at the difference between a German labor union and an American one: In Germany, the labor union works together cooperatively with management as a part of the team to move forward together. In America? LOL… The labor unions are almost always the diametric opposite, adversarial parasites bordering on organized crime, while management is out to screw everyone out of everything, to include the customers. Where a company has no union and a good corporate culture, there’s no need for an American-style union or a German-style one, so the decent, functional American companies usually eschew the whole thing. The reason we can’t have nice things, here in America? We’re essentially the scum skimmed off the rest of the world’s population groups, the rebels, the non-conformists and the people who won’t go along to get along. That’s who came here; the complaisant and compliant all stayed home. You wanna make a system that works in Germany or the UK work in the US? You, sir, are ‘effing delusional. It. Will. Not.

    Something else might, something wrapped around the fact that Americans are a bunch of non-conformist, self-interested individuals, but a collectivist system meant for domesticated animals that think they’re human? Nuh-uh… Will not happen, and if they force it, the whole thing is going to come crashing down around their ears in a flurry of unintended and unforeseen second- and third-order consequences.

  22. We’re essentially the scum skimmed off the rest of the world’s population groups, the rebels, the non-conformists and the people who won’t go along to get along

    I would prefer the term “The Cream” for that group. The same term was used by my Irish friend as he explained why the Irish don’t like Americans coming over looking for their “roots.” “They know the cream left.” The sheep stayed behind.

  23. @MikeK,

    Through the good offices of some extremely OCD great-great-grandaunts who apparently had little better to do with their time, I happen to actually know, by name, who a lot of my ancestors were, what they did before they came here, what they did to get here, and what they did after they arrived.

    There were some who I’d like to sit down to a table with, at some hypothetical family reunion where we could all meet. Decent, upright, God-fearing folk I’m proud to number as mine.

    There are also a considerable number of outright scroundrels, criminals, thieves, pirates, and Governors that come out when you shake the family tree, and of them? I’m actually more embarrassed by the crooked political hacks, some of whom were literally in bed with the scoundrels, criminals, thieves, and pirates. And, who betrayed them to the authorities of the time, whilst absconding uprightly with the majority of the loot. Which, I am afraid, did not long stick to their fingers.

    Scum is actually a bit of an understatement. I know whereof I speak, and I am completely comfortable with it.

    Of course, on a long enough timeline, we’re all pretty much related to each other. I’ve got slave-owning Southron plantation owners back there right alongside Bible-thumping raging abolitionists whose great-grandchildren got together and boinked their brains out in a complete state of oblivious passion. Hell, some of their flippin’ kids didn’t cavil at congress with the previous generation’s blood enemies.

    Good humor, all around.

  24. I have about 4500 people in my family tree. I have not found any criminals, a few alcoholics, including my immigrant great grandfather. A few with poor judgement, in my opinion, like my great uncle who enlisted in the Union Army and died after being wounded at Vicksburg, leaving behind a wife and two children. None I know of that I would call “scum.” Most were farmers and had healthy big families away from the dirty cities. Maybe there are hidden stories. I suspect most are typical of America midwesterners.

  25. “COVID showed the federal system actually works pretty well if you’re measuring by practical response as opposed to measuring whether your preferred non-medical intervention was uniformly established and enforced nationwide.”

    You have among the worst results on the planet. I’m glad that works for you.

  26. That’s the thing people don’t get–You want German health care? You best start importing yourself some Germans to run it, along with a German population to participate in it as patients. Otherwise, a German solution in the US is just going to turn into a disaster.

    Newt Gingrich made similar points about the Clinton health scheme in1993 or 1994. He said that if you changed the speed limit to 50 on the Autobahn everybody would drive 50, but if you did the same thing here nobody would obey the rule. The point isn’t specific to Germany vs. the USA, it’s that you have to take the culture of the users into account when you design new rules for any system.

    As was the case with the people who pushed the Clinton scheme, the current enthusiasts for single-payer medicine are almost entirely concerned about their own power and control, and only slightly if at all concerned about how their proposed reforms might work in the real world for ordinary people.

  27. Funding medical care. Doesn’t anybody have a system (in FL its a county system) where a portion of your property tax goes for “indigent care”? There are two large hospitals in my county. They receive the property tax from the respective areas of the county. This is in addition to Medicare/Medicaid. The State’s portion (supposed to be half) is now the largest single expenditure in the state budget, exceeding education.

  28. The thing that gripes me is that there’s this vast, bloated bureaucracy that’s more concerned with the paperwork than the health care. And, we don’t know what percentage of our health care dollar is going to that bureaucracy. On top of that, the “solutions” they keep coming up with and implementing don’t address a damn thing about actually improving health care or health care delivery, but all focus on the money.

    You want better health care? You start telling people the truth, and holding ’em accountable: Sweetie, you’re twice the weight you should be. That’s why you’re sick, that’s why you’ve got Type II diabetes. You’re fat. You’re sedentary. You’re lazy, and want a magic pill to fix that. So, guess what? Society ain’t paying a dime for your fat ass. You want to pay for that morbid lifestyle, you best be earning your own money and paying your own way, ‘cos your ill health is a lifestyle choice, a luxury.

    Same with smoking. Same with about 90% of the crap that really costs the big bucks, and it’s only gonna get worse as time goes on and more of these beached land-whales get older. At some point, the health care system for all of the rest of us will collapse under their weight–Literally. And, they’re gonna dun the rest of us to pay for their poor choices.

    There really ought to be a complete re-think on all this crap. I’ve done my best to take care of myself, avoided smoking, excessive alcohol, kept my weight down, exercised–But, my health care pricing is no different from the typical obese fatass who’s done none of that. So… What happens with all that, under “single payer”? Shall we begin policing people’s lifestyle choices? And, if not… Why not?

    The root of all this boils down to one thing, and one thing only: Wishful thinking. People do not want accountability for their choices, or to pay their own way. You smoke all your life? You really ought to be paying massively higher health care insurance prices, and if you’re on the public dime, you should not get any more “health care” than someone who’s done their best to lead a healthy life. These are unpleasant facts, but there are fundamental truths behind them. If your health issues stem from things you could have done something about, like “not smoke”, then you really ought not be billing your peers and descendants for what it costs to deal with the consequences.

    As for the all the money spent on “health care” that’s actually overhead vs. actual health care costs? Prune the friggin’ bureaucracy, and undo all the paperwork requirements. Now, how you do that and square up with all the rest? No idea, but when the friend of mine who’s in health care billing tells me that about 60 cents on every dollar is going to documentation and overhead, then I start to wonder about the rest. The paperwork fiddles they have to do in order to get reimbursed for crap that some bureaucrat has arbitrarily decided they won’t pay for but is absolutely necessary are nuts, and a large part of why you see those thousand-dollar bills for a bottle of aspirin.

    Actual reform would address these things, but since the proposed things like Obamacare manifestly do not, we can presume that reform is not the object.

  29. You should do a welfare check on your friend. If he thinks that shit will fly, he may no longer be up to taking care of himself.

    The reason why that is a non-starter has two parts.

    One part, after all the heat pumped into racial politics, can the American people afford to trust a Federal bureaucracy with the power to meddle in medical treatment? You have a nominally pro-black faction that is anti-white, and a faction the first faction describes as pro-white and anti-black. Should whites trust faction one not to murder them? Should blacks trust faction two not to murder them? There are zero grounds for persuading Americans that influence in a single payer Federal bureaucracy will be kept away from race nutjob factions.

    Second part, there are a minimum of three professions who have let their institutions get screwed up to the point that the laymen will probably be forcing reforms.

    AMA, pretty obviously, has screwed up with the combination of handling COVID and with embracing race war nonsense. AMA’s monopoly on control of medical schools is probably something that can no longer be tolerated. Note, State power to regulate medical licensure may be an avenue for forcing a break up.

    Lawyers have also screwed up. That January 12th, 2021 letter by the 150 odd law school heads created an appearance of partiality. Combined with the ABA’s shenanigans, and certain court cases, they’ve made it look like they are capable of pulling off a profession wide conspiracy to defraud.

    Engineering schools have probably seriously messed up by not telling the university administrations to take their ‘mathematics is not for blacks’ and go fuck themselves with it.

  30. Kirk: “You smoke all your life? You really ought to be paying massively higher health care insurance prices …”

    I understand the thought — and agree with the underlying message that individuals have a responsibility to look after themselves. But stop and think about this.

    The smoker pays a bunch of tobacco taxes over her smoking life. Since money is fungible, that all goes into the maw of Big Intrusive Government to pay for health costs and much else. If we believe “science” — and it is an open question these days whether politicized “science” is credible on this as on so much else — then she will run up some high medical costs and die at a younger age.

    In the meantime, the man who choses not to smoke will not pay those tobacco taxes. He will live longer than the smoker, probably end up with dementia like Joey Biden*, and run up very high medical care costs over his years of decline. There have been some estimates that lifetime health care costs for non-smokers exceed those of smokers because of the high costs of caring for the mentally-impaired elderly over their multiple years of extended life.

    Net it out — the non-smoker probably requires more subsidy from his fellow-citizens than the smoker.

    It is a complicated world, with lots of unsuspected loops & links. The only rational approach seems to come back to reducing Political Class bureaucratic involvement, letting people make their own decisions, and leaving them to face the consequences of their own choices.

  31. AMA’s monopoly on control of medical schools is probably something that can no longer be tolerated. Note, State power to regulate medical licensure may be an avenue for forcing a break up.

    The powers of the AMA are a myth. It is run buy a small group for its own purposes, most of which are related to the income of the Board of Trustees. Medical schools are accredited by the AAMC, the American Association of Medical Colleges, and I fear they are going the way of the universities in Diversity, Equity and Inclusion, which mean anti-white/Asian racism. The majority of my students the last few years I taught were Indian or foreign born blacks or Chinese. American blacks tend not to do well. Few white students recently.

  32. @Gavin,

    I have always found those arguments fairly specious, TBH. The lifelong non-smoker, by the time you get done subtracting all the “smoke breaks” that they didn’t take, and all the rest of the “unaccounted for” costs, is probably way more productive. For one thing, they’re not hacking up lungs, are in general healthier in terms of staying on the job, and it goes on and on. The smoker’s net costs are not reflected in their health care pricing, at all–That tobacco tax money ought to be going towards health care, but we all know it isn’t.

    Aside from that, the point that I’m making with that is that we’ve socialized the expenses on all of this “by choice” vice that affects people’s health, and made no real attempt to fairly extend the costs onto the vice-ridden. If you had it highlighted in terms of pricing just what it actually cost for a smoker per package of cigarettes or other form of tobacco, then that’d be a hell of a lot more honest. As well, there is also the questionable morality of a government making money off of vice in the first place–Historically, Russia’s tax structure was based heavily on an alcohol tax. Which is why we have a Russia that has a historical reputation as basically a nation of drunks. God knows how many man-hours of wasted life that represents, and all so they could support the state’s revenues. Long-term, such policies are ruinous.

    The vice-ridden ought to be paying the expenses for their vice, and the rest of us should not. You want to smoke, fine–Do it where I don’t have to smell it, clean up after yourself, and bear the true costs all on your own. Same with everything else–You want to be a heroin addict? Fine; you pay for it, buddy, not me or anyone else. And, the state stays the hell out of the business of creating addicts, because once you do as we have with tobacco and alcohol, it’s actually in their interest to keep and create more addicts, ‘cos the money’s easy. If you control the source of someone’s addiction, you don’t have to worry about going around and collecting taxes–They’ll come to you. Government ought not be in that business, period. Levy and administer social costs? By all means, but do not allow it to take any more than what it really costs. Government by the people and of the people should not be in the business of shortening those people’s lives in the name of fiscal benefit.

    One way you could make this work is to break the country down into taxing districts for vice, and then look at the expenses accrued due to vice-related issues. Forest fire caused by a carelessly-discarded cigarette butt? The expenses for that go into the calculation for next year’s taxes on cigarettes in that district. Lung cancer gets diagnosed, and we can determine it was likely smoking-related? Public expenditures, to include all health care expenses in excess of those for someone with a healthier lifestyle, all of that goes into the tax bill for the next fiscal period. Same with alcohol–Dude gets drunk and beats his wife, requiring a police call? Costs go into the alcohol tax bill for the next year. Kid wrecks his car and winds up on the public’s expenses because he was drunk and now disabled for life? Alcohol tax goes up. Let people see the consequences of their piss-poor decision-making, and have to pay for them. If that bottle of Jim Beam is actually costing the rest of us a hundred dollars a bottle, in terms of those “missed costs”, then by God, make the drinkers pay and leave the rest of us the hell alone.

    I don’t mind your vices, but do not, I pray you, ask me to pay for them. In any way, shape, or form.

    If you think I sound nuts, recognize this much: You go for something like single-payer, such arguments are going to become extremely persuasive, and you’re going to see society as a whole looking at these things with a far different eye than they do now. The path we’re on? I see a lot of degradation of personal civil liberties, and a lot more “socialized costs” being spread out onto others, in order to make it easier for the morally fraught to embrace their vices. My argument is that the costs ought to be built into the vice.

    And, as a corollary thought… If it is true that the shorter and more miserable lives of smokers and drinkers pay off in terms of fewer Social Security and pension payments, then shouldn’t those people get refunds? Or, at least… Their heirs?

    Of course, then you have the likely spectacle of people encouraging their elders to take up life-shortening vices… “Here, grammy… Lemme buy you another carton of ciggys, huh?”.

    Right now, the state of affairs is such that the true costs of these vices are mostly invisible to the vice-ridden. I would submit that were you to do as I suggest, that would be a lot less true, and if you had to reflect on the cost while purchasing your bottle of Mad Dog 50/50, then you might, just might, begin to consider it’s effect on your life. And, maybe reduce your intake? Maybe?

  33. Kirk — that is an interesting perspective. I suspect you are slightly tongue-in-cheek, because we both know that if there were a Big Intrusive Government agency tracking the full social costs of smoking, drinking, etc, it would be stacked with an excessive number of highly-compensated bureaucrats working on their pensions when they were not doing political work on behalf of a certain Party or going to “Hate Whitey” trainings. The costs of that bureaucracy would far exceed the revenues from any feasible level of taxes. And we all know that when taxes go too high, all that happens is that a black market is created — and then the politicians cream off some of those illegal revenues.

    But let’s not beat about the bush. The biggest “sin tax” on the rest of the population comes from teenage girls getting pregnant as a ticket to life-long taxpayer subsidies. We can all understand the original good intentions of helping innocent illegitimate babies by subsidizing their foolish mothers. But we end up creating incentives for teenage girls (not the most stable demographic) to behave irresponsibly and send the bill to the rest of us. Are we prepared to eliminate all support for unmarried mothers and send their babies to orphanages? In the lng run, can we afford not to?

    I suspect we would reduce the sum total of human misery if we nuked Big Intrusive Government with all its good intentions and went back to individual responsibility and individual charity. Maybe the Chinese Communist Party will let us do that after the coming inevitable collapse?

  34. My tongue is somewhat in cheek, but the opinion remains: You want to sin, that should be your own business and nobody else should pay for it. Single-payer means that everybody pays for everyone else, no matter how you parse it. That being the fact, then we’re only a short step away from people mandating things like I suggest. It will happen, and almost certainly with a level of coercion and unfairness that you can only regard with horror.

    Doubt me? Look at what is going on in the UK, where sanctimonious gate-keepers to the NHS are already cutting people off from health care, ‘cos it’s unfair that their obesity is being paid for by others. People go into socialized health care schemes because they want someone else to pay for their health, not thinking of the inevitable consequences generations down the line. You want strangers to pay for your health care? Well, don’t be real surprised when those strangers suddenly take an interest in your poor life decisions. If they don’t, then the entire system goes bankrupt trying to care for those idiots that eat themselves into immobility and all the rest of the others that make similar choices.

    It’s a slippery slope; the UK is only on the precipice of the steep bit, and will probably fall down it during our lifetimes. The US will inevitably follow, should we be so ‘effing foolish. What can’t go on, won’t.

    And I wouldn’t hold out hope for the Chinese somehow saving us from ourselves. Their own internal contradictions imply that their collapse is what is most likely to trigger our own, and in fairly short order. I think the people looking at China as this great big factor in the future are failing to remember their history–Remember Japan, Inc.? Weren’t they supposed to be running the world right about now, with the US and everyone else relegated to also-rans?

    China is a threat, but I think the major threat they pose is from their implosion more than anything else. Right now, the CCP is riding high and making plans. God and his leading minion, Murphy, are waiting in the wings to dispose them. My guess is that the Chinese have got maybe another generation, maybe two, and the whole thing is going to cave in under the inherent contradictions. They may not even last that long–You don’t build out that much crap with a declining population and then somehow escape the consequences, either economically or socially. The repression of the Uyghurs and other minorities is a telling thing–Confident cultures that are heading for success don’t do things like that, because if they were really confident and going to succeed, they wouldn’t need to. The Uyghur situation is a symptom of a deep cultural lack of confidence in themselves and their future. Watch this space, because you’ll start to see the cracks there, first.

    I honestly doubt that China as we know it is going to last much past about 2050. Your typical Chinese dynasty is good for about two-three generations of competency, and then the corruption starts to work its way in. Xi is symptomatic–He’s doing and saying things that your typical insecure late-dynasty leader does, and that’s an expression of the fact that they’ve lost their confidence in the entire enterprise. You can tell that by the way they’re doubling-down on Mao; the founder of the dynasty.

    You could not pay me to become Chinese, were such a thing possible. There is going to be a huge comeuppance due, and it will likely take every idiot westerner that bet the farm on the CCP with them when it goes.

    At least, that’s the way I read the tea leaves.

  35. Kirk: “I honestly doubt that China as we know it is going to last much past about 2050.”

    The magic date is 2049 — the centenary of the founding of Communist China. By then, Taiwan needs to be under Chinese Communist Party rule, one way or another.

    You are certainly right that China’s (or rather, the CCP’s) day in the sun will come to an end. At the moment, China is doing great because the infrastructure is all new, most of the housing is new, the malls are new, the factories are recent transplants from the West. In 30 years time, they may have the same problems with under-maintained infrastructure that the West faces today.

    Strange thing about “Communist” China is that it is closer to the Kirk rule of “Take Care of Yourself” than we are in the “Capitalist” West. There is very little (government) social safety net in China — mostly people have to look to themselves and to their extended families for help when things go south. Most Chinese apparently have to pay for schooling their children, pay for medical treatment. Maybe that is why they take education much more seriously than we do?

    Because the world is so interlinked these days, it would be a definite downer for China if (when) the US economy collapses. On the other hand, it would be an absolute disaster for the West if China collapses first — because China is the source of so many essential manufactured goods, from nails to ships. Troubled times ahead, either way.

  36. There can be no “right” to something that others must pay for. I don’t pay for anyone’s right to free speech or assembly. Our rights are freedoms from government intervention, not to “free” stuff.

  37. @PD Mason,

    Ah, but you see “they” don’t see it that way. Just like the slaveowners felt they had a “right” to the labor of their slaves, the modern-day collectivists think they have a right to your labor, your property, and your life. Because.

    In the final analysis, I think the common factor behind all this is a drive to control others. Slaveowners? Control. Modern progressive leftists? They want to tell everyone how to run their lives and what to do. They get off on that, the same way the slaveowner and others of that ilk get their jollies cracking their whips.

    The Marxist school is merely passive-aggressive aristocracy, wherein they try to guilt everyone into doing their will, and they try to supplant the existing class structure with their own. They’ve got no more real “virtue” than the old aristocracy, it’s just that they cast theirs as being somehow “better” and more “fair”. Reality? All they did was replace the old-time aristos with their own, drawn from a different class. As well, they had to oppress those they supplanted, because that was half the reason they did what they did–Not a desire for equality, just a drive to dominate. Same thing with today’s BLM types–They don’t want a level playing field, they want to be on top of the pyramid while crapping on everyone below them.

    It’s interesting to observe–The lowly middle-class bourgeoisie supplanted and overwhelmed the hereditary aristos, and now you see the spectacle of the aristo class’s children doing their best to destroy the basis of middle-class life, whilst mouthing the platitudes of their Marxists preceptors who’ve taught them a passive-aggressive guilt that they turn into self-justification for all they’re doing. All while parasitizing decent society, much as their aristo ancestors did. I don’t really see a lot of difference between any of them, TBH…

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