JayB

Yes.

Friedman pretty well summed it up. "If you think healthcare's expensive now, just wait until it's free." ------------------------------------------------------------------- It's also worth pondering precisely how much good getting an insurance policy does for you when price controls restrict the supply of primary physicians at the same time that demand for their services increases. Particularly when you have to get a PCP's referral for diagnostics, specialist visits, etc. How come there's a shortage of PCP's? Couldn't have anything to do with government price control schemes, could it? The next well-intentioned development in the devolution of medical care was the mechanism by which medical fees were set, a system called Resource-Based Relative Value Scale (RBRVS). This was the invention of Professor William Hsiao, an actuary at the Harvard School of Public Health. RBRVS attempted to price every item in medical care based on the resources required to create it. Procedures or devices that were expensive to make were priced higher. Physicians who required more training and preparation were paid more. What a dream for insurance companies—pricing without negotiation. In any industry but medicine, this would be called "price fixing" and probably be illegal. Instead, RBRVS was immediately adopted by Medicare in 1988. It has been a fixture in insurance reimbursement ever since. Unfortunately, there was a problem with RBRVS—it killed primary care. Just as bad, it caused a natural migration to more and more expensive treatments. The primary-care doctors didn't have expensive procedures, and they didn't spend as many years in training as the specialists. In the RBRVS world, they were nearly worthless. In real markets, prices are determined by what customers value and are willing to pay: Too high a price, no sale. In health care, if it is expensive to produce, we pay more. If you want to understand why American medical care is dominated by specialists doing expensive procedures, you need look no further than this. Despite growing mountains of data showing that medical systems dominated by primary-care physicians produce better health outcomes at lower cost, we persist with an insurance system programmed to annihilate primary care and encourage expensive procedures. Good summary of the effects of third party payment/rationing on healthcare... The primary physician shortage is already a reality in MA. The state had a problem before they implemented their strategies to cover everyone, but it's become considerably worse since then. Guess what happens when people are sick and worried and either can't find a doctor, or can't see them in less than six weeks?

How about "I'm cool with allowing any possible infringements on our liberty like (get ready for this bombshell) mandatory seat belt laws (shivers) to work their way through the normal legislative process that you and yours are so keen to remind us is the best system in human history like any other laws rather than satisfying any and all theoretical potential ideological boogymen that you can toss out while people are dying because they can't afford healthcare". That's what I meant. Or..."Hey, I'm cool with the state outlawing stuff in exchange for single payer." Got it. People die because of the rationing imposed by single-payer systems as well - which a quick look at the comparative survival stats for various cancers will readily show. The mortality and morbidity stemming from inferior trauma care, inadequate diagnostic capabilities, delayed treatment, etc are just as real as the deaths from the lack of health insurance. Ditto for the people who have and will die as a consequence of the drugs and other medical innovations that haven't and won't be developed as a result of price controls imposed by various governments - even though they're impossible to determine. How about people who can't afford coverage because the mandates that legislatures have imposed make even the least expensive coverage vastly more expensive than it would be otherwise? If your goal is simply to insure that everyone has coverage, it'd be much cheaper to simply give anyone who couldn't afford private insurance (A) or wasn't already covered by an existing government program (B) already - (care to venture what percentage of the uninsured are left after controlling for A and B) - income indexed subsidies and tax credits to purchase high deductible plans and fund their HSA's to some threshold of the deductible. Or you can pretend that the only mechanism for doing so is via nationalization/single-payer.

Nope, the people enable the state to regulate the pushers for suicidal behavior. More lies and fear-mongering. Western democracies with single payer formula have better healthcare than we do, private practioners and HMO's that make health related decisions, private addtionial health insurance for those who need it, and no rationing. 1. Who are the "pushers for suicidal behavior," what qualifies as such, who makes that decision, and what additional powers would you like to give the government in order to prohibit/criminalize it? 2. Better by what definition? Spare me another iteration of life-expectancy/infant-mortality argument. 3. What part of the state deciding who's too old to bother treating, who's too ill to continue tying to save, how injuries get diagnosed, which injuries get treated, how they get treated, and when, which chemo options are too costly, how much money gets allocated for surgical services, etc don't constitute rationing? I heard about all of the above on a case-by-case basis for months in a country that supposedly has no rationing. Rationing will be a fixture of any system, the only question is who makes the calls when the time comes to make choices that involve various tradeoffs. The only real question is whether its better to allocate the same pool of resources in a way that leaves the vast majority of those decisions in the hands of individuals or third party payers. If we're left with only a choice between the latter, it's worth asking whether a cash-strapped state monopoly that's immune from liability or a competitive insurance market that has to answer to both the state and the consumers is more likely to have the means and motive to enforce the more stringent rationing. 4. Once you strip away the effects of public-to-private cost shifting, rationing, and bogus accounting the cost advantages of publicly administered care completely disappear. Ever look at the administrative costs of non-Medicare programs? The reason that Medicare's administrative costs tend to be significantly lower than other government programs have quite a bit to do with the bogus accounting that I've detailed elsewhere, but they also have quite a bit to do with the fact that the government doesn't administer the claims directly. It solicits bids from private contractors who do the administering per Medicare's rules - which is probably one reason why overbilling and fraud are far more costly for Medicare than private insurers who spend the money necessary to combat these problems effectively.

So - the argument isn't that the state hasn't/won't use the "the state's paying for the ill effects of (insert unpopular behavior that sane adults choose to do to themselves here), the state has the right to outlaw it" rationale if given the chance. It's that the fact that you're willing to exchange whatever liberties the state deems necessary to restrict in the name of cost-containment in exchange for whatever security you expect a third party rationing mechanism run by a state monopoly to provide. Or "Hey, I'm cool with the state outlawing stuff in exchange for single payer." Might as well be clear about it.

What's your understanding of the rationale used to justify compulsory seatbelt and helmet laws for adults? Drug prohibition? The government is unlikely to outlaw dangerous, fringe activities for the simple fact that very few people participate in...dangerous fringe activities, and the simple lack of resources would make such bans next to impossible to enforce even if legislators thought that doing so was desirable. Motive - yes. Means - not likely. However, if you are someone that participates in a more popular activity that's likely to impose significant aggregate health-related costs on the state - it's quite a bit more likely that a state funded and administered healthcare monopoly will have both a strong motive to curtail whatever potentially costly behavior that you are engaging in. Whether the state/monopoly-healthcare-provider will ever try to procure the means necessary to inhibit whatever bit of potentially costly, non-fringey personal freedom that you're exercising is an open question - whether they'll have the motive to isn't. Not sure "It hasn't happened yet, therefore it won't" is a heuristic that I'd be willing to bet all of my chips on in that context. There's probably a few brewers/distillers that set up shop in 1919 that wish they wouldn't have followed that approach...

He'd first have to show that not providing affordable health coverage to people is cheaper than giving them treatment in the emergency room because of that dangerous "socialist" idea, the hypocratic oath. What the national tab for caring for the uninsured vs cost shifting by Medicare/Medicaid? What does the data from MA suggest? Making sure that everyone has the resources necessary to procure healthcare doesn't necessarily require forcing them into a third-party cost-containment algorithm based on forcing medical decisions into rigid compliance with a set of abstract statistical aggregates.

Dude! That's awesome! Congrats - you deserve it! Hopefully nothing but positive stuff precipitated the move out of 'Joisey.

Jim: 1. There are serious problems with dividing the total spending on healthcare in a given country and dividing by the population - at least if you are interested in comparing apples to apples. How much is discretionary, does it make more sense to compare non-discretionary spending between states with significant differences in per-capita income in terms of dollars or percentage of income, etc? Are we interested in apples-to-apples comparisons here, or not? 2. I lived right next door to a hospital in NZ, and heard about the disposition of hundreds of cases and the parameters that drove the state's decision making regarding who got what care - since my wife treated those patients herself and dealt directly with the administrators. At least in NZ - you don't get the treatment that you and your doctor agree upon, you get the treatment that the state allows. I'm not out to disparage their system here - just to inform you that the state rationing system in place there, coupled with very little recourse for patients and families in the event of malpractice (which tends to happen as soon as the payouts for lawsuits/settlements start coming directly out of the state's pockets), results in limitations on care that are considerably more severe than those that prevail here. When we're comparing alternatives, let's be honest and admit that we're comparing alternate rationing mechanisms. On one side we have competing sets of algorithmic third-party rationing mechanisms with incentives that are at best poorly aligned with those of their ostensible beneficiaries, and at worst completely at odds with them. If you think that a set of competing private insurers subject to the restraints of competition, government oversight, and monetary liability is going to impose more severe limitations on care than a government monopoly that's subject to none of these - I hope you'll explain how and why that's the case. A high-deductible/HSA model coupled with income indexed credits and subsidies is off the table would likely cost less, do a better job of aligning the incentives of patients and providers, and leave people in control over the rationing of 95% of the medical choices that they'll ever have to make - but since that's largely off the table at this point I'll leave it at a discussion of third-party rationing via a competitive private system or a public monopoly. 3. Costs. How do CHAMPUS, Medicaid, SCHIP and other government programs stack up in terms of administrative costs? If you want to stick to medicare - how certain are you that the comparisons of administrative costs are both meaningful and accurate? Here's an argument that they aren't: "Advocates of a public plan assert that Medicare has administrative costs of 3 percent (or 6 to 8 percent if support from other government agencies is included), compared to 14 to 22 percent for private employer-sponsored health insurance (depending on which study is cited), or even more for individually purchased insurance. They attribute the difference to superior efficiency of government,[1] private insurance companies' expenditures on marketing,[2] efforts to deny claims,[3] unrestrained pursuit of profit,[4] and high executive salaries.[5] However, on a per-person basis Medicare's administrative costs are actually higher than those of private insurance--this despite the fact that private insurance companies do incur several categories of costs that do not apply to Medicare. If recent cost history is any guide, switching the more than 200 million Americans with private insurance to a public plan will not save money but will actually increase health care administrative costs by several billion dollars. Fuzzy Math Medicare patients are by definition elderly, disabled, or patients with end-stage renal disease, and as such have higher average patient care costs, so expressing administrative costs as a percentage of total costs gives a misleading picture of relative efficiency. Administrative costs are incurred primarily on a fixed or per-beneficiary basis; this approach spreads Medicare's costs over a larger base of patient care cost. Even if Medicare and private insurance had identical levels of administrative efficiency, Medicare would appear to be more efficient merely because of an artifact of the arithmetic of percentages--Medicare's identical administrative costs per person would be divided by a larger number for patient care costs. Imagine, for a moment, that Fred and Jane each have a credit card from a different bank. Fred charges $5,000 a month, and Jane charges $1,000 a month. Suppose it costs each bank $5 to produce and send a plastic credit card when the account is opened. That $5 "administrative cost" is a much lower percentage of Fred's monthly charges than it is of Jane's, but that does not mean Fred's bank is more efficient. It is purely a mathematical artifact of Fred's charging pattern, and it would be silly to compare the efficiency of bank operations on that basis. Yet that is how many analysts compare Medicare with private insurance. Background Administrative costs are customarily expressed as a percentage of total costs, that total being the sum of administrative costs and health benefit claims paid. In the case of Medicare, the cost to the Centers for Medicare and Medicaid Services (CMS) of operating the Medicare program has ranged in recent years from 2.8 to 3.4 percent; adding in costs incurred by other government agencies in support of Medicare brings the total to a range of 5.7--6.4 percent.[6] In the case of private insurance, administrative costs are measured by the difference between premiums collected and claims paid. The result is that this includes some costs that are not really "administrative." For example, many private insurers provide disease management services for patients with chronic conditions and/or on-call nurses for patients to consult by phone. Because these services are provided directly by the insurance company, they do not result in a claim being paid. In addition, most states impose a "premium tax" on health insurers; this tax is obviously not a health benefit claim. However, because all non-benefit costs are defined as "administrative," these and other similar expenditures are reported as administrative costs. In recent years, these so-called "administrative costs" have accounted for 11.4--13.2 percent of total health insurance premiums.[7] Why Measuring Administrative Costs as a Percentage Is Misleading Administrative costs can be divided broadly into three categories: 1. Some costs, such as setting rates and benefit policies, are incurred regardless of the number of beneficiaries or their level of health care utilization and may be regarded as "fixed costs." 2. Other costs, such as enrollment, record-keeping, and premium collection costs, depend on the number of beneficiaries, regardless of their level of medical utilization. 3. Claims processing depends primarily on the number of claims for benefits submitted. Claims processing is the only category that is at all sensitive to the level of health care utilization, and it is more correlated with the number of claims than on the cost or intensity of service provided on each claim. Furthermore, it represents only a very small share of administrative costs. For example, in the case of Medicare, the total claims processing expenditure in FY 2005 was $805.3 million,[8] which represented 4.04 percent of Medicare's administrative costs--which is, in turn, only 0.234 percent (less than 24 cents for every $100) of total Medicare outlays.[9] Clearly, only an extremely small portion of administrative costs are related to the dollar value of health care benefit claims. Expressing these costs as a percentage of benefit claims gives a misleading picture of the relative efficiency of government and private health plans. Medicare beneficiaries are by definition elderly, disabled, or patients with end-stage renal disease. Private insurance beneficiaries may include a small percentage of people in those categories, but they consist primarily of people are who under age 65 and not disabled. Naturally, Medicare beneficiaries need, on average, more health care services than those who are privately insured. Yet the bulk of administrative costs are incurred on a fixed program-level or a per-beneficiary basis. Expressing administrative costs as a percentage of total costs makes Medicare's administrative costs appear lower not because Medicare is necessarily more efficient but merely because its administrative costs are spread over a larger base of actual health care costs. Administrative Costs per Person When administrative costs are compared on a per-person basis, the picture changes. In 2005, Medicare's administrative costs were $509 per primary beneficiary, compared to private-sector administrative costs of $453. In the years from 2000 to 2005, Medicare's administrative costs per beneficiary were consistently higher than that for private insurance, ranging from 5 to 48 percent higher, depending on the year (see Table 1). This is despite the fact that private-sector "administrative" costs include state health insurance premium taxes of up to 4 percent (averaging around 2 percent, depending on the state)--an expense from which Medicare is exempt--as well as the cost of non-claim health care expenses, such as disease management and on-call nurse consultation services."

Might as well get to specifics here and cite both the details of the policies that you have in mind, the manner in which they hand over unchecked power to the state, and how that renders them consistent with the free-trade, free-speech, anti-prohibition, etc arguments that I've made here.

If you want to discuss various statistical aggregates and how they specifically implicate the morals of a particular country or ideology, I'll be happy to have those discussions in due time. You may have a compelling set of facts and logic to support the claim that the absence of a universal single-payer health care renders every American the moral equivalent jihadists, for example, and I hope that you'll give that argument the lengthy treatment that it deserves as soon as you can. In the meantime, I hope that you'll spare a moment to respond to the arguments put forth by Hamid about the connection between specific tenets of the Muslim faith and violent acts of jihad directed against civilians, etc, and use your superior knowledge of Islam to demonstrate why he and the other reformers, apostates, etc that have spoken out and share his agenda are wrong. You might also spell out precisely what, exactly, qualifies you to evaluate the convictions of those who self-identify as Muslims and who publicly proclaim themselves as such aren't, in fact, Muslims. "For 20 years, I have preached a reformed interpretation of Islam that teaches peace and respects human rights. I have consistently spoken out--with dozens of other Muslim and Arab reformers--against the mistreatment of women, gays and religious minorities in the Islamic world. We have pointed out the violent teachings of Salafism and the imperative of Westerners to protect themselves against it. Yet according to CAIR's Michigan spokeswoman, Zeinab Chami, I am "the latest weapon in the Islamophobe arsenal." If standing against the violent edicts of Shariah law is "Islamophobic," then I will treat her accusation as a badge of honor. Muslims must ask what prompts this "phobia" in the first place. When we in the West examine the worldwide atrocities perpetrated daily in the name of Islam, it is vital to question if we--Muslims--should lay the blame on others for Islamophobia or if we should first look hard at ourselves. According to a recent Pew Global Attitudes survey, "younger Muslims in the U.S. are much more likely than older Muslim Americans to say that suicide bombing in the defense of Islam can be at least sometimes justified." About one out of every four American Muslims under 30 think suicide bombing in defense of Islam is justified in at least some circumstances. Twenty-eight percent believe that Muslims did not carry out the 9/11 attacks and 32% declined to answer that question. While the survey has been represented in the media as proof of moderation among American Muslims, the actual results should yield the opposite conclusion. If, as the Pew study estimates, there are 2.35 million Muslims in America, that means there are a substantial number of people in the U.S. who think suicide bombing is sometimes justified. Similarly, if 5% of American Muslims support al Qaeda, that's more than 100,000 people. To bring an end to Islamophobia, we must employ a holistic approach that treats the core of the disease. It will not suffice to merely suppress the symptoms. It is imperative to adopt new Islamic teachings that do not allow killing apostates (Redda Law). Islamic authorities must provide mainstream Islamic books that forbid polygamy and beating women. Accepted Islamic doctrine should take a strong stand against slavery and the raping of female war prisoners, as happens in Darfur under the explicit canons of Shariah ("Ma Malakat Aimanikum"). Muslims should teach, everywhere and universally, that a woman's testimony in court counts as much as a man's, that women should not be punished if they marry whom they please or dress as they wish. We Muslims should publicly show our strong disapproval for the growing number of attacks by Muslims against other faiths and against other Muslims. Let us not even dwell on 9/11, Madrid, London, Bali and countless other scenes of carnage. It has been estimated that of the two million refugees fleeing Islamic terror in Iraq, 40% are Christian, and many of them seek a haven in Lebanon, where the Christian population itself has declined by 60%. Even in Turkey, Islamists recently found it necessary to slit the throats of three Christians for publishing Bibles. Of course, Islamist attacks are not limited to Christians and Jews. Why do we hear no Muslim condemnation of the ongoing slaughter of Buddhists in Thailand by Islamic groups? Why was there silence over the Mumbai train bombings which took the lives of over 200 Hindus in 2006? We must not forget that innocent Muslims, too, are suffering. Indeed, the most common murderers of Muslims are, and have always been, other Muslims. Where is the Muslim outcry over the Sunni-Shiite violence in Iraq? Islamophobia could end when masses of Muslims demonstrate in the streets against videos displaying innocent people being beheaded with the same vigor we employ against airlines, Israel and cartoons of Muhammad. It might cease when Muslims unambiguously and publicly insist that Shariah law should have no binding legal status in free, democratic societies. It is well past time that Muslims cease using the charge of "Islamophobia" as a tool to intimidate and blackmail those who speak up against suspicious passengers and against those who rightly criticize current Islamic practices and preachings. Instead, Muslims must engage in honest and humble introspection. Muslims should--must--develop strategies to rescue our religion by combating the tyranny of Salafi Islam and its dreadful consequences. Among more important outcomes, this will also put an end to so-called Islamophobia. Dr. Hamid, a onetime member of Jemaah Islamiya, an Islamist terrorist group, is a medical doctor and Muslim reformer living in the West."

your "most fucked up religion on the planet" award must take into account the entire history of the religion, no? the recent outbreak of muslim insanity can be balanced against a great deal of stabilty and reasonability in the previous centuries. at any rate, no matter what they profess, most folks' true religion is greed, and that is no doubt a better candidate for your vaunted accolade I think it's worth taking the historical track record into account, and I'm more than happy to give Muslims credit for being less barbaric than Europeans during the crusades, etc - but there's only so far take your moral accounting before you start placing modern-day Swedes on an equal footing with the Taliban because of their propensity to rampage and pillage in the 11th and 12th centuries... Not very pithy, I know, but it's probably helpful to remember that, even if many tens of thousands of Muslims are violently radicalized (and that would be generous), that would represent less than 1/1000th of a percent of the total worldwide population of 1.4+ billion. These evildoers are hardly an accurate representation of the faith in general. If you think they are, then by the same statistical logic all Americans are homocidal hermaphrodites. "The Trouble With Islam Sadly, mainstream Muslim teaching accepts and promotes violence. by TAWFIK HAMID Tuesday, April 3, 2007 12:01 A.M. EDT Not many years ago the brilliant Orientalist, Bernard Lewis, published a short history of the Islamic world's decline, entitled "What Went Wrong?" Astonishingly, there was, among many Western "progressives," a vocal dislike for the title. It is a false premise, these critics protested. They ignored Mr. Lewis's implicit statement that things have been, or could be, right. But indeed, there is much that is clearly wrong with the Islamic world. Women are stoned to death and undergo clitorectomies. Gays hang from the gallows under the approving eyes of the proponents of Shariah, the legal code of Islam. Sunni and Shia massacre each other daily in Iraq. Palestinian mothers teach 3-year-old boys and girls the ideal of martyrdom. One would expect the orthodox Islamic establishment to evade or dismiss these complaints, but less happily, the non-Muslim priests of enlightenment in the West have come, actively and passively, to the Islamists' defense. These "progressives" frequently cite the need to examine "root causes." In this they are correct: Terrorism is only the manifestation of a disease and not the disease itself. But the root-causes are quite different from what they think. As a former member of Jemaah Islamiya, a group led by al Qaeda's second in command, Ayman al-Zawahiri, I know firsthand that the inhumane teaching in Islamist ideology can transform a young, benevolent mind into that of a terrorist. Without confronting the ideological roots of radical Islam it will be impossible to combat it. While there are many ideological "rootlets" of Islamism, the main tap root has a name--Salafism, or Salafi Islam, a violent, ultra-conservative version of the religion. It is vital to grasp that traditional and even mainstream Islamic teaching accepts and promotes violence. Shariah, for example, allows apostates to be killed, permits beating women to discipline them, seeks to subjugate non-Muslims to Islam as dhimmis and justifies declaring war to do so. It exhorts good Muslims to exterminate the Jews before the "end of days." The near deafening silence of the Muslim majority against these barbaric practices is evidence enough that there is something fundamentally wrong. The grave predicament we face in the Islamic world is the virtual lack of approved, theologically rigorous interpretations of Islam that clearly challenge the abusive aspects of Shariah. Unlike Salafism, more liberal branches of Islam, such as Sufism, typically do not provide the essential theological base to nullify the cruel proclamations of their Salafist counterparts. And so, for more than 20 years I have been developing and working to establish a theologically-rigorous Islam that teaches peace. Yet it is ironic and discouraging that many non-Muslim, Western intellectuals--who unceasingly claim to support human rights--have become obstacles to reforming Islam. Political correctness among Westerners obstructs unambiguous criticism of Shariah's inhumanity. They find socioeconomic or political excuses for Islamist terrorism such as poverty, colonialism, discrimination or the existence of Israel. What incentive is there for Muslims to demand reform when Western "progressives" pave the way for Islamist barbarity? Indeed, if the problem is not one of religious beliefs, it leaves one to wonder why Christians who live among Muslims under identical circumstances refrain from contributing to wide-scale, systematic campaigns of terror. Politicians and scholars in the West have taken up the chant that Islamic extremism is caused by the Arab-Israeli conflict. This analysis cannot convince any rational person that the Islamist murder of over 150,000 innocent people in Algeria--which happened in the last few decades--or their slaying of hundreds of Buddhists in Thailand, or the brutal violence between Sunni and Shia in Iraq could have anything to do with the Arab-Israeli conflict. Western feminists duly fight in their home countries for equal pay and opportunity, but seemingly ignore, under a façade of cultural relativism, that large numbers of women in the Islamic world live under threat of beating, execution and genital mutilation, or cannot vote, drive cars and dress as they please. The tendency of many Westerners to restrict themselves to self-criticism further obstructs reformation in Islam. Americans demonstrate against the war in Iraq, yet decline to demonstrate against the terrorists who kidnap innocent people and behead them. Similarly, after the Madrid train bombings, millions of Spanish citizens demonstrated against their separatist organization, ETA. But once the demonstrators realized that Muslims were behind the terror attacks they suspended the demonstrations. This example sent a message to radical Islamists to continue their violent methods. Western appeasement of their Muslim communities has exacerbated the problem. During the four-month period after the publication of the Muhammad cartoons in a Danish magazine, there were comparatively few violent demonstrations by Muslims. Within a few days of the Danish magazine's formal apology, riots erupted throughout the world. The apology had been perceived by Islamists as weakness and concession. Worst of all, perhaps, is the anti-Americanism among many Westerners. It is a resentment so strong, so deep-seated, so rooted in personal identity, that it has led many, consciously or unconsciously, to morally support America's enemies. Progressives need to realize that radical Islam is based on an antiliberal system. They need to awaken to the inhumane policies and practices of Islamists around the world. They need to realize that Islamism spells the death of liberal values. And they must not take for granted the respect for human rights and dignity that we experience in America, and indeed, the West, today. Well-meaning interfaith dialogues with Muslims have largely been fruitless. Participants must demand--but so far haven't--that Muslim organizations and scholars specifically and unambiguously denounce violent Salafi components in their mosques and in the media. Muslims who do not vocally oppose brutal Shariah decrees should not be considered "moderates." All of this makes the efforts of Muslim reformers more difficult. When Westerners make politically-correct excuses for Islamism, it actually endangers the lives of reformers and in many cases has the effect of suppressing their voices. Tolerance does not mean toleration of atrocities under the umbrella of relativism. It is time for all of us in the free world to face the reality of Salafi Islam or the reality of radical Islam will continue to face us. Dr. Hamid, a onetime member of Jemaah Islamiya, an Islamist terrorist group, is a medical doctor and Muslim reformer living in the West. "

Classical liberalism = anarchist? Really? Interesting perspective. Handing over unchecked power to the state, even if it happens to be ruled by a clique of leftist intellectuals with the best of intentions, seems a touch dubious as the best way to promote, much less secure anything that could be described as social progress, but I'd be more than happy to read any defense of this idea that you care to offer.

your "most fucked up religion on the planet" award must take into account the entire history of the religion, no? the recent outbreak of muslim insanity can be balanced against a great deal of stabilty and reasonability in the previous centuries. at any rate, no matter what they profess, most folks' true religion is greed, and that is no doubt a better candidate for your vaunted accolade I think it's worth taking the historical track record into account, and I'm more than happy to give Muslims credit for being less barbaric than Europeans during the crusades, etc - but there's only so far take your moral accounting before you start placing modern-day Swedes on an equal footing with the Taliban because of their propensity to rampage and pillage in the 11th and 12th centuries... Not very pithy, I know, but it's probably helpful to remember that, even if many tens of thousands of Muslims are violently radicalized (and that would be generous), that would represent less than 1/1000th of a percent of the total worldwide population of 1.4+ billion. These evildoers are hardly an accurate representation of the faith in general. If you think they are, then by the same statistical logic all Americans are homocidal hermaphrodites. I personally think that the more salient metric is the percentage of all deliberate ideologically driven attacks on/slayings of civilians over the course of the past 30 years that have been perpetrated by Muslims relative to all other faiths. It's also worth examining the motives of the people committing these attacks as they themselves understand and justify them, the long established ideological/theological infrastructure that recruits, funds, sustains, motivates and posthumously justifies them. In the end, the most effective means of dispelling a connection between Islam and retrograde barbarism in the minds of non-Muslims will be a vigorous, sustained, public repudiation of all of the above by the other 1.39999999 billion Muslims. I suspect that most of the non-Muslim world is eagerly awaiting such a movement and will greet it with open arms when and if it ever materializes. Not about Muslims as people, but about an ideology that claims their faith as the central motivation for what they believe and do. Hopefully they'll start to listen to guys like Tawfik Hamid and respond accordingly: http://www.pointofinquiry.org/tawfik_hamid_my_life_as_a_muslim_terrorist/ "Tawfik Hamid, an expert on Islamic terrorism, joined the Islamic group Muslim GI (al-Gama’a al-Islamiyya) in Egypt, while in medical school. His colleagues in the terror movement included Al Zawaherri, then a friend with whom Tawfik used to pray, and now the number 2 person of Al Qaeda. Eventually Dr. Hamid questioned the feelings of hatred and impulses to violence that his participation in extremist Islam was fomenting within him. He became a physician, and also a scholar of Islamic texts. When he began to preach in Mosques to promote a message of peace instead of violence and hatred, he himself became a target of the Islamic extremists who had previously been his friends. They threatened his life, forcing him and his family to flee Egypt , and then Saudi Arabia . His appearance on Fox TV in early 2006 and his testimony at the first major Intelligence Summit in Washington have further established him as a leading authority on global terror movements. He explains why extremist Islam is far more prevalent and poses a far more serious threat than most Americans appreciate to our economy, ecology, and national security. In this discussion with D.J. Grothe, Tawfik Hamid discusses his experiences with extremist Islam and the Al Quada affiliated organization he joined, the question of moderate Islam and moderate Muslim organizations such as the Council on Islamic American Relations. He also explores the dire need for Islam to be reformed, and the recent CFI-sponsored Secular Islam Summit in St. Petersburg, Florida. Also in this episode, Ibn Warraq reads the Declaration from the Secular Islam Summit, which has received worldwide press and grassroots attention."

your "most fucked up religion on the planet" award must take into account the entire history of the religion, no? the recent outbreak of muslim insanity can be balanced against a great deal of stabilty and reasonability in the previous centuries. at any rate, no matter what they profess, most folks' true religion is greed, and that is no doubt a better candidate for your vaunted accolade I think it's worth taking the historical track record into account, and I'm more than happy to give Muslims credit for being less barbaric than Europeans during the crusades, etc - but there's only so far take your moral accounting before you start placing modern-day Swedes on an equal footing with the Taliban because of their propensity to rampage and pillage in the 11th and 12th centuries...

Unclenching fist alert...

1. What specific health outcomes are you talking about here? I'm more than happy to compare apples to apples here. 2. Cost shifting. Are you making the "argument from personal incredulity" here on purpose, or do you really not believe that this really happens? The government pays providers less than the cost of providing care. Providers recoup the losses by charging private payers more. There's an hour-long interview with a CEO of a major hospital chain where he's quite frank and explicit about how they go about shifting costs to make ends meet here: http://www.econtalk.org/archives/2008/12/lipstein_on_hos.html "Steven Lipstein, President and CEO of BJC HealthCare--a $3 billion hospital system in St. Louis, Missouri--talks with EconTalk host Russ Roberts about the economics of hospitals. They discuss pricing, the advantages and disadvantages of specialization in modern medical care, and culture and governance of non-profit hospitals vs. for-profit hospitals. At the end they talk about the positives and negatives of a national health board patterned after the Federal Reserve." The alternative to cost shifting is simply turning patients away. We can talk about why hospitals that take a mix of patients with public/private insurance are unlikely to do so, and why small practices are increasingly doing so if you wish. If you still think that I'm making this up, I invite you to consult the literature and evaluate their analysis/conclusions. Here's a representative paper: "Hospital Cost Shifting, Provider Segmentation, and the Game of Medicare Payment Policy. Mayes R, Lee J; AcademyHealth. Meeting (2005 : Boston, Mass.). Abstr AcademyHealth Meet. 2005; 22: abstract no. 3586. University of Richmond, Political Science, 28 Westhampton Way, Richmond, VA 23173 Tel. 804-287-6404 Fax RESEARCH OBJECTIVE: The goal of our paper is to gain a better understanding of some of the leading factors that influence Congress annual adjustment of Medicare payment policy and how medical providers (primarily hospitals) respond to changes in reimbursement by public health insurance programs....The paper concludes that cost shifting is becoming an increasingly important issue for individuals, because they have assumed a disproportionate share of the dramatic increase in health care costs that have occurred in recent years." http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=103623049.html 3. Costs of bureaucracy. You are conflating "low overhead" with efficiency here. Going light on claims review, fraud prevention, and other functions that are served by admin reduces administrative costs, but does not necessarily do anything to improve the efficiency of overall medical spending. Since you have studied this matter in some depth, you may also be able to tell me if the cost estimates that you cite account for the fact that Medicare/Medicaid get their funding directly from the Treasury. Private insurers have to account for the costs of raising money and staying solvent, which includes maintaining capital reserves sufficient to satisfy their claims in addition to billing for premiums, etc. Do the cost figures that you cite account for the cost of raising the funds necessary to pay for claims via taxation? How about maintaining capital reserves? The future costs of pension/healthcare liabilities for government employees? 4. I'll hope that you'll add something more flesh out your more general claim that eliminating competition and creating monopolies reduces costs and improves quality. I don't think that a mixed market with government imposed price controls that transfer costs onto others isn't the best example with which to make this case, but I'd be more than happy to continue this discussion. 5. Bankruptcy. Let's look at the data as opposed to swapping anecdotes. Once we've established whether it's the costs of care or the costs of disability that drive more people into bankruptcy, we can talk about the pros and cons of price controls and the real but seldom understood costs that come along with them. Any time you have a conversation about costs, it's worth asking -"Compared to what?" What were the costs associated with the condition/disease/etc before there was an effective treatment? How likely is it that the costly treatment would be available at all under a centrally administered price control regime/monopoly? Would it exist in the first place? Would the government pay for a supply commensurate with demand, and if not - how many people would get it? 6. Public/Private competition. Do you really think that this will be a fair competition - e.g. that the government would be willing or able to create a plan that has no competitive advantages that aren't due solely to its power to draft legislation, etc? E.g. advantages that no private company, no matter how lean, efficient, or innovatvie could ever hope to duplicate since the very fact of being a private company precludes them from doing things like...drafting legislation that restructures the rules that govern the entire medical economy? ... More malarky for you to enjoy. Have a nice weekend.

This supposes that it's the medical bills alone, rather than the combination of medical bills plus income lost to disability that puts people under. I don't think that the statistics concerning the percentage of people who have coverage *and* go bankrupt bear this conclusion out. Do all other nations in the world include 100% pre-injury income replacement to prevent bankruptcies brought about by post-injury incomes that are no longer sufficient to meet pre-injury obligations? If you want to talk in terms of generalities like "mystical markets," though, I'd be interested in hearing of some other cases where eliminating competition creating a monopoly has decreased costs and improved quality before we assume this will happen if we transfer monopoly control of healthcare over to the government. It's also worth considering the connection between profits and efficiency. If one could increase efficiency (raise the value of total outputs relative to total inputs) simply by eliminating profits, then GM would have been widely admired as one of the more efficient car companies in the world, and Toyota would be widely derided for their woeful performance on this front. "Look at all of the *profits* that Toyota is making on their cars. GM not only isn't profitable, they're losing billions every month. That means that they must be spending more on flawless engineering, high-quality parts, and top-notch assembly than they could possibly hope to recoup in the sale price of one of their vehicles! I'd better buy a GM product to insure that I get a better deal! Ha! Take that ...Toyota!" I'd prefer to constrain the discussion to specifics that pertain to a government monopoly in health care though, such as whether keeping "overhead" low by *not* spending an extra dollar on claims review and fraud prevention actually constitutes greater efficiency if doing so will save, say two dollars. I'll just tack that one onto the examples I gave above if anyone wants to address any of them at some point. Then there's the matter of what would happen to costs when there's no private payers for the government to shift its costs onto. Right now the government pays less than the actual costs of providing medical care, and private payers make up the difference. When there's no longer any private payers around to do so, and the funding necessary to sustain the existing medical infrastructure has to be financed by government expenditures alone, one of two things will happen. Capacity will contract or the government will have to spend more to deliver the same amount of care. There's no escape from this. With regards to high deductible plans, it'd be worth considering the effect of low-premium, high-deductible plans coupled with tax deductible HSAs (or even income indexed subsidies) that build in incentives to spend wisely (like getting to keep a portion of what you don't spend) vs a universal zero-dollar coverage scheme in terms of efficiency and cost containment. The reason that high deductible plans cost consumers less is because they result in lower costs for the insurer. How certain are you that moving the entire population from their existing insurance plans into a universal, first-dollar/zero-deductible plan is actually going to result in lower total spending on medical care? *We have private disability coverage. Safe - no. As secure as we can reasonably expect to be here or elsewhere in the world - I think so.

Depends on how you measure efficiency, no? A software algorithm that dispensed money per a pre-determined set of rules would cost quite a bit less than all of the above, but it's far from certain that it would be more efficient in any sense that's meaningful. That is, in terms of medical benefits delivered per dollar spent. There's plenty of examples where medical innovation has moved faster than medicare/medicaid's capacity to adjust their payout schedule, and providers simply capture the excess payments. Less overhead? Yes. More efficient? No. There's also the matter of simply gaming the system to derive maximum compensation. There are plenty of cases where medicare won't pay unless providers do X, even if X is unnecessary. What happens? They do X and bill medicare/medicaid. Once again - less costly overhead? Yes. More efficient? No. Anyhow - shouldn't the measure of efficiency be left to individuals to determine on their own behalf? If it turns out that the government can actually deliver higher quality care and better outcomes more rapidly and at a cost that's lower than or equal to those that private insurers can offer, then the "public option" will ultimately prevail under these conditions of competition, no? If anything, it seems like gaining converts via competition would actually be better for anyone interested in seeing the "public option" persist for more than a single election cycle, since people who enroll in a government sponsored health insurance plan because they want to, not because they had to, will ultimately be more faithful allies of such a system.

You haven't lived, as a bike commuter in Seattle, until one of your fellow cyclists rolls up to you at an intersection and delivers the same sermon. Seems like most motorists that deliver those lines are more than happy to see you grinding up a hill at 5mph on the sidewalk instead of obstructing traffic...

Compared to what? If I'm not mistaken, Canada is seeing something like one private clinic opening per week in the wake of the supreme court ruling that overturned the rules that forced doctors and patients into the public system. Also, the UK has started relaxing the restrictions on patients who want to bypass the restrictions on treatments, medications, etc by paying the difference between the care they want and what the government is prepared to pay for. Both indicate a movement away from, rather than towards, a strict single-payer modality - which moves them closer to the models that prevail in most of Europe and elsewhere. Quick overview of the German system: http://www.civitas.org.uk/pubs/bb3Germany.php

Neither life expectancy, nor infant mortality, nor preventable deaths are actually good measures of how well the health care system that we have treats a given medical condition vs the rest of the world. Ditto for the WHO report - which I invite you to read and carefully examine the methodology they used to rank health care systems. I've provided the links, data, and arguments before at length - but it's worth repeating the following. What constitutes a live birth that gets counted in infant mortality stats vary widely from country to country. The fact that the US has one of the highest infant mortality rates in the developed world has much more to do with the relative stringency of our standards for counting very premature or sick babies as live births than it does with any deficiencies that we have in caring for them. Life expectancy stats that purport to measure how well the health-care system works have to account for deaths from murders, suicides, accidents, and variations in lifestyle to generate meaningful feedback about mortality that the health system can actually do something about. Ditto for preventable deaths. Preventable by what? Smoke heavily, drink heavily, overeat and sit on your ass for thirty years straight and there's not a hell of a lot that any doctor can do to spare you from the consequences of your actions. And finally - there's cost. Let's break down the per-capita spending stats in terms of voluntary vs elective care, covered vs out of pocket spending and see where that gets us instead of simply taking "total medical spending" and dividing by population. Do the numbers indicate that people in the US spend more because they can, because they have to, or some combination of both? Having said all of that - I have no problem with a "public option" provided that it doesn't rig the game against private insurers. The following is most of a letter that I've been sending to republican senators. "One mechanism for insuring that legislation which provides for a "public option" that doesn't unfairly rig the game against private insurers would be a provision that mandates equal income-indexed government funding for public and private plans. Allow me to illustrate what that phrase means by way of a concrete example. Let's suppose that under the rules governing a "public option" an individual making $50,000 per year would qualify for a government sponsored health insurance plan with total costs equal to $10,000 per year, provided that he or she paid in income-indexed premium. For the sake of this example, let's assume that the premium for such an individual would be $2,000. So, the individual pays $2,000 and the government pays the remaining $8,000. Under "equal income indexed government funding," the government would be required to grant the same individual the option to accept $8,000 per year in tax-credits or direct subsidies to apply towards a private medical insurance policy of his or her choosing. In short, the government would be required to make same investment in their health care, whether they opted for private or public coverage. Failure to do so would make for unfair competition between the government and private insurance companies and would unfairly favor people enrolled in public plans over those enrolled in private plans. If the choice is between paying $2,000 a year and getting access to benefits worth $10,000 a year, and paying $2,000 a year and getting access to benefits worth...$2,000 a year (or any amount less than $10,000) it's not terribly difficult to predict which plan the public will want to join under such lopsided "competition." Rules that mandated a neutral allocation of government resources between public and private plans would also force the health care delivery system organized under the public plan to compete in terms of value and quality. The only way for the public option to prevail in a competition organized under such rules would be to provide superior care at a lower price per out-of-pocket dollar. This - of course - is entirely consistent with the stated rationale for providing a public option in the first place. Consequently, including such a rule in the legislation would appeal to the motives of those who sincerely believe that a public plan is the best mechanism by which to deliver the best care at the lowest price, and expose the motives of those who are intent on using a public plan as a mechanism to to drive private insurers out of business and thereby bring about a single-payer regime by default." Would all of you single-payer fans find such a compromise acceptable? If not - why not?

Just curious, what climbing area is that? Reasonable question given that this is a climbing forum, but I was referring to attitudes towards helmets in whitewater kayaking so "the river" = a river.

Well, that’s just one statement by Ayers that, in principle, one could agree with although it does not justify his particular course of action of criminality. But the real question is what is more criminal? Now, I condemn violence as the solution because most commonly there is a corresponding backlash that does not address the aggrieving condition but instead serves to perpetuate it. Governments have been accused of actually inviting these actions as an excuse to clamp down; something called the “strategy of tension”. I do, however, question the assumption that only legal, non-violent means are necessary in all cases involving liberal societies where essential liberties are publicly proclaimed. Sometimes society requires a nudge in a particular direction. For instance, civil disobedience requires breaking the law to show others the injustice of a particular societal framework. Now also, what is violent depends to some extent on who is making that determination. If the authority structure is threatened by direct action then most likely that action will be defined as violent, therefore, it is aberrant and pathological. Paradoxically though, sickness can be a way to a higher health. But you’re right; the common man should stick to the tried and true ways of seeking and maintaining a virtuous society. If we were confining our discussion to abstractions, there's quite a bit of what you've written that I might agree with. However, the fact that we're talking about concrete realities here means that I have to confess that I don't think that it's possible to mount a defense of Ayers by reference to non-existent infringements of his liberties that he wasn't actually subject to. Much less with recourse to considerations of how governments that he wasn't living under might distort the meaning of the word "violence" to include virtually any action that they pleased. Ditto for equating non-violent civil disobedience with anything that would satisfy conventional definitions of violence. We're talking about a white, college educated baby-boomer living in the US in the 1970's here. Ayers had recourse to the full spectrum of constitutionally protected rights and liberties, which were more than sufficient to enable him and others like minded folks make their case and persuade the public to adopt their beliefs, policy ambitions, etc as their own and vote accordingly. These liberties weren't merely proclaimed, they were matters of political fact. The fact that they opted for physical violence was a frank concession of the fact that they saw an uncrossable gulf between what they wanted and what they could persuade their fellow citizens to support. I'm not sure if planting bombs was a sincere attempt to bridge that chasm with violence, or simply a violent temper-tantrum directed at a society that refused to do as he told. His primary claim to virtue, so far as I can tell, is the fact that he didn't personally kill anyone and it's debatable whether mercy or ineptitude played the greater role in that, IMO.

Loaners, my man, loaners. They're still on the to-read list, but realistically it'll be a while before they're on deck. The cartage is no problem, since I'll be lugging down a kayak and some fly-fishing gear for the weekend, but you'd have to swear on the plaster-of-paris-with-wine-spouting-stigmata that I'd be able to get them back when you've finished with them. If you're hurting for an immediate fix to fill the lurch, take a look at the preface to Johnson's dictionary. While in Australia my wife and I spent some time staying with a confirmed bibliophile who, naturally had a copy of Johnson's dictionary on his shelves, and I whiled away a very enjoyable morning reading through it. http://andromeda.rutgers.edu/~jlynch/Texts/preface.html