Saturday, August 25, 2007

Free-Market Healthcare for Dummies

While conservativism doesn’t cause idiocy, it does provide idiots with the necessary tools to feel secure in exposing their idiocy to the rest of the world. Without the backdrop of conservatism, idiots would have no interest in discussing issues they knew nothing about, and would instead focus their energies on matters which are more within the boundaries of their mental capabilities; such as staring at the sun and breathing.

But with conservatism egging them on, they bound ass-first into a world they haven’t the ability or inclination to understand. Rather than ever attempting to find out what the hell is going on, they prefer instead to tell everyone else what’s going on and act really annoyed when nobody else knows what the hell they’re talking about.

Of course, there is one group who knows what these flakes are talking about, and that would be other conservatives. And that's only because conservatives are so dumb that they imagine that they already understand what everyone’s trying to say, so they have no problem assuming that the other conservatives are making as much sense as they imagine they must be making. But even they don't truly understand what they're saying, because there's nothing to understand.

To understand conservatism is to debunk conservatisim. The solid ground they imagine they're standing on is just smoke & mirrors; a handy delusion intended to justify selfishness, greed, and ignorance. And even still, the only people they allow to act selfishly, greedy, or ignorant are those who help each specific conservative in their quest to acting selfish, greedy, and dumb. But if your selfishness, greed, or ignorance causes you to act in ways that hurt them, then you are the enemy and must be stopped. Hypocrisy isn't a separate flaw in conservatives. It's a prerequisite.

The Me-First Market System

Healthcare is just one of many issues that conservatives know so little about that they have no problem with exposing their complete ignorance on the subject. Moreover, it exposes how little they know about the "free-market system" they're always espousing. For them, "free-market" means nothing more than that they're free to do whatever benefits them the most; and everyone else should do the same thing, just as long as it doesn't stop these people from doing what they want to. Beyond that, things get a little fuzzy.

I already covered one free-market health-care wiz a few posts ago, and via Ron Chusid of Liberal Values, I stumbled upon an embarrassing piece of free-market healthcare advocacy from the idiot John Stossel. This time around, John's upset that the World Health Organization ranked countries in healthcare according to criteria that John disagrees with. And why does John disagree with it? Why else: Because it ranked America low, and that wasn't what he wanted to hear. So if it contradicted John Stossel, it must be wrong.

And why does John dislike this kind of talk? Well he never says it, but it's obvious that he has excellent healthcare and never has to worry about this stuff. So any changes to our system can't possibly make his healthcare improve, and might make it worse. And what's the point of that? He's already taken care of; let everyone else do the same. Somehow it hasn't occurred to these schmucks that we are trying to take care of everyone else's healthcare, using the government as a tool for this. I guess that's considered cheating.

His analysis never really goes deeper than insisting that the highest level of healthcare in America is better than anywhere else, and this trumps any problems people might have with our system. I mean, not only does he refuse to acknowledge that lack of healthcare is a problem in America; he insists that this is an unfair standard to hold America to. As if "socialized medicine" was just some gimmick to improve a country's ranking with WHO, rather than a real solution to a real problem.

Other People's Money

Now, that's not to suggest that Stossel doesn't find any problems with our system. He sees one big problem: We don't rely on the free-market enough. Yes, he actually said that. And the biggest flaw that John finds is that we're not spending enough of our own money on healthcare. And as he quotes from the All-Mighty Milton Friedman: "no one spends other people's money as carefully as he spends his own".

But note the subtle message in that quote. Friedman's not saying that Joe Blow always spends his own money more carefully than other people spend Joe Blow's money. He's saying that Joe Blow will spend his own money more carefully than he spends someone else's. I don't necessarily agree with that, but don't find it particularly objectionable. But nothing in this quote suggests that Joe Blow is always the best person for knowing how to spend his money.

Yet that's exactly how Stossel is using the quote. But everyone knows this is complete poppycock, and I say that as someone who doesn't use that word lightly. Because some people are complete fools with their own money. Like the dummies who give money to Linda Chavez's PAC's, which really only funds Linda Chavez and the people who raise money for her PAC's. I have no doubt that I could spend these people's money more wisely than they are. And the first thing I'd do would be to have them stop giving it to Linda Chavez.

But seriously, it's an indisputable fact that people can be quite careless with their money. They get conned by Nigerian princes. They buy stupid stuff they see on infomericals. They buy stocks based on "feelings". There are apparently even people who have given their money to Alan Keyes so he could run for political office...on six separate occasions! (Yes, I know!) People carelessly blow their money on all kinds of idiotic things. And conservatives know that. That's the only way many of them can make any money.

And people trust their money with other people all the time. They use stockbrokers who actually understand how the markets works. They hire people like me to balance their books and take care of the payroll. They hire professionals to buy them fancy stuff at auctions. And it makes sense. There is such a thing as expertise in this world and just because you own the money doesn't mean that you know what to do with it. Most likely, there's someone else who can handle your money more wisely than you can.

And there's no way Stossel isn't aware of any of this. When he misinterpreted the Friedman quote, it wasn't the misinterpretation that threw him off the track. He was just looking for some sort of quickie quote to add authority to his absurd claim and really hadn't thought about the quote at all. He doesn't really believe that people always know how best to spend their money. He was just bullshitting. What a surprise.

Third-Party Spending

The reason why Stossel mentioned that quote was because he said the "most important" problem with our system is that "six out of seven health-care dollars are spent by third parties, which means that most consumers exercise no cost-consciousness." But exactly who's money is being spent? Obviously not the patient's. In many cases, it's the insurance company's. So Stossel is suggesting that these company's can't be trusted to spend their own money? Huh?

It's a fact that these companies negotiate prices with doctors and hospitals that would be impossible for any of us to do. They also have strict guidelines about which doctors you can see, which services they'll pay for, and what procedure you need to follow to have this stuff done. We pay them so they'll take the risks we don't want to worry about. So when they spend money, it's their money being spent. Not ours. And they're very cost-conscious.

In fact, the big problem I've had with insurance companies was never that they were careless with their money, but rather the complete opposite. They kept trying to screw me over and make me pay for things that they were supposed to pay for. And making me jump through hoops to get what I needed. So if anyone's being careful with their healthcare dollars, I'd say it was these third-party a-holes Stossel's complaining about.

And let's not forget, Stossel's complaint isn't just about healthcare not being paid by the patients. His argument is really against the concept of insurance itself! He somehow thinks it goes against the free-market for people to pool their money together to insure against risk. Yet that's entirely within the free-market system. State Farm isn't a charity. They know what they're doing. The free-market system isn't a death pact, and people shouldn't be expected to take risks that other people are willing to accept for a fee.

State Farm is willing to take the risks that we as individuals can't afford; and if they don't screw-up, they'll make a tidy profit from it and everyone's happy. Or at least that's how the theory goes, and it usually works out. I don't know if John Stossel understands this concept, but it's obvious he didn't apply it when he came up with this argument. And remember, this was what he claims is the "most important" example of the free-market system being denied in America. What an idiot!

The Magic of Words

The final point I'd like to make is regarding Stossel's strongest argument against the WHO report. And that is that Stossel doesn't agree with it's criteria. Specifically, that it gave the highest ratings to countries that provided the best healthcare to the most people. And Stossel doesn't like that criteria, because while our system does provide top-notch healthcare, it's really not available to that many people, and some people barely get any at all. He cites people coming to our country for medical care, but neglects to talk about all the people right here in our own country who are denied access to that same medical care because they can't afford it.

As he says:
By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution.

And this is the kind of thing that just blows John's puny mind. He just doesn't understand why other people deserve good healthcare. After all, he's taken care of, so why is anyone else important?

All those other people are just background characters in his life. Background characters that can be much too inconvenient for John's liking; especially when they want the same kind of stuff John has. Sure, sometimes they can help add a little color to one of his news segments and he won't complain when they watch him on TV or read his articles, but it would really be best if we had some cold storage facility to keep them in the rest of the time. Besides, if they really wanted good healthcare, they can just grow coolguy moustaches and become conservative hack journalists like John. After all, he's got absolutely no talent or brains and look how far it took him.

And to seal the deal, he whips out a dreaded label: Socialized Medicine. We saw Megan McArdle do that in the previous healthcare post I wrote, in which she insisted that the term "insurance" couldn't be applied to a single-payer healthcare system and replaced it with the word "Tax". That's how easy it is with these people. If you can't beat an argument, just find a way to slap a negative label on it and voila!, the argument is instantly demolished. And in their minds, they truly believe it worked.

And really, this is the entire crux of his argument. He knows that millions of people get screwed out of good healthcare in our country. And he likes it that way and thinks it's unfair to suggest that people deserve equal healthcare to what he gets. He's not really debating the merits of our system. Hell, reading his piece you'd almost assume that we had no healthcare problem at all. Nor does he suggest any solution at all for our problem. It's obvious that the biggest problem he has with our healthcare system is that anyone's complaining about it, and he wants that to stop.

Stossel ended his piece saying:
For all its problems, the U.S. ranks at the top for quality of care and innovation, including development of life-saving drugs. It "falters" only when the criterion is proximity to socialized medicine.

Indeed it does. That's what we're complaining about, dipshit.


Update: I've got a similarly themed follow-up to this post here: Free-Lunch Healthcare

32 comments:

Jim Campbell said...

Dude: You are seriously funny. Talk about somebody that has no clue about what he is talking about? You take the cake. I challenge you to go to my website
http://stopsocializedmedicine.blogspot.com Unlike you, I'm not in the attack mode, I've matured to understand that in the U.S. we can do it better, I'm looking at all the different systems and hope to come up with ideas that may make health care affordable to all using market based principles. I'd love for you to go on to my web and comment as much as you want because I too learn from all possible ideas on how to fix a system that is in need of an overhaul. Good job with your web be happy to link with you.

Anonymous said...

You have got to be kidding with this whole argument.

If you need major cardiac surgery, which country on the WHO list above America are you going for your treatment? I think I will choose American care. See if you can think a little more in depth.

Free Market does work and I have no desire to pay for your healthcare. I might discuss it with anyone if they cancel their cell phone and cable first.

In my company a single person has a net of $30 a month to pay for their healthcare. Ahh, that is less than the charge for a cell phone monthly account.

Jim Campbell said...

Your Comments: "While conservativism doesn’t cause idiocy, it does provide idiots with the necessary tools to feel secure in exposing their idiocy to the rest of the world. Without the backdrop of conservatism, idiots would have no interest in discussing issues they knew nothing about, and would instead focus their energies on matters which are more within the boundaries of their mental capabilities; such as staring at the sun and breathing. Well they are absolutely hysterical, and I could use the same to call out liberals. But what is your point? You add nothing to the conversation, why not provide solutions. Our health care system needs some work, buy you quite frankly obviously aren't up for an intelligent discussion. J.C

Doctor Biobrain said...

Jim - The point of this post was to criticize John Stossel for writing a boneheaded piece on healthcare and to explain why he was wrong; and I believe I did a fine job of it. Am I not allowed to do that? To my knowledge, this is my blog and I get to write anything I like. But please let me know if I'm wrong about that and need to write what you tell me to.

BTW, I don't write posts on solutions for healthcare because I really don't know enough on the subject to add anything of substance to the discussion. If anything, I'd just be repeating what everyone else writes, and that's not what I do. This is a blog for original content. I only write stuff that you can't read elsewhere; and my speciality is explaining why stupid people are wrong. But again, if you're my new boss, please let me know and I'll start following your orders. Oh, and where are my paychecks?

Perhaps next time you could try telling me what I said that was wrong, rather than insulting me repeatedly without explaining why. Sure, I insulted John Stossel and other conservatives, but I gave reasons for it. I expect the same from my critics. Did you even read what I wrote? Or did you just stop at the insult at the beginning?

To my knowledge, I have no conservative readers, so my insults in this post aren't intended to be personal. But feel free to take them that way if you like. I'm also planning to write a post criticizing one of your pieces, but because you might read it, I'll be nicer than I was to the idiot Stossel; as well as being nicer than you've been to me. You're welcome.

Doctor Biobrain said...

Anon - Please try reading what I wrote before you criticize it. In case you didn't understand the point, John Stossel and many other conservatives do not even understand what the free-market system is, and think it means they get to do whatever they want. Nor do they understand the concept behind insurance. But I didn't write anything criticizing the free-market system. My attack was only on John Stossel as well as conservatives who don't know what they're talking about.

Secondly, I wasn't discussing the merits of various healthcare systems. I was criticizing John Stossel's piece and don't think I said anything wrong. BTW, one reason why our healthcare is better may be because we spend so much for it. We spend almost twice per capita what Canada spends. Yet we don't cover as many people. Is it any surprise our system has better care for those who can afford it? But offhand, I'd guess this has more to do with spending levels than the system spending it.

As for your company, I have no idea what you're talking about. I've never heard of insurance that costs $30. If that's what you're paying, then I'd guess your employer is paying the rest of the tab. Do you really believe that health insurance only costs $30??

I'm not at all surprised that my only two critics attack me for being dumb, but have so far failed to explain anything I said that was wrong. It's like I didn't say anything at all and they're just responding to the strawman liberal they were told about. People, I'm not a potted plant.

Jim Campbell said...

Dr Biobrain: As owner of the blow I defer to you. That being said, as you said you don't know much about the issue and you attack Stossel is actually quite foolish. I've spent 34 years in the system as a clinical research liaison in oncology. Why bother to post on as issue you admit you know nothing about? Why not educate yourself before blasting "conservatives" and Stossel...He is right for the most part, and you need to play catch up in this area. But like you said it's your blog. Go on mine and blast your horn. Jim

Doctor Biobrain said...

Jesus, dude. Are you ever going to tell me what I said that was wrong? I may not be a healthcare expert, but I know dumb. And that Stossel piece was dumb.

And I never said I didn't know much about the issue. I said that I didn't know enough to add anything meaningful that other people aren't already saying. And again, it didn't take expertise to debunk that Stossel piece. He obviously knows far less about this stuff than I do.

BTW, you can save your argumentum ad verecundiam for someone else. Either tell me how I'm wrong or keep your insults to yourself. I respect arguments, not authority.

Jim Campbell said...

Oh yea, I'm going to not only tell you that you are wrong but you are beyond clueless. Try reading up on areas in which you choose to pontificate. You are truly a blow hard with very little to blow about.

Jim Campbell said...

And dude, if your specialty is proving why other people are wrong, you need to find a new specialty. On this topic you can't find your ass with both hands.

Doctor Biobrain said...

Wow, dude. You really schooled me, didn't you. You're the guy who comes in as an "expert", but refuses to even tell me one thing I'm wrong about and insults me repeatedly while insisting he's not in "attack mode". And you dare call me a blowhard??

If you've got something to say, say it. But your pointless insults are just tiring. At least when I insult people, I explain why I'm insulting them. But instead of explaining anything, you just keep piling on more insults. Awesome. Your expertise really has me on the ropes.

Jim Campbell said...

Dr. Biobrain: You want direct, I was trying to let you know that your comment about knowing dumb when you see it, and the Stossel piece was dumb just is a reflection of your total ignorance on the topic. He said nothing that wasn't on the money. You want dumb review your comments.
I can find nothing factually incorrect about what he writes below. Try reading his article, and BYW he isn't a conservative he's a libertarian. Enjoyed the banter...over and out.
Why the U.S. Ranks Low on WHO's Health-Care Study
By John Stossel

The New York Times recently declared "the disturbing truth ... that ... the United States is a laggard not a leader in providing good medical care."

As usual, the Times editors get it wrong.

They find evidence in a 2000 World Health Organization (WHO) rating of 191 nations and a Commonwealth Fund study of wealthy nations published last May.

In the WHO rankings, the United States finished 37th, behind nations like Morocco, Cyprus and Costa Rica. Finishing first and second were France and Italy. Michael Moore makes much of this in his movie "Sicko."

The Commonwealth Fund looked at Australia, Canada, Germany, New Zealand, the United Kingdom and the United States -- and ranked the U.S. last or next to last on all but one criterion.

So the verdict is in. The vaunted U.S. medical system is one of the worst.

But there's less to these studies than meets the eye. They measure something other than quality of medical care. So saying that the U.S. finished behind those other countries is misleading.

First let's acknowledge that the U.S. medical system has serious problems. But the problems stem from departures from free-market principles. The system is riddled with tax manipulation, costly insurance mandates and bureaucratic interference. Most important, six out of seven health-care dollars are spent by third parties, which means that most consumers exercise no cost-consciousness. As Milton Friedman always pointed out, no one spends other people's money as carefully as he spends his own.

Even with all that, it strains credulity to hear that the U.S. ranks far from the top. Sick people come to the United States for treatment. When was the last time you heard of someone leaving this country to get medical care? The last famous case I can remember is Rock Hudson, who went to France in the 1980s to seek treatment for AIDS.

So what's wrong with the WHO and Commonwealth Fund studies? Let me count the ways.

The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries. That's not a health-care problem.

Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.

When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.

Diet and lack of exercise also bring down average life expectancy.

Another reason the U.S. didn't score high in the WHO rankings is that we are less socialistic than other nations. What has that got to do with the quality of health care? For the authors of the study, it's crucial. The WHO judged countries not on the absolute quality of health care, but on how "fairly" health care of any quality is "distributed." The problem here is obvious. By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution.

It's when this so-called "fairness," a highly subjective standard, is factored in that the U.S. scores go south.

The U.S. ranking is influenced heavily by the number of people -- 45 million -- without medical insurance. As I reported in previous columns, our government aggravates that problem by making insurance artificially expensive with, for example, mandates for coverage that many people would not choose and forbidding us to buy policies from companies in another state.

Even with these interventions, the 45 million figure is misleading. Thirty-seven percent of that group live in households making more than $50,000 a year, says the U.S. Census Bureau. Nineteen percent are in households making more than $75,000 a year; 20 percent are not citizens, and 33 percent are eligible for existing government programs but are not enrolled.

For all its problems, the U.S. ranks at the top for quality of care and innovation, including development of life-saving drugs. It "falters" only when the criterion is proximity to socialized medicine.

Doctor Biobrain said...

Ok Jim, this is just embarrassing. I obviously DID read the Stossel piece as evidenced by the fact that I quoted from it repeatedly and discussed what he wrote...and found things that were wrong with it. And it's obvious that you can't find anything wrong with what I wrote; and no, quoting Stossel's entire piece does not somehow prove me wrong.

BTW, most libertarians ARE conservative. Once again, I have no idea what you're talking about. This whole time, you've done nothing but confirmed everything I wrote in my post about conservatives. So I guess you were at least good for something.

Mumphrey Bibblesnæð said...

I don't get libertarians. I guess the kind of society they want the U.S. to become is great in theory, but then, a lot of things are great in theory. Communism is a great system to live under if you happen to be a figment of some communist theoretcian's imagination. In real, life, it's not such a winner. It's the same with libertarianism. They're always talking about shrinking the government and privatizing things and how great it would be if we all were responsible for our own retirement savings, and on and on.
Well, I lived in a country for 2 years where there was no government social safety net, and guess what? It's really not all that wonderful. There's essentially no social security and the public school system is badly lacking since the government doesn't have enough money to build schools in much of the country.
Now, I love my adopted country, and I have a lot of friends there, and I go back as often as I can, and in a lot of ways, I think they could teach us a lot. But people suffer there for lack of a strong and active government that helps those who fall by the wayside in life. I guess libertarians would argue that if some poor soul can't make it in life, that's their own problem. I see things another way, and I think that if anybody falls by the wayside, we are all diminished a little bit. We're all human, after all, and every one of us has worth and potential. I just get the feeling that for libertarians, deep down their whole system of belief is just a way to be able to be greedy and selfish and feel good about it.

Anonymous said...

"If you need major cardiac surgery, which country on the WHO list above America are you going for your treatment? I think I will choose American care. See if you can think a little more in depth."

I think that you're the one who needs to think a little more in depth. Which country would I go to over the US? France, Canada, Italy, UK. Take your pick. Better to have less than the best than nothing at all. That's the problem with people like you and Mr. 'Stache, and BioBrain addressed it.

R.Bobak said...

Further to doctor biobrain in “Free-market healthcare for Dummies” (Aug. 25, 2007) when he says “…as if “socialized medicine” was some gimmick to improve a country’s ranking with WHO, rather than a real solution to a real problem”, he should stop for a moment and contemplate. “Socialized medicine”, like in Canada, where I live, is certainly a “gimmick”. Don’t kid yourself, or others. This quagmire is a reality in Canada, not some pipedream college thesis that would be ‘fun-to-try’. It is not a real sustainable solution to a real problem.

It denies our marketplace rights to choose our healthcare payer, and its inevitable rationing ensures we have little to no choice in healthcare providers. The state taxes us AND reduces coverage at the same time. The state now denies funding to some cancer patients, deeming their treatment options to be experimental. Does that enter into the left’s cozy, rosy ‘blue-state’ realm of possibilities? You would just give up the great sovereignty your people have created in the marketplace for no-choice socialist healthcare?

In Canada, several provinces now have constitutional challenges winding their way through the courts which challenge the legality of the government-run-health-monopoly denying patients timely medical treatment (there’s your “gimmick”), while ALSO denying patients the right to buy health insurance to ameliorate the negligence of the state’s failure to provide. This foreshadows your future should you decide to follow our path. Legally, we have no alternative in our own country should the state – as it often does – fail to deliver its promises. Would you rather be able to at least fight with your HMO in a marketplace tempered with choice and the courts, or, do you want give up to a faceless government-institutionalized health bureaucracy? People die on our waiting lists, too…and the “gimmick” , 40 years ago, when Canada’s lefties conned us into this Ponzi-scheme, was that we would have heaven on earth! That grace never materialized. Neither will yours. There's a reason that not many Americans need to go to Canada for their healthcare.

biobrain ridiculed Megan McArdle's position, "in which she insisted that the term “insurance” couldn’t be applied to a single-payer health-care system, and replaced it with the word “Tax”. That’s how easy it is with these people. If you can’t beat an argument, just find a way to slap a negative label on it and Voila! The argument is instantly demolished. And in their minds, they truly believe it worked.”

But, really, she’s right: biobrain’s the one easily slapping labels without an argument – there IS NO insurance in a single-payer system, if by ‘insurance’ you’re referring to something that’s actuarial based, takes into account risks, and is accountable to its stakeholders. That is not what we have in Ontario, we have a “tax”. A lot of tax. What was once actuarial-based has been given a budget by our politicians, and has become the state-run-health-rationing-board. There is no competition, no incentive for institutional improvement. Everything relies on the politicized blessings of a gaggle of meddling politicians. Hospitals rely on huckstering lottery schemes to raise money. Some may think this is just fine, but I wouldn't wish it upon others.

Jim Campbell rightly wrote that “in the US we can do it better. I’m looking at all the different systems and hope to come up with ideas that may make healthcare affordable to all using market-based principles.”

The attitude of the biobrain/Michael Moore/HillaryCare-types reminds me of a scene in the film Deer Hunter, when during the wedding the three main characters approach the uniformed vet drinking at the bar, who’s obviously just returned from Vietnam. “What’s it like over there” they eagerly ask. The vet looks at them and sees the three young, bright, men and says, to their bewilderment: “f--k it”. in a way,Canada is like that vet character, saying to the newbies enamoured with socialism: I’ve been there, it’s horrible, and, there’s nothing I can say or do to stop you from going down the same road. You will have to learn for yourselves.” (And please, for the time being, for this analogy at least, let’s leave out Canada’s non-role in Vietnam, for a moment!)

The inconvenient truth for the left on both sides of our border is that Canadians are forced to travel to the States because the theory of socialized medicine in practice fails to deliver! (And the bizarre part is, Canadian lefties – after 40 years of socialism - are still blaming that on ‘privatization’!) Don’t envy Canada as the answer to your healthcare woes. Your system can surely be improved, just don’t emulate ours.

Doctor Biobrain said...

I responded to r.bobak's comment/post here:
In Defense of Canadian Healthcare

splashy said...

Loved the piece. Those that think the US is doing just fine obviously do have decent health care. They really have no clue about the choices people end up having to make when they don't have any kind of insurance, or if they have poor insurance. If you can't pay, you don't get, no matter what. You suffer and die for no good reason.

Thanks for the laughs. You really nailed it.

Anonymous said...

i'm supposed to pay for your healthcare because you are too stupid to spend money on it, and would rather spend money on jelly beans and gucci bags?

your attack on the free market in this way is correct. someone uneducated will act irresponsibly.

however our solutions differ. i advocate educating someone and you advocate me paying for someone who is stupid. f that.

your expertise argument doesn't hold water. a financial expert will tell you where to invest to get the greatest return. what is my (government, haha!) health care expert going to tell me? "the doctor said you need a hip replacement. you should have a hip replacement."

your comparison to state farm is correct! we should have health insurance in that way - for catastrophic incidents. we should not have health insurance the way we do now, where every single visit goes through insurance. so you've found a good ideal for the free market. obviously not where health care is today however.

how is a single payer system not socialized? all in the community are forced to contribute, and the payer has no competition. the government will set costs - as if the government knows better than the market.

have you seen stossel's piece on education? it can be argued in parallel with healthcare. and what do we see? the US spends the most money per student, yet is far from the best results per student. HMM.

Doctor Biobrain said...

HMM Anon - Way to ignore just about everything I wrote to repeat what you guys always say. Couldn't see that one coming. Perhaps some day one of you guys can actually tell me how my specific arguments are wrong, rather than just repeating yourselves.

As for your points, why do you guys always pretend that uninsured people have lots of extra income and just blow it away? Do you know how expensive insurance is? That'd have to be a lot of jellybeans and gucci bags. It's much easier to blame people than to find real solutions, huh. Sure, some people probably could buy insurance and don't. But many people simply don't have the money. And you'd prefer to see them die for it.

As for your mention of catastrophic insurance, I actually agree with that to an extent. Except, what you're suggesting is actually the MOST expensive way to do things; of having people only see doctors once something is seriously wrong. Preventative medicine is much cheaper. I think we need a system where everyone has open access to preventative medicine on a regular basis, and catastrophic insurance for the big things.

As for calling it "Socialized Medicine," words mean things. Socialized Medicine means that the doctors and hospitals are run by the government. While a single-payer system is not much different than what we have now. I have no problem with the government setting prices for these things. They already do so in many regards. I find your preference for wealth-based rationing to be completely immoral.

And I find it hilarious that Stossel is willing to accept that our schools are failing while being unwilling to accept that our healthcare is failing. Especially as many of the reasons he said why our healthcare only appears to be failing applies even more so to our school system. That's the exact kind of thing I was talking about with him; just cherrypicking the information he likes while ignoring what he doesn't like.

Anyway, if you're ever willing to tell me how my specific arguments are wrong, feel free to do so. But please don't waste my time by repeating the same old lousy arguments again. They didn't work the first time, and they're not going to work now.

Anonymous said...

my response regarding jelly beans and gucci bags is in regards to the fact that yes, there are people doing that, and also that your implication that an expert is available to invest in financial matters implied that you were speaking of people that had enough disposable income that they could afford but merely needed someone else to manage their expenses.

of course there will be people who simply cannot afford health care but this is where charity comes in, which research shows goes up when people are able to keep more of their own income. if sadly americans have become less compassionate than need be, government programs should be set up to help those who simply cannot afford care, however this should be done closest to those that need it and the organizations that provide it. the percent of each dollar that is actually productively used erodes as bureacracy grows, so these programs should be at the local/state level - not just immediately set atop the massively inefficient federal govrnment. the biggest organization there is, with the added benefit of no competition.

how is the catastrophic insurance the most expensive way to do things? car insurance (to my knowledge) is pretty much untouched by government meddling, and right where it should be. if you disagree maybe you should look at canada's government required insurance and how much it costs. it is ridiculous.

preventitive medicine is great. but should i be forced to do it? under edwards cradle to grave plan, my freedom is undermined and the state dictates that i must do it. i'm sure it also forces vaccinations on kids too. and forces my choice of health care, since it won't pay for alternatives i may wish to try. isn't this undermining my freedom to choose anything??

Edwards:
"It requires that everybody be covered. It requires that everybody get preventive care," he told a crowd sitting in lawn chairs in front of the Cedar County Courthouse. "If you are going to be in the system, you can't choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK."

socialized medicine does not necessitate the state to be the ones running the show. by definition it could just be a community. regardless it is the outcome that is the problem, no competition and no reward for excellency. no market setting of price.

why don't you have a problem with government setting the price? what makes you think they have any idea that tylenol should cost this much or that a hip replacement costs this much? if they set the price too high we are just wasting money. if they set the price too low then something will suffer in quality. this is why the free market should be setting the price.

i don't prefer "wealth based rationing" - i prefer a free market system where care is affordable and quality is good. for the truly poor charity and the most local levels of government can be used to subsidize care. you live in a fantasy if you think "equal" care can ever be attained. affluent individuals come to the US if need be, or to local private care in their own countries where the national system fails to provide for them.

i am curious as to how you think our education system can be improved. what i would find hilarious is if you thought more competition was better for education while not better for healthcare. of course, you may be in the camp that just thinks we need to "spend more money" on schools, ignoring the fact that we already spend more than everyone else, yet our education is actually worse.

you invite people to debate specific arguments in your post, but you should know that your writing style doesn't really invite it. there's so much garbage surrounding the actual arguments that it is kind of painful to wade through. for example, going off and rambling about conservatives. there is a lot of garbage to wade through to even find the argument to respond to. i would advise changing your writing style if you actually want to invite someone to speak to your points. for now it's not an exercise i'm going to run though, i'm thirsty as hell and need to go out and change my oil.

Doctor Biobrain said...

Anon - You need to re-read my post. I never suggested that the people who didn't have insurance had investment advisors. I was referring to the fact that people often hire other people to take care of their money; and that nobody finds that to be a problem. And that was in contrast to John Stossel, who pretended as if people always know how to best spend their own money. We know that to be false.

Regarding catastrophic care, yes, that is the most expensive way of doing things. It's the same for people who don't do regular maintenance on their car. If you don't change the oil and get a regular tune-up, you're going to be sorry and pay a whole lot more in the long run. And believe it or not, it's more expensive for people if they wait until something goes wrong, rather than getting an annual physical and see their doctor when a problem first arises, rather than waiting until it gets worse. It's much better for someone to be told how to handle their worsening heart condition than to wait until they have a heart attack. You should be embarrassed to even suggest anything else.

Of course, if car maintenance was as expensive as human maintenance, and as essential; we'd probably want mandatory auto maintenance insurance.

Charity?? Paying for medical care??? You must be crazy. Do you have any idea how expensive this stuff is? America spends over $6000 per person for medical care. Charity will not cut-it. And this isn't just an issue of poverty, as many middle-class families can't afford medical insurance. And where is this charity? Why do you imagine it will pop-up, when it's already not doing the job?

And I completely disagree with your idea that having hundreds of bureacracies handling a problem is more efficient than having one handle it. Who is more efficient: thousands of mom-and-pop stores or Walmart? Walmart, of course, who can do all kinds of things that thousands of little stores can't do. Similarly, the Federal Government has resources that Alabama and small towns don't have; and can fix this problem much more easily. More importantly, the only reason anyone wants the Feds to handle it is because these other options clearly aren't doing the job. If towns, states, and charities were handling the problem, we wouldn't be having this discussion.

As for Canada's medical care, we pay about twice as much per person as Canada does. I repeat, we pay about twice as much per person. We also pay a higher percentage of our GDP in medical care. So if you think Canada's medical costs are "ridiculous," I can't imagine how you justify our costs.

As for your attack on Edward's insurance, do you even know how our medical system works? We already have forced vaccinations, and regular insurance already has strict limits on your choices. I know I do. They limit which doctors I can see, which services they'll cover, and which hoops I have to jump through to get medical care. I've never had insurance that was any different. And I don't even pick my insurance provider; my wife's employer does and we have no say in the matter. In all of my adult life, I've never seen the mythical free-market medical system conservatives keep describing.

And again, you are simply mistaken about what Socialized Medicine means. It only means that the government runs everything. That is the definition. I believe England and France have Socialized Medicine, and Canada does not. Again, this is a real definition and it doesn't matter what you want to call it.

And you might not like my label of "Wealth-based rationing" but that's exactly what the "free-market system" is. Our "free-market system" gives us healthcare that is far more expensive than any other country. And it's unavailable to many people. And you prefer instead a fantasy in which people will voluntarily give money that they currently aren't giving and pretend we have choices we don't have. Right.

And for the record, no I don't see how more competition would help our education system. I don't believe that other countries have competition either, so I don't see why you're comparing us to them; when they have the same system.

And yes, more money does help schools and every conservative believes that. Conservatives don't mind when their kid's school gets more money and will scream bloody murder when someone tries to take money away. They just complain when they have to finance someone else's school. But they expect their own kid's school to be well-financed.

And finally, I invited no one to debate this post. I don't write for conservatives. I write for liberals, and they seem to have liked this post. And if you can't find the things in my post to disagree with, then maybe you shouldn't tell me that I'm wrong. But if you're going to tell me that I'm wrong, you need to explain why I'm wrong. Otherwise, you're just wasting my time.

Anonymous said...

we know that educated people know best how to spend their own money. what if i don't agree with the type of treatment the government says i should have? you did not address that and i posted it earlier. you also strolled on through the government required cradle to grave preventitive care being forced on me as a citizen. and people are more careful in how they spend money, it's easy to abuse a system that is perceived to be "free" or very close to it.

regarding your catastrophic car costs scenario, do you think the government should take care of that then too? after all, then the public would have more money to invest in the ecnoomy right? so why not put a program in place to require it as well? oh i see you did put a note on that. you do not seem to be very big on personal responsibility. i suppose if there were any democrats as authoritarian as giuliani you might be all over them.

charity already covers some medical care today. it is not "6k for this job" it is the time and materials of the person doing the work in addition to money. and these ridiculous prices are a result of abuse of the free market, not the free market. if we remove the meddling the prices will come down to where they should be - according to the actual market forces. i also stated if charity cannot cover it then local solutions would be far better than public ones. i did not state it is highly likely that charity could solve everything.

my point wasn't regarding canada's medical care, it was regarding their auto insurance, an industry that the government has not been involved in to my knowledge in the US. it costs WAY more to insure your car in canada and the service is poor. i worked in vancouver for 6 months and everyone complained about it. i have a friend who moved their temporarily (for a year+) who has left his car here at home.

you forget that the hundreds of businesses bureaucracies are all less than the government, and that they're competing against eachother as well. what is driving the government to be more cost efficient? not a gdamn thing!

i don't think it's a reasonable comparison to make to wal-mart at all, that's not a good analogy. if you wish to keep it though without a thought you can point out the difference in quality of customer service and product at wal-mart. ugh that is still a bad analogy though. wal-mart is a big bully. and wal-mart still has competition. wal-mart is not the government. i am curious as to what government entities ever even strive to get more efficient.

regarding your edwards comment - you pointed out that our market was not free enough. i agree!

why am i mistaken in what socialized medicine means - when the system you describe seems to meet the definition, which does not require state support? in both systems, some singular entity is controlling price and availability and forcing all members of the community to support it, is it not?

free market healthcare isn't a fantasy, we merely need to actually do it. what we have now is not free market healthcare. it's not a fantasy to believe that the more money and control of their money people have that the more they are charitable. and again if we do have subsidies for healthcare then it will provide the most return at the lowest level, not at the highest federal government level.

regarding education, go watch stossel's 20/20 stupid in america video then, it's available on google. yes other countries have more competition. there's plenty to critique, make another stossel hate blog if you like. but you still can't deny the fact that we spend the most money, and we are far from number 1. more money will get marginal improvement at best. i think you have a poor understanding of free markets and what actually drives people to improve and perform.

in your comments you've invited people to debate points in your post. i've found enough to discuss in your comments that i don't feel like struggling through that post again to find the actual talking points. if you want an explanation why you're wrong, then find a good book on actual free market healthcare. and stop pretending we have it today.

http://www.harrybrowne.org/hb2000/print/health.htm

i'll find a book for you by next post, if you're interested in actually reading it.

Doctor Biobrain said...

No, we do not know that educated people best know how to spend their own money. That is completely and totally false. Particularly in regards to healthcare. I'm an educated guy, but I have no idea how much medical care should cost. I am completely at the mercy of doctors and nurses. And my insurance company is much more capable of negotiating prices than I am. Buying healthcare just isn't like buying televisions.

As for car costs, I already said why those are different. But if car costs were as high and as essential as medical care, that would be different.

And you admit that the free-market is being abused, yet you want more of it? Please explain how more free-market fixes anything. Details, please.

As for Canada's auto insurance, I know nothing about that. It certainly looked like you were talking about medical care. We do have mandatory auto insurance in this country, however. I don't know why you mentioned this.

As for my point on Walmart, it's not just Walmart. Every large company has HUGE advantages over little companies. Target, Sears, Amazon, Exxon, I could go on and on. They're all HUGE, yet they're usually more successful than millions of little companies. It's obvious that while large organizations have disadvantages, those disadvantages are less important than the huge advantages they have. You are simply mistaken for believing that large organizations are inherently flawed.

Regarding our free-markets, it's obvious that you are entirely ignorant about what that term means. It doesn't mean you get to do whatever you want. It doesn't mean free choice. If the market doesn't want to provide what you want for a cost you're able to pay, you don't get it. There's nothing free about the free-market. And that's our problem with healthcare. People can't afford what they need. But they'll need it anyway. I really like having health insurance.

As for Socialized Medicine, you are just wrong. It means that the government owns the hospitals and the doctors work for them. That's all that it means. Sorry.

And no, I won't watch Stossel's piece on education.

And I never invited anyone to debate me. All I said was that if someone was going to criticize what I wrote, they should criticize what I wrote.

Anonymous said...

we do know that people are most thrifty with their own money. you claim you don't know what medical care should cost - so why do you expect the government to know any better? if all they do is come in with no competition and no market force and simply say, hey, this is what it's going to be?

why is it different than car costs? why shouldn't health care be similar? i can pay for routine checkups and have catastrophic health insurance. if something major goes wrong i can pay my health deductable and insurance will cover the rest.

your free market explanation is just plain ignorant, or you are purposely saying something that silly as a joke. i will turn it around on you, well if your little socialism is then good, why not go to full out socialism? eh? it's just a ridiculous argument. we haven't had a truly free market, that is the point. we have one that has been meddled with. if it was truly free then we wouldn't have the problems we do today, such as ridiculous prices and attachment of health care to the employer. why is it that all other forms of insurance our attached to us our an asset, yet health care is through an employer? government meddling in the free market. did you read that link? we do not have a true free market today. i didn't hear your comment regarding the book, and you're asking me how the free market fixes anything, so if i link you a book will you actually read it?? i'd be happy to read an economic book on the benefits of socialism in health care if you could point one out to me. i have been (lightly) looking for one actually.

i mentioned canada's car insurance because auto insurance was brought up by your or i (forgot whom and heading out the door soon so i will lazily not scroll up) - in any case it is government required, it costs a shit ton, and it works like ass.

what do you do for a living? because i don't think it's a doctor and i don't think it's anything that takes too much business knowledge. as i said earlier, you can't compare wal-mart to the government, wal-mart still has competition. they happen to actually be quite large and efficient (an exception i assure you) because of the way they do business. the way they do business arguably causes economic harm, and provably causes lower quality. check out the book "the wal-mart effect". as far as your claim of success - that does not mean they are efficient. large companies are less efficient in much of what they do vs. smaller ones, you can learn that first week of business 101 at any community college. they are constantly working on ways to become more efficient. i'm an IT consultant, i go to major corporations all the time. what mom and pop could do in a day takes these guys a week, or weeks, sometimes even months. anyone will echo what i just said who has any reasonable amount of business exposure.

also note that you say these large companies are successful, which to me, implies profitable. yet you are using them to definate a system that you think should... not have any profits. so of course we then would want to keep costs down... and back to my argument (go ask some business friends if you don't believe me, as i would even say this is a fact) the larger organization is less efficient; doing less with your money; in effect, it costs more, once again.

i think it is you that does not understand the free market. it does mean free choice. the market will provide what i want for a cost i can afford. the laws of supply and demand will bring the price down to where it should be. if this price is still very high (i don't know, 10k for a hip replacement?) then my insurance will pay for it.

webster: any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods

i'll give you that i'm mixed on terming it socialism. i mean the government is definately controlling the distribution as far as availability is concerned. can you tell me what the difference even is if the government runs the hospitals or not? if they have already fixed prices and taken the money from the taxpayer?

again you ignored the forced and alternative care points i brought up.

why wouldn't you watch stossel's piece on education? i guess you don't like facing that you may be wrong about throwing more money at a problem that already has more money than it needs and seeing no significant return on the outcome.

it's good you never invited anyone to debate you, i don't think i'm very good at debating but it's not too difficult to criticize what you're writing in these comments.

Doctor Biobrain said...

First off, I disagree with the idea that people are more thrifty with their own money than with other people’s money. Many accountants are very frugal with their employer’s money, yet buy luxuries for themselves that they can’t afford. This happens frequently. And as I wrote, people often get scammed and buy unnecessary stuff for themselves. Even educated people can be quite dumb with their own money.

Secondly, as I wrote in my post, there is likely to be someone else who can spend your money better than you. When people have home repairs, they’re likely to have their handyman purchase the supplies for them. An investment banker is likely to know more than you how to best invest your money. And finally, the government and insurance providers most definitely have a better idea how much medical care costs than you or I. Additionally, the government and insurers are much better at negotiating prices than you or I. I find it unimaginable how you could suggest otherwise.

As for car costs, I already explained twice why they’re different. But to repeat myself again, those costs aren’t nearly as high and a car isn’t as essential as our health.

As for why I don’t support full socialism, I don’t think it’s necessary or a good idea. I don’t think the government should force all of our doctors to work for them or to take over all of our hospitals. Why would you even suggest that I’d support such a thing? Again, it seems like you really don’t understand what Socialized Medicine is.

And can you please explain how the government is meddling with our system now? Medicare and Medicaid go to people who usually can’t afford their own care and who insurance companies don’t want. And while they do regulate the insurance and healthcare industry, I think this is generally a good thing. Overall, I fail to see how these things make healthcare more expensive.

And if you think that employer-paid insurance goes against the free-market, then you obviously don’t understand what the free-market is. And no, I’m not going to read any book on the subject. I always feel that if you can’t explain something yourself, then you probably don’t understand it very well. So far, you’ve explained nothing on how you think this will actually work.

As for Canadian auto insurance, I don’t think anyone mentioned it before you, though I could be wrong. And as I said, I believe auto insurance is mandatory here in America. But again, I don’t understand why you brought up this point. Perhaps you were reading us discussing Canada’s healthcare system.

As for my job, as my profile says, I’m a CPA with my own home-based bookkeeping firm. So yes, you should assume that I’ve taken a few business courses in my time, as well as being somewhat familiar with how businesses work. I’ve briefly worked for the federal government and a city government, as well as companies large and small. All of my clients are small businesses.

As for Walmart, Sears, Amazon, and the other large corporations; while it’s obvious that they suffer from disadvantages due to their large size, it’s equally obvious that the huge advantages clearly outweigh those disadvantages. Otherwise, they wouldn’t be as large as they are. Similarly, while the federal government suffers from some disadvantages, the advantages can often outweigh the disadvantages; depending on what you want them to do.

And the way to compare these isn’t to compare one tiny company against one large company, but to compare the amount of service provided. For instance, if one Sears store sells as much as one thousand smaller stores, which is more efficient: That one Sears store or the one thousand smaller stores combined? If run properly, one large entity is more efficient at handling the same amount of work as numerous smaller entities. As for Walmart, I agree that they’re evil and try to avoid shopping there as much as possible; but damn if they aren’t cheaper than most other places.

And overall, I see no reason why you think the government isn’t effective at setting medical care costs. First off, they do that now and most doctors don’t complain. But secondly, if their rates are too low, the doctors won’t accept their business. And there are many good reasons why they won’t set rates too high.

As for efficiency, if the doctors and hospitals are still run as they are, then there is still competition. A doctor with good services will have more patients and therefore make more money. A spendthrift doctor will have lower profits. Inefficient hospitals will lose money. We’re not changing any of that. We’re just slightly changing who pays the doctors and hospitals; not how the doctors or hospitals operate. That’s how this is different from Socialized Medicine.

And again, most doctors and hospitals already work using this model. The only difference is that millions of people currently have no insurance or are under-insured, and so if they get medical care, it costs more. They’ll wait until their bad hip gets worse. They’ll wait until they get the heart attack instead of taking medication and precautions to prevent it. And they’ll go to an expensive emergency room, rather than seeing a regular doctor who knows them. There are cheap ways of doing things and there are expensive ways. I’m proposing one of the less expensive ways. Your way is how things were done for thousands of years, and how things currently work in many third-world countries. Sure, there are advantages to that, but the disadvantages are quite obvious.

As for your part on free choice, I think you need to re-read what you wrote. That’s obviously wrong. If you can’t afford something you need, they don’t have to lower the price; you just won’t get it. And even if no one can afford something at the lowest price a supplier is willing to charge, then they just won’t provide it. That’s where the free-market breaks down: It can only guarantee service if someone is willing to sell at a price that someone else is willing to pay. And that’s where the government steps in; to provide essential services that the free-market couldn’t provide at a reasonable price. Like roads and libraries and police services. Governments provide these because we couldn’t afford to buy them ourselves; yet society agrees that we need these things. Healthcare is considered an essential service.

Healthcare costs too much money for individuals to afford. I don’t know about you, but I’ve got three kids and couldn’t afford to cover the healthcare costs that are mandatory for kids. Vaccinations are required and most doctors won’t give them unless the kid gets a well-child check-up every year. And beyond that, my three kids have more sick visits in a year than me and my wife have had in five years. That just goes with the territory. Kids get sick and hurt.

This is all too expensive for us to pay ourselves; and no, I don’t believe that these prices will magically go down if we forced everyone to pay for it themselves. Instead, we’d just get fewer doctors and hospitals. It wouldn’t happen immediately. But over time, if doctors couldn’t make enough money, fewer people would become doctors. Hospitals would close. We’d also see fewer doctors come to our country to practice medicine. They’d just stay in their own country. And even in the short-term, we’d just get worse healthcare service and technology.

As for Stossel’s piece on education, no, I can assure you that I’m not avoiding it because I think it will convince me I’m wrong. I’m avoiding it because A) It’s not a topic I’m interested in and B) John Stossel is a nimrod. I could write more on this, but this comment is too long and I really just don’t want to discuss that issue. Search my blog and you’ll see education isn’t an issue I write about.

Finally, while I’m sure you find it easy to criticize what I write, you’ve written nothing that’s actually rebutted anything I wrote. Instead, you only keep repeating your belief in a magical free-market system, though you haven’t begun to explain how it would actually provide cheaper service for more people. Something to consider is that there are plenty of countries that have the unregulated free-market system you conservatives desire. The only problem is that people don’t want to live in those places. I guess it has something to do with poor education, lack of infrastructure, and crippling corruption. All a coincidence, I’m sure.

Anonymous said...

if i'm buying dinner and drinks aren't i, and everyone, thriftier than if hey, work is buying us drinks and dinner tonight? if you're buying a new hdtv do you research which one to get and what provides the best value per dollar? i suppose you could consult an "expert" then but it's simply work you could do yourself. you think the whole system should be fundamentally changed because someone can get scammed? scamming in say, the housing market, sounds like a problem of consumer education and industry regulation to me. not of oh government, please step in and take care of me. i don't know how to live my life any better than you dictate.

the government and medical providers do not know how to determine cost better than the market. have you ever taken an economics course? how is price set? between the balance of supply and demand. many price points converge to meet the equilibrium point, the price something SHOULD be. you can't get to this state with a *single* price point. that is just the government's guess, hmm, it should cost this much. if the government guesses too high we are wasting money. if the government guesses too low we will be sacrificing quality.

as far as car costs, medical insurance might be similar if we had not gone the route in history that it has. how do you think individuals paid for health insurance in 1950? you can't seem to get it out of your head that prices can be lowered by something other than government fixation.

i don't think you understand how close hr676 comes to socialism. the rationing of care will still force the movement of doctors around, whether private or government will it not? it is still a forced taking of every person in the community's work product for redistribution, is it not? there is no real competition, is there? how different do you imagine it being? if it's not socialized or near to it, what is this solution? it is certainly not capitalism.

you ask me to explain how the government is meddling with free market health care now, and claim i don't understand a free market? here is the 2nd time i'm posting this link: http://www.harrybrowne.org/hb2000/print/health.htm

i brought up canadian auto insurance because it is governmnent run over there. it is a perfect example. in the us, car insurance is required. in canada, car insurance is required. in the us, it is unregulated to my knowledge, we have a competitive market, and my friend pays 800/yr for his 2005 wrx from allstate near chicago. in vancouver, british columbia, the often complained about government provided car insurance for a 2005 wrx is 2300 a year. not sure if that is CAD or USD, they are near parity now anyway (way to go federal reserve). chalk one up for that idea...! worse service and almost 3 times the price. that is working well.

if you're a CPA i have no idea why you do not have faith in true free market economics. my parents are both CPAs, my father is partner in a firm he started. they both recognize the failures of this plan. they both easily see inefficiencies when viewing a small business to a large business or even viewing the pig of government.

what advantages does a big government have? have you ever read about anyone working as a government contractor? i could move a server at a small business at an afternoon. at sears it would take 2 weeks. government God only knows. there is no shortage of ridiculous stories out there i am sure. if you had $10,000 to donate to every school, how much of it would actually go towards something useful if you donated it directly to the schools? vs. the state depts of ed to give to the schools? vs. the federal dept of ed to go to the schools? useful value is quickly eaten away at each step up that ladder. that is also ignoring that a specific school should know how to better spend the money than the fed dept of ed may dictate.

what advantages do those big companies have? it's not efficiency, it's not even buying in so much bulk to give you the best price. it's easy to find rinky dink shops online that are cheaper than amazon. and walmart only carries low quality stuff. so i would say it's only price sometimes, and quality rarely. what else can they do better? marketing? but with hr676 there's only one real game in town anyway. you don't need to market a choice when there is only 1 thing to choose. i don't understand what advantage you think big government would have for health care, or for anything really. other than being wasteful with money and growing itself bigger. you know what is interesting in the EU? belgium. they have 6 governments worth of bureaucracy there. 1 out of 4 people work in government, and 1 out of 10 people are unemployed. the only thing worse than big government is bigger government.

# of sales/# of stores is hardly a good measure of efficiency IMO. efficiency of distribution per store i guess? a better measurement would be how much was the cost of each sale at the stores? what was the revenue per item? the revenue may very well be better at the smaller store, and i would term it more efficient. sears may have less revenue per item, but it sold so damn many that they the stock still looks pretty good and they come out with a profit. but it may very well be not as large as the profit per item a small store is attaining. "if run properly" is a BIG if for large businesses. even when they are, a small business is always many times more agile. wal-mart is probably the most efficient big store out there. and i would say very much the exception to other major corporations. they are also completely brutal to those that they do business with and make large sacrifices to quality. they ruin product reputations, compromise saftey, compromise quality. the levis you buy at wal-mart aren't the levis you buy at the levi store.

i believe the cato institute has a major critique on the costs the government does set now for medicare. also note that social security and medicare are making the country go bankrupt even further, the lead accountant for the us (gao comptroller or whatever the title is) is touring the country and speaking about how these "entitlements" alone will take up the entire federal budget by 2040, at least originally it was 2040. it might be 2030 or even 2020 now. how can a doctor not accept the government's business? i suppose we would have private health care in addition to the proposed care, as is done in canada and such. this is BS of course too, since if i choose private care, i must pay for it in addition to the forcible taking of my money for univeral health care.

why are there no good reasons why the government wouldn't set rates too high for things? they pay ridiculous prices for everything else in government already. if it is set too low for some operation and doctors are actually able to refuse to do the business, then how is that area expected to advance? how available will that care be? with only people doing it that *had* to take the job, wouldn't you expect lesser quality?

i think your idea about what competition with doctors would become is dangerous. it sounds like quantity not quality to me. funnel (ration?) them in, run some shit, bill them, move on to the next one. with all the stories of wait times in other countries i don't think the "bad" or "worse" doctor in your example would have trouble getting people in anyway. i wonder if price fixing, if done below the free market equilibrium point, would make some people think that becoming a doctor is just not worth it, or developing expertise in an under rewarded area was just not worth it. this would only exacerbate the problem of wait lines and diminishing quality.

i don’t think you can compare roads to products meant for individuals. what services do you think the free market would be unwilling to provide?? if people couldn’t afford something they would determine it to be overpriced and lower the price. i’m confused as to what you think would simply stop being provided. healthcare is not actually considered an essential service, at least not in the USA yet anyway. the way the US is set up, the only thing you are entitled to is your civil rights and protection of them. economically in our system also, the federal government is not entitled to the fruits of your labor (although they're currently taking it) and similarly others are not entitled to the fruits of your labor.

you keep pointint out healthcare costs too much for individuals to afford. i agree with you. but that's only because costs have exploded. if costs came down to their real levels, ie. time/resources/materials, instead of the maximum an insurance company or organization can charge, then you could afford it and it would be just like car insurance. your deductable wouldn't be 25 bucks a visit, you'd simply pay the market value of a checkup for a routine visit and not use your insurance. if you needed a hip replacement or had cancer then you would use the catastophic health insurance you purchased, just the same as you insured your house or your car.

it's not magic that the prices will go down, it's market forces. how much is heart surgery, 150,000 bucks for 6 hours? do you really think that the salary of those involved, plus operating costs, plus materials, etc. really adds up to 150k worth of value? it doesn't. if organizations weren't allowed to sit there and charge the max possible for every little thing like they are able to do today because of existing government intervention, then that surgery will come down to the real cost of 15,000 instead, and health insurance could cover it. if we had true free market healthcare, it's very unlikely we'd have fewer doctors. i think you are mistaken if you assume them to be great benefactors of outrageous prices, the bulk of that is definately not going to them. a plane with no or artificial competition is likely the one to produce less doctors. nobody wants to get into a field where they are not recognized for their excellence and compensated accordingly. why would we see fewer doctors coming in to the country? they are already coming here from canada. competition breeds better healthcare and technology. it's the lack of it that stifles innovation. why do you think america invents and creates so much stuff?

just throwing more money at something is not incentive enough. let's say bill gates tells me that if i can buy a ferrari cash, he'll give me a check for that amount once i'm done. i want a ferrari. i'll work towards this goal. but what if he gives the same offer to you, and then says only one of us at the end will get his check? i don't know about you but i'd be working a hell of a lot harder.

the free market system isn't magical. it's merely economics that works. i don't trust your opinion of other countries having unregulated free market systems because you appear to think that we are in one of them, which is certainly not true. why do you mention poor education here if you don't want to talk about it? i think it interesting that you point to a country where you think socialism is working better than here and claim that we should have it, while the same country has a provably better free market education system which you choose to ignore in favor of throwing more dollars away in our provably worse one.

Doctor Biobrain said...

Anonymous - I really don't want to debate this further. It's obvious that you don't give a damn what you're actually saying and will say anything to prove your point. And I can't debate under those conditions.

For example, you can't think of ANY time when people are more thrifty with other people's money than their own...including the examples I gave? You HONESTLY think there is NO ONE who knows better than you how to spend your money in EVERY situation? You REALLY think you know better than the government's experts on how much medical care should cost for everything?? I refuse to believe you could be so dumb that you'd believe any of this. You're just saying what you need to say to prove a point. But I don't think you believe it at all.

And you know perfectly well that a large company has huge advantages that smaller companies don't have. Yet you persist with this myth that smaller companies work better, in spite of the overwhelming evidence to the contrary. You know there are pros and cons to this stuff, but insist on only seeing the side that helps your argument. That's dishonesty.

I already wrote more examples of what you said that I'm sure you don't believe, but deleted it and won't go on. You are intellectually dishonest and your whole argument relies on pretending that I'm an idiot and fantasies about a magical free-market system that you still haven't explained.

It's clear you're working under the delusion that doctors and hospitals will provide to us similar services to what we're getting now at a price we can afford. That is obviously false. The free-market does not guarantee service and if you can't afford what they need to charge, then you just won't get the service. That's how third-world countries work and we send doctors to those places as charity work.

Nor have you explained how I was wrong about anything. The system I'm proposing is just a slightly modified version of what we already have, which would fix many of the problems we have, while your system is a completely revolutionary one that could be a huge disaster. The prices would be fixed, but the profit-motive would provide plenty of competition and reasons for efficiency. Hell, would you honestly choose a doctor based upon price? You want the cheapest doctor? You'd stay at the cheapest hospital?? That seems insane. I want a good doctor, not a cheap one.

And yes, according to the free-market system, the best doctors would be the most expensive and the worst doctors would be the cheapest. And so the less money you had, the worse healthcare you'd receive. And you wouldn't go to a doctor until your condition got really bad. That's how millions of people do things now and it's the most expensive way of getting healthcare. People shouldn't wait until they have a heart attack before they see a doctor. That's one reason why our healthcare costs too much and your system would only make that worse.

But again, you can only make an argument by twisting what I wrote into absurdities. I say that doctors would provide better service because it would give them more patients, and you say something about quantity over quality? Huh?? I specifically said better service and that if a doctor provided bad service they'd lose patients. How does that mean quantity over quality, when the emphasis was clearly on quality? Dishonest.

Again, I have too much faith in your intelligence to assume that you believe what you wrote.

BTW, Social Security currently provides us with far more revenue than it pays out. If we didn't have Social Security, we'd have to raise taxes (unless you believe Washington would actually cut spending). And no, Social Security will not eat up our entire budget by 2040 or 2030 or 2020. The dates you're thinking of are the theoretical dates at which it starts paying out more than it takes in; which might never happen. And that wouldn't be a problem, except that we're currently spending the money instead of saving it. Al Gore wanted to lock that money aside and was made fun of for it. Bush is spending it just as we have since the 80's. But as I said, Social Security has been a real boon for our budget. But that's only because politicians refuse to make us pay for the services we demand.

Finally, when I referenced countries that have unregulated free-markets, I obviously wasn't referring to ours. I was talking about third-world countries, moron. And no, I have no problem with insulting someone who clearly thinks I'm an idiot. I mean, honestly. How on earth would my statement have made any sense if I was referring to our country?

I support the free-markets and obviously understand how they work. But sometimes they don't provide us with what we need. I already explained that. And I'm sure you understand that. But again, you refuse to see it now because it undermines your point. The free-market system does not guarantee service, and so we use the government to provide essential services that the free-market isn't providing. And our society considers healthcare to be an essential service that isn't being provided by the free-market.

Again, the places that don't have regulations and allow the free-markets to reign supreme are really crappy places where no one wants to live. Sorry to be the one to have to tell you this, but modern society is very expensive and forces you to make sacrifices that you might not want to make. And if you don't like it, there are places you can go. But I can assure you that many of the people in those places would gladly pay our taxes if it meant they'd get our services.

Anonymous said...

not really bio, people are thriftier with their own money if they are going to buy a good. your examples don't work because buying a car is a good that you can't buy with someone else's money. and as an accountant you should recognize that investing is not the same as spending. my example works because you are going to buy dinner and drinks anyway. what do you order when it's on you vs. on work?

i never said that i know better than a "government expert" at setting a price. don't accuse me being dumb when i have stated many times that it is the market that sets the price. see that? i didn't say me. i said the MARKET. the exact same way the price is set for... everything else you buy!! i guess understanding economics is not necessary to balance books.

you complain that criticism does not go to certain points in your long rambling post above. you are guilty of the same charge in my direct post. i ask you what advantage the big company has? you reply with none. you claim success as profit is greater in the larger organization so they must be more efficient - a fellacious argument. i present to you the real world argument that their margin is not better, they make more money as volume. maybe you have only worked in small places all of your life, and that lack of exposure is why you think this. i have seen big and small.

i worked at computer discount warehouse, the largest computer/parts distributor in the world. i worked there 2 years. i could buy parts elsewhere - for less than my cost + 1% discount at cdw! additionally, if i bought a computer from a mom and pop store, they are likely to make more profit on it than cdw did. to you both of these things seem unfathomable - to me they are common sense. you are truly naive in how these large businesses work. i have worked at small companies, i have also worked at 8 fortune 1000 companies. 7 of which are fortune 500, 3 were actually fortune 100. i have worked in the us, canada, england, new zealand, australia, and the philippines. i am an IT consultant. i am hired because i know how to do things and do them efficiently. i go to large companies and work on projects to improve these companies FOR A LIVING. i am not being dishonest i am merely restating a business fact. bring it up in conversation with your clients. you are mistakenly thinking that bargaining power = efficiency. or that large and profitable = buying product at the lowest price. both are absolutely false assumptions.

there is not magical fantasy about a free market. i can't explain it to you any simpler than supply and demand intersect at the market value of something. that is it's price. i can't hold your hand through that any more, take a community college economics course or read a book if you fail to grasp this fundamental component of a free market.

i already told you how hospitals will provide the same services to you at a price you can afford. when price is set by supply and demand, instead of government fixes, or a corrupt system merely charging maximums, then the price for normal service will come down. catastrophic things will be covered under your affordable catastrophic health insurance. it would work exactly like car insurance. or dental insurance! i know you can understand those, so why can't you understand this?? my theory is that in your mind the only way you can perceive a price to drop is by government control and not the market actually determining it. you bring up charity in this paragraph yet you seem to deny it would provide any benefit locally in previous comments, heh.

the system you are proposing is not a "slight modification" - it is forcing me to pay for my health insurance, forcing me to pay for other people's health insurance, fixing prices and rationing out care. that is a fundamental modification. i don't think you even understand the consequences if you term it "slight". my suggestion is not "slight" either - but it's a continuation of what we have, not a fundamental change. it would work just as every other type of free market insurance available out there; house/car/dental/fire/flood/etc. your version would be the exception.

i don't understand your good/bad doctors post. there will always be good and bad doctors. and guess what? those that have money will always have access to the best ones. if you think under socialized medicine that someone living on the street would now have access to the leading cardiologist in the country you are wrong. this guy would STILL be in the private sector and would be in demand enough to live just fine. government intervention is not going to make doctors any better and it is not going to make the higher levels of care accessible to everyone. in fact, unless private car is outlawed (which would surely be illegal) - wouldn't you expect those that excel in their fields to continue to operate in the private sector where they will be rewarded for their excellence? so congratulations, i think you'd be likely to push many of the better doctors out of your government care system.

i am not twisting around your more patients argument. i am merely pointing out the real world affect you don't see or choose to ignore. in the free market, the better doctor may or may not have more patients, and is rewarded not only based on the number of patients, but the quality/cost of care. in your plan, the doctor that seems more patients makes more money. PERIOD. this is exactly what you state - more patients = more money. which is true - since you aren't rewarding for quality. you're assuming that higher quality will bring in more patients. it will *attract* more patients, and it will also make those patients happier with the better quality care - but there is no reward for it under your system. now about the pure quantity guy, all he does is usher them in wham bam thank you mam and usher them out. he could easily see as many patients, or spend less time on each and see more, and make more money based on your own statement of more quanity = more money. but you don't think he'd have patients. why not? there are waiting lines in all of these other countries. as the price of health care falls the demand will go up. if you had 0% cost to the consumer per visit health care you'd have virtually infinite demand. so yes, bad doctor would be getitng just as many patients as good doctor - maybe even more if he ushered them through like cattle with $ signs attached to each.

social security and medicare are bankrupting us. the GAO comptroller is the head accountant and he is on a wake up tour of the country to attract attention to the problem. if this guy says that in 2040 we won't be able to pay for a thing, guess what, i believe him.
http://video.google.com/videoplay?docid=-7461407498377956300

your 3rd world country free markets as i pointed out earlier, moron, are likely not free markets, as you believe the US is one. if you believe this is one, how can i trust that you are correctly judging another country to be a free market? you don't even understand the one you're living in!

our society does not yet consider healthcare to be an essential service, and it is certainly not constitutionally one. what services is it not providing? it is providing everything without the governmemt just fine right now. it's not providing them to everyONE - but you're stating that the services simply don't exist without the government. they DO. they just need to be made cheaper and more available. which can be done without the government. the government is precisely the problem!

by the way, geeeez, i'm still waiting for your comment on edwards, in that i will be forced to basically have yearly checkups. what's next? i won't be allowed to smoke? or eat big macs? although i can't blame you for not wanting to defend that point, as it is hard to argue for better healthcare through tyranny.

Doctor Biobrain said...

Ugh, I can’t believe I’m still going over this. Just so you know, I decided to write the actual healthcare portions of my answer as a new post on my blog. You can find it here:
Free-Market Fantasies

Below are my comments for the rest of the stuff. Because these items are fairly well separated, I’d prefer that you responded to stuff written in that post on the commentboard of that post. The stuff written here can be written here. Not trying to be weird, but this really was getting long and I wanted to share some of my thoughts in a forum people would read.

Regarding the idea that I might splurge on dinner when the company’s paying, I’ve never had a job that required travel or sales, so I’ve never had my work pick-up my tab. I have, however, been the guy who checks over expense reports and can tell you that I’ve never worked anywhere that allowed people to do what you’re suggesting. In fact, I was always that penny-pincher accountant who would fight over every last penny and would never reimburse people if they exceeded their per diems, which were set by the IRS. At one place I worked, one girl kept trying to make us reimburse her for her People Magazine that she’d buy at airports, but I’d fight that every time.

I was proud of the fact that nothing got by me and all our employees knew it. I can be quite a dick when I want to be. All the accountants I’ve known who processed expense reports were the exact same way. We took this stuff personally. And I most certainly have splurged on meals and drinks that exceeded the IRS’s per diem, when I was paying the bill.

The main trouble I had were from the business owners. Particularly at one business. This guy would spend obscene amounts of money buying food and alcohol for large groups; both at expensive restaurants and his golf club. He was the only one allowed to do that. He was also bad about turning in expense reports and receipts. It wasn’t until he started dating his secretary that I could get these things regularly, as she was always with him. He eventually got a divorce and married her. And no, I’m not making that up.

And the best people I did expense reports for: city politicians. Those guys had spotless expense reports and even had their campaigns reimburse the city for items I didn’t think they needed to. I guess they knew they’d catch hell if they got caught doing anything funny. As a claim to fame: I once bled on a future mayor’s expense report when I cut myself removing a staple from his expense report.

So even with your one example, I dispute it. Some people (like you) will rip off the company and spend extravagantly, while other people (like me) are more careful with their boss’s money than their own. And I can think of lots of times that people are frugal with their boss’s money and extravagant with their own. And therefore, your point is wrong and mine is right. I can’t believe I had to explain this to you.

Unnecessary Care

And let’s get to what the point of this is: John Stossel misused a Milton Friedman quote into meaning that healthcare costs would go down if people had to pay their own costs. By that, he wasn’t saying that costs would go down if people couldn’t pay more (though I’m sure he believes that too). He was saying that people were getting unnecessary medical care because they weren’t paying for it. In other words, they were being “careless” because they were spending other people’s money. But is that an issue? Do we have a huge medical problem due to people getting healthcare they don’t need? I seriously doubt it.

I do think end-of-life care needs to be rethought, but otherwise, don’t see excessive healthcare as a big problem. I don’t doubt that this happens, perhaps too frequently, but can’t imagine that this is a huge problem significantly driving up costs. If you’ve got solid evidence that I’m wrong, I’d be glad to see it. But it needs to be real evidence, and not an assertion by someone like Stossel telling me that this happens. I want data.

And as I’ve said before, a bigger problem is when people avoid seeing a doctor until their condition gets severe. Like people who don’t get mammograms and prostate exams until their cancer is in the later stages. The most expensive way to get healthcare is to wait until a problem gets bad and going to emergency rooms. And as I’ve said, your “solution” would surely make that problem worse. It’s better to see the doctor too much than to not see him enough.

Saving Entitlements

As for Social Security, I watched that clip but didn’t see what you said. You said that the entitlements would eat up the entire budget by 2040. Perhaps I heard it wrong, but I think he said that debt repayment would eat up the budget and that we’d barely have money to pay some entitlements. But I guess that’s why I hate TV news, as it’s harder to learn stuff than if you read it.

As for cutting Social Security and Medicare, remember that we currently receive more money than we pay out for these programs. So if we cut these programs, we’d have to raise taxes to compensate. That’s one of the problems with privatizing Social Security. If we start sucking money out of the system now, we only make the crisis happen sooner. As things are, we need Social Security to help pay our bills. That’s why this is a problem. It’s not that Social Security costs too much. It’s that we’re already spending the money.

Then again, one big solution would be to actually start saving these funds and raise other taxes to their appropriate levels. For all of the talk about Bush’s tax cuts, 15.3% of almost all paychecks is still being funneled into the system. Even poor people pay that. So if we started setting that money aside for the pending crisis, we could see what our real current budget looks like.

And sorry to get partisan on you, but if Republicans hadn’t turned tax increases into such a political tool, we’d be able to increase revenues. Instead, Bush and the rest of the “fiscal conservatives” convinced America that tax-cuts are magical and raise revenues, and now it’s considered poisonous to any politician to raise taxes at all. And that wouldn’t be a problem, except they refuse to cut spending too. Not good.

And all the same, we need these entitlements. I’m not convinced that the outlook for Social Security is as gloomy as he suggested, but agree that we need to do something about our growing debt. But if we allowed our elderly to live in utter poverty and illness, things would get worse. I’d go into more details of what I think we should do, but you’ll think they’re terrible ideas, so I won’t go further.

Anyway, that’s it. If you have something to say about any of this stuff, say it here. Otherwise, put it on the other board.

Anonymous said...

your money vs. other people's money - you are talking about something a little different with expense reports and allowances. in my example, the expense is being charged in regardless, it's just company or you paying for dinner. so do you order salad or lobster? here is an even simpler example - a wedding. cash bar vs. open bar. which one do you drink more at? on a personal level, hey, you might be that guy that actually drinks less. but overall which one does the wedding drink more at, every time? people are not more frugal with their boss's or friend's money. if your company was giving you a company car and gave you a budget of 50k, would the average person look at 15k cars or 45k cars?

i agree with you on your interpretation of stossel's quote, i think it unlikely that people are receiving unnecessary care as a whole. however there are cases when they are, i'm sure a google search could find people going to the emergency room for the most assanine of reasons. if you lower/remove a copay it is quite likely that there would be more of this. i also do not think stossel implies that this mere move alone will have a significant impact on the price of care, 82% free is better than 80% free market but it does not get it to the point where it should be.

as per your avoidance of seeing a doctor - i agree, you shouldn't put it off. but i haven't seen a doctor since i was 20, and i'm 28 now. i make enough money to go see one, whether health insurance pays 0 or 100%. the creation of UHC isn't really going to make me rush out to go to the doctor now. while as price goes down demand certainly goes up, i really don't think you'd see the significant statistical gain improving in this area that you'd hope for. the only real area where i think you'd see preventitive care stemming these things is the uninsured that actually want to go to the doctor. so whatever percent of that 45 mil that would actually go. of course if you cut out illegal immigrants and people that make a decent amount of money that stat gets much closer to 10 million. i really don't see the rate of breast cancer dropping by 50% or anything like that.

to try and support this i looked for a cancer by country metric. here is a breast cancer one.
http://i.a.cnn.net/cnn/interactive/health/0503/popup.cancer.charts/breast.cancer.incidence.gif

now these statistics are hard to conclude anything about, because there are such vast cultural differences. certainly everything is not under control while the type of health care is acting as a differentiator. crap, i just noticed the US is not even separated from canada, and wonder if northern america here includes mexico or not. anyway, incidence could be based on culture, preventitive care, both, and who knows what else. but an interesting stat to see is number of deaths divided by number of incidences. this stat is lower, in a non-trivial amount, in... north america. so i would make an arguable assumption that north american lifestyle contributes to greater amounts of breast cancer, but that north american health care is the best at treating it. i think it hard/impossible to find any stats that would say switching to UHC will decrease the number of incidences though.

i don't pay attention to social security/medicare stuff much because i am young. i do undertand that it is going to fail me for retirement and the system is in need of major reform. whether it is 100% failure or 50% failure by 2040 i don't know. if to stem that failure there is the option of saving myself through privitization (which many people are doing anyway with IRAs and such) vs. merely giving the government more money (that they've obviously f'd up with) i will take the former. "but poor people don't have IRAs!" - well, the ones that are working are still paying for social security. they can funnel that same amount right into a private fund. for those that are truly poor or those too irresponsible to save the money themselves then we would be back to charity/local government resolution before federal resolution of the problem. solve it where it is the cheapest.

i disagree about raising taxes and completely agree about cutting spending. there is far too much wasted money regardless of party. the problem i have with democrats is the feeling that money will always fix a problem, the problem just needs more and more money and usually to no end. whereas the problem can be resolved much better through policy change.

jumping to education again, i do believe more money would help teachers, but think this should be introduced through a competitive model. i'm sure whatever price/performance was achieved with a more free market/competitive system would ultimately very easily best the cost to meet the same performance level in the current system while just throwing money at it. of course performance is kind of hard to measure, for example if you have seen board of ed approved reform math, apparently it has made standardized test scores go up. i would, however, it does not teach the discipline and problem solving skills that math is supposed to teach you as a critical thinker, and ultimately that "reform math" has a negative effect on education. http://www.youtube.com/watch?v=Tr1qee-bTZI

kinda off on a tangent there, i'll check your new post when i have time...

C. L. Hanson said...

In a recent post here, I claimed that the reason U.S. healthcare is in the state it's in is because Americans don't want to hear that American healthcare is anything other than the best in the world. I was joking when I wrote it, but I guess I was more right than I thought...

I've also written about my personal experiences with U.S. healthcare as compared to French healthcare here.

ElectroRocket said...

I couldn't see past your first paragraph. Next time try making an argument without name-calling, arrogance and vitriol. More people will give it a chance.