I agree with President Obama that it was all time-wasting silliness

[fpb]

The best thing about this is that it may at last have killed the insane Trump candidacy (I can't believe there was anyone in the Republican Party disposed to give this lecherous crook the time of day). The only good thing, in turn, about the Trump candidacy, is that it should make us Italians feel less bad about Berlusconi.

Comments

Re: I'm not happy with either side

[lectorpoemarum.livejournal.com]

Well, depends what you mean by 'not work'. Certainly it can exist without immediate disaster; but I am less convinced it provides a *net* benefit (I'm still fairly undecided on that; but I think the situation is way more complex than either side tends to admit.)

Europe is not America; not only would administrative burdens be much worse in a country as big and diverse as America, but the whole attitude toward government is quite different than most of Europe. Also I don't believe our Constitution actually allows the federal government to do it (not that anyone seems to *care* anymore). State-level programs, I have much less trouble with in principle.

I'm certain that simply removing Medicare would have bad results; I am far less certain that we are better off now than we would have been had it never existed. Part of what makes these programs profoundly dangerous (even if and when they are necessary) is that they produce dependence - not only on the personal level, but they affect the market and society as a whole.

Re: I'm not happy with either side

[mindstalk.livejournal.com]

"Scaling" has never been a convincing objection to me. No one's shown that you need significantly more administration per capita. Especially when we're only a bit over twice the size of Japan, and under 4x the size of the bigger European countries. Also given that systems like the one we opted for are simply using and expanding the existing corporate administrations (as well as the Medicaid one, for the really poor.) 80+% of Americans are already insured, and the ACA tries to rock the boat minimally, as opposed to switching us to Medicare for All; the insurers can't handle 20% more customers and the money that comes with them?

"attitude toward government": Possibly true, but this is depressing; it's saying Americans can't have nice things because we refuse to imagine them being possible. Self-defeating prophecy and defeatism.

A literal reading of our Constitution doesn't allow an Air Force or regulation of nuclear weapon material, either. Or a war on drugs. While I'm sympathetic to the idea that the Constitution should be obeyed and updated as needed, I see no reason to give ground here while conservatives are chasing pot smokers and trying to censor the Internet. To hijack Mr. Cheney, "the Constitution is not a suicide pact" and lives really are at stake here.

Dependence? Employer-linked health care seems far more dangerous in creating dependence, and in discouraging entrepreneurship.

Re: I'm not happy with either side

[lectorpoemarum.livejournal.com]

It's not just population... Japan isn't 50 historically-largely-independent different administrations.

No, insuring everybody else in itself isn't that problematic... it's the methods you take to get there. *Requiring* people to buy insurance, for example, is colossally problematic precedent-wise. In any case, in my view, the problems in the current system are precisely with the way insurance works: that's why I say they're too deeply-rooted to realistically be fixed.

Mmm. I think the conservative-American attitude is *healthier* in the long run; the fact that it has certain particular flaws in this (and certain other) matters doesn't, I think, outweigh its being a protection against what I see as the really serious problems.

I would like to see the argument about how the Constitution prohibits an Air Force. Regulation of nuclear weapon material... depends on what you mean. I don't think that the Second Amendment prohibits the government from forbidding nuclear weapons, if that's what you're referring to. War on drugs... when did I say I supported *that*, either? I think a very large part of what the federal government does is unConstitutional, and should be dropped or given to the states.

We have a process to amend the Constitution. If it *Really* needs to be changed, use the process. But I don't think end-runs around it are ever, ever OK. Rule of law is critical, and a big part of what separates successful nations from failing ones - to do *anything* reliably, you need to be able to rely on the law being predictable ... in the long run, undermining it is bad for everybody.

I don't have any particular stake in defending the current system either, but I'd argue that you can change employers a LOT easier than you can change governments. Discouraging entrepreneurship, I can see... but IMO that's a problem with the *whole system*.

Fundamentally, the problem is that *healthy* people need insurance AT ALL. Insurance is always, mathematically, a bad bet -- otherwise the insurance companies couldn't make a profit! The problem is that the insurance companies are "in bed" with the hospitals, etc., so *they get charged a lower rate than an uninsured person would*. It's not just that the insurance 'foots the bill'... the hospital actually gets less money, total. And THAT is the problem. In a healthy system, the average person shouldn't NEED insurance except to cover the risk of really dramatic things like being disabled in a car-wreck; the fact that insurance gets involved at ALL in going to an ordinary doctor's visit is itself a sign of critical problems.

Re: I'm not happy with either side

[mindstalk.livejournal.com]

Japan does have its own internal subdivisions. And I don't think all 50 of our states have been largely independent, and think that Medicare scales just fine, but this quibbling won't go anywhere.

car accidents: and cancer, and MS, and various bad genes and chronic illnesses, and whether one ages well or goes infirm quickly. There's lots of medical situations that are intense personal disasters and thus cause for insurance.

That one needs insurance to pay for a doctor's visit is indeed messed up, and may be partly the fault of insurance, but also of medical guilding, and a stagnant if not shrinking number of medical schools, and incentives to become specialists rather than GPs. And government policies can probably take some blame for all that.

OTOH, once you're insuring people for their serious illnesses, it can make sense for the insurer to pay for their preventive care, to keep the insurer costs down. If you're potentially on the hook for someone's diabetes, you don't want them skipping diabetes prevention because it costs $100/hour.

Though US insurance breaks that link, actually: if someone changes insurance with jobs or interstate movement, and eventually goes on Medicare, then the insurer paying for preventive care likely ends up saving someone else money. So the insurer doesn't do it because it doesn't make sense, and the patient doesn't do it because when you're financially strapped long-term maintenance is the first thing to go, and you end up with the US spending more for shorter lifespans than anyone. A cradle to grave system has more reason to keep you healthy.

Of course the Constitution doesn't prohibit an Air Force. The point is that it doesn't *authorize* an air force -- and if you take enumerated powers seriously, the gov't can only do what it's empowered to do, right? Army and navy are mentioned, not air force, naturally since flight didn't exist then. But if you're a literalist that shouldn't matter.

Ditto for nukes -- and if you think the Second Amendment allows prohibiting nukes, even though there is no power granted to do so, you're interpreting the Constitution. Just like the rest of us.

Rule of law is critical; so is flexibility in changing circumstances. If you impose a fully literalist interpretation society will fall apart; if you do so selectively, you're not improving rule of law any.

Re: I'm not happy with either side

[lectorpoemarum.livejournal.com]

I didn't mean that all 50 states had been literally independent nations, but that before the 20th century, and especially before the Civil War, most of the ordinary business of government happened on the state level. The US is really not designed for big sweeping federal programs -- and this is a *feature*, not a *bug* (or it was until people, largely starting with FDR's New Deal disasters, insisted on driving big sweeping federal programs through anyway). Stuff like this is supposed to be handled on the state level, if it must be handled.

Yes, I didn't mean literally "only car accidents"; the point is that for the average person with no major health problems, if insurance is so much better financially that you HAVE to have it, something is severely wrong.

I agree that government policies may have some blame for the rising costs; Medicare/Medicaid is probably a factor (since the cost probably gets transferred to non-Medicare/Medicaid patients). The whole medical school/incentives to specialize thing is almost certainly also driving it.

Yes, there is of course an advantage to insuring preventive care. I'm saying that insurance shouldn't be NECESSARY -- the fact that "being uninsured" is a really bad thing (to people who don't have some really severe illness) is itself a sign of a fatally flawed system.
Ultimately, I don't think it can be improved much

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I'm not THAT stark of a literalist; there is really some space for interpretation ... but we have gone far, far too far in the other direction - interpretation needs to actually stay with what is written. The Supreme Court long ago gave up actually looking at the Constitution when they make their arbitrary fiats. So the risk of too-literal interpretation does not strike me as at all a real threat in the current climate.

Also, technology has legitimately changed things in the military stuff. How has a need for universal health care developed that HAS to be federal, not state? I do not think the problem is big enough to warrant even considering end-running around the Constitution.

I do think even some of the changes that needed to be done should have been done *by actual Constitutional amendment*, though.

(I also don't think even under a fully literalist interpretation "society would fall apart"; all that would do is move more stuff to the states, and US states are as large as many functional nations, so I don't think any amount of moving-power-to-the-states would make society collapse.)