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The Expansionist
Thursday, March 04, 2010
 
NO! to Obamacare. It is theoretically possible that a bill on some topic or other could be worse than the present Senate measure that President Obama wants the House of Representatives to endorse, but it would pretty much have to be written as a joke, vying for "World's Worst Legislation" in the Guinnesss Book of World Records.
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The present legislation arises from a severely defective analysis, and proposes a draconian and totalitarian (fascistic) solution that will almost certainly make many things worse. In attempting to fix one problem, this measure would produce economic catastrophe for millions, and increase offshore outsourcing.
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The justification for compelling everyone to buy private health insurance (the "individual mandate") is that people who now have health insurance are wrongly required to pay for the healthcare of people who don't have health insurance ("cost shifting"), so there is a wrongful transfer of wealth from one group to another. The problem with this analysis, aside from the fact that it is dubious, is that cost shifting is just moved to different people. And tho present-day cost shifting is of limited scope, requiring tens of millions of Americans to buy health insurance they neither want nor can afford is a HUGE transfer of wealth to private health insurance corporations, with massively negative consequences upon the people who do not now have such insurance.
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Is massive cost shifting a real problem, for which Obamacare's individual mandate is a sensible and fair remedy? Austin Frakt, "a health economist and principal investigator with the Department of Veterans Affairs' Health Services Research and Development Service and assistant professor with the Boston University School of Public Health", addressed this issue in an August 31, 2009 blog essay called "The Health Care Cost Shifting Myth"
In conclusion, cost shifting is not as large and widespread a phenomenon as some would believe. Under some market conditions it is inconsistent with economic theory. And, while it can occur under other market conditions it is far from a dollar-for-dollar shift in costs. The most recent studies of the phenomenon find little evidence of cost shifting or very low levels of it. Claims that reductions in public payments for health care will necessarily show up as commensurate increases in private payments are unfounded.
So why is Government forcing people to buy private health insurance? Is this just some enormous boondoggle to increase the already obscene profits of private insurance companies?
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The proposed fix to inconsequential cost shifting doesn't fix a thing, because it entails subsidizing some people at other people's expense. So there is still a transfer of wealth from some to others. But the biggest transfer of wealth is from private citizens to mega-health insurance corporations, which people are to be compelled to buy from, at suchever rates as those heartless corporations may charge. Competition is supposed to keep costs low. Oh? That's worked really well thus far, hasn't it? Oh. No. It hasn't worked at all. And now there will be even less incentive to keep costs down, because people have absolutely no choice. They all will have to buy from these heartless corporations, at any price they care to set.
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Since those mega-corporations will no longer be able to keep their costs down by refusing coverage to people with preexisting conditions, and no longer be able to cut people off once they have passed a payout maximum of the corporation's choosing, the costs to the corporations will inescapably go up, which means that the premiums will inevitably go up too, because the corporation is certainly not going to take those increased costs out of profits. No, they will maintain their obscene profitability by raising rates as high as the sky, because people can't cancel their insurance because Government will punish them if they do. And where is all the money collected in fines to go? If people calculate that it is much cheaper to pay a fine than to pay exorbitant health insurance premiums, we will again have millions and millions of Americans without health insurance, and the problem will not have been solved in the slitest.
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Unfortunately, tens of millions of Americans could not possibly pay either regular healthcare premiums or the fine that Mussobama demands they pay, because they are already deep in debt and going deeper into debt every year WITHOUT health insurance or a fascistic fine pushing them yet deeper into debt.
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The supposition underlying Obamacare must be that the 50 million Americans who do not now have health insurance could perfectly well afford it, but they just selfishly and short-sightedly refuse to buy it, preferring instead to throw their money away on frivolous things like dancing their lives away in clubs or buying booze and lottery tickets. The fact, however, is nothing like that. The reason the bulk of the uninsured do not have health insurance is that they simply cannot afford it.
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Never have Congress and the White House shown more plainly how completely out of touch they are with the way ordinary Americans live. They seem to think we can all afford another $475 a month, for a single person, or $750 a month for a family, for health insurance, taken from our "discretionary income", I suppose; and our choice not to spend that money on health insurance is irresponsible selfishness. The reality is that for tens of millions of Americans, if they have $2 left when they arrive at work to pick up their check on payday, they feel very lucky, and each month they are a little further in debt than the month before — debt they can never escape because the Government smiles upon usury, and traps people in debt.
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Now, the working poor and lower middle class will be compelled to take health insurance, and Government will generously subsidize those whom the GOVERNMENT says can't afford it, to the extent of what the GOVERNMENT thinks is fair. Two questions: (1) will the subsidy cover EVERYTHING, or will the working poor and lower middle class still have to pay something, which they cannot afford?; (2) where is the money for the subsidy to come from, if not from other people? Is the Government just going to print money to give out? Or is it going to take the subsidy out of taxes? If the latter, as one would hope, the very thing the bill is supposed to fix — cost shifting!: the unwilling transfer of money from some people to others — will be the very thing the bill itself does! How is that better than what we have now?
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On the contrary, instead of other people's health insurance premiums having to cover the uninsured (supposedly because doctors and hospitals bill insurance companies at higher rates to cover costs of services rendered to the uninsured), taxpayers, even of relatively modest means, will have to cover those costs. And instead of, say, 1 in 10 or 20 uninsured people racking up thousands or tens of thousands of dollars in medical bills because of illness, accident, or crime they have fallen victim to in a given year, almost EVERYBODY — perhaps 9 out of 10, or 17 out of 20 of the people who used to be uninsured — will be racking up hundreds of dollars a year in medical bills, because now they feel entitled to use a health plan they are paying for, or which is being paid for them by the Government. Whereas before, they wouldn't go to the doctor unless they felt really bad, now they'll go when they feel only moderately bad. And there will STILL be that 1 in 10 or 20 who racks up thousands or tens of thousands of dollars in bills in any given year. How does that save a thing?
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There will be MORE cost-shifting rather than less, and unlike a single-payer system financed by higher taxes on the rich, who can easily afford it, the bulk of the cost-shifting of the Obama plan would be increased impositions upon people of modest means, many of whom are hard-pressed to cover current expenses WITHOUT being forced to pay more for health insurance to cover people supposedly even worse off than they are. It's insane, and unfair. The people who have all the money, the rich, get off scot-free. Indeed, they get to cut benefits to employees of the companies they own, and if they own health insurer stocks, they make TONS of money off all the new premium-payers.
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Moreover, unless I missed it, there is nothing whatsoever in the bill to control healthcare costs. So if hospitals and doctors keep raising their rates, and health insurers have to pay those rates, and insurers have to cover people who cost more, whom they were previously allowed to refuse to insure, total healthcare outlays will continue to rise ever higher and higher and higher, gobbling up more and more of the Nation's gross domestic product. And why wouldn't hospitals and doctors profiteer if everybody has to pay whatever healthcare providers demand?
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One could argue that preventive care, which the uninsured do not avail themselves of, will, in this new regime, keep people from developing catastrophic illness. That would be the "Stitch in Times Saves Nine" theory of medical costs. Does the math really work? Will people in any way alter their lifestyle to avoid major medical problems just because they can go to a doctor early enuf for an intervention? Will people actually go to the doctor for early detection testing, or go only when they're not feeling well? Men as a group are notorious for not going to the doctor unless they feel really bad, and some classes of women feel they should be giving care, not getting it. Will the working poor really take time off from work — for which they will be docked, or perhaps even fired — to see a doctor for preventive care? I doubt it. And will they really take "doctor's orders" about lifestyle, what they eat, how much they exercise, whether they smoke? Or will they just ignore anything they don't want to hear? President Obama still smokes, despite the best medical treatment on Earth and access to smoking-cessation products and therapies.
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The individual mandate is, further, completely unconstitutional, and fascistic. Government asserts the right not just to take one fourth of our money before we get to spend a cent on things we personally want, but now also asserts the right to tell us how we must spend hundreds of after-tax dollars each month too! There is no authority in the Constitution for Government's requiring individual citizens to spend their own money on ANYTHING of Government's choosing; not ANYTHING, even if it costs only 5¢, much less thousands of dollars a year, year after year without end. Quite the contrary, the Fifth Amendment forbids Government to take people's private property (their income, in this case) except for public use, at just compensation. "Just compensation" means MONEY. If the Government takes $475 a month from you, it must be for a Governmental use, and the Government must pay you $475 a month! Plainly that is not what is envisioned here.
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No, Government says that as a condition to your living in the United States, you must spend thousands of dollars a year on something you may not want, and that you must buy it from a private company you may not want to do business with at all. Where does Government get the NERVE to tell you that you HAVE to buy health insurance, or a car, or a house, or anything else, just because the Government says it's "good for you" – "We know best, and you will do as you're told, or we will fine you. And if you refuse to pay the fine, we will send you to PRISON."
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This is not what we want. No free people can consent to such tyranny.
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Worse, the bill would not take effect for four years, during each of which years (at least) 45,000 uninsured Americans will DIE. That's 180,000 Americans who will DIE from a preposterous delay in implementation of universal healthcare, by any plan. How do they justify that? This preposterous delay suggests again that Obama is a Republican agent, putting forth a bill that is hugely unpopular and delaying its implementation until long after the midterm Congressional elections this year. If the bill is something people would actually like, they won't know that they like it until after it goes into effect in 2014, by which time control of both houses of Congress may have passed to Republicans, who can defeat the bill either by repealing it before it even goes into effect or by simply refusing to fund it. Would Obama veto a repeal? Or sign it, because he's really a Republican? And if he were to veto it, might the Republicans have achieved a veto-proof majority in both houses because of this bill?
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What the people of the United States really want is single-payer. We want to be able to show up at any hospital or make an appointment with any doctor and have all the expenses covered as of right. The supposition underlying the current plan is that healthcare is a privilege, not a right, and you have to pay for it as a separate charge — or set of charges: health insurance premium, deductible, and co-pay — and if you can't afford that, that's tuf, because the Government is going to force you to pay for it. If that means you have to cut back on other things, like food, heat, electricity, rent or mortgage payment, that's tuf. Because you don't have the right to spend your own money as you choose. You will buy what we tell you to buy, and if that means you lose your house or heat in the winter, that's your problem.
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What "unintended consequences" might this measure produce? Here's one: people who now work in the arts, and sacrifice to keep their expenses low so they can afford to create art, books, dance, drama, comedy, will have to give up on all that and just take a job to cover the costs of everything they now pay PLUS healthcare. They will have to relegate their art to such few hours as they have left over from all their other responsibilities.
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Here's another presumably unintended consequence: People now struggling to make ends meet and keep a roof over their head will be forced into foreclosure, or homelessness. They will have to take a less expensive apartment, and cram a family of five into a three-room apartment. But that will increase family closeness, a good thing, right? No, it will exacerbate family tensions, and produce an increase in violent interpersonal conflicts. Let's increase domestic violence. What a good idea!
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Here's another: corporations that now provide health insurance will shift more of the costs to employees, because no tax credit is really going to offset completely the costs of health insurance, and in this age of cutthroat world competition, an American corporation that has to provide health insurance is going to be unable to compete globally. So either they shift the costs onto employees or, if that is forbidden by Mussobama, they close down operations in the United States entirely and move everything to China, India, and other low-wage countries — which is completely fine with Mussobama. One way of shifting costs to employees without cutting health insurance as such is by cutting wages, or refusing to provide periodic wage increases, which amounts to the same thing: lower wages in real dollars. And so the Senate bill will speed the race to the bottom that Americans are now suffering from.
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Is that actually an unintended consequence? Or is the present measure INTENDED to push the bulk of Americans into poverty, so the rich can pay ever less and reap ever more? Obamacare will trap everyone from the middle-middle class to the poor in a downward spiral of ever lower wages and benefits, and debt they cannot escape, now made worse by having to pay hundreds of dollars a month for health insurance. Many people will not know how to apply for Government subsidy, or will find that the Government doesn't think they are desperately poor enuf, so won't give them a subsidy. They will be ruined. They will have to work at anything they can find, at any wage, because they will be trapped by a system designed to crush them.
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Would that be an unintended consequence of the present healthcare bill, or its actual intent: to reduce the bulk of Americans to wage slavery and debt slavery to the rich, while pretending to be bestowing a great boon upon them?
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At end, it doesn't matter whether the bill is intended to destroy personal freedom and reduce Americans to economic slaves of the rich, or such enslavement is not actually intended but just a fully foreseeable consequence. It is part and parcel of a move in recent decades to destroy the quality of life of Americans and give them the income and lifestyle of the bulk of people in the Third World. A sentence in the Declaration of Independence comes to mind: "when a long Train of Abuses and Usurpations, pursuing invariably the same Object, evinces a Design to reduce them under absolute Despotism, it is their Right, it is their Duty, to throw off such Government, and to provide new Guards for their future Security."
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The Senate plan must be defeated; single-payer must be enacted, effective immediately; and the costs of single-payer healthcare must come out of the pockets of the rich. They have all the money in the world, and it all comes from us, whom they exploit and sell to. It's time for them to give some of our money back. If they don't like that, THAT'S tuf. We may not have been able to get to George III and slit his throat. The abusive rich are, however, well within striking distance. They should "be afraid; be very afraid". There's only so far you can push Americans before they snap.
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(The current U.S. military death toll in Iraq, according to the website "Iraq Coalition Casualties", is 4,380 — for Israel.)



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