Health Care systems according to Uwe E. Reinhardt

Uwe E. Reinhardt is the James Madison Professor of Political Economy at Princeton University in New Jersey.

There seems to be a lot of passion surrounding this issue around here. I found this to be an interesting article addressing some of the less spoken points in the debate.

http://www.americamagazine.org/content/article.cfm?article_id=11011

A pitfall inherent in these social insurance systems is that governments may underfund them.

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No indeed. The only valid "pitfall" is the fact that ALL such systems require stolen goods to pay for them, however poor or wonderful they may be.

The only real controversy is whether theft is ever justified. Most people are relatively happy about it as long as they believe someone else is paying for what they get, or that they are not having any more stolen from them than the next person. A false sense of entitlement has been bred into the last two full generations.

Governments do not have anything EXCEPT that which they have stolen from people who actually produce wealth.

Let's be clear. Government is not capable of producing anything. They can only steal it, one way or another.

In short, the proposition that a so-called private-market approach to health care would be the best means of controlling the cost and quality of care, or the annual growth in health care spending, does not find empirical support.

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Based on their argument we will never know if the above conclusion is the case since government is involved to some degree in health insurance. Arguing for national health care or for private health care is worthless...we should let the results speak for themselves. Private health care (pretty much unregulated) has NOT worked...now it's time to give national health care a run.

Taxation is not theft. Taxation without representation, that is theft.

Arbitrarily deciding that just because one individual's income is higher than another's, or one's bank account balance is larger JUSTIFIES making them pay a higher tax rate than someone else is THEFT!

Our Federal Goverment's responsibilities and capabilities are specified in the US Constitution. Any and all actions taken by the federal government that is more than or less than those specifications IS A VIOLATION OF OUR US CONSTITUTION and we as a people must stand up and correct those that we have elected to represent us that have either perpetrated the violation or failed to stop it!

The Federal Goverment's legal power and authority is Limited---Any responsibilities/rights NOT given to the Federal Government by the Constitution are reserved to the States or to the people!

JoeSparky said:

Arbitrarily deciding that just because one individual's income is higher than another's, or one's bank account balance is larger JUSTIFIES making them pay a higher tax rate than someone else is THEFT!

Our Federal Goverment's responsibilities and capabilities are specified in the US Constitution. Any and all actions taken by the federal government that is more than or less than those specifications IS A VIOLATION OF OUR US CONSTITUTION and we as a people must stand up and correct those that we have elected to represent us that have either perpetrated the violation or failed to stop it!

The Federal Goverment's legal power and authority is Limited---Any responsibilities/rights NOT given to the Federal Government by the Constitution are reserved to the States or to the people!

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You are right, it is limited. Apparently taxing you and I falls within the scope of their Constitutional authority. As for them "arbitrarily" taxing you, nope, they can't just do it at a whim...there is a process they have to go through in order to raise taxes. Ever heard of a majority vote?

The rich should pay their share. And there are a number of billionaires and multi-millionaires that agree with my view.

Plus, you should read up on what the courts have concluded with regards to taxing YOU. And read the 16th Amendment. The crux is that SCOTUS interprets the 16th Amendment to determine the constitutionality of whatever law in place. I know, I know, I am wrong.

Beretta92FSLady said:

The rich should pay their share. And there are a number of billionaires and multi-millionaires that agree with my view.

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Without wading into this steaming pile of thread, I would like to point something out. Nothing stops those who are billionaires, multi-millionaires, etc from paying more. It's perfectly legal for them, if they believe they are not taxed enough, to pay more. What gets me is that it's not usually "we should all pay more, and to show that I support this, I'm upping my effective marginal tax rate on earnings over 1 million to 50%, as well as retroactively paying that amount over the next 10 years", but "we should all pay more, so I'm going to bitch about it and fund an initiative that will more greatly affect those who are rising in wealth, rather than me with my established wealth."

Tawnos said:

Without wading into this steaming pile of thread,

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I like that...funny!

What I think is pathetic is that something like 60%+ of the population think that one day they will be rich. The rich are the only ones making a sh*t-ton more money every single year, while the common persons wage is dropping and the common person is barely able to make ends meet. Sure, in another dimension it makes sense.

Beretta92FSLady said:

You are right, it is limited. Apparently taxing you and I falls within the scope of their Constitutional authority. As for them "arbitrarily" taxing you, nope, they can't just do it at a whim...there is a process they have to go through in order to raise taxes. Ever heard of a majority vote?

The rich should pay their share. And there are a number of billionaires and multi-millionaires that agree with my view.

Plus, you should read up on what the courts have concluded with regards to taxing YOU. And read the 16th Amendment. The crux is that SCOTUS interprets the 16th Amendment to determine the constitutionality of whatever law in place. I know, I know, I am wrong.

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My issue with regard to taxes is not that I am taxed but that someone is taxed at a higher marginal rate than another. We are all SUPPOSED to be equal in the law. You know--- "Justice is Blind!" This is one of our basic principles in our Country-- That means that no one should get a special benefit or a special penalty. Equal under the law---- And please don't get me started on the special congressional retirement benefits, healthcare, and other perks ALLOWED to Presidents, vice-presidents, Congressmen, Senators, ect!

Hopefully, one day, we will have national health care.

I know, I am a commie-socialist-(insert name)

Beretta92FSLady said:

Hopefully, one day, we will have national health care.

I know, I am a commie-socialist-(insert name)

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I just don't understand why ANYONE would wish for that as there has NEVER be one single instance of it working???
It's a flawed ideal that LOOK'S good on paper but no government has EVER been able to get it to work in reality !!!!!
least of all MY Country that hasn't even been able to run the plans it currently has Medicare=BROKE Veterans admin medical system= Broke how are we to think they can make it work for an even larger group???? Don't get me wrong I LOVE my Country I served it and I have lived all over the globe I wouldn't want to live ANYWHERE else .

Beretta92FSLady said:

I like that...funny!

What I think is pathetic is that something like 60%+ of the population think that one day they will be rich. The rich are the only ones making a sh*t-ton more money every single year, while the common persons wage is dropping and the common person is barely able to make ends meet. Sure, in another dimension it makes sense.

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Like I said, don't really feel like wading into this thread, rather comment from the shores. I made my constitutional argument against federally-provided healthcare here and here. If I'm feeling more up to it later, I may step in and start giving opinions here, but for now, I'll be a douche and self-quote:

I don’t address the need for single payer healthcare, because I think the forum must be decided, first. Should enough of the People find it within the legitimate interests of Congressional control, I contend those people should follow the amendment process. Until then, each State, county, municipality, etc should have the choice to enact or reject its own program. Should the experiment of such be found effective, other states can witness the resounding success, convincing them such a plan benefits them. Moreover, the state-by-state competition allows the People a manner by which to compare the real-world quality and impact of such plans, before deciding which is better, if any at all. It is then the forum can be expanded, only after the experiment has been proven worthwhile within our system of governance.

Supreme Court Justice Louis D. Brandeis is famous for his dissenting opinion in New State Ice Co. v. Liebmann, oft called “Laboratories of Democracy” quote:

It is one of the happy incidents of the federal system that a single courageous state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.

Though others point to other countries as examples of these laboratories, the comparison falls short. Our government, its rules, and the composition of our nation’s heritage differs than those other countries. While such countries may inspire states of a similar bent to follow their plans, it is hardly a just comparison to state the entirety of the states must plunge into the murky waters of such a plan. This holds doubly true when one considers our legal history and the requirements placed upon our Federal government. Ultimately, the move towards a single-payer system lies in the hands of the States, or the People. Taking another path subverts and short-circuits the nature of our country’s policies. Perhaps it’s a city v. countryside issue, but that is in the realm of another post.

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Beretta92FSLady said:

Hopefully, one day, we will have national health care.

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You have been to an airport recently? You've watched the horrors of the TSA unfold? You've visited the post office that can't compete with UPS, even though UPS isn't subsidized. Have you visited a courtroom and watched an innocent person sent to prison due to a corrupt prosecutor or the fact that the judge refused to "allow" any testimony that would prove his innocence - even though we are supposed to be innocent until PROVEN guilty? You've watched the housing market and manufacturing base of the country collapse due to government subsidies and interventions that destroyed businesses by the thousands? You've watched your government print money by trillions, making every dime in YOUR pocket worth less and less and destroying what was once the greatest economy on earth?

You want THOSE people to be providing your health care too?

They have bankrupted the entire country, destroyed the credit and reputation of America all over the globe, and made us a laughingstock everywhere on the planet...

And you want them to provide your health care?

CharleyMarbles said:

I just don't understand why ANYONE would wish for that as there has NEVER be one single instance of it working???
It's a flawed ideal that LOOK'S good on paper but no government has EVER been able to get it to work in reality !!!!!
least of all MY Country that hasn't even been able to run the plans it currently has Medicare=BROKE Veterans admin medical system= Broke how are we to think they can make it work for an even larger group???? Don't get me wrong I LOVE my Country I served it and I have lived all over the globe I wouldn't want to live ANYWHERE else .

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Citations needed badly.

Please, show me some empirical evidence to support your claim that no social insurance or socialized medicine system has worked.

The national health service in the UK for example is still up and running and has been for a long while now. This is socialized medicine, so there is an instance of it working.

The Scandinavian local social heath networks are also another example of a fully functioning quality social health care system. I suppose that's an instance as well.

So please, present a more supported argument and at least attempt to prove your point. Though, I must say, your extra exclamation points did almost drive it home for me.

CharleyMarbles said:

I just don't understand why ANYONE would wish for that as there has NEVER be one single instance of it working???
It's a flawed ideal that LOOK'S good on paper but no government has EVER been able to get it to work in reality !!!!!
least of all MY Country that hasn't even been able to run the plans it currently has Medicare=BROKE Veterans admin medical system= Broke how are we to think they can make it work for an even larger group???? Don't get me wrong I LOVE my Country I served it and I have lived all over the globe I wouldn't want to live ANYWHERE else .

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Next, you are going to tell me that Vet's don't know what they are talking about. Maybe they are lying?

http://www.defense.gov/news/newsarticle.aspx?id=14560

"Veterans who recently used VA services and were interviewed for the 2005 ACSI survey gave the VA's inpatient care a rating of 83 on a 100-point scale -- compared to a 73 rating for the private-sector health care industry. Veterans gave the VA a rating of 80 for outpatient care, five percentage points higher than the 75 rating for private-sector outpatient care and 9 percent higher than the average satisfaction rating for all federal services."

Medicare was sabotaged to bankrupt in order to push it into the private market.

Beretta92FSLady said:

Next, you are going to tell me that Vet's don't know what they are talking about. Maybe they are lying?

http://www.defense.gov/news/newsarticle.aspx?id=14560

"Veterans who recently used VA services and were interviewed for the 2005 ACSI survey gave the VA's inpatient care a rating of 83 on a 100-point scale -- compared to a 73 rating for the private-sector health care industry. Veterans gave the VA a rating of 80 for outpatient care, five percentage points higher than the 75 rating for private-sector outpatient care and 9 percent higher than the average satisfaction rating for all federal services."

Medicare was sabotaged to bankrupt in order to push it into the private market.

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Nice picking the low hanging fruit that happens to agree with your perspective there.

Now let me let you in on what it is actually like to be seen by the VA in most circumstances:

#1. For serious medical conditions I have been made to wait for over 6 months now, necessitating trips to the emergency room twice for said condition.

#2. I have ear trauma related to combat. This was confirmed during my exit physical by an otolaryngologist at Fort Hood prior to leaving. This has left me with balance problems due to damage to my eustachian tubes. I saw the doc at the VA here in Seattle, and he took a look in my ears (Initial intake exam after moving up from California), and told me, and I quote, "They look just fine. Looks like you might have a minor ear infection, and maybe that's playing with your balance. This can happen.".

I ask, "Is there anything odd or unusual or any interior damage to my ear?".

He says, "No, everything looks good.".

I follow up with him a grand total of two times after this meeting, and he tells me again, my ears look fine.

He advised me to seal off my ears with cotton balls and vaseline to kill off the moisture.

Fast forward 3 weeks, and I collapse in the hall because god damn it I can't tell up from down, left from right, and forward from backwards.

My buddy cruises over to take me to the ER.

ER doc takes one look in my ears and the first thing he says is "Whoa, you have some significant scarring on your eardrums. Have you had any concussions or any other head trauma like a fall of some sort?".

Yes I have.

He then gives me a test while sitting and then laying down to figure out my symptoms.

He says, "Ok, well I'm giving an initial diagnosis of BPPV. I will get you some meclizine for the balance, and we'll see how that works for now. All we can do is wait for the otoconia to reset or be reabsorbed, and until then I advise against driving, or any other physical activities.".

I go back to the VA doctor.

I ask him to take a look in my ears, and he says, again, "Looks good. Looks like the infection is going away.".

So I ask him, "Hey doc, so I had to go to the emergency room for complete loss of balance, and while there the doctor says I have significant scarring on my eardrums.".

He says, "Oh yes well...you see...".

I cut him off with, "How come you never told me this before?"

He says, "Well I thought you were aware, that you know, you had...".

He then suddenly finishes up with, "Ok well is there anything else I can do for you?".

I said, "No doc, thanks. I think I have had enough.".



This is the consistent pattern of treatment that I have observed with other veterans in the hospital, whether in Sacramento, Oakland, or here in Washington.

Some other things for your, "Stellar review":

http://www.citizensforethics.org/files/Letter%20to%20Armed%20Services%20re%20PTSD.pdf

http://www.armytimes.com/news/2008/05/military_va_adjustmentdisorder_051508w/

Just to show a couple of what is really a myriad of problems with the VA.


Your article is convenient in that it is a government site, praising a government agency on behalf of the constituency.

Any vet who has EVER been in the VA system knows that the VA likes to make stuff up on the fly so long as it suits them.

It's just a fact of the system.


Now, since 7.5 million veterans have serious issues just getting the regular medical care they need, let alone reasonable health care, let's throw another ~196million patients into the mix.

Reality is a bitch.

Beretta92FSLady said:

Private health care (pretty much unregulated) has NOT worked...now it's time to give national health care a run.

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Quite the contrary. For many years, private health care and its supporting insurance companies worked excellently in this nation. The problems we have been seeing in more recent years are due to other factors. Just for kicks, let's take 1970 as a point year. At that time, I worked for a wholesale electrical distributor with perhaps 50 employees and we did around $10-$12 million a year in business. Our hospitalization was paid for by the company and was excellent. When my first child was born in 1973, via C-section, I paid all of $9.00! And that was for phone rental. My next daughter, two years later, cost me $35.00 and I cannot recall why the increase.

So before we listen to all of the negatives about private health insurance, we may want to ask ourselves what transpired between, say, 1970 and the past ten years? What do you suppose has occurred to force costs to raise significantly and out of proportion to people's wages? I know some of the answers but I certainly don't know all of them.

MamaLiberty said:

No indeed. The only valid "pitfall" is the fact that ALL such systems require stolen goods to pay for them, however poor or wonderful they may be.

The only real controversy is whether theft is ever justified. Most people are relatively happy about it as long as they believe someone else is paying for what they get, or that they are not having any more stolen from them than the next person. A false sense of entitlement has been bred into the last two full generations.

Governments do not have anything EXCEPT that which they have stolen from people who actually produce wealth.

Let's be clear. Government is not capable of producing anything. They can only steal it, one way or another.

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A major problem with a national, or universal, health care system is: 1) From where does the money come? 2) At what point does it stop?

The government has no money; they get funds primarily from two sources. Taxation (all types) and borrowing (again, all types). They make nothing, produce nothing, and are not business entities. This means that there is a finite amount of money to be had by the government for all of its budgeted cost items. A national health care system falls under this umbrella. There is no money tree for health services. It is the government who pays for medical services (all types) under a national system. Think of a bucket of money paying for everything the government budgets and the amount of money in the bucket is fixed. Yes, they can borrow, but remember.. borrowed money must be paid back and with interest.

On the other hand, when the private sector has unlimited monetary resources for health care. You go to a doctor or a hospital and either you or your insurance company, or both, pay the costs. A thriving and vibrant, and unhindered economy, supplies the monies for these services and more. Unlimited because it is a demand, free-market system.

Governments which socialize portions of a nation's economy must also insert a level of control and limitation. Otherwise, the coffers will be drained to feed the open hands of those who would attempt to take as much as they can and deposit little in return. And socialization is a very important and significant step down the road towards socialism and its more evil children.