SCOTUS backs Obamacare (Addended)

George Rebane

The notion that we have a conservative lean to SCOTUS vanished this morning as the high court announced its decision on Obamacare.  The only scrap thrown to conservatives was the ruling that the act’s individual mandate to buy health insurance was really a federal tax, and not the exercise of a federal power under the 14th Amendment’s commerce clause (something its backers have strongly denied).

So now the nation is looking into its largest tax increases since WW2 as it struggles to end Depression2.  To progressives this makes no nevermind , since they don’t believe that tax rates affect economic activity.  There are other provisions of the court’s voluminous ruling which will become clear as it is dissected word by word, and then, of course, litigated.

But the clear impact of the ruling is that US healthcare will now become a commons like its European forbears, especially the British National Health Service.  And it will suffer the same fate, only on an accelerated time scale since our nation’s debts and unfunded liabilities are already astronomical.  Specifically, fewer people will study to be healthcare professionals, thereby making healthcare resources more scarce and expensive – it all has to be paid for by someone.  And state rationing will become inevitable as the costs of delivery are further disconnected from impacting the patient.

When we now look at the Arizona and Obamacare rulings as a piece, we ask what can we hope from SCOTUS in slowing our gallop to becoming a socialist state on the way to revolution or autocracy.  The Great Experiment – can Man govern himself? - that the Founders set up for us now seems on the brink of failure.  This November will let the historically challenged electorate decide – we live in the age of spin and sound bites.  To be sure, the socialists are already happy dancing in the streets, and promising to redouble their efforts in "building a new world."  Stay tuned.

[Addendum] Commenter MickeyMcD points us to a piece on mises.org, one of my favorite websites.  From there I filched the above graphic and reproduce the following by Murray Rothbard -

Our very real medical crisis has been the product of massive government intervention, state and federal, throughout the century; in particular, an artificial boosting of demand coupled with an artificial restriction of supply. The result has been accelerating high prices and deterioration of patient care. And next, socialized medicine could easily bring us to the vaunted medical status of the Soviet Union: everyone has the right to free medical care, but there is, in effect, no medicine and no care.

And Erick Erickson's 'I'm not down on John Roberts' fills in the details on the political vs constitutional aspects of the court's ruling.

Comments

[THEMIKEYMCD]

Time for word association game: #tyranny #Indebted #enslavement #autocracy #obamacare #SCOTUS

[THEMIKEYMCD]

It is official, I hate Obama (or at a minimum whoever is writing his speeches).

His final comments today regarding Obamacare:
Time to focus on getting people back to work [despite a new law that forces employers NOT to hire]
Time to focus on paying down debt [despite Obamacare adding over $1,000,000,000,000 in debt over 10 years]
Time to have a system where success is rewarded [despite skyrocketing taxes on success]

The socialist win again... George, you are correct, we are past the tipping point "...from the last great century of man"

[Douglas Keachie]

Danged legislating judges!

Or are these guys part of the Constitution you are normally so fond of?

[Steven Frisch]

If I had a dollar for every time man has said "doomsday is just around the corner", I would be a happy man. I prefer, like historian Walter McDougall, to believe that "Freedom Is Just Around The Corner".

"American character": rather the conditions of liberty in America, merely allowed the human nature common to all people to flourish and express it in the most complete way, the good, bad, and ugly alike. The good we embrace, the bad we reject, the ugly, we understand as we strive to do better. This is what makes us truly "exceptional", not the drumbeat of popularized but shallow patriotism.

And lest we forget, the struggle to make health care cover everyone, and be the best it can be is not over. It will require change over time to perfect.

But, in 50 years history will look back on this day and say, "President Barack Obama achieved something that Teddy Roosevelt, Franklin Roosevelt, Harry Truman, Lyndon Johnson, Richard Nixon and Bill Clinton could not; freedom from fear of illness due to lack of care."

[George Rebane]

DougK 936am - you missed it again. SCOTUS did nothing unconstitutional in its Obamacare ruling. Among the details of the ruling, it simply called Obama and his Congressional echo chamber liars when for months they kept assuring the country that the individual mandate was not a tax.

You don't have to agree with everything that comes out of SCOTUS, POTUS, and COTUS to accept that they are indeed the three branches of our constitutional government. Capice?

[Douglas Keachie]

Maybe you should explain that to Todd.

[Douglas Keachie]

I suppose you have a problem with the Social Security tax?

[George Rebane]

StevenF 1001am - "... freedom from fear of illness due to lack of care." As argued here for years, that freedom is not assured by nationalized healthcare, since no one has yet to crack the code on the combination of sustainable levels of cost vs care as the EU countries have demonstrated.

We know the healthcare debate and legislation are not finished, but just getting its second (umpteenth?) wind. Maybe we will revamp Obamacare with enterprising factors that will make it economical and sustainable, or maybe it will be repealed and a system based on more free market capitalistic principles (as discussed in these pages) established. In either case you may still be right; I don't have anything against President Obama being remembered for getting the ball out of center court.

[THEMIKEYMCD]

Not a good day for life expectancy.

http://fb.me/xbHxCzC6

[THEMIKEYMCD]

Ironically, today's decision is Bush's fault #judgeroberts #Obamacare #SCOTUS

[George Rebane]

DougK 1010am - Social Security is now a dead horse named Ponzi whose rotting carcass continues to feed the entitlements epidemic. And we are all like flies feeding on it as long as it lasts.

[Ryan Mount]

Thinking out loud, I wonder if Judge Roberts just boosted Romney's prospects?

http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/june_2012/health_care_law_has_already_lost_in_court_of_public_opinion

[Douglas Keachie]

I kinda doubt Romney will be able to get any votes from those with pre-existing conditions. I rather think that is enough to swing the election right there. Woodsy shall pay $100 to Hospitality House.

[Michael Anderson]

George wrote: "Maybe we will revamp Obamacare with enterprising factors that will make it economical and sustainable, or maybe it will be repealed and a system based on more free market capitalistic principles (as discussed in these pages) established. In either case you may still be right; I don't have anything against President Obama being remembered for getting the ball out of center court."

As I have expressed to your personally, George, most of the things I find refreshing on this blog are of a non-political nature. I just wanted to acknowledge that these are the most refreshing political words I have seen you post here. I completely share your sentiments that PPACA is still very much a work in progress, and I think that is a very good thing.

I would have been disheartened had the ball gotten stuck back in center court.

Michael A.

[Ryan Mount]

Yes Doug, I doubt anyone with a pre-exisiting condition will vote for Romney. That seems obvious. But they can thank me later for my higher taxes and premiums I'll have to pay come 2014.

My point is Roberts is shrewd and he may be thinking longer term given the most recent poll results listed above.

Suddenly for the Republicans, this became their issue. And as long as 54% of Americans don't like PPACA, which has remained unchanged since its introduction, they might have discovered their rallying point.

Earlier I was convinced that Obama was gonna coast into a second term. I'm not so sure anymore. In fact, I'll go out on a limb here and say that this arguable win for the Democrats might actually work against them come November.

[David King]

I'm so glad we can finally call this tax, a tax!

http://www.youtube.com/watch?v=7UcxU8PtzRs

Now I get, oh wait, what about that 250,000.00 no tax thingy?

http://www.youtube.com/watch?v=4zvn_MOQUvA

[billy T]

This is all the more reason to get the private sector job market rolling again. Its all a mute point if only half the tax payers pay any Federal Income Tax. We need to get the economy geared up so those who do not purchase insurance now will be able to purchase insurance when they are forced to. And pay they will.

[Douglas Keachie]

This is Mrs. Keachie, Dianka, Many things to say... First of all, in Conn. and Boston where I was raised and have many links, the health care system which Romney crafted with the Kennedy era relatives,etc., could not succeed without healthy younger people contributing a small fee to help pay for the ,"others" including members of their OWN FAMILIES. THIS GROUP OF YOUNGER CITIZENS (20-40) ALSO HAS THE HIGHEST AUTO ACCIDENT RATES, AND THE WOMEN HAVE THE HIGHEST RATE OF BIRTH AND PRENATAL COMPLICATIONS. It is total hypocrisy for Romney to disrespect the Obama's health care solution, while also disowning the hard work he did to create the only working universal health care system,(still w. problems), in a progressive state. People of Massachusetts think that the rest of the states are full of idiots for not facing the reality that we ALL NEED HEALTH CARE! Conservatives will scream about Obamacare, while also screaming if you touch MEDICARE, the largest socialized medical system already in existence in America. CHAMPIS, the second largest medical system in America, also serves the military and dependents.
There are 77.7 million boomers who poured lots of money into Social Security and Medicare during their most productive working years,(that's us boys). The Bush and Reagan Presidencies who opened the coffers, and preached trickle down economics, and kicked mentally ill people onto the streets, merely spread the social responsibility around. Hospital emergency rooms are shutting down because of the large number of uninsured and immigrants w. no care.

The stratified education system you protect so strongly produced the 1% of Wall Street with no ethics. "Greed is good" for them, including Hank Poulson, the leader of finance who was also involved in thinking up the financial instrument of "CREDIT DEFAULT SWAPS ON MORTGAGES". I RECALL READING HE MADE 500 MILLION AND WAS BOWED TO, AS A GENIUS OF FINANCE. (Will check that fact to be sure.) He was also the voice of TARP which gave 245 BILLION to the banks. Look what the 1% have done to our country! (Many of them are very good people who refused to participate.) Oh yes, lets not encourage our leaders to stand up and fix immigration in a humane way, while ER's close, free student lunch is 55% in many schools, and very good teachers are being put down because teenagers with NO ACADEMIC TRADITION in any language are being "Tested" with native born students. The stats on language acquisition are that verbal fluency in three years is achievable, but full academic literacy takes 7 years with a motivated student. Some of the students I have, work hard, learn, and move on and up. Then, of course the billions and billions we spent on the WARS, “BORROWING,” (creating the financial shambles George alludes to) from Social Security, is money poor spent. Our Social security was spent to pay for the wars, and the younger generation is screaming, and the talk show hosts are propagandizing that the Boomers are stealling from Gen X etc.

The people in Denmark and Sweden pay 50% in taxes and are very satisfied with the cradle to grave services. Older people here call "socialism" bad, very bad. The Danes get pregnant and they have complete choice, birth with full medical, daycare and home assist for first time mom, OR abortion, OR adoption. Their taxes pay for all education, including university 4 years, OR trade school, while receiving full medical care their entire lives..Elders receive full services. When interviewed they say, "of course, its a lot to pay, but we have what we need and we don't have to worry and fight over each little piece. We care about our families and our citizens in this country. Our lives are good here."

America does not care for all its citizens, and squabbles over the pieces. Give tax cuts to the billionaires and roll the dice on the rest of the pieces. Remember the 49'r fire? I was told that it began because a homeless man with schizophrenia and off his meds, lit toilet paper on fire in the woods. How many people lost their homes? How many acres and personal tales of loss because there was not enough tax money, and social workers to help this person? Add up what you really spend on alternative taxation problems. Roll the dice. Get off your butts and volunteer somewhere, because trickle down has failed.

Children and families are hungry and hurting all over this country. Romney crafted a workable start to health care compromise in Mass. Obama crafted a workable start to healthcare compromise here and now. That's what we need more of, representatives who craft solutions to our problems. Work together. Don't we all want a better, humane, place to live? Or would you rather step over the bodies of homeless on the streets of our U.S. cities? ~Dianka~

[George Rebane]

DougK 532pm - Welcome Dianka! It is heartening to see spouses caring and of one mind. You give new meaning to flying in tight formation. Please come again.

[billy T]

My my Mrs Keachie, you certainly have much to say. And I thought my posts as well as your hubbie's posts were long winded at times. I see this a one big job killer for small businesses across the land. Young people will live forever and are invincible and they already know there is no penalty if they are too busy to get around to signing up for insurance. Relying on young people to pay the freight is akin to having young workers pay your pension as well as theirs. That is not fair, now is it? With unacceptable unemployment rates among our youth (especially our youth of color)I do indeed see this as just another good intention with the proverbial road to hell pavers. Another Medicare if you will. Every study shows the Social Security system can be salvaged, but what is unsustainable is Medicare and SS Disability. They are crushing us, our budget, and have no "sustainability". Love that word "sustainability", don't you? Just using it gives me warm fuzzies. Wonder why Obamacare cuts half a billion from Medicare. But, I digress once again. Billions upon billions of tax increases to pay for the ride is a budget buster and a small business job killer. We need small businesses to get their sea legs back or else we as a nation are doomed. Small businesses employ more people than any other category. Forget the evil 1%ers and the abominable subsidies to the evil corporate energy producers (the green industry that is raping us and not paying their fair share)and the mean banks who now are required to increase cash and capital reserves before lending. Forget all of that. Lets put the horse before the cart for once and get small businesses going. Then work on Obamacare. We can't have half the folks pushing the cart filled with the other half of the population. This is the biggest middle class tax hike in history.

[billy T]

Not surprised you mentioned the Danes. If only this was Euroland. The answer to all our problems is to tax more, take from the producers and give to the non producers and spend like drunken sailors. Yep, I have heard that song and dance before in academia. Haven't heard it from Main St. If only we were more like Sweden. Life would be grand and free from worry, boredom, and care. God Bless Northern Euroland.

[George Rebane]

billyT 644pm - I've always been puzzled by the absence of high tech start-ups in Denmark, and their reported steady loss of entrepreneurs seeking greener pastures elsewhere. The only thing they seem to compete on is wind turbine blades. According to Heritage, Denmark has dropped its rating considerably but is the 11th freest economy in the world (US is 10th).

[billy T]

I suppose we will all have to wait to see how all these Obamacare taxes work out. At least the Supreme Court calls it what it is. The mandate is simply a tax. I am more scared out the effects of the taxes after 2016 than the taxes levied in 2014. Its anyone's guess right now. I do remember the summer of 2010 that made those usually boring town hall meetings rather exciting. What was the catalyst for all that rambunctious behavior that summer? Something to do with Obamacare I think, but I could be wrong. First we have Recovery Summer, then Green Sprouts Summer, then Town Hall Summer. Well, I just got to wait and see how it all pans out. Congress can pass taxes and Congress can receind taxes.

[billy T]

Meanwhile, back in the Golden State: http://www.latimes.com/business/la-fi-supreme-health-calif-20120629,0,2484724.story?page=2

[Account Deleted]

re: Ms Keachie and and her rant. Thanks for finally revealing who runs the sock puppet named Douglas. Your ageist and fact-less nonsense just shows what we conservatives are up against. "THIS GROUP OF YOUNGER CITIZENS (20-40) ALSO HAS THE HIGHEST AUTO ACCIDENT RATES, AND THE WOMEN HAVE THE HIGHEST RATE OF BIRTH AND PRENATAL COMPLICATIONS" OK - let's run the numbers on young black males and the justice system. When will we tax the young black males a couple of hundred a month for their existence in this country? Oh that's right, that's different. "I was told that it began because a homeless man with schizophrenia and off his meds, lit toilet paper on fire in the woods. How many people lost their homes? How many acres and personal tales of loss because there was not enough tax money, and social workers to help this person?" So, Ms Keachie - you are for forced medication of those deemed to be in need of meds by the govt? There is not enough money in the world to make schizos take their meds. I have way too much personal knowledge of those who need meds and will not take them. The idea that more money is needed is BS. Once you are 18 you can legally refuse to take meds, even if a doctor prescribes them as necessary. You had better go back and look at the judicial rulings that led Reagan to "throw them in the streets". Why not? There was no point in caring for folks who would lounge in state facilities and not take the medication they needed. Forced medication of citizens is an extremely delicate subject that requires the attention of people that have more brains than bile and you don't qualify. Politicizing this subject as left vs right is childish and dishonest. Please come back and discuss this subject with some facts and a open, honest discussion of what powers the state has to mandate medical drug use.

[Russ Steele]

Dear Dianka, welcome to the discussion. For the record CHAMPIS died over 10-15 years ago and was replaced by Tri Care, a huge improvement. CAMPIS had so many forms, reviews and lost paper work, that may just refused to be bothered and sought care outside the system, we did for years. As a 20 year vet, we now get excellent care under Tri Care For Life, but under the new rules our care costs are going to triple, with no increase in the level of service.

However, when we were in the military, the level of care for my family was hit and miss. We had no option to choose the doctor, you got who ever was on duty, even if the doctor could hardly speak English. There was very little continuity of care, it was Doc A one day, Doc B the next and a week later Doc C. As a flyer, I got special care from the flight surgeons.

If you do a little research your will discover it was President Johnson (D) that opened the Social Security Coffers to pay for his “great society.” We are still paying for it and the poverty levels have not changed much, but now those great society members are living in poverty with flatscreen TVs, cable, food stamps, free cellphones with a 100 free minutes a month, and many make up the growing obese population in this county. I personally think that we could solve a good portion of the US obese problem by having monthly weigh ins for all food stamp recipients.

Denmark spend 7% of GDP on health care and the US about 16%. The difference is that in the US is due to the lack of medical tort reform, US doctors are forced to practice defensive medicine to reduce the lawsuit risk. Congress refuses to address the tort reform issue, and we go on paying for it. Now Obama Care is poised to institute the “death panels” of faceless bureaucrats with no medical training deciding if citizens over 75 are worth the medical expense of a critical test or procedure. As 74 year old, I am concerned and all those of advancing age should be as well. I have no idea how old you are, but if in your 60s enjoy life before you get to the age where you to have deal with the “death panels,” just to stay alive and spend a few more days with the grandkids.

[George Rebane]

If you are looking for something to mull over before retiring tonight, consider a United States that now can mandate citizens to do damn near anything that comes to a socialist's mind by just calling the mandate and its related cost a tax. SCOTUS today said that was OK.

Sweet dreams.

[billy T]

I have to agree with Dianka K. Sorry fellas but she knows what she is talking about. WOMEN HAVE THE HIGHEST RATE OF BIRTH AND PRENATAL COMPLICATIONS. Now, who in their right mind can argue with that. Passing stones in no way compares with passing little crumb snatchers. Sweet dreamies back at you, Dr. Rebane. Hopefully tomorrow we will all wake up and hold hands and begin anew. Nah, just kidding.

[Michael Anderson]

Russ wrote: "I personally think that we could solve a good portion of the US obese problem by having monthly weigh ins for all food stamp recipients."

I think this is already a TV show. Or maybe there's an app for that?

[George Rebane]

Given that we understand the difference between a right and a privilege, http://rebaneruminations.typepad.com/rebanes_ruminations/2010/03/rights-and-privileges.html

has anyone a clue on the reasonable basis for a state to make healthcare a right - as maintained by progressives - which causes that resource to become a commons and suffer the inevitable fate of all commons? And while doing so, it will contribute to the drain of society's wealth creating juices, thereby finally impacting everyone's quality of life.

[Paul Emery]

George

A reasonable level of health care for all is a necessity in a modern country. Also, you again extrapolate the fate of all commons on unfounded theories by selected trumpets. I question the whole premise you offer therefore it is hard to expand on the conversation.

[Todd Juvinall]

I think Anerica spends 1/6 of every dollar its people make on health care. Now, maybe someone could do a per capita and let us know what the amount is mine?

[George Rebane]

PaulE 1015am - Not sure which of the several premises I offered are 1) unfounded, and 2) not expandable.

But if you reject that all resource commons will ultimately be destroyed, then you're going to have to present us with the 'trumpets' that so profess. The other side is filled with trumpets who understand what a commons is, and therefore its fate (cf. Garrett Hardin et al). No collectivist has ever accepted 'The Tragedy of the Commons', that would collapse the foundation of their public policy process.

And yes, with such a rejection the conversation would grind to a halt, because it would require communication across the boundary separating two universes.

[George Rebane]

Apparently I have here missed the mark (even with the hint in my 952pm) on identifying the real impact of this ruling. I make another attempt at
http://rebaneruminations.typepad.com/rebanes_ruminations/2012/06/conservatives-miss-impact-of-scotus-ruling.html

Hope this helps to clarify and focus the discussion.

[Paul Emery]

George

I believe that the necessity for health care is much the same as the necessity for clean air and water, both accepted "commons" to use you're language. . Of course I reject the notion that all commons will ultimately be destroyed. That position is totally simplistic and would imply that all modern nations that have a universal health care system are doomed to some ugly fate. That of course will not happen. History up to this date has shown that. I suggest reading Land of Promise: An Economic History of the United States by Michael Lind for a different perspective.

[Paul Emery]

More about Land of Promise

From one of America’s leading intellectuals comes a sweeping and original work of economic history, recounting the epic story of America’s rise to become the world’s dominant economy.

In Land of Promise, bestselling author Michael Lind provides a groundbreaking account of how a weak collection of former British colonies became an industrial, financial, and military colossus. From the eighteenth to the twenty-first centuries, the American economy has been transformed by wave after wave of emerging technology: the steam engine, electricity, the internal combustion engine, computer technology. Yet technology-driven change leads to growing misalignment between an innovative economy and anachronistic legal and political structures until the gap is closed by the modernization of America's institutions—often amid upheavals such as the Civil War and Reconstruction and the Great Depression and World War II.

Against the dramatic backdrop of shattering tides of change, Land of Promise portrays the struggles and achievements of inventors like Thomas Edison and Samuel Morse; entrepreneurs like Henry Ford, John D. Rockefeller, Andrew Carnegie, Bill Gates, and Steve Jobs; financiers like J. P. Morgan; visionary political leaders like Henry Clay and Franklin Roosevelt; and dynamic policy makers like Alexander Hamilton and Vannevar Bush. Larger-than-life figures such as these share the stage with the ordinary Americans who built a superpower, from midwestern farmers, southern slaves, and the immigrants who created canals and railroads to the sisters of Rosie the Riveter, whose labor in factories during World War II helped to end Hitler's dream of world domination.

When the U.S. economy has flourished, Lind argues, government and business, labor and universities, have worked together as partners in a never-ending project of economic nation building. As the United States struggles to emerge from the Great Recession, Land of Promise demonstrates that Americans, since the earliest days of the republic, have reinvented the American economy—and have the power to do so again.

[George Rebane]

PaulE 1044pm - thank you for the air and water examples, for they underline the point of how the commons are destroyed. You really should study up on the commons and its dispositions throughout history. It's cognitive territory where the progressive and capitalist have been able to meet and agree. Their differences re-emerge when they offer solutions for protecting the commons which they both agree is there.

Each commons has a natural carrying capacity. When the commons' resource is consumed at or below its carrying capacity, it remains intact. When exceeded, it begins to destruct. LA's air mass achieved that excess during the later WW2 years and literally destructed during the heat wave of 1948. This gave rise to regulatory oversight which over the years has brought that commons back into relative health, since that stopped its intense over-consumption. Other jurisdictions in similar straits around the world have similarly stopped the destruction of their air commons. Those that haven't are now poster children for what happens to an over-consumed commons.

The same kinds of examples can be given where water (especially riverine) is a commons which is over consumed by, say, fishing and/or as a receptacle for wastes. Again, each body of water has a certain carrying capacity as a resource. When that is left as a commons and over-used, the commons is destroyed, and that happens with the certainty of sunrise.

Socialized healthcare can become and has readily become a commons, since the costs of its consumption are not directly borne by its users (i.e. the costs are delayed, hidden, and/or distributed to dilution for the consumer). For this reason it is not sustainable (constant services for constant costs) anywhere in the world, and its semblance can only be continued by strict oversight and ever greater rationing, else its costs run away and the healthcare commons is destroyed.

But I have explained all this numerous times in these pages. Oh well ...

[Michael Anderson]

George, I'm having trouble with your characterization of PPACA as a Commons. It's not Single Payer. Private insurance companies will still compete for our business. It's just like the states requiring that people have auto insurance, and penalizing them if they don't. (Yes, I understand that a state is different than the fed, but we aren't discussing constitutional law here, just the metaphor of the Commons.)

If Single Payer was being implemented I would be able to see your point. But w/ PPACA, I'm having trouble. Please help me out, thanks.

[Gregory]

"It's just like the states requiring that people have auto insurance, and penalizing them if they don't."

It's not at all like auto insurance. First, if you don't drive your car on public property, you don't need insurance at all. Second, the insurance that is required isn't to pay your own bills, it's a liability policy of a minimum amount to cover damages your negligence or error in operating your car to the persons or property you damage. If car insurance was like Obamacare, the policy you would be forced to buy would not only fix your car when damaged, but would pay for regular oil changes, fixing broken power windows and engine or transmission overhauls.

Now, if someone else actually owns your car (say a bank or a finance company) they will force you to buy a comprehensive insurance policy that actually does fix your car if you break it.

OK, I think I understand the analogy being made by the Obamacare partisans... the government actually owns your body and the bodies of your family, so it is their right to force you to buy a comprehensive health insurance policy they specify that will fix what they say needs fixing. And perhaps, someday, to issue a penalty tax if your supermarket purchase records indicate you've not been eating enough broccoli.

[Gregory]

George, the healthcare commons has already been slowly eaten away by cost shifting forced by the half of all healthcare that has already been socialized. Medicare and Medicaid don't pay enough to providers to cover their bloated costs, so to balance their books, hospitals and other providers boost the prices to everyone else. If you have an HMO/PPO, you in essence are also paying 'protection money' to the insurance company to make sure you will be charged less than the poor schmuck who walks in without a promise the charges will be "usual and customary".

There hasn't been a free market in healthcare since the Medicare "Great Society" commons combined with the former "fringe benefit" of employer provided healthcare that grew out of a WWII wage and price control dodge by the largest defense contractors like Kaiser Heavy Industries, pioneer of the HMO. People haven't been spending their own money for years, and a goldplated employer healthcare policy represents a huge amount of untaxed income to the lucky recipient. It also fuels the wildfire of healthcare cost shifting.

This commons has been overgrazed for years.

[Paul Emery]

George

Since we agree that healthcare is a commons like air and water then imposed regulations are in order to insure against overgrazing. Single payer is the only realistic solution. The Repubs offer nothing but empty rhetoric and a hope and a prayer with no current examples currently in place and the Dems gave us Obam's plan what we have today.

[George Rebane]

Re healthcare. I think that MichaelA’s 1257am points are a relevant expansion of this discussion, and Gregory’s 709am covers well the deterioration of our healthcare system to the degree that it has subsumed the trappings of a commons. PaulE’s 755am(also MichaelA’s?) prescription to promote Obamacare into a single payer system – which all progressives and Democrats want – will complete the journey of healthcare into a commons by 1) removing the cost-to-service link, 2) reducing healthcare resources (personnel, medicines, facilities, technologies), 3) increasing costs to an ever greater fraction of GDP, and 4) imposing rationing so as to lower availability of service (carrying capacity).

Recall that one critical characteristic of a commons is that its consumers are punished to the extent that they reduce their consumption of the commons, i.e. practice altruism. The British National Health Service is the poster child of this behavior.

The healthcare ‘safety valve’ for quality of care will be offshore enterprises in the Caribbean, India, Thailand, … that will be sought out by those who can afford it. Whether these entrepreneurial efforts are enough to continue attracting investment and commitment of creative juices to develop new medicines and medical technologies is yet to be seen. But the forces will be there to put a damper on such efforts.

[Douglas Keachie]

Thanks for your response and clarifications. Re Champis, etc. I am well aware of the difficulties of the military type system, as I lived in Japan years ago with a Navy doctor and volunteered on the base in 2 clinics. Changing doctors, like in Kaiser, is a problem for some people. There are many ways to structure rationed care, as no one likes to call it. For example, the creative "for profit" health care providers have found that satellite clinics are more cost effective in covering preventive care and "minor health problems". All players in the system need to sit down together, the Clintons' learned this in their research. One of the players is the AMA & Medical Board system which strictly regulates the number of physicians in the system nationwide. They are predicting a large shortfall of physicians nationwide, particularly in family medicine,(which earns less money than higher paid specialists). The AMA also blocks the number of PA's, physician's assistants in clinics.

This new level of extra training for RN's to diagnostic and medical level privileges in treatment is far cheaper than expensive doctor care. Millions more people would get important care which catches "expensive" problems like low birth weight babies in teens, diabetes in all age groups, infections and minor injuries,(stitches and wound care). Also, in regard to the "death panels", I ask when you were last admitted to surgical admission? The first thing they shove in front of you is a paper asking if you have a living will designate, to limit care at end of life. We need more reality based pragmatism in helping more people prepare for their end. Free computer programs for living wills and designated last wishes for end of life care are common sense ways to help our large boomer population conserve medical resources. One of the worst problems doctor's face is squabbling relatives, when a loved one is comatose or with major brain damage after a stroke. This high tech group of computer users could help a lot in such preparation and dissemination of program information to help many. The DMV system has been used very effectively to increase the sign-up for organ donors, why not living wills, in a one-page concise statement of choice? It could work. Dianka

[Gregory]

Price tends to chase available dollars. Cost of college educations, another commons, has been driven by the flood of student loan fundings, and even more of that money has been made available by the resurrection of indentured servitude as student loan debt, once incurred, can't be discharged by a bankruptcy. It's yours until you die; you can take it with you.

When I was an undergrad, the cost of four years at a gold plated top tier private college, including room and board, was less than the cost of a nice Porsche. Now you're coughing up a Porsche every year. Gold plated insurance drives healthcare costs up just as much as student loans and scholarships drive up college costs, and like at the colleges, where the slush inflates the bureaucracy and not the actual education, there's not that much money going to the doctors and nurses actually providing care.

If people actually had to pay taxes on the formerly "fringe" benefit of employer paid insurance, they'd think twice about going on strike to get more.