America is special!  We're too evil to risk universal health care.

The health care proposal of Hillary Clinton is "nationalized" care in only the loosest sense. It would require individuals making under $75k to buy into the current system, not just preserving the corporate structure of the current system that already screws poorer people but paying it off. I can't see why anyone conservative or liberal wouldn't see this as a mistake on an absolutely massive social scale. I can't believe any independently thinking people would be so lost in their zeal for "universal coverage" that they would accept this proposal as "progress." The only exceptionalism present is in Clinton's sorry plan.

It is easy to buy small plaster models of what you think life is like.

Actually, for those voting Democrat, the health care plan is a moot issue as Obama's health care plan is basically a rip-off of Hillary's plan.  Health care advocacy has always been Hillary's strength and her lead in the way that Iraq was for Obama and national poverty for Edwards.  

Given that there were three strong competitors in the beginning, each candidate's strength pushed the others to come up with strong competing or similar plans.  And this does show that there was at least one advantage in there not being a clear-cut lead for the Democrat presidential nomination.

In comparison, look at the idiotic comments McCain have been making all over the place.

Given that there were three strong competitors in the beginning, each candidate's strength pushed the others to come up with strong competing or similar plans.  

No government mandated health insurance, no unnecessary government interference in private health matters. People invest in themselves and their futures by keeping themselves healthy, working out, eating right, etc. The free market and competition allows prices to decrease, most people win. Contrast this to universal health care or increases in entitlements which send taxes and spending soaring as everybody subsidizes the poor lifestyle choices of their neighbors.

And I'm not even running for president, or anything.

No government mandated health insurance, no unnecessary government interference in private health matters. People invest in themselves and their futures by keeping themselves healthy, working out, eating right, etc. The free market and competition allows prices to decrease, most people win.

Must be nice living in your world. Too bad so many of your brethren aren't quite "fittest" enough to pull up their own bootstraps to survival height.

But as it stands, why should society be forced to subsidize the health care cost of people who do not care about themselves or respect other people? People who call 911 to get an ambulance to take them to the ER for allergies or minor conditions. People who load up on fatty foods, salty TV dinners and all kinds of garbage. Otherwise healthy people without any underlying medical conditions who allow themselves to become morbidly obese. I'm not in perfect shape either, but at least I make an effort.

Is it possible that the reason so many people are in dire straits is because they have learned dependence? As in, "Why should I bother to get a job, find insurance, etc if everything is provided for me by the government?" Isn't that more hurtful in the long run? Why do we need some government bureaucrat inserting themselves in people's private health insurance choices by forcing them to take certain actions and possibly punishing them for it? Why do we need this nanny state telling us how to live our lives or what to do?

Wouldn't it be better for everybody if well run private charities were allowed to assist up the truly needy, and everybody worked to better themselves?

The same folks you describe as being in dire straights could also be in dire straights while being on an employer sponsored health plan as well.  Are they more entitled to being entitled because they and their employer are paying for it?

Also, like you, I make an effort...but a year + of desk work has put me in an uncomfortable place.  What effort is good enough?

Finally, you make a good point about government bureaucrats getting involved in our lives...however, folks with purchased health insurance already have corporate bureaucrats making the rules for them.  In short, we a nanny business in our lives.

Perhaps if we did away with health insurance altogether...no government plan, no employer plan, no welfare, and left people to their own devices it might work out in the long run.  Certainly it would be painful in the short run, but at least everyone would be forced to work to better themselves.

It's the end of the world as we know it, and I feel fine

I was typing my reply to port while you made your post. I think a few issues overlap, so I will be brief here.

The same folks you describe as being in dire straights could also be in dire straights while being on an employer sponsored health plan as well.  Are they more entitled to being entitled because they and their employer are paying for it?

In this case it is a private agreement between an employer, employee, and a private corporation to provide health insurance coverage. There is no public interest or dollars in that case. However, I assume the company could provide incentives to their enrollees like rate cuts or rebates for people who don't use the services as much or who fit various metrics.

Also, like you, I make an effort...but a year + of desk work has put me in an uncomfortable place.  What effort is good enough?

I don't know. That is a question I will leave to somebody much smarter than I. I have a BMI of 26, which means I am slightly overweight. However, I can do a standard workout (35 pushups, etc) or run up the 2-3 story subway stairs without major problem.

Finally, you make a good point about government bureaucrats getting involved in our lives...however, folks with purchased health insurance already have corporate bureaucrats making the rules for them.  In short, we a nanny business in our lives.

But at least the nanny business is accountable to the contract and civil liability laws. I am currently embroiled in a dispute with my local jurisdiction and getting them to live up to their basic responsibilities in a criminal matter has been like pulling teeth. At least with a company you could always sue.

Perhaps if we did away with health insurance altogether...no government plan, no employer plan, no welfare, and left people to their own devices it might work out in the long run.  Certainly it would be painful in the short run, but at least everyone would be forced to work to better themselves.

+5, brilliant. I would still keep employer plans because that is a salary benefit from a company to a worker, a private affair. But such a plan would force responsible people to save and be accountable, which is a good thing.

+5, brilliant. I would still keep employer plans because that is a salary benefit from a company to a worker, a private affair. But such a plan would force responsible people to save and be accountable, which is a good thing.

Employers also have a vested interest in having healthy workers (of course, this could be taken too far with employers targeting smokers who only light up at home, etc) .  

If we really wanted to "end welfare as we know it", we would have to go with my draconian cold turkey plan.  And with that, we'd have to really increase spending for police and perhaps suspend some civil liberties because it's for certain that the masses will revolt in some way.  Either through increased crime (I can't find a job with benefits, so I'll sell drugs, rob, etc to get the money) or outright rebellion.  I agree that the situation is pig-ugly and it's also in an ugly place but here we are.  We need to rip that bandaid off and let the festering wound drain.  

Finally, you are correct about private affair between employer and worker...I too would like to see folks act more responsible (keep your goddamn cig butts IN the car)...but at the same time, as loudly as people crow for a free market, what sorts of guarantees do we have the corporations will act responsibly?

Finally...finally...isn't this a thread on rape?

It's the end of the world as we know it, and I feel fine

If we really wanted to "end welfare as we know it", we would have to go with my draconian cold turkey plan.  And with that, we'd have to really increase spending for police and perhaps suspend some civil liberties because it's for certain that the masses will revolt in some way.  Either through increased crime (I can't find a job with benefits, so I'll sell drugs, rob, etc to get the money) or outright rebellion.  I agree that the situation is pig-ugly and it's also in an ugly place but here we are.  We need to rip that bandaid off and let the festering wound drain.  

I don't know, if most of the welfare money is spent on crime ridden inner cities... how bad could it possibly get? If my work is not safe from marauding gun packing 14 year olds during/after dusk (or sometimes in broad daylight) then how could it possibly get any worse? Just saying.

Finally...finally...isn't this a thread on rape?

Probably not anymore.

Actually, the amount of real dollars spent on welfare has shrunk considerably since the Clinton reform.

Is it possible that the reason so many people are in dire straits is because they have learned dependence?

So that's why Europeans are so fat and lazy!

People invest in themselves and their futures by keeping themselves healthy, working out, eating right, etc.

Which is all well and good, except for that portion of disease caused by environmental factors and genetic heritage which are largely beyond our control.  This is especially true now that genetic pre-screening is becoming increasingly possible.  In your libertarian fantasy world, do insurance companies have the freedom to pre-screen people for genetic predispositions to certain diseases and deny them coverage if they're in a high risk group?  Or is government regulation cool then?

Which is all well and good, except for that portion of disease caused by environmental factors and genetic heritage which are largely beyond our control.  This is especially true now that genetic pre-screening is becoming increasingly possible.  In your libertarian fantasy world, do insurance companies have the freedom to pre-screen people for genetic predispositions to certain diseases and deny them coverage if they're in a high risk group?  Or is government regulation cool then?

In my libertarian fantasy world, the sanctity of each person's genome would be protected by privacy laws denying governments the right to mine them for information on disease. If a person wishes to submit to DNA testing in a private agreement with some company that is ill-advised but all well and good. However, as you know not all employers insurance plans demand genetic testing, and a genome wide screen for every type of genetic predisposition known will so cost much money to make it impossible to test every applicant.

Look, when I examine this issue I see a lot of people proposing false dichotomies. It's either "Everybody has insurance" or "People dying in the streets from mumps." That is simply not true. There are other ways to vastly reduce healthcare costs that few people talk about.

Ever notice how most MDs now go and take residencies and sometimes fellowships to specialize and sub specialize in certain fields? Do we really need a guy with allergies or a cold going to a physician with 3 board certifications charging $400 a visit? Why can't the majority of these issues be handled by a nurse practitioner or a physicians assistant? Why can't the number of in pharmacy or in store clinics be expanded? Why can't more medical schools be built to increase the supply of MDs and thus lower salaries and costs? If we free up the advanced MDs time to deal with the more challenging cases that creates more slots for people without insurance.

Does everybody without insurance or with a horrible genetic disease end up dying in the streets from mumps? What have we done up until now without universal coverage? You can't tell me there are no free clinics where MDs and other professionals volunteer their time. You can't tell me there are no offices where residents or interns in training see patients at a discounted rate. There is one a block from my house, and several more within walking distance. Then again, I do live on the edge of a rough area, but still.

The free market will work to lower the cost of medical care, and as mentioned before, charities and other agencies can take care of the truly needy and disadvantaged, especially if taxes are reduced so donors have more money to give. There is no perfect solution. But increasing spending to cover everybody in some kind of universal coverage plan is far from an ideal answer to the problem.

In my libertarian fantasy world, the sanctity of each person's genome would be protected by privacy laws denying governments the right to mine them for information on disease. If a person wishes to submit to DNA testing in a private agreement with some company that is ill-advised but all well and good.

Some years ago, I applied for a couple hundred* jobs with the U.S. government. For each one, I provided my SSN. The applications all stated that I was by no means required to provide my SSN, it's just that they'd throw my application out without it. So I didn't have to provide that bit of information, and in exchange, they didn't have to consider my application.

In the absence of government regulations preventing insurance companies from demanding DNA samples before granting insurance policies (and I assume that absence would be the case in your libertarian fantasy world), there will probably be a time when testing for genetic predispositions to disease is inexpensive and sophisticated enough that insurance companies will require it before insuring people. If that becomes the case, you won't be required to hand over your DNA to an insurance company, of course...unless you want health insurance.

In regione caecorum, rex est luscus.

Damn, I forgot to follow up on my asterisk. That was:

*The process for applying for federal jobs online is becoming more streamlined and uniform as time goes on, so applying to a couple hundred, while still a lot of work, isn't as bad as it might sound.

In regione caecorum, rex est luscus.

In the absence of government regulations preventing insurance companies from demanding DNA samples before granting insurance policies (and I assume that absence would be the case in your libertarian fantasy world), there will probably be a time when testing for genetic predispositions to disease is inexpensive and sophisticated enough that insurance companies will require it before insuring people. If that becomes the case, you won't be required to hand over your DNA to an insurance company, of course...unless you want health insurance.

And if a company really wants to retain its workers and they have trouble finding reliable people without a non-intrusive insurance plan that will change.  If people are willing to pay a premium for privacy somebody will fill that market. Look at No-Documentation loans.

And if a company really wants to retain its workers and they have trouble finding reliable people without a non-intrusive insurance plan that will change.  If people are willing to pay a premium for privacy somebody will fill that market

You assume way too much of people.  People won't look at this as a reason to find another job - they'll just go without health insurance.  Even at that, it may well be that they won't be able to find another job - it's not like the job market is exactly screaming hot right now.  If it's a choice between having a job where you can't get health insurance or not having a job and not having health insurance, most people will take the job.

You assume way too much of people.  People won't look at this as a reason to find another job - they'll just go without health insurance.

So health insurance is so important that people want it to be one of the top planks in a campaign platform but not important enough that they will research potential employment opportunities or switch jobs in order to get it?

Ok.

The relationship between people and their government and people and their employers is vastly different...people think they can just demand whatever from the government and it should magically appear for no cost while people end up taking whatever dead end job they can get their hands on. So long as the majority of people are insured, the motivation for employers to provide it simply won't be there. Market forces will dictate they lower their costs when their competitors are increasing their bottom line by shrugging the cost off onto the new system. The vast majority of large employers will dump the healthcare costs and increase salaries slightly.

It is easy to buy small plaster models of what you think life is like.

The vast majority of large employers will dump the healthcare costs and increase salaries slightly.

Except for the "increase salaries slightly" part.

not important enough that they will research potential employment opportunities or switch jobs in order to get it?

You make it sound like it's so easy to just change career paths...if only it were so.

So health insurance is so important that people want it to be one of the top planks in a campaign platform but not important enough that they will research potential employment opportunities or switch jobs in order to get it?

In my industry, most people either get partial coverage or there's also a lot of people who get none.  It would shock most people to hear that about publishing, but I know a great many literary scouts, the lower rung of the literary agency world, where health insurance doesn't exist.  

Why do people do it?  I am not sure.  But even on most jobs I've had with publishing houses, coverage often doesn't cover dental nor optometry.  Nothing is crappier financially than having to spend $4,000 on dental surgery. So why do it?  It's as Port 1080.  It's hard to change career paths.  I've tried, and the insurance coverage and pay are better.  But the job bores the bejeezus out of me.

And I am now returning to a publishing job full-time and taking the job without dental or optometry insurance coverage.

Why do people do it?  I am not sure.  But even on most jobs I've had with publishing houses, coverage often doesn't cover dental nor optometry.  Nothing is crappier financially than having to spend $4,000 on dental surgery. So why do it?  It's as Port 1080.  It's hard to change career paths.  I've tried, and the insurance coverage and pay are better.  But the job bores the bejeezus out of me.  

That's the thing right there. At my work I do not get dental insurance, which is ironic considering who I work for. That is a choice I made, and so I pay cash when going to a dentist. If dental was a higher priority for me I could probably look and find another job.

However, I chose to work at a place that does not have that type of insurance and for me to demand that everybody else give me free dental coverage from their tax dollars would be blatantly unfair.

If dental was a higher priority for me I could probably look and find another job. ...and what if you can't find a job that provides dental coverage? You probably could, considering your educational performance, but there are a whole lot of people out there who aren't capable of your achievements (and if everyone could get a PhD in the hard sciences, a hard sciences degree probably wouldn't be worth enough to get you dental coverage, in any case). The problem isn't people who could get better insurance, but don't - the problem is people who can't get better insurance, period, because they aren't educated / qualified enough to have the job mobility to search for a job that offers insurance. It's easy enough for you to say that they should go back to school and get a job - but you say that from the privileged position of someone who grew up in a stable household with two reasonably well off parents who made sure you had all the opportunities you needed to succeed. A lot of people don't, and never will have that kind of support network. I'm willing to do without to try to give those people a little more of a chance... and it surprises me that you no longer are.

The restaurant across the street from work offers dental for a service industry job. If I felt dental insurance was that important I could stop working here and go serve lunches. There never will be a perfect job that offers awesome compensation and all encompassing benefits for anybody. Therefore, workers have to prioritize why a particular job or companies offer works best. As mentioned in #36 sometimes better compensating careers or jobs suck. Sometimes things don't work out. If not being bored and avoiding the feeling of being trapped in a bad place is a higher priority than dental insurance (and I would agree that is so) then the smart move is to take the job where your mental health is not in danger.

So where does that leave us? We will probably never have a situation where the overwhelming majority of society gets dental coverage. What do we do about it? We could either raise taxes and expand the welfare state to give 'free' benefits to everybody, we could 'require' people to buy dental insurance (even if they can't afford it) or we could worry about solving the problem from the other end.

No solution is perfect, but what is the best answer? It's probably not the easiest one (eg government freebies).

No solution is perfect, but what is the best answer? It's probably not the easiest one (eg government freebies).

I agree with you that no solution is perfect, but I'm not convinced by your arguments that government provided health care shouldn't be considered the "best of the worst" option.  I would rather live in a society where we make an effort to make sure everyone has their basic needs met than live in one where we just accept that a certain percentage of people will necessarily be fucked by the system so the rest of us can live fat and happy.

we could worry about solving the problem from the other end.

How do you propose to do this?  The only thing I've really seen you throw out there so far is that we should expect private charities to step in in place of the government.  This may sound like a good idea, but it has lots of problems of its own.  I know you believe strongly in civil liberties - well how much of your civil liberties can be protected when you a forced to go to a religious charity for food hand-outs?  Do you really think that the free food the Scientologist or LDS charities hand out will come without any strings attached?  Government run programs are at least theoretically minimally accountable to the entire pubic (you can always vote to "throw the bums out").  In the case of private operations, even that minimal accountability is completely gone - indeed, if they are religious charities our first amendment rights actually afford them, in many cases, a strong degree of protection from any sort of public accountability at all.

Basically, as I see it, there are three choices to deal with the disadvantaged - either the state does it, private charities do it, or we just accept the cynical social Darwinist view that the weak must die for the strong to thrive.  I won't accept the third option on moral and ethical grounds, and I find the second option to be lacking on the civil liberties grounds I noted above.  Hence I find myself left with the third option.  I fully admit that it is less than ideal, and I think that the bureaucracy is and will always be in constant need of reform and stronger oversight.  Still, I would rather we put our energy into fixing those state programs than that we turn to private charities which are ripe for civil liberties abuses, or just say fuck it and tell the disadvantaged to work or starve (and if you can't work,well, just starve quick so your suffering doesn't make me feel uncomfortable!).

I would rather live in a society where we make an effort to make sure everyone has their basic needs met than live in one where we just accept that a certain percentage of people will necessarily be fucked by the system so the rest of us can live fat and happy.

Where does it end? There was an op-ed piece in the newspaper the other day supporting a bill that would start a new 50¢ per paycheck tax to fund paycheck replacement for any new mother for 12 or 16 weeks after her delivery. I think we can all agree that having moms stay with their new babies at home first the first months, if they so choose, is the best idea. But does everybody else have to fund somebodies fourth, fifth or sixth maternity leave? I think we can all agree that using less energy is a good thing. Does that mean I should get tax subsidies to re-insulate my home when the fuel savings will be mine alone? I think we can all agree that education is a good thing -- so when can I get my metric boatload of school loans wiped off? Do I get to send my kids to college for free?

Finally, success in life is not conditional upon other people being fucked by the system.

How do you propose to do this?  The only thing I've really seen you throw out there so far is that we should expect private charities to step in in place of the government.  This may sound like a good idea, but it has lots of problems of its own.  I know you believe strongly in civil liberties - well how much of your civil liberties can be protected when you a forced to go to a religious charity for food hand-outs?   Do you really think that the free food the Scientologist or LDS charities hand out will come without any strings attached?  

There are secular charities as well. I am sure a quick google search or perusal of your phonebook could come up with a few in the local areas. In addition, while the Scientologists and LDS will put strings on aid, not all religious charities are sleezeballs. Many give help without regard to color, religion, etc.

Government run programs are at least theoretically minimally accountable to the entire pubic (you can always vote to "throw the bums out").  In the case of private operations, even that minimal accountability is completely gone - indeed, if they are religious charities our first amendment rights actually afford them, in many cases, a strong degree of protection from any sort of public accountability at all.

I disagree with this assertion. Sure, you can have a charity that is not accountable. You see stories of these all the time. However, the more reputable ones publish reports detailing how the money is spent and where it goes. Catholic Charities explains how it sends 90% of the money it takes in back into the community to help the poor. In today's world with the internet, mass media, saavy consumers who want the most bang for their donation buck I would argue that private charities are more accountable than welfare services. If even accusations get out that a charity is misappropriating funds they will find their stream of donors dry up.

Can the same be said about public social services agencies? Could I refuse to 'contribute' every time I see a person with a state benefits card buying junk food or selling the benefits money for cash, alcohol or tobacco? I bet if I tried I would find myself jailed for tax evasion.

The employees of these government agencies have a vested interest in maintaining their budget. If the number of clients decreases their budget drops, leading to potential job cuts and loss of government benefits. What incentive do they have to reduce the welfare rolls? How is that accountable? But, with limited resources the private agencies give only to those truly in need. Their vested interest is in getting a client back on their feet as soon as possible, not supporting people looking for a handout or addicting unfortunate people to cash benefits which cause them to get stuck in some kind of poverty cycle.

Give a choice between the two, I would say that a well-run private charity is the way to go.

Private charities have a long history of abuse.  The United Way, which was supposed to be "the answer" in terms of setting up a large, multi-purpose, accountable private charity, has been heavily criticized for having excessive overhead and focusing more on getting donations than on helping people.  The American Red Cross board was also also criticized for its poor performance in recent years.  If these two groups, which are two of the largest, most high profile non-profit organizations in the country, can't get it together (even though they should, in theory, attract the highest talent in the non-profit industry) what makes you think that the private non-profit sector will actually be able to effectively take over the burden the government shoulders right now?  Right now the gov't handles the vast majority of the load, while non-profits deal with the overflow.  That gives non-profits the advantage of being able to run lean, volunteer-based operations.  If you push the entire burden on them they will be forced to professionalize, bureaucratize, and expand substantially...and you'll start to see them facing the exact same problems we get from the government, except we'll have even fewer options when it comes to asking them to reform.

But for every bad example, there are good ones. CC, as pointed out above, has been running for 280 years but still keeps its management and fund raising expenses at just below 10%. Like charities there are good governments and bad governments. And what do we do when government social services become so burdensome that they start to negatively affect the region they serve?

What do we do when taxes become so high that affected areas suffer from "brain drain" and the loss of the wealthier people? Who pays the taxes for the social services agencies then?

If you push the entire burden on them they will be forced to professionalize, bureaucratize, and expand substantially...and you'll start to see them facing the exact same problems we get from the government, except we'll have even fewer options when it comes to asking them to reform.

Except for as pointed out above, cut off donations. Without the money the agency dies and a competitor can come in. You can't refuse to pay taxes, and you have to wait until the next election cycle to vote out a bad government. Private charities are accountable every day for their actions.

Except for as pointed out above, cut off donations. Without the money the agency dies and a competitor can come in. You can't refuse to pay taxes, and you have to wait until the next election cycle to vote out a bad government. Private charities are accountable every day for their actions.

Ehh, that sounds all well and good, but in reality I'm not sure it works that well.  The United Way is a great example of this, in fact - they've become so big and so entrenched that it's been very hard to force them to reform.  I remember complaints about their high overhead costs as far back as the mid 1990s, and yet you still see the same criticisms over and over again.  What happens when one charity is responsible for providing social services to 2 or 3 million people and it gets hit by a scandal?  Do you let the charity fail and just accept the fallout that will happen when a few million people have to go looking elsewhere for support, or do you bail the charity out and hope that it will be able to reform itself?  Face it, if you go with a private solution at the end of the day you either end up with very similar inefficiencies to what you see in government, or you are forced to accept that there will be substantial gaps in coverage as "market selection" occasionally weeds out the bad charities.  The place where you live is an unfortunate case, but there are plenty of much more well run cities which maintain government support networks while not having those problems.  The trick is to get cities like yours to implement effective reforms.  I'm not saying that we should go whole hog with the welfare state - and I do think that most aid should be attached to the recipient completing job training, etc.  I also agree that the incentive structure for state employees should change - but that could easily be done if we're willing to get creative (tie job bonuses for caseworkers to the number of people they're able to get off the welfare rolls and back to work, for example).  The biggest problem, to my mind, is public employee unions - making them illegal, or at least severely constraining them, would be a good place to start fixing what's wrong with the bureaucracy.  Getting a state job shouldn't be your ticket to an unaccountable gravy train...I think that this mentality has been far more problematic than just straight up welfare.  If government performed better, perhaps we'd be a bit more willing to trust it to carry out some of these tasks.

Ehh, that sounds all well and good, but in reality I'm not sure it works that well.  The United Way is a great example of this, in fact - they've become so big and so entrenched that it's been very hard to force them to reform.  I remember complaints about their high overhead costs as far back as the mid 1990s, and yet you still see the same criticisms over and over again.  What happens when one charity is responsible for providing social services to 2 or 3 million people and it gets hit by a scandal?  Do you let the charity fail and just accept the fallout that will happen when a few million people have to go looking elsewhere for support, or do you bail the charity out and hope that it will be able to reform itself?

Corporations go bankrupt all the time, punishing their employees, customers and their families. Theoretically we society is okay with that happening because as you point out the clients will go elsewhere just as terminated employees look for new jobs.

The biggest problem, to my mind, is public employee unions - making them illegal, or at least severely constraining them, would be a good place to start fixing what's wrong with the bureaucracy.  Getting a state job shouldn't be your ticket to an unaccountable gravy train...I think that this mentality has been far more problematic than just straight up welfare.  

I agree with this to an extent. As I read your earlier posts I chuckled to myself saying "Good luck getting unions to go along with that." As it stands, unions are now used to protect the incompetent and extort unreasonable demands from management (in the case of public sector employees the unreasonable benefits and salaries come from taxpayers). They have strayed so far from the organizations that protected workers back in my  grandfather's era that it is not funny. But again, good luck getting the unions to go away. It would probably be easier to just follow Lou's suggestion upthread and go cold turkey on welfare programs.

If government performed better, perhaps we'd be a bit more willing to trust it to carry out some of these tasks.  

Unfortunately at this point it would have to perform orders of magnitude better for me to have the requisite trust.

What do we do when taxes become so high that affected areas suffer from "brain drain" and the loss of the wealthier people?

Where has that happened?

Tons of places. I'm living in one right now.

Finally, success in life is not conditional upon other people being fucked by the system.

And yet, you seem to have no problem with it happening.

There are secular charities as well.

If charities could do the job, we wouldn't be having this conversation, because we wouldn't have a poverty or a health care distribution problem.

I think we can all agree that using less energy is a good thing. Does that mean I should get tax subsidies to re-insulate my home when the fuel savings will be mine alone?

Since you'll be using less energy, you'll be 1) reducing demand, and 2) reducing pollution.  Others benefit from that.

I think we can all agree that education is a good thing -- so when can I get my metric boatload of school loans wiped off? Do I get to send my kids to college for free?

It worked out really well for Ireland.  The debt-for-education system we have here in America is nothing but welfare for the lenders, since they make a profit off of your loan, and yet have no risk at all due to government guarantees.  Better to have the government give you the money, and get it back in taxes and economic growth.

If charities could do the job, we wouldn't be having this conversation, because we wouldn't have a poverty or a health care distribution problem.

If the government could do the job without fraud and waste we wouldn't be having this conversation.

I hope you don't approach your own life with that sort of perfectionism, because you'd never get anything done.  No project is ever going to be accomplished at anything more than an adequate level.  If you want perfection, you will never be satisfied.  So in order to live, we have to settle, that's a fact of life.  When it comes to corruption, the US is one of the most honest countries in the world, so the degree of fraud is probably worth the reduction in social problems.  And getting rid of social programs is no protection against fraud and corruption, as the Republicans have so ably proven over the last decade or so.

And yet, you seem to have no problem with it happening.

I hope you don't approach your own life with that sort of perfectionism, because you'd never get anything done.  No project is ever going to be accomplished at anything more than an adequate level.  If you want perfection, you will never be satisfied.  So in order to live, we have to settle, that's a fact of life.  When it comes to corruption, the US is one of the most honest countries in the world, so the degree of fraud is probably worth the reduction in social problems.  And getting rid of social programs is no protection against fraud and corruption, as the Republicans have so ably proven over the last decade or so.

And I hope you don't live your life with that type of cavalier attitude. A person comes in discussing alternative ways to ensure social welfare besides massive government intervention and mandates and he ends up being castigated as somebody who goes around laughing with glee as people get "fucked by the system."

Look, I live in an area with an absurd tax base that suffers from colossal brain drain. I have close friends who have gotten permanently fucked (no lube) by the welfare system in their hour of need. Yet, every time I go to the store I see people buying junk food with benefits cards. Half the time I have people try to sell me their food stamps so they can buy heaven knows what. The few times I have visited the ER here I found it swamped with people treating it as a primary care service, when I know of two clinics within walking distance of my house and am told there are many around the city.

Entire neighborhoods in my city are vacant or burned out, suffering from dangerous crime levels despite the fact that I live in one of the most generous welfare states. I have a co-worker who has been at my work for over 30 years, raising her family in the same house in this city. However, her neighborhood went down the crapper and she told me she can't sell. Adding insult to injury her place was home invaded by some crackheads who did some Really Bad Shit. That was months ago and she is still not the same. Yesterday on the subway I listened to some 17 year old casually discuss how he was joining the Crips and how their bandanna or colors system worked. He also explained how he doesn't give a shit about school and if he fails out he is just going to "go work and do gang business." Try taking the subway during the day, sometimes I find it busier than rush hour with people just riding around all day. Try looking out the window at midnight at night. People wandering around aimlessly (it is much worse in the "challenging" areas) -- perhaps they don't have work the next day? Yet the newspaper has a bulging job ad section every week.

So you will have to excuse me if I try to find a different way to solve these problems, because it is patently obvious that the current approach of free money and services for some is not working at all. I think the problem might be that the government programs naively assume some people have some semblance of personal responsibility, when many people on these programs are looking for a handout, not a hand up. This is why I pushed private charities, it seems they do a better job of separating the deadbeats from those truly down on their luck.

I have close friends who have gotten permanently fucked (no lube) by the welfare system in their hour of need. Yet, every time I go to the store I see people buying junk food with benefits cards.

So...is the welfare system generous, or is it punitive?  You don't seem to be able to work out which one it is.

The few times I have visited the ER here I found it swamped with people treating it as a primary care service

And yet you oppose universal health care...

There are going to be criminals in every society, there's no way around that, it's just human nature.  But when certain segments of the population have little opportunity beyond crime, you're going to see a lot more of it.

This is why I pushed private charities, it seems they do a better job of separating the deadbeats from those truly down on their luck.

They had private charities in Dickens's London.  Worked really well...

Jimmy, I generally agree with your take on this, but your criticism in this comment is somewhat disingenuous.  You say "So...is the welfare system generous, or is it punitive?  You don't seem to be able to work out which one it is"  - it's really not that hard to figure out what he's saying.  What he's saying is that people who actually need help aren't getting it and that those who don't need it get it in spades.  This is, I think, a legitimate problem - it takes some knowledge of the system to actually be able to effectively collect government benefits, so a lot of people who probably should get them don't or can't because they don't know how to fill out the proper forms, say the right things, etc.  On the other hand, people who grew up in the system and know it well can often easily scam it due to knowing the ins and outs of how it all works.  It's undeniably a real problem, and while I don't think (as pO157 does) that on its own this amounts to a reason to scrap the system, I still think it's something that we need to figure out how to address.  

Let me expand on that a little bit.  The system was set up with more concern about chiselers taking advantage of it than for people who needed help getting iced out.  That's why p057's friends had such little luck getting help.

Chiselers are inevitable, but I'd rather see a few chiselers taking advantage of the system than have people who need help not getting it.  Frankly, the chiselers are not likely to be good employees anyway, so you could think of it as paying them to stay out of the hair of the small businessmen who would have to put up with their chiseling otherwise.

The worries about chiselers taking advantage is what led to the major dysfunction in the system.  Because intact families were not allowed to collect AFDC, under the assumption that the father should get a damn job, men were forced out and we ended up with multi-generations of single-parent families.

The second major dysfunction in the system comes out of the same fear of chiselers.  If you earn any money at all, it gets subtracted straight out of your aid check.  But if you earn money, it also gets taxed, so you don't get as much money on your paycheck as you lost from your aid check.  So there's a major disincentive for people on welfare to work, since they lose both the time they spend working, and money.  If the system allowed recipients to benefit from working, you'd see a lot more people working their way out of welfare.  Something along the lines of cutting the aid check by 25% of take-home pay would be what I would envision.

The third major dysfunction comes from the lack of health coverage for the poor.  If a welfare recipient gets a job, they lose their Medicaid.  If you have kids, that's a major loss.

The solution we got to those problems was a time limit on aid.  So if a child is born to an indigent mother, she'd better get employed by the time he's five, or he'll be awfully hungry.  During the Clinton years, that worked, because unemployment was low.  I don't think it's working quite so well now.

All good points.  Years ago, I worked with many AFDC families to help them find work and you description matches my experience.  Also, here in Maine, in order to root out "chiselers" a total assessment was done by the welfare department.  If the claimant had a car worth over $1500 she had to get rid of it or not get benefits.  So, if for whatever reason you had a decent car (a useful thing to find and keep a job), you had to get rid of it and get a beater...a less useful thing for finding an keeping a job.

There was another quirk in the system.  Household income was only counted among family members.  So, if the claimant lived with her (sometimes wealthy) boyfriend, his income wasn't counted...even though he contributed materially to the claimant.  Those folks got to drive the spankin' nice cars since it was in the boyfriend's name.

(and Gord...before you get all het up...these folks were white)

It's the end of the world as we know it, and I feel fine

Let me expand on that a little bit.  The system was set up with more concern about chiselers taking advantage of it than for people who needed help getting iced out.  That's why p057's friends had such little luck getting help.

I disagree. The system does not appear to be set up with any significant level of concern for preventing able bodied people from milking the system.

Perhaps it is just the wonders of my region being a dystopian shithole, but since I have moved here it has completely soured me on some of these types of programs. My major problem is they really don't seem to breed independence or help people who are down on their luck in the short term.

For example, let's say my house burns down tonight because of the friendly neighborhood arsonist. Is any type of public assistance group going to provide me temporary housing until my insurance agent cuts a check? No, that will come from the Red Cross or some area church.

Why? From what I am told, the public housing authority has a 1-2 year waiting list. What is the point of having a public housing authority for the down and out if that organization cannot service those who are truly undergoing major temporary problems and just need a little bit of help in the short term to get back on their feet? Why is there no space for these type of clients? Well, the units are heavily subsidized, utilities included and people end up not moving. There was recently an article in the paper about how the housing authority wanted to raise the rent for a 1-2 br waterfront unit from $400 a month since there have been no rent increases in over half a decade.  The residents pitched a fit, complaining to the media. Many have been living there for years, and apparently had no plans to leave. Why should they? If I had the government paying  for me to live in an $400 a month rent controlled, all utilities included, waterfront housing place I would totally have no incentive to move.

You can get cash home heating assistance, physical renovations to your home to make it more energy efficient, food stamps, medical, dental, education, transportation, etc. Like you, I wonder what incentive many people on welfare have to get off of it? Why should people clip coupons and go on budgets if they can simply walk up to a cash register in the store, dump a pile of food on it, and buy whatever goes through before the total exceeds the $ on their benefits card?

If we really wanted to help people, why not do something to allow those who want to become self sufficient in the long run to better themselves? For example, I live in an area with declining population and negative growth. If jobs are really that hard to find, why not assist people who are finding it tough to get by with providing them cash to move to a boom state like Arizona, Nevada, Florida or wherever has jobs that can support them? Why do we spend state funds to keep people in multi-generational cycles of poverty? I am certain some out of the box thinking could easily lead to several other possible ideas besides just shoveling scads of cash into the hands of social services clients.

The point is, there have to be better ways of solving the poverty problem and helping those who want the help or who just need to get past a rough patch in their lives. Then again, perhaps this is just the wonderful Empire State, so your mileage may vary.

e finding it tough to get by with providing them cash to move to a boom state like Arizona, Nevada, Florida

During the Murial Boatlift, the governor of Florida (or someone on his staff) floated the idea of giving bus tickets and cash to folks who wanted to go elsewhere.  IIRC, other governors lost their minds.  Not a popular thing to do to your brother govs.

It's the end of the world as we know it, and I feel fine

There has to be a way of making it work. I assume tickets would only be given to those who had job guarantees in another state. Some areas seem to be hurting for agricultural and service job labor, so if somebody wants to fill an otherwise empty slot, why not help them do so? Wouldn't it be better in the long run for that type of program than to rely on outside, illegal labor?

I'm sure there is a way to make it work...unfortunately it more than likely involves another layer of government bureaucracy. And unless that agency had some real teeth, it's not likely to work anyway.

Relocation Agent:  Ok, Mr. Jones...we have a lovely house keeping job in Bitter Sands, Arizona.
Mr. Jones:  Don't wanna go.
Agent: But Mr. Jones it's lovely warm there...not like the harsh winters we have here.
Mr. Jones: Don't wanna go.
Agent: Ok...next!

You are on to something though...at least in a sense of sending undesirables elsewhere.  It seems that what your town needs is a little good old gentrification. It's worked in other areas.  The upwardly mobile...not unlike the pioneers of old...move in and start rehabing a neighborhood, turning bars into flower shops and such.  Soon, rents and property values rise to a point where the underclass have to move away...maybe to Newark.  All it takes is a seed.  Maybe you are that seed.  Soon with any luck, through the process of benign gentrification, the undesirables either become desirable or they stake their new homestead on a garbage dump outside of Quezon City.

It's the end of the world as we know it, and I feel fine

I'm sure there is a way to make it work...unfortunately it more than likely involves another layer of government bureaucracy. And unless that agency had some real teeth, it's not likely to work anyway.

If this idea worked it would likely remove other layers of government bureaucracy (social workers paid to keep folks in benefits for the long term) and get those who want to get over a bad spot back on their feet. It would probably be a net gain.

On second thought, who even says it has to be a government program? If it worked, I am sure a private charity could help run it. Everybody wins in the long run.

 The upwardly mobile...not unlike the pioneers of old...move in and start rehabbing a neighborhood, turning bars into flower shops and such.

My neighborhood needs a bar first. It has a burned out, graffiti covered hulk two blocks away which I assume based on the dancing Irishman signage used to be a bar. I'd be happy to settle for a bar.

He's saying "People I know need help, people I don't know are a bunch of chiselers."

So where does that leave us? We will probably never have a situation where the overwhelming majority of society gets dental coverage. What do we do about it?

First off, I think we do a class action suite against the insurance executives who somehow came up with the idea that teeth and eyes are not part of our overall health.  After all, nothing is more excruciating to the senses than a toothache.

Seriously, I think that teeth and eyes should be covered under the general health plan.  It's just as important as any other part of the body, and I can't understand why it's not covered under one plan.  Most years, I am in more need of a dentist than a general check-up of the rest of me.

I'm not a clinician, but couldn't it be that dentistry and optometry generally require non-MD specialists? I know my health plan excludes services provided by DPMs, dieticians, and a whole host of allied health people. Although they recently added in chiropracters (and massage therapists, WTF?).

The point is, I can see OD and DMD/DDS services requiring seperate policies because they are covered by completely seperate providers. It is kind of stupid, but I can see where some insurance administrator is coming from. Perhaps our own resident insurance agent, Mr. Lou, could chime in here?

Dental coverage was excluded for health coverage because back when our insurance system was established, there wasn't the awareness of the impact dental health had on overall health.

And it wasn't included in Medicare because most folks old enough to qualify didn't have teeth anymore.

People won't look at this as a reason to find another job - they'll just go without health insurance.

My experience with doctors in San Francisco have been dismal.  The first thing they ask is whether you have an health insurance plan, on a recorder often.  And if you don't leave the name of a health insurance provider, the doctor's office never calls you back.  Since I hate leaving voicemail messages, it took me a couple of calls around to health providers to figure this out.  Personally, I think this should be illegal.

I really don't know what people in San Francisco without health insurance do.  I suppose they end up at clinics or emergency rooms.  In New York, all the doctors are willing to take on uninsured clients, often at a lower charge, because they know that not everyone has a job with health insurance.

People on this thread have talked about a national health care plan breaking the system.  Personally, after my experience in San Francisco, I would say it's already broke.  Between the dentists I can't stand because it always feels like they are trying to push extra procedures for the money from the insurance company, the family doctors who don't return phone calls, the HMO that let's me self-diagnose myself....what exactly is broke if not that?  My body isn't a body so much as a vehicle for profit.

Between the dentists I can't stand because it always feels like they are trying to push extra procedures for the money from the insurance company,

This pisses me off. A few years ago I had the dental insurance of an Omani Prince. I had the civil servant BC/BS insurance, and as such my ex-dentist tried to sell me on some completely medically (dentally?) unneeded invis-align braces that would have been cosmetic at best. It would have been thousands (tens of thousands?) of dollars, but he didn't even bother to quote me on the price. He just shoved those glossy brochures at me and said insurance would cover it all as he counted dollar signs in his head. That type of shenanigans is almost as bad as the people who intentionally defraud insurance agencies.

It would have been thousands (tens of thousands?) of dollars, but he didn't even bother to quote me on the price.

That's what really annoyed me.  My dentist did the same thing.  

And I want to trust a dentist given that teeth are pretty important.  So, rather than rush through on getting a last check-up before I check-out of this job, I've decided to wait until I move back to New York where my old dentist is.  I'd much rather pay him for a procedure rather than having a dentist pushing unnecessary procedures on me.  

I have to check and see what kind of individual dental plans for available.  There must be something.  

The free market will work to lower the cost of medical care, and as mentioned before, charities and other agencies can take care of the truly needy and disadvantaged, especially if taxes are reduced so donors have more money to give. There is no perfect solution. But increasing spending to cover everybody in some kind of universal coverage plan is far from an ideal answer to the problem.

I agree with you that we see too many specialists, etc., but I don't think that the free market is the solution to that - I think it's the cause. People become specialists because they can charge more for their services - and people go to specialists because it's impossible to make rational decisions about your health, on your own. If you have cancer and have a 2% better chance of beating it by going to a specialist, well, you'll go. If we went to a completely pay-for-services model that might solve things, but I think it would probably just lead to more people going into debt and declaring medical bankruptcies (especially if hospitals continue to be required to render emergency care regardless of the patient's ability to pay).

Ever notice how most MDs now go and take residencies and sometimes fellowships to specialize and sub specialize in certain fields? Do we really need a guy with allergies or a cold going to a physician with 3 board certifications charging $400 a visit? Why can't the majority of these issues be handled by a nurse practitioner or a physicians assistant? Why can't the number of in pharmacy or in store clinics be expanded? Why can't more medical schools be built to increase the supply of MDs and thus lower salaries and costs?

You are making a lot of assumptions as well as giving too much credit to the current medical system.  First off, most places I've been to recently, I saw a doctor for all of 15 minutes, if not.  I have a health care system where I don't even have to see the doctor to get certain medications, where if it's low enough symptoms, they basically let me self diagnose myself over the phone. Do they charge the insurance company for what is basically my self diagnosis so that I can get some anti-biotics when I need it: you bet!

However, such self-diagnosis is dangerous because people can get their symptoms wrong.  The reason why somebody with an expensive degree should look in on people who come to the hospital (or who call for their anti-biotics as I can on my stupid worst health care plan ever) is because there might be other symptoms that is not immediately apparent.  

My friend's wife had pain around her mid-riff area.  The resident checked her out, said can't figure it out and turned her out.  My friend was pissed off, decided that a resident's say so wasn't enough and demanded they keep her until they figure out what's wrong.  Well, turned out her appendix had burst, and she was eight months into a pregnancy.  Turned out okay, but what if my friend hadn't protested the initial shoddy treatment?

The problem with the current health care system is legion, but to blame it on the patients is to blame the very people who are getting the short end of the stick.  The hospitals and insurance companies ar