Well without delving into the social contract theory, I think everything about Libertarianism is good, in that it reduces the scope of federal and state government down to: protect the people and their property.
Libertarianism is socially Liberal and fiscally Conservative. That to me is the best imaginable government.
Well without delving into the social contract theory, I think everything about Libertarianism is good, in that it reduces the scope of federal and state government down to: protect the people and their property.
Libertarianism is socially Liberal and fiscally Conservative. That to me is the best imaginable government.
Well it's social Liberal in that it leaves the decision on social issues to the people of each state. Plus you will never see a libertarian supporting any type of government run or imposed universal healthcare.
"When one gets in bed with government, one must expect the diseases it spreads." - Ron Paul
Well without delving into the social contract theory, I think everything about Libertarianism is good, in that it reduces the scope of federal and state government down to: protect the people and their property.
Libertarianism is socially Liberal and fiscally Conservative. That to me is the best imaginable government.
You know, that was my impression at first too, but the more I read up on it, the more it concerns me. Their focus is narrow, I think. And there seems to be a diversity of libertarian perspectives.
The greatest obstacle to discovery is not ignorance,
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
Well it's social Liberal in that it leaves the decision on social issues to the people of each state. Plus you will never see a libertarian supporting any type of government run or imposed universal healthcare.
mammasan, speaking of health care, what is the libertarian approach? Our current system is needs much improvement. Do they have any ideas? I'm sure I can look it up, but you probably can save me the effort.
The greatest obstacle to discovery is not ignorance,
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
You know, that was my impression at first too, but the more I read up on it, the more it concerns me. Their focus is narrow, I think. And there seems to be a diversity of libertarian perspectives.
True there is no one clear Libertarian vision. There are libertarians who just want a scaled back version of our federal government and less government intervention in our everyday lives. then you have libertarians who want government for the sole purposes of national defense. Our federal government has grown to big and powerful to every be truely removed, but it can be scaled down significantly. Libertarians seem to be the only ones wanting to do this. Check out Ron Pauls website and see where he stands on the issues.
"When one gets in bed with government, one must expect the diseases it spreads." - Ron Paul
True there is no one clear Libertarian vision. There are libertarians who just want a scaled back version of our federal government and less government intervention in our everyday lives. then you have libertarians who want government for the sole purposes of national defense. Our federal government has grown to big and powerful to every be truely removed, but it can be scaled down significantly. Libertarians seem to be the only ones wanting to do this. Check out Ron Pauls website and see where he stands on the issues.
Thanks mammasan. I agree that our government has become somewhat bloated and needs some work. I'm actually on Paul's site now. Like I said, I'm sure I'll have more questions after I'm a bit more educated on the subject.
The greatest obstacle to discovery is not ignorance,
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
mammasan, speaking of health care, what is the libertarian approach? Our current system is needs much improvement. Do they have any ideas? I'm sure I can look it up, but you probably can save me the effort.
Well libertarians don't believe that the government should force all it's citizens into one universal healthcare plan. I'm not 100% sure on their stance because mine varies sightly, but that is what I understand it to be. I don't support universal healthcare because I believe our government is too corrupt and plaqued with ineptitude to properly manage something so big. Much like most social programs in this country the amount of mismanagement of funds and lack of over-sight is sickening. The same problems would inhabit universal healthcare and in the end it would probabaly end up being more expensive to tax payers than if they went out and procurred their own healthcare coverage.
"When one gets in bed with government, one must expect the diseases it spreads." - Ron Paul
Well libertarians don't believe that the government should force all it's citizens into one universal healthcare plan. I'm not 100% sure on their stance because mine varies sightly, but that is what I understand it to be. I don't support universal healthcare because I believe our government is too corrupt and plaqued with ineptitude to properly manage something so big. Much like most social programs in this country the amount of mismanagement of funds and lack of over-sight is sickening. The same problems would inhabit universal healthcare and in the end it would probabaly end up being more expensive to tax payers than if they went out and procurred their own healthcare coverage.
so what is the libertarian answer for those that through no fault of their own are uninsureable and are not independently wealthy? under libertarian policy are they supposed to fuck off and die?
so what is the libertarian answer for those that through no fault of their own are uninsureable and are not independently wealthy? under libertarian policy are they supposed to fuck off and die?
I have that same question, prism.
And, Yea, this thread is about libertarian ideology again!
The greatest obstacle to discovery is not ignorance,
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
so what is the libertarian answer for those that through no fault of their own are uninsureable and are not independently wealthy? under libertarian policy are they supposed to fuck off and die?
Like I said I'm not 100% sure as to what libertarian belief is on universal healthcare. I deviate from them, slightly, in that aspect. farfrom glorified would be better equiped to answer the question. I don't think that libertarians what people to fuck off and die as you so eliquently put it. They just believe that it is not the role of the government to provide this service.
"When one gets in bed with government, one must expect the diseases it spreads." - Ron Paul
And, Yea, this thread is about libertarian ideology again!
I'm sure that they have an answer, I just don't know it. Personally I would like to see communal healthcare. Where a community of people come together form a group and approach a healthcare insurance provider to offer their group insurance coverage on a group rate. The larger the group the lower the individual premiums will go. This can be organized by religious or non for profit organizations. I don't know if it is feasible but it can provide affordable healthcare coverage and it is a voluntary program without any government involvment.
"When one gets in bed with government, one must expect the diseases it spreads." - Ron Paul
Like I said I'm not 100% sure as to what libertarian belief is on universal healthcare. I deviate from them, slightly, in that aspect. farfrom glorified would be better equiped to answer the question. I don't think that libertarians what people to fuck off and die as you so eliquently put it. They just believe that it is not the role of the government to provide this service.
well my questions stand for ffg to answer as well
if not the goverments job then who's job is it? surely not the insurance companies since they already deny health insurance to millions of people based on various pre-existing health problems that exist though no fault of their own.
if not the goverments job then who's job is it? surely not the insurance companies since they already deny health insurance to millions of people based on various pre-existing health problems that exist though no fault of their own.
I have explained why i don't want the government involved in universal healthcare. Trust me I would love nothing more than to see every body have healthcare coverage but knowing how fucked up our government is it would just become another fiscal blackhole.
"When one gets in bed with government, one must expect the diseases it spreads." - Ron Paul
so what is the libertarian answer for those that through no fault of their own are uninsureable and are not independently wealthy? under libertarian policy are they supposed to fuck off and die?
If individual people care enough, then they should donate some money to a chairty. It's not the gov'ts responsibility to hand out cash to any cokehead douchebag without a job.
My personal policy is that if you have a job but still need welfare (because you have a min. wage job) then the gov't should add whatever amount of $ that will raise you above the poverty level. But if you have no job, you get nothing.
I have explained why i don't want the government involved in universal healthcare. Trust me I would love nothing more than to see every body have healthcare coverage but knowing how fucked up our government is it would just become another fiscal blackhole.
I don't think anyone is claiming that it would be perfect but it would sure beat the shit out of what we have now. *edit* i meant National Health care not libertarianism
National Health Insurance
Liberal Benefits, Conservative Spending
by Steffie Woolhandler, MD, MPH and David U. Himmelstein, MD
FEW WOULD dispute that our health care system is deeply troubled. Thirty-nine million Americans are completely uninsured and millions more have inadequate coverage. After a brief lull, health care costs have resumed their exuberant growth; health maintenance organizations (HMOs) have fallen to the basement of public esteem and have failed to contain costs; commercial pressures threaten medicine's best traditions; and healing has become a spectator sport, with physicians and patients performing before a growing audience of bureaucrats and reviewers. Opinion on solutions is more divided.
Debate over health care reform has been muted since the defeat of the Clinton Administration Rube Goldberg scheme for universal coverage. But the fast developing health care crisis--business leaders grappling with rapidly rising premiums, workers and unions facing cutbacks in coverage, governments confronting deficits, and a sharp upturn in the number unemployed and uninsured--promises to spur new interest in reform.
We advocate a fundamental change in health care financing, national health insurance (NHI), because we are convinced that lesser measures will fail.
In the 35 years since the implementation of Medicare and Medicaid, a welter of patchwork reforms has been tried. Health maintenance organizations and diagnosis related groups promised to contain costs and free up funds to expand coverage. Billions of dollars have been allocated to expanding Medicaid and similar programs for children. Both Medicare and Medicaid have tried managed care. Oregon essayed rationing in its Medicaid program, Massachusetts and Hawaii passed laws requiring all employers to cover their workers, Tennessee promised nearly universal coverage, and several states have implemented high-risk pools to insure high-cost individuals. For-profit firms pledged to bring business-like efficiency to running HMOs, hospitals, dialysis clinics, and nursing homes. And market competition has roiled health care's waters.
None of these initiatives has made a dent in the number of uninsured, durably controlled costs, or lessened the inexorable bureaucratization of medicine.
All such patchwork reforms founder on a simple problem: expanding coverage must increase costs unless resources are diverted from elsewhere in the system. With US health care costs nearly double those of any other nation and rising more rapidly,1 and the economy gone sour, large infusions of new money are unlikely.
Absent new money, patchwork reforms can only expand coverage by siphoning resources from existing clinical care. Advocates of managed care and market competition once argued that their strategy could accomplish this by trimming clinical fat. Unfortunately, new layers of bureaucrats have invariably overseen the managed care "diet" prescribed for clinicians and patients. Such cost management bureaucracies are not only intrusive but expensive, devouring virtually all of the clinical savings.
Resources seep inexorably from the bedside to the executive suite. The shortage of bedside nurses coexists with a proliferation of RN utilization reviewers. Productivity pressures mount for clinicians, while colleagues who have withdrawn from the bedside to the executive suite rule our profession.
Bureaucracy now consumes nearly 30% of our health care budget.2-4
The latest policy nostrums--medical savings accounts and voucher schemes like President Bush's "premium support" proposal for Medicare--would further amplify bureaucracy and limit care. Medical savings accounts discourage preventive and primary care, while failing to curb the high cost of care for severe illnesses (which account for most health spending). Such plans would also require insurers to start keeping track of all out-of-pocket spending, while retaining their existing bureaucracy, and would slash the cross-subsidy from healthy enrollees to the sick.
Voucher programs are thinly veiled mechanisms to cut care. The vouchers offered are invariably too skimpy to purchase fully adequate coverage, forcing lower-income individuals into substandard plans. Voucher schemes also posit that frail elders and other vulnerable patients will make wise purchasing decisions from a welter of confusing insurance options. Finally, vouchers would boost insurance overhead by shifting people from group plans (ie, Medicare or employer groups) into the individual insurance market where overhead averages more than 35% of premiums.5
WHY NHI?
The fiscal case for NHI arises from the observation that health care's enormous bureacratic burden is a peculiarly American phenomenon. No nation with NHI spends even half as much administering care, nor tolerates the bureaucratic intrusions in clinical care that have become routine in the United States.
Our biggest HMOs keep 20%, even 25%, of premiums for their overhead and profit6; Canada's NHI has 1% overhead2 and even Medicare takes less than 4%.7 And HMOs inflict mountains of paperwork on physicians and hospitals. The average US hospital spends one quarter of its budget on billing and administration,4 nearly twice the average in Canada. American physicians spend nearly 8 hours per week on paperwork, and employ 1.66 clerical workers per physician,8 far more than in Canada.
Reducing our bureaucratic apparatus to Canadian levels would save 10% to 15% of current health care spending, at least $120 billion annually, enough to fully cover the uninsured and upgrade coverage for those now underinsured. Proponents of NHI,9 disinterested civil servants,10, 11 and even skeptics12 all agree on this point.
HOW NHI? Unfortunately, piecemeal tinkering cannot achieve significant bureaucratic savings. The key to administrative simplicity in Canada (and other nations) is single-source payment. Canadian hospitals (mostly private, nonprofit institutions) do not bill for individual patients. They are paid a global annual budget to cover all costs, much as a fire department is funded in the United States. Physicians (most of whom are in private practice) bill by checking a box on a simple insurance form. Fee schedules are negotiated annually between provincial medical associations and governments. All patients have the same coverage.
Unfortunately, during the 1990s Canada's program was starved of funds by governments responsive to pressure from the healthy and wealthy who sought to avoid cross-subsidizing care for the sick and poor. Where once Canadian and US health care spending were comparable, today, Canada spends barely half (per capita) what we do.1 Shortages of expensive, high-technology care have resulted. Yet, Canada's health outcomes remain better than ours (eg, life expectancy is 2 years longer1), and most quality comparisons indicate that Canadians enjoy care equivalent to that for insured Americans. A system structured like Canada's, but with double the funding, could provide high-quality care without the waits or shortages that Canadians have experienced.
The NHI that we propose would create a single tax-funded comprehensive insurer in each state, federally mandated but locally controlled. Everyone would be fully insured for all medically necessary services, and private insurance duplicating the NHI coverage would be proscribed (as is currently the case with Medicare). The current byzantine insurance bureaucracy with its tangle of regulations and wasteful duplication would be dismantled. Instead, the NHI trust fund would dispense all payments, and central administrative costs would be limited by law to less than 3% of total health care spending.
Each hospital and nursing home would negotiate an annual global budget with the NHI, based on past expenditures, projected changes in costs and use, and proposed new and innovative programs. Many hospital administrative tasks would disappear. There would be no hospital bills to keep track of, no eligibility determination, and no need to attribute costs and charges to individual patients. Cost shifting would be pointless as there would be nowhere to shift costs to.
Clinics and group practices could elect to be paid fee-for-service, or receive global budgets similar to hospitals. While HMOs that merely contract with providers for care would be eliminated, those that actually employ physicians and own clinical facilities could receive global budgets, fee-for-service, or capitation payments (with the proviso that capitation payments could not be diverted to profits or exorbitant executive compensation).
As in Canada, physicians could elect to be paid on a fee-for-service basis, or receive salaries from hospitals, clinics, or HMOs.
Properly structured, NHI would not raise costs; administrative savings would pay for the expanded coverage. While NHI would require new taxes, these would be fully offset by a decrease in insurance premiums and out-of-pocket costs. Moreover, the additional tax burden would be smaller than is usually appreciated, since nearly 60% of health care spending is already tax supported (vs roughly 70% in Canada). Besides Medicare, Medicaid, and other explicit public programs, our governments fund tax subsidies for private insurance that exceed $100 billion annually.13 In addition, local, state, and federal agencies that purchase private coverage for government workers account for 22.5% of total employer health care spending (D.U.H. and S.W., unpublished analysis of Current Population Survey data from the US Census Bureau, 2001).
Demonstration projects in 1 or more states might precede national implementation of NHI. Initially, funding might mimic existing patterns to minimize economic disruption, but all payments would be funneled through the NHI trust fund. Thus, Medicare and Medicaid moneys, as well as current government expenditures for employee health benefits, would go to the trust fund. Employers would pay a tax equivalent to the average now spent for health benefits. In the long run, a shift to a more progressive, income tax funding base would provide a fairer and more efficient revenue stream.
The NHI we propose faces important political obstacles. The virtual elimination of private health insurance will evoke stiff opposition from insurance firms. Similarly, investor-owned hospitals and drug firms fear that NHI would curtail their profits.
Practical problems in implementing NHI also loom. The financial viability of the system we propose is critically dependent on achieving and maintaining administrative simplicity. Canada's macromanagement approach to cost control -- enforcing overall budgetary limits is inherently less administratively complex than our current micromanagement approach, with its case-by-case scrutiny of billions of individual expenditures and encounters. However, even under NHI, vigilance (and statutory limits) would be needed to curb the tendency of bureaucracy to reproduce and amplify itself.
National health insurance could solve the cost-vs-access conflict by slashing bureaucratic waste. It would reorient the way we pay for care, and eliminate financial barriers to access. National health insurance could restore the physician-patient relationship, offer patients a free choice of physicians and hospitals, and free physicians from the bonds of managed care.
How many more failed patchwork reforms, how many more patients turned away from care they cannot afford, how many trillions of dollars squandered on malignant bureaucracy, before we adopt the only viable solution: NHI?
Steffie Woolhandler, MD, MPH
Cambridge
David U. Himmelstein, MD
1493 Cambridge St
Cambridge, MA 02139
REFERENCES
1. Organization for Economic Cooperation and Development. OECD Health Data 2001 [computer database]. Paris, France: Organization for Economic Cooperation and Development; 2001.
2. Woolhandler S, Himmelstein DU. The deteriorating administrative efficiency of US health care. N Engl J Med. 1991;324:1253-1258.
MEDLINE
3. Himmelstein DU, Lewontin JP, Woolhandler S. Who administers? who cares? medical administrative and clinical employment in the United States and Canada. Am J Public Health. 1996;86:172-178. MEDLINE
4. Woolhandler S, Himmelstein DU. Costs of care and administration at for-profit and other hospitals in the United States. N Engl J Med. 1997;336:769-774. MEDLINE
5. Pauly MV, Percy AM. Cost and performance: a comparison of the individual and group health insurance markets. J Health Polit Policy Law. 2000;25:9-26. MEDLINE
6. Special report. BestWeek Life/Health. April 12, 1999.
7. Heffler S, Levit K, Smith S, et al. Health spending growth up in 1999: faster growth expected in the future. Health Aff (Millwood). 2001;20:193-203. MEDLINE
8. Remler DK, Gray BM, Newhouse JP. Does managed care mean more hassles for physicians? Inquiry. 2000;37:304-316. MEDLINE
9. Grumbach K, Bodenheimer T, Woolhandler S, Himmelstein DU. Liberal benefits, conservative spending: the Physicians for a National Health Program proposal. JAMA. 1991;265:2549-2554. MEDLINE
10. US General Accounting Office. Canadian Health Insurance: Lessons for the United States. Washington, DC: US Government Printing Office; 1991. Publication GAO/HRD-91-90.
11. Congress of the United States Congressional Budget Office. Universal Health Insurance Coverage Using Medicare's Payment Rates. Washington, DC: US Government Printing Office; 1991.
12. Sheils JF, Haught RA. Analysis of the Costs and Impact of Universal Health Care Coverage Under a Single Payer Model for the State of Vermont. Falls Church, Va: Lewin Group Inc; August 2001.
13. Sheils J, Hogan P. Cost of tax-exempt health benefits in 1998. Health Aff (Millwood). 1999;18:176-181. MEDLINE
I necessarily have the passion for writing this, and you have the passion for condemning me; both of us are equally fools, equally the toys of destiny. Your nature is to do harm, mine is to love truth, and to make it public in spite of you. - Voltaire
I don't think anyone is claiming that it would be perfect but it would sure beat the shit out of what we have now. *edit* i meant National Health care not libertarianism
But why do we need to rely on the government specially with their track record. Why not cut the cord and ween ourselves off the government. It just seems that we as a scoiety have become dependent on our government, expecting it to care for us from craddle to grave. We need to take the initiative and care for ourselves. That's why I think we need to organize and coordinate with religious and/or non profits to provide affordable healthcare. All it would take is one company to cooperate and the rest would follow.
"When one gets in bed with government, one must expect the diseases it spreads." - Ron Paul
If individual people care enough, then they should donate some money to a chairty. It's not the gov'ts responsibility to hand out cash to any cokehead douchebag without a job.
My personal policy is that if you have a job but still need welfare (because you have a min. wage job) then the gov't should add whatever amount of $ that will raise you above the poverty level. But if you have no job, you get nothing.
the thing is people already DO NOT care enough for charities to be able to fund their healthcare. sure chairities do help some but not nearly enough. it's a fact that people DO NOT care about alot of health issues unless they are directly affected
I'm not talking about cokehead douchebags. I'm talking about people that get sick to where they can no longer work because of debilitating health problems that are NO fault of their own.
But why do we need to rely on the government specially with their track record. Why not cut the cord and ween ourselves off the government. It just seems that we as a scoiety have become dependent on our government, expecting it to care for us from craddle to grave. We need to take the initiative and care for ourselves. That's why I think we need to organize and coordinate with religious and/or non profits to provide affordable healthcare. All it would take is one company to cooperate and the rest would follow.
well when you consider that religious organazations (the Catholic Church) are already running many FOR profit hospitals and clinics. you many wanna drop them from the picture
well when you consider that religious organazations (the Catholic Church) are already running many FOR profit hospitals and clinics. you many wanna drop them from the picture
That's one organization. There are many other organizations. I'm not saying that this is the answer or that it may even work. I just think we need to investigate alternative means of providing healthcare, not just relying on big brother to provide us with everything.
"When one gets in bed with government, one must expect the diseases it spreads." - Ron Paul
the thing is people already DO NOT care enough for charities to be able to fund their healthcare. sure chairities do help some but not nearly enough. it's a fact that people DO NOT care about alot of health issues unless they are directly affected
I'm not talking about cokehead douchebags. I'm talking about people that get sick to where they can no longer work because of debilitating health problems that are NO fault of their own.
Like I said (sort of) if you are actually trying to make it, then the gov't should give you $ enough to put your income above the poverty line. Nothing more, and certainly nothing less.
Like I said (sort of) if you are actually trying to make it, then the gov't should give you $ enough to put your income above the poverty line. Nothing more, and certainly nothing less.
I was referring to healthcare spending
but just so you know that SSI (the US federal program for the disabled) pays $2,734 less per year than the federal poverty guideline for one person.
As Stefan points out in one of his podcasts. The minarchist government established by the founders of the USA has long since exploded beyond it's constitutional boundaries.
I necessarily have the passion for writing this, and you have the passion for condemning me; both of us are equally fools, equally the toys of destiny. Your nature is to do harm, mine is to love truth, and to make it public in spite of you. - Voltaire
well when you consider that religious organazations (the Catholic Church) are already running many FOR profit hospitals and clinics. you many wanna drop them from the picture
Plus religious organisations tend to push forward an ideology through their actions. You can easily imagine a christian founded hospital refusing to practice abortions, refusing to help hiv positive patients or similar things. There would be refusals to cure based on origins and opinions, which is contrary to the spirit of medicine.
Society may not be responsible for individual illnesses but I still believe it should protect the equality of its members as well as their freedoms. What is the libertarian point of view on equality btw?
If individual people care enough, then they should donate some money to a chairty. It's not the gov'ts responsibility to hand out cash to any cokehead douchebag without a job.
I'm all about charities, but we would have to give so much more in donations to charity to fully replace government social spending. And I'm not so sure that people who hate paying taxes would gladly surrender an equal amount to charity.
Edit: I would also add that charities tend to be localized. This will be a major problem for the poor communities.
The greatest obstacle to discovery is not ignorance,
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
I'm all about charities, but we would have to give so much more in donations to charity to fully replace government social spending. And I'm not so sure that people who hate paying taxes would gladly surrender an equal amount to charity.
Yes, exactly. Meaning the people that want to support charity can do so, and the people that don't want to give away their money can keep it.
EDIT: I guess this sounds quite cold-hearted, which it is. I dunno.
As Stefan points out in one of his podcasts. The minarchist government established by the founders of the USA has long since exploded beyond it's constitutional boundaries.
I'm sure it has. Yes, gov't was smaller, but society was VERY different pre-industrial revolution. We were basically a nation of farmers. I would even argue that the state and local governments had a much greater influence then, almost like a state religious authority. The type of gov't we had back in the day would be quite out of place in todays society.
The greatest obstacle to discovery is not ignorance,
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
but just so you know that SSI (the US federal program for the disabled) pays $2,734 less per year than the federal poverty guideline for one person.
But if we're giving out fewer checks and free operations, then each check/medical assist we do give out can be bigger. Fo every unemployed person that doesn't get a free meds, we can divert his money to somebody who neeeds that $ to move above the poverty line.
By only giving welfare and free health care to people with a job/disability, the people we do help get a bigger check (which would help make up that 2700 dollars). In addition to that, it would encourage more people to get employed instead of taking handouts.
Anyway, I just read through the wikipedia site for libertarianism and there appears to be several angles ranging from wanting to minimize government to out right dissolving it. I still need to read up on Paul to see exactly what kind of libertarian he is. Overall, libertarianism to be a bit too self-serving for me. I mean, it really seems to be what we already have without the all the protections. There are really many points that raise questions. It just seems incomplete, I see many possible disadvantages.
As far as 'protectors of liberty or freedom', I don't know, but it seems to me that is the governments job via a national defense, police, or the constitution.
Your last statement is consistent with most Libertarian ideals. Anarchism and Libertarianism are not synonymous.
As far as taxes, well I look at that as a social contract. Yes, this contract can and has been abused, but I prefer to work on those issues than reinventing the wheel with a untested libertarian approach. I don't buy the 'taxes are theft' argument. One can break this social contract at any time and denounce residency. No gun here, unless you break that contract. Everyone here benefits from some sort of government services.
I'm sure I'll have more..........
Any good Libertarian, anarachist, or objectivist will tell you that "silent consent" is a contradiction. The "social contract", absent individual agreement, is an anti-concept. One might as well equate rape with making love.
so what is the libertarian answer for those that through no fault of their own are uninsureable and are not independently wealthy? under libertarian policy are they supposed to fuck off and die?
The Libertarian answer would be "read the Constitution". There is no federal mandate for a national healthcare plan. Libertarians believe that governmental healthcare systems are only valid on the state or local level, per the Constitution.
Most Libertarians would oppose UHC on any level of government.
Comments
Libertarianism is socially Liberal and fiscally Conservative. That to me is the best imaginable government.
Well it's social Liberal in that it leaves the decision on social issues to the people of each state. Plus you will never see a libertarian supporting any type of government run or imposed universal healthcare.
You know, that was my impression at first too, but the more I read up on it, the more it concerns me. Their focus is narrow, I think. And there seems to be a diversity of libertarian perspectives.
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
mammasan, speaking of health care, what is the libertarian approach? Our current system is needs much improvement. Do they have any ideas? I'm sure I can look it up, but you probably can save me the effort.
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
True there is no one clear Libertarian vision. There are libertarians who just want a scaled back version of our federal government and less government intervention in our everyday lives. then you have libertarians who want government for the sole purposes of national defense. Our federal government has grown to big and powerful to every be truely removed, but it can be scaled down significantly. Libertarians seem to be the only ones wanting to do this. Check out Ron Pauls website and see where he stands on the issues.
Thanks mammasan. I agree that our government has become somewhat bloated and needs some work. I'm actually on Paul's site now. Like I said, I'm sure I'll have more questions after I'm a bit more educated on the subject.
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
Well libertarians don't believe that the government should force all it's citizens into one universal healthcare plan. I'm not 100% sure on their stance because mine varies sightly, but that is what I understand it to be. I don't support universal healthcare because I believe our government is too corrupt and plaqued with ineptitude to properly manage something so big. Much like most social programs in this country the amount of mismanagement of funds and lack of over-sight is sickening. The same problems would inhabit universal healthcare and in the end it would probabaly end up being more expensive to tax payers than if they went out and procurred their own healthcare coverage.
so what is the libertarian answer for those that through no fault of their own are uninsureable and are not independently wealthy? under libertarian policy are they supposed to fuck off and die?
angels share laughter
*~*~*~*~*~*~*~*~
I have that same question, prism.
And, Yea, this thread is about libertarian ideology again!
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
Like I said I'm not 100% sure as to what libertarian belief is on universal healthcare. I deviate from them, slightly, in that aspect. farfrom glorified would be better equiped to answer the question. I don't think that libertarians what people to fuck off and die as you so eliquently put it. They just believe that it is not the role of the government to provide this service.
I'm sure that they have an answer, I just don't know it. Personally I would like to see communal healthcare. Where a community of people come together form a group and approach a healthcare insurance provider to offer their group insurance coverage on a group rate. The larger the group the lower the individual premiums will go. This can be organized by religious or non for profit organizations. I don't know if it is feasible but it can provide affordable healthcare coverage and it is a voluntary program without any government involvment.
well my questions stand for ffg to answer as well
if not the goverments job then who's job is it? surely not the insurance companies since they already deny health insurance to millions of people based on various pre-existing health problems that exist though no fault of their own.
angels share laughter
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I have explained why i don't want the government involved in universal healthcare. Trust me I would love nothing more than to see every body have healthcare coverage but knowing how fucked up our government is it would just become another fiscal blackhole.
If individual people care enough, then they should donate some money to a chairty. It's not the gov'ts responsibility to hand out cash to any cokehead douchebag without a job.
My personal policy is that if you have a job but still need welfare (because you have a min. wage job) then the gov't should add whatever amount of $ that will raise you above the poverty level. But if you have no job, you get nothing.
I don't think anyone is claiming that it would be perfect but it would sure beat the shit out of what we have now. *edit* i meant National Health care not libertarianism
National Health Insurance
Liberal Benefits, Conservative Spending
by Steffie Woolhandler, MD, MPH and David U. Himmelstein, MD
FEW WOULD dispute that our health care system is deeply troubled. Thirty-nine million Americans are completely uninsured and millions more have inadequate coverage. After a brief lull, health care costs have resumed their exuberant growth; health maintenance organizations (HMOs) have fallen to the basement of public esteem and have failed to contain costs; commercial pressures threaten medicine's best traditions; and healing has become a spectator sport, with physicians and patients performing before a growing audience of bureaucrats and reviewers. Opinion on solutions is more divided.
Debate over health care reform has been muted since the defeat of the Clinton Administration Rube Goldberg scheme for universal coverage. But the fast developing health care crisis--business leaders grappling with rapidly rising premiums, workers and unions facing cutbacks in coverage, governments confronting deficits, and a sharp upturn in the number unemployed and uninsured--promises to spur new interest in reform.
We advocate a fundamental change in health care financing, national health insurance (NHI), because we are convinced that lesser measures will fail.
In the 35 years since the implementation of Medicare and Medicaid, a welter of patchwork reforms has been tried. Health maintenance organizations and diagnosis related groups promised to contain costs and free up funds to expand coverage. Billions of dollars have been allocated to expanding Medicaid and similar programs for children. Both Medicare and Medicaid have tried managed care. Oregon essayed rationing in its Medicaid program, Massachusetts and Hawaii passed laws requiring all employers to cover their workers, Tennessee promised nearly universal coverage, and several states have implemented high-risk pools to insure high-cost individuals. For-profit firms pledged to bring business-like efficiency to running HMOs, hospitals, dialysis clinics, and nursing homes. And market competition has roiled health care's waters.
None of these initiatives has made a dent in the number of uninsured, durably controlled costs, or lessened the inexorable bureaucratization of medicine.
All such patchwork reforms founder on a simple problem: expanding coverage must increase costs unless resources are diverted from elsewhere in the system. With US health care costs nearly double those of any other nation and rising more rapidly,1 and the economy gone sour, large infusions of new money are unlikely.
Absent new money, patchwork reforms can only expand coverage by siphoning resources from existing clinical care. Advocates of managed care and market competition once argued that their strategy could accomplish this by trimming clinical fat. Unfortunately, new layers of bureaucrats have invariably overseen the managed care "diet" prescribed for clinicians and patients. Such cost management bureaucracies are not only intrusive but expensive, devouring virtually all of the clinical savings.
Resources seep inexorably from the bedside to the executive suite. The shortage of bedside nurses coexists with a proliferation of RN utilization reviewers. Productivity pressures mount for clinicians, while colleagues who have withdrawn from the bedside to the executive suite rule our profession.
Bureaucracy now consumes nearly 30% of our health care budget.2-4
The latest policy nostrums--medical savings accounts and voucher schemes like President Bush's "premium support" proposal for Medicare--would further amplify bureaucracy and limit care. Medical savings accounts discourage preventive and primary care, while failing to curb the high cost of care for severe illnesses (which account for most health spending). Such plans would also require insurers to start keeping track of all out-of-pocket spending, while retaining their existing bureaucracy, and would slash the cross-subsidy from healthy enrollees to the sick.
Voucher programs are thinly veiled mechanisms to cut care. The vouchers offered are invariably too skimpy to purchase fully adequate coverage, forcing lower-income individuals into substandard plans. Voucher schemes also posit that frail elders and other vulnerable patients will make wise purchasing decisions from a welter of confusing insurance options. Finally, vouchers would boost insurance overhead by shifting people from group plans (ie, Medicare or employer groups) into the individual insurance market where overhead averages more than 35% of premiums.5
WHY NHI?
The fiscal case for NHI arises from the observation that health care's enormous bureacratic burden is a peculiarly American phenomenon. No nation with NHI spends even half as much administering care, nor tolerates the bureaucratic intrusions in clinical care that have become routine in the United States.
Our biggest HMOs keep 20%, even 25%, of premiums for their overhead and profit6; Canada's NHI has 1% overhead2 and even Medicare takes less than 4%.7 And HMOs inflict mountains of paperwork on physicians and hospitals. The average US hospital spends one quarter of its budget on billing and administration,4 nearly twice the average in Canada. American physicians spend nearly 8 hours per week on paperwork, and employ 1.66 clerical workers per physician,8 far more than in Canada.
Reducing our bureaucratic apparatus to Canadian levels would save 10% to 15% of current health care spending, at least $120 billion annually, enough to fully cover the uninsured and upgrade coverage for those now underinsured. Proponents of NHI,9 disinterested civil servants,10, 11 and even skeptics12 all agree on this point.
HOW NHI? Unfortunately, piecemeal tinkering cannot achieve significant bureaucratic savings. The key to administrative simplicity in Canada (and other nations) is single-source payment. Canadian hospitals (mostly private, nonprofit institutions) do not bill for individual patients. They are paid a global annual budget to cover all costs, much as a fire department is funded in the United States. Physicians (most of whom are in private practice) bill by checking a box on a simple insurance form. Fee schedules are negotiated annually between provincial medical associations and governments. All patients have the same coverage.
Unfortunately, during the 1990s Canada's program was starved of funds by governments responsive to pressure from the healthy and wealthy who sought to avoid cross-subsidizing care for the sick and poor. Where once Canadian and US health care spending were comparable, today, Canada spends barely half (per capita) what we do.1 Shortages of expensive, high-technology care have resulted. Yet, Canada's health outcomes remain better than ours (eg, life expectancy is 2 years longer1), and most quality comparisons indicate that Canadians enjoy care equivalent to that for insured Americans. A system structured like Canada's, but with double the funding, could provide high-quality care without the waits or shortages that Canadians have experienced.
The NHI that we propose would create a single tax-funded comprehensive insurer in each state, federally mandated but locally controlled. Everyone would be fully insured for all medically necessary services, and private insurance duplicating the NHI coverage would be proscribed (as is currently the case with Medicare). The current byzantine insurance bureaucracy with its tangle of regulations and wasteful duplication would be dismantled. Instead, the NHI trust fund would dispense all payments, and central administrative costs would be limited by law to less than 3% of total health care spending.
Each hospital and nursing home would negotiate an annual global budget with the NHI, based on past expenditures, projected changes in costs and use, and proposed new and innovative programs. Many hospital administrative tasks would disappear. There would be no hospital bills to keep track of, no eligibility determination, and no need to attribute costs and charges to individual patients. Cost shifting would be pointless as there would be nowhere to shift costs to.
Clinics and group practices could elect to be paid fee-for-service, or receive global budgets similar to hospitals. While HMOs that merely contract with providers for care would be eliminated, those that actually employ physicians and own clinical facilities could receive global budgets, fee-for-service, or capitation payments (with the proviso that capitation payments could not be diverted to profits or exorbitant executive compensation).
As in Canada, physicians could elect to be paid on a fee-for-service basis, or receive salaries from hospitals, clinics, or HMOs.
Properly structured, NHI would not raise costs; administrative savings would pay for the expanded coverage. While NHI would require new taxes, these would be fully offset by a decrease in insurance premiums and out-of-pocket costs. Moreover, the additional tax burden would be smaller than is usually appreciated, since nearly 60% of health care spending is already tax supported (vs roughly 70% in Canada). Besides Medicare, Medicaid, and other explicit public programs, our governments fund tax subsidies for private insurance that exceed $100 billion annually.13 In addition, local, state, and federal agencies that purchase private coverage for government workers account for 22.5% of total employer health care spending (D.U.H. and S.W., unpublished analysis of Current Population Survey data from the US Census Bureau, 2001).
Demonstration projects in 1 or more states might precede national implementation of NHI. Initially, funding might mimic existing patterns to minimize economic disruption, but all payments would be funneled through the NHI trust fund. Thus, Medicare and Medicaid moneys, as well as current government expenditures for employee health benefits, would go to the trust fund. Employers would pay a tax equivalent to the average now spent for health benefits. In the long run, a shift to a more progressive, income tax funding base would provide a fairer and more efficient revenue stream.
The NHI we propose faces important political obstacles. The virtual elimination of private health insurance will evoke stiff opposition from insurance firms. Similarly, investor-owned hospitals and drug firms fear that NHI would curtail their profits.
Practical problems in implementing NHI also loom. The financial viability of the system we propose is critically dependent on achieving and maintaining administrative simplicity. Canada's macromanagement approach to cost control -- enforcing overall budgetary limits is inherently less administratively complex than our current micromanagement approach, with its case-by-case scrutiny of billions of individual expenditures and encounters. However, even under NHI, vigilance (and statutory limits) would be needed to curb the tendency of bureaucracy to reproduce and amplify itself.
National health insurance could solve the cost-vs-access conflict by slashing bureaucratic waste. It would reorient the way we pay for care, and eliminate financial barriers to access. National health insurance could restore the physician-patient relationship, offer patients a free choice of physicians and hospitals, and free physicians from the bonds of managed care.
How many more failed patchwork reforms, how many more patients turned away from care they cannot afford, how many trillions of dollars squandered on malignant bureaucracy, before we adopt the only viable solution: NHI?
Steffie Woolhandler, MD, MPH
Cambridge
David U. Himmelstein, MD
1493 Cambridge St
Cambridge, MA 02139
REFERENCES
1. Organization for Economic Cooperation and Development. OECD Health Data 2001 [computer database]. Paris, France: Organization for Economic Cooperation and Development; 2001.
2. Woolhandler S, Himmelstein DU. The deteriorating administrative efficiency of US health care. N Engl J Med. 1991;324:1253-1258.
MEDLINE
3. Himmelstein DU, Lewontin JP, Woolhandler S. Who administers? who cares? medical administrative and clinical employment in the United States and Canada. Am J Public Health. 1996;86:172-178. MEDLINE
4. Woolhandler S, Himmelstein DU. Costs of care and administration at for-profit and other hospitals in the United States. N Engl J Med. 1997;336:769-774. MEDLINE
5. Pauly MV, Percy AM. Cost and performance: a comparison of the individual and group health insurance markets. J Health Polit Policy Law. 2000;25:9-26. MEDLINE
6. Special report. BestWeek Life/Health. April 12, 1999.
7. Heffler S, Levit K, Smith S, et al. Health spending growth up in 1999: faster growth expected in the future. Health Aff (Millwood). 2001;20:193-203. MEDLINE
8. Remler DK, Gray BM, Newhouse JP. Does managed care mean more hassles for physicians? Inquiry. 2000;37:304-316. MEDLINE
9. Grumbach K, Bodenheimer T, Woolhandler S, Himmelstein DU. Liberal benefits, conservative spending: the Physicians for a National Health Program proposal. JAMA. 1991;265:2549-2554. MEDLINE
10. US General Accounting Office. Canadian Health Insurance: Lessons for the United States. Washington, DC: US Government Printing Office; 1991. Publication GAO/HRD-91-90.
11. Congress of the United States Congressional Budget Office. Universal Health Insurance Coverage Using Medicare's Payment Rates. Washington, DC: US Government Printing Office; 1991.
12. Sheils JF, Haught RA. Analysis of the Costs and Impact of Universal Health Care Coverage Under a Single Payer Model for the State of Vermont. Falls Church, Va: Lewin Group Inc; August 2001.
13. Sheils J, Hogan P. Cost of tax-exempt health benefits in 1998. Health Aff (Millwood). 1999;18:176-181. MEDLINE
http://www.commondreams.org/views02/0525-06.htm
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Actually he seems like a pretty smart guy on the subject. I'm still working on convincing him he has no free-will though.
Anyway, Stefan at http://www.freedomainradio.com pushes the anarchist view on his podcasts.
But why do we need to rely on the government specially with their track record. Why not cut the cord and ween ourselves off the government. It just seems that we as a scoiety have become dependent on our government, expecting it to care for us from craddle to grave. We need to take the initiative and care for ourselves. That's why I think we need to organize and coordinate with religious and/or non profits to provide affordable healthcare. All it would take is one company to cooperate and the rest would follow.
the thing is people already DO NOT care enough for charities to be able to fund their healthcare. sure chairities do help some but not nearly enough. it's a fact that people DO NOT care about alot of health issues unless they are directly affected
I'm not talking about cokehead douchebags. I'm talking about people that get sick to where they can no longer work because of debilitating health problems that are NO fault of their own.
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well when you consider that religious organazations (the Catholic Church) are already running many FOR profit hospitals and clinics. you many wanna drop them from the picture
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That's one organization. There are many other organizations. I'm not saying that this is the answer or that it may even work. I just think we need to investigate alternative means of providing healthcare, not just relying on big brother to provide us with everything.
Like I said (sort of) if you are actually trying to make it, then the gov't should give you $ enough to put your income above the poverty line. Nothing more, and certainly nothing less.
I was referring to healthcare spending
but just so you know that SSI (the US federal program for the disabled) pays $2,734 less per year than the federal poverty guideline for one person.
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Plus religious organisations tend to push forward an ideology through their actions. You can easily imagine a christian founded hospital refusing to practice abortions, refusing to help hiv positive patients or similar things. There would be refusals to cure based on origins and opinions, which is contrary to the spirit of medicine.
Society may not be responsible for individual illnesses but I still believe it should protect the equality of its members as well as their freedoms. What is the libertarian point of view on equality btw?
I'm all about charities, but we would have to give so much more in donations to charity to fully replace government social spending. And I'm not so sure that people who hate paying taxes would gladly surrender an equal amount to charity.
Edit: I would also add that charities tend to be localized. This will be a major problem for the poor communities.
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
Yes, exactly. Meaning the people that want to support charity can do so, and the people that don't want to give away their money can keep it.
EDIT: I guess this sounds quite cold-hearted, which it is. I dunno.
I'm sure it has. Yes, gov't was smaller, but society was VERY different pre-industrial revolution. We were basically a nation of farmers. I would even argue that the state and local governments had a much greater influence then, almost like a state religious authority. The type of gov't we had back in the day would be quite out of place in todays society.
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
But if we're giving out fewer checks and free operations, then each check/medical assist we do give out can be bigger. Fo every unemployed person that doesn't get a free meds, we can divert his money to somebody who neeeds that $ to move above the poverty line.
By only giving welfare and free health care to people with a job/disability, the people we do help get a bigger check (which would help make up that 2700 dollars). In addition to that, it would encourage more people to get employed instead of taking handouts.
Your last statement is consistent with most Libertarian ideals. Anarchism and Libertarianism are not synonymous.
Any good Libertarian, anarachist, or objectivist will tell you that "silent consent" is a contradiction. The "social contract", absent individual agreement, is an anti-concept. One might as well equate rape with making love.
The Libertarian answer would be "read the Constitution". There is no federal mandate for a national healthcare plan. Libertarians believe that governmental healthcare systems are only valid on the state or local level, per the Constitution.
Most Libertarians would oppose UHC on any level of government.