…a discussion about the prospect of rationing in a public health system is not only permissible but unavoidable. Every nation that has promised comprehensive, low-cost health coverage for all citizens has faced a similar dilemma. Eventually it is not enough to increase public spending or to reduce waste. More direct forms of cost control become an overwhelming priority. And because health expenditures are weighted toward the end of life, the rationing of health care often concerns older people most directly.
Keith Hennessey, former director of the National Economic Council, puts the dilemma simply: “Resources are constrained, and so someone has to make the cost-benefit decision, either by creating a rule or making decisions on a case-by-case basis. Many of those decisions are now made by insurers and employers. The House and Senate bills would move some of those decisions into the government. Changing the locus of the decision does not relax the resource constraint. It just changes who has power and control.”
Because no one likes to ration directly, nations such as Britain and Germany employ “comparative effectiveness research” to lend an air of science to the process of cost constraint. Are “quality-adjusted life years” worth the public expense of a new drug or technology?
I am not impressed with the Congressional plan. But I am for reasoned debate.
The fact is that healtcare is rationed now. We do not call it that but anyone who thinks insurance companies do not do the same thing planners do is simple not paying attention.
FWIW
jimB
Any resource that is not in infinite supply is “rationed.” If and when the Central State takes over such rationing, not only will rationing decisions be made weighing one citizen’s needs against the other’s, but also weighing the demands of health care against legitimate government expenditures and also other special interests’ rent-seeking at the national level.
The rationing advocated by some–and practiced in the U.S. along with bureaucratic gatekeepers (insurance companies, Medicaide, Medicare)–is economic. Those who are wealthy can get any sort of medical care they want (Michael Jackson is a recent horrible example) and those who are not wealthy are “out of luck”. It does seem to be a very irrational means of allocating scarce medical resources.
Doesn’t the federal government, through Medicare, already ration end-of-life health care? Is the real, unstated, argument by the pro-reform side as follows: Medicare is currently too generous at the end of life (I’ve seen the statement that 20-25% of Medicare expenditures are during the last 2 months of citizens’ lives), and under the cover of thousands of pages of health care reform, citizens’ end-of-life care will be pared back?
Mark Brown
San Angelo, Texas
August 21, 2009
That’s one scenario, Mark, but I don’t think it’s the realistic one given the political climate of the US. More likely is a never-ending series of stories in the media describing the horrors of the rationing the government has implemented, replete with images of those killed, in agony, maimed, disabled, etc. by the system. This will be followed by politicians and wannabe politicians huffing and puffing about what an outrage this is and how they’ll reform the reform, obviously including the treatments previously excluded.
The result, of course, will be Medicare write large, with costs exploding exponentially as more people and more procedures are brought in, with fewer providers able to give care as reimbursements are screwed down. It will be interesting to see if the “system” or America’s financial standing collapses first.
Welcome to post-Constitutional America.
We really need to get the government OUT of health care. Medicare would be vastly improved if it were in the private sector. To be honest, everyone who likes Medicare is likely saying she or he likes the private insurer who supplements the government part.
When the government gets in the business of mandating and processing and implementing, they also get in the business of controlling private lives.
And as far as rationing is concerned, everyone above has pointed out–accurately, I believe–that rationing occurs in the private and the public, the economic and the health care sectors–no matter what anyone says. But to be sure, there is choice in those arenas when an individual can opt out of one private company for another (true, the individual might not be able to afford it, but he still has choice.) With government mandates, there is no “opting out,” no choice.
It IS a conundrum!
Please lets keep our eye on the ball. It’s not what kind of government health care or how much government health care, it’s getting government out of health care period! That is what needs to be pushed. In fact, America needs to return to the concept of constitutional government. Think of what a better country this would be if the federal government was truly restricted to the powers granted it by the Constitution.
drjoan, sorry to jump in with very similar thoughts to those you expressed. I was composing mine without realizing you had already put in your comment.
Food is rationed, you are limited by what you are willing to pay. Do you want the government distributing food so everyone can have something to eat?
Housing is rationed, you are limited by what you are willing to pay. Do you want the government assigning housing so everyone can have something to eat?
Jobs/pay are rationed, you are limited by what someone else is willing to pay you to do. Do you want the government assigning jobs so everyone can have a job?
Health care is rationed, you are limited by what what you can pay or what your insurance will cover. Do you want the government running health care so everyone can have some?
I would bet most people would say no to 1-3, so why are so many willing to say yes to #4?
Rationing in terms of free market economics is a misnomer. The proper term is “price”. Price is the variable which perfectly matches supply to demand. It is color blind, in fact it is totally blind to everything except the transaction between two people.
When supply exceeds demand price goes down in order to stimulate demand and restablish the equilibrium. When demand exceeds supply price goes up (we all know this from buying gasoline).
Innovation (new ideas for delivering a service) and marketing (discerning customer needs and best filling those needs) are two tools which private enterprise uses to drive profitability while living within the confines of the supply-demand curve. Thus I can expand supply if I figure out a new way to create what others want.
Government neither innovates nor employs the tool of marketing because it has no profit motive. Because it doesn’t innovate it is stuck in a time warp. Medicare a hundred years from now will look like medicare today except for more fee reimbursement battles.
Since innovation and marketing don’t apply, all government can do to control costs is truly ration. And this is true rationing, done according to rules adopted in a politicized environment: typically in favor of some groups and unfavorable to other groups.
I am not rich like Ted Kennedy. If I get a brain tumor I will not get anything like the treatment I imagine he is getting. Nor do I expect to. If on the other hand, I am able to purchase a catastrophic health insurance policy (which I can’t today), I will have chosen the level of care I wish to receive should this rare but possible event occur in my life, as long as I maintain the health insurance policy. Under government rationing rules, I may just be told “no” according to some set of rules I may have had no part in formulating.
The cute thing about the Captain’s analysis is that it really has nothing other to say about health care other than — if sick people outnumber doctors, the doctor’s fee goes up; if doctor’s outnumber sick people the doctor’s fee goes down. It’s not entirely clear that this is actually true or even that it is the correct reading of the law of supply and demand. (For example, what happens to price when the number of sick people exactly matches the number of doctors–i.e., what in economics is referred to as supply-demand equilibrium.)
In any event, it is an irrational way to allocate scarce medical care. It really isn’t rational to allocate health care to the rich, even if they are healthy or to deny health care to the sick just because they are poor.
Oh, btw, “the government” does engage in marketing.
Somehow the “Law of Supply and Demand” was missing from the stone tablets YHWH gave to Moses.
9. JustOneVoice wrote:
[blockquote]Food is rationed, you are limited by what you are willing to pay. Do you want the government distributing food so everyone can have something to eat?[/blockquote]
I hate to have to be the one to tell you this, but the government distributes food so everyone can have something to eat. Ever hear of food stamps? Ever hear of “Free and Reduced Price Lunch”? Farmers and grocers like these programs. The Chamber of Commerce and Tourist Bureau doesn’t like to have people starving in the streets.
[blockquote]Housing is rationed, you are limited by what you are willing to pay. Do you want the government assigning housing so everyone can have something to eat?[/blockquote]
I assume you meant to say “somewhere to live.” I hate to be the one to tell you this, but the government assigns housing. Ever hear of low cost housing, public housing, rent subsidies, and homeless shelters? Developers and apartment owners like the idea. Besides the Chamber of Commerce and Tourist Bureau doesn’t like people camped out in the streets.
[blockquote]Jobs/pay are rationed, you are limited by what someone else is willing to pay you to do. Do you want the government assigning jobs so everyone can have a job?[/blockquote]
Well, it is true that government doesn’t assign jobs. But it does tell most employers the minimum they must pay, minimum safety standards, minimum ages of workers and the like. But I suppose the Chamber of Commerce would like to pay 6-year-olds $1 a week for dangerous work.
[blockquote]Health care is rationed, you are limited by what what you can pay or what your insurance will cover. Do you want the government running health care so everyone can have some?[/blockquote]
I’m pretty happy with my government run health care; more so than I was with my insurance company run health care. So are a lot of the old folks, federal employees and veterans I know.
[blockquote]I would bet most people would say no to 1-3, so why are so many willing to say yes to #4? [/blockquote]
Possibly they say “yes” to 1-4 because (1) they care about others and do not want to see them starving, freezing to death in the winter and dying of heatstroke in the summer, the dignity of employment where they are not exploited and enjoy health or (2) because starving, homeless, sick, unemployed or under-employed or exploited workers are a drag on the national defense,the general welfare, the economy and the quality of community life and the existence of slums like one sees in India, Brazil or in Africa are an affront to the image of America, the Beautiful. Take your pick.
It goes without saying that since I’m a disabled veteran, and the VA has always treated me very well, I’m happy and pleased with my government-run healthcare.
[Comment deleted by Elf – please address issues, not other commenters – Elf]
[Comment deleted by Elf – please address issues, not other commenters – Elf]
Ken
Thank you for pointing out that even though we are (supposed to be) a capitalist society we have learned that government does have a limited role.
Government regulates housing standards, they don’t say what kinds of houses companies must build. They don’t set housing prices. They build a few housing projects and we all know how well that works out. I would support some free or subsidised clinics/hospitals.
Government sets up work place protections, they do not pay everyone’s salary or tell people where to work.
Government set food standards, they do not grow all the food and tell you how much of what foods you should eat and how much it will cost. The provide the means for the poor to buy food on the open market.
Which shows the problem with this bill. It is not about insuring those who are not insured. It is about controlling the health care of everyone. By setting the rules of the health exchange, competing on the health exchange and being the main entity setting payment rates, they would be taking over the health insurance far beyond what is necessary.
Medicare and Medicaid are going to need to get more tax money or cut services. They already pay less than the market rate, causing higher rates for everyone else.
The reason the USA has been able to afford to do as much as it has for the poor is because of the wealth it generates. We have been able to generate this wealth because we have a capitalistic system. If you ruin that system, you will have killed the goose that laid the golden egg and we will end up like those countries you mentioned.
Ken Peck, I could say that you also follow the Alinsky tactic of attacking when you don’t have a good response., but I won’t be uncivil and do that. Goodbye to you.
Some are satisfied with their VA healthcare. That is good. My mom I’m sure would report perfect satisfaction with her medicare so far. That is good. Does that mean medicare is the model for a whole nation’s healthcare?
1. Doctors and hospitals currently survive through it because they can cost shift
2. As new treatments and technolgies developed by private enterprise come on the market Medicare eventually signs on to them.
3. Mom doesn’t care, or doesn’t know, that the unfunded future liability of Medicare is beyond the ability of this nation to afford.
So, since everybody is happy, let’s pour on more of the same.
And let’s ram it through before anyone gets a chance to see what we are doing or has a chance to inject new ideas into the mix!
PS—–and what is the price of a good when supply and demand are in equilibrium (I know people are on the edge of their seats for this one!)? It is the agreed upon perception of value between buyer and seller. Price deviates from that point as supply and demand fluctuate. I know that drives liberals nuts (because it may not lead to the holy grail of “equal outcomes”, but it sure does open the playing field to the conservative cherished holy grail enshrined in our Declaration of Independence: equal opportunity!
17. Capt. Deacon Warren wrote:
[blockquote]1. Doctors and hospitals currently survive through it because they can cost shift[/blockquote]
I’ve noticed that. It has come up earlier in this discussion. It is true not only with Medicare/Medicaid, but insurance as well. The “negotiated price” is invariably lower than that charged to patients paying directly. The costs of Medicare, Medicaid, insured and indigent care are shifted to patients paying cash directly. Note that when an uninsured patient shows up in the emergency room with some sort of major medical problem (some of which could have been treated much more easily if caught early) and that patient is unable to pay, for example is forced into bankruptcy, who pays? Well the rest of us pay through taxes, higher medical bills and higher insurance premiums.
[blockquote]2. As new treatments and technolgies developed by private enterprise come on the market Medicare eventually signs on to them.[/blockquote]
The same is true of insurance. I’m not exactly sure what your point here is, except that new treatments and technologies contribute to the rising costs of medical care in general.
[blockquote]3. Mom doesn’t care, or doesn’t know, that the unfunded future liability of Medicare is beyond the ability of this nation to afford.[/blockquote]
We hear a lot about this “unfunded future liability” of both Medicare and Social Security. For a discussion of this see The “Unfunded Liabilities” Ruse
There are, I think, two issues here.
First are the predictions of when revenue exceed expenses. That problem is being aggravated by the current recession and high levels of unemployment. It is also aggravated by the increasing costs of medical care and the number of us senior citizens.
Second is the matter of trust funds. The programs are set up so that when expenses exceed revenues, the trust funds (i.e., the invested surpluses collected in previous years) can be tapped to make up the difference. The problem here is that these trust funds are invested in treasury notes and used to finance the national debt, so that when Social Security and Medicare have to draw on those funds, the treasury has to pay back debt. And there are essentially three ways the treasury can pay back those I.O.U.s: (1) full employment at good pay and economic growth, (2) increased taxes and (3) increased money supply (i.e., inflation). I think everyone agrees that #1 is the best way to go; most of us would prefer not to have higher taxes; but the alternative (inflation) everyone agrees is a bad idea.
So the issues boil down to find some way to control medical costs and to improve employment and GDP. It seems to me that those who are opposing any sort of reform of medicare are not addressing any of these issues. About the only suggestion I hear that would actually lower costs are tort reform (which would lower insurance costs for doctors and hospitals and probably reduce the amount of “defensive medicine”), early intervention and more efficient medical record keeping.
The idea that if we just get the government out of health care altogether and let everyone buy the level of health care they can afford will do nothing to lower costs. What it would mean is a lot more untreated sick and dead people. And, generally speaking, sick and dead people are not as productive as living, healthy people. Yes, this is a utilitarian argument that views people in terms of their economic contributions to society in general. But it is, nevertheless, a fact of life. Living, healthy people produce and consume more goods and services and pay more taxes than sick and dead people.
Ken Peck
We also need to quit using medical insurance for every cold and scratch. Health savings accounts would allow patients to pay doctors directly without all the cost of insurance companies or governemt. Health insurance should be limited to catestrophic care. This may lead to the point were we could get employers out of the health insurance and let individuals do it.
A comparison is with your car. You don’t have insurance for oil changes and minor break downs, you have it for wrecks.
This is where I think the governement can play a role, make health savings accounts more easily available to everyone and then they can subsidize those who need it. But the main part of the solution is to let the patient pay the doctor and let the two of them decide what care is needed without interference.
Like I said, [url=http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082103033.html?sub=AR]unconstitutional[/url].
Outside of the debate on whether national health care in theory is a good idea or not, this plan is not, and one reason is because, contrary to Pres. Obama’s statements, it will use federal dollars to pay for abortions. From FactCheck.org, a project of the Annenberg Public Policy Center (for those keeping score, not exactly a right-wing outfit):
[blockquote]We hear a lot about this “unfunded future liability†of both Medicare and Social Security. For a discussion of this see The “Unfunded Liabilities†Ruse[/blockquote]
It’s not a ruse. There’s nothing in the SSTF but IOUs. Is your grocery store going to accept IOUs in exchange for their shredded wheat?
19. JustOneVoice wrote:
[blockquote]We also need to quit using medical insurance for every cold and scratch.[/blockquote]
I really don’t know of anyone who uses medical insurance for every cold and scratch. I certainly don’t. I suppose if I went to my doctor, he would bill my Medicare/insurance. But I know what he is going to say (at least until it turns into pneumonia or gangrene), so I “self treat”. But then, I’m the guy who broke his thumb and, thinking I had merely bruised or overextended it, did nothing for a couple of weeks before going to the doctor. I probably would have experienced better results had I gone to the doctor initially, gotten a correct diagnosis and had the thumb immobilized.
[blockquote]Health savings accounts would allow patients to pay doctors directly without all the cost of insurance companies or governemt.[/blockquote]
Well, maybe the government could set something up that would offer an HSA to everyone. I had that back when I was employed and it was a nightmare. Yes, it enabled me to have planned expenses deducted from my pay check each month, have big planned expenses paid for at the beginning of the year, and a way to deduct some medical expenses from my taxable income without having to itemize deductions. But it was also wasteful in that if I over estimated my planned medical expenses, I would either lose the money in the MSA or end up in December going out and buying a bunch of OTC stuff that I thought I might need next year.
But now that I am retired, I’m no longer eligible for an MSA. And the fact remains that there are a significant number of people who either are ineligible for an MSA or who simply lack the resources to participate in an MSA. But, then a medical insurance policy that pays for some routine medical care is a kind of MSA which is profitable for insurance companies. I don’t know if I would save anything by “self-insuring” against those expenses, because the doctors charge individuals more for services than they charge insurance companies.
[blockquote]Health insurance should be limited to catestrophic care. This may lead to the point were we could get employers out of the health insurance and let individuals do it.[/blockquote]
Define “catastrophic care”. For someone who works at a minimum wage job, a broken arm can be “catastrophic”. For Bill Gates there probably isn’t anything that would be catastrophic.
[blockquote]A comparison is with your car. You don’t have insurance for oil changes and minor break downs, you have it for wrecks.[/blockquote]
Well, there are companies out there that are selling insurance that covers “minor repairs” (I’m not sure what that consists of–most of my repairs have been pretty expensive) and even routine maintenance. Admittedly they aren’t a particularly good idea from the consumer’s point of view–but not necessarily because insuring against “catastrophic repairs” (like a transmission or engine replacement) is a bad idea, but rather because apparently they are ripoffs. Incidentally, “extended warranties” are something along the line of insurance against major repairs.
But someone has pointed out that comparing car insurance (typically a liability policy, with a relatively minor provisions for collision and theft) to health insurance is comparing apples and oranges. For one thing, it doesn’t cover “catastrophic maintenance”–for example, replacing a transmission or engine. But more importantly, I can always weigh the costs of maintenance of a car against the cost of buying a new car. I have, typically, bought new cars when the cost of maintaining the old car (all those rather expensive things that go wrong with older cars) exceeds the cost of buying a new one. However, I’ve been issued only one body and I’ll never be able to trade it in on a new one because the old one stops working.
[blockquote]But the main part of the solution is to let the patient pay the doctor and let the two of them decide what care is needed without interference.[/blockquote]
Which simply means that a lot of people will go without medical care because they simply cannot afford it–which in turn means a lot more sick and dead people.
Are we a nation of law or of men?
Will we actually follow the Constitution or will be let the mob rule?
Will the Republic of the United States survive, or will we destroy ourselves with bread and circuses (and health care/cap and trade/etc.)?
22. Jeffersonian wrote:
[blockquote]It’s not a ruse. There’s nothing in the SSTF but IOUs. Is your grocery store going to accept IOUs in exchange for their shredded wheat?[/blockquote]
Trust funds invariably are I.O.U.s. People who set up and operate trust funds don’t put a bunch of dollar bills in a vault somewhere. They buy things like bonds–in other words, I.O.U.s.
I’ve not needed grocery store credit for a good many years. But there was a time when I would go to the grocery store, sign an I.O.U. and pay the bill at the end of the month. Today I do accomplish the same sort of thing with a credit card from my Credit Union, although Kroger’s would like for me to get a Kroger’s MasterCard and try to encourage me to do so with incentives.
I have a multi million dollar retirement fund. Currently it just has IOU’s from myself in it, but that’s just a technicallity.
24. Sick & Tired of Nuance wrote:
[blockquote]Are we a nation of law or of men?
Will we actually follow the Constitution or will be let the mob rule?
Will the Republic of the United States survive, or will we destroy ourselves with bread and circuses (and health care/cap and trade/etc.)?[/blockquote]
It is fairly obvious that different people interpret the Constitution in different ways.
It is also fairly obvious that it depends to a large degree on whose “ox is being gored”.
I do not recall the people who are complaining about proposed government health care reform today on constitutional grounds complaining about warrant-less wiretaps and people being held prisoner without [i]habeas corpus[/i] and without criminal charges or without being informed of charges. I don’t recall them complaining about torture of prisoners under various ruses in violation of the rule of law.
The Constitution does grant Congress the power to provide for the general welfare (health care, and cap and trade), to regulate interstate commerce (cap and trade) and to provide for the national defence (health care and cap and trade).
And I do seem to recall John McCain calling for health care reform in his campaign for President. To be sure, his proposals (now largely abandoned by McCain and the Republicans) were different from Barack Obama’s proposals. It is also the case, though, that a majority of the American people voted for Obama and not for McCain. And the American people also sent a majority of Democrats to the House and to the Senate. And that’s how the Constitution proposes that it be done–you know, that “We the people” sort of stuff. Mob rule? I suppose that it was mob rule that elected George Bush twice and gave him Republican majorities in both houses of Congress for four years out of eight years.
[blockquote] [blockquote] But the main part of the solution is to let the patient pay the doctor and let the two of them decide what care is needed without interference.[/blockquote]
Which simply means that a lot of people will go without medical care because they simply cannot afford it—which in turn means a lot more sick and dead people. [/blockquote]
This would not prevent the government from helping the poor and needy. The could have a program like food stamps (health stamps) that allows the doctor and patient to decide on health care.
You seem to think the only way the government can help the poor is to take over health insurance. There are other ways.
The problems you mentioned with HSAs are exactly what needs to change. More people allowed to have them. Allow carry over.
Every sore thumb also does not require an MRI. Let the patient and doctor decide what care is needed. Get the insurance companies and government out.
28. JustOneVoice wrote:
[blockquote]This would not prevent the government from helping the poor and needy. The could have a program like food stamps (health stamps) that allows the doctor and patient to decide on health care.[/blockquote]
In other words, there needs to be a “public option” in health care reform. That is what the President asks. I suppose we could set it up like food stamps. Or we could set it up as a public insurance type program. I would think the “insurance” approach would work better if, for no other reason than health care isn’t a “stable” expense like food. People don’t go along with a certain level of food costs and then suddenly experience a huge jump in cost; that happens with medical care. The idea of insurance is that of pooled risk; that’s not involved in food stamps.
[blockquote]You seem to think the only way the government can help the poor is to take over health insurance.[/blockquote]
The President certainly isn’t calling for the government to take over health insurance. Neither is anyone in Congress that I know of.
[blockquote]Every sore thumb also does not require an MRI. Let the patient and doctor decide what care is needed.[/blockquote]
My sore thumb required an X-ray for diagnosis and appropriate treatment. Both were covered by Medicare and insurance. I did end up paying out of pocket for some tongue depressors and tape to make a workable splint.
[blockquote]Get the insurance companies and government out.[/blockquote]
I have no idea what you proposing here. Apparently no medical insurance, no Medicare, no Medicaid, no Health Savings Plans, no public hospitals or clinics. Maybe no licenses for doctors, nurses or hospitals. It sounds far more radical than anything being proposed by the President or the Congress.
Insurance companies are involved and will continue to be involved. Government is involved and will continue to be involved.
[blockquote]Trust funds invariably are I.O.U.s. People who set up and operate trust funds don’t put a bunch of dollar bills in a vault somewhere. They buy things like bonds—in other words, I.O.U.s.[/blockquote]
True, but not applicable in the case of the SSTF. When a trust fund buys a bond, it buys it from someone else, creating an obligation on the part of the seller. That’s not what the SSTF is doing. What the federal government is doing is akin to a pension fund board taking its members’ contributions, buying “bonds” the board itself issued, then spending all the money on stuff the board likes to buy. Bernie Madoff went to the pokey, justly, for doing this.
Just wait until those IOUs need to be redeemed…you ain’t seen debt until you’ve seen what happens then. But hey, as long as the checks cash, eh?
[blockquote]It is fairly obvious that different people interpret the Constitution in different ways.
It is also fairly obvious that it depends to a large degree on whose “ox is being goredâ€.[/blockquote]
Uh, not really. As I irrefutably pointed out earlier, the original intent of the “general welfare” clause was to state a principle, not to confer a specific power upon Congress. To say that it does in the face of such evidence is the deliberate dissemination of a falsehood, not to mention a clear call to gut the Constitution itself and bankrupt the nation.
A pretty steep price to get Uncle Sugar to take care of our aches and pains.
16. JustOneVoice wrote:
[blockquote]Thank you for pointing out that even though we are (supposed to be) a capitalist society…[/blockquote]
Where is it written that we are supposed to be a capitalist society?
The Constitution doesn’t really address capitalism. It does, address things relating to the economic theory known as mercantilism. For example, the Constitution deals with the power to levy duties and imposts–taxes on exports primarily, which was important in mercantilist theory, which sought to limit imports and promote exports so as to produce a favorable balance of trade. The Constitutional power to regulate the value of money is also related to mercantilism, in that the “wealth of a nation” was in terms of its accumulated bullion–hence the gold and silver standards which existed well into the 20th century.
Capitalism may be a very efficient economic system, although it is prone to dramatic shifts between booms and busts, as many of us know, having been on an economic roller coaster for decades. But it isn’t enshrined in the Constitution. Nor was it handed down by God to Moses on Mount Sinai or given to us by Christ in the Sermon on the Mount. It is an economic theory which is quite capable of crushing the children of God. And no, I’m not saying that Marxism is any better; in most respects it is much worse. Either system is quite capable of empowering the few to exploit the many.
31. Jeffersonian wrote:
[blockquote][blockquote]It is fairly obvious that different people interpret the Constitution in different ways.
It is also fairly obvious that it depends to a large degree on whose “ox is being goredâ€.[/blockquote]
Uh, not really. As I irrefutably pointed out earlier, the original intent of the “general welfare†clause was to state a principle, not to confer a specific power upon Congress.[/blockquote]
You have convinced yourself of what you “irrefutably pointed out”. Not everyone is so convinced. Your opinion and several dollars will buy you a drink at Starbucks.
Ultimately what the Constitution means is what the courts say it means. That is the only interpretation that matters in the end. And so far, the courts have not adopted your narrow interpretation of its meaning–not even the current conservative court.
And I would note that you do not address the serious constitutional questions raised by the actions of the previous administration.
Actually, the fundamental meaning of the constitution is probably best determined by trying to understand the intent of its framers. Similar to the exegetical work that theologians and clergy engage in with scripture. The Supreme Court (in theory) looks at laws passed by congress, at unresolved cases from lower courts, and attempts to apply the constitution to those issues and thus determine “constiutionality”.
Now this whole health subject sure has some legs, so while I was out sailing today, I missed a lot, but this gem from Ken Peck caught my eye………….[i]”I’m not exactly sure what your point here is, except that new treatments and technologies contribute to the rising costs of medical care in general”.[/i]
Ahhhhh, the heart of a true Stateist or bureaucrat. The focus is budgets and comparative costs: if a new drug costs more, a new machine costs more, or a new procedure costs more, we have to limit it or deamonize it. And why is that? Because the Stateist or the bureaucrat cannot look to the value that is delivered.
If a new Magnetic Resonance technique eliminates a certain amount of exploratory surgery, along with the risks of that surgery, and the use of expensive hospital resources, one has to weigh the value of that against the costs. But the stateist will fight that tooth and toenail and create a budget slot that shows how that machine increases costs while never squaring the books with the value it delivers.
This type of “systems analysis” was so well exemplified when Robert McNamara was running the Defense Dept. for Kennedy and Johnson. Endless studies showed how closing this base or postponing that weapon saved dollars. Then when capability slipped we had to spend even more to catch up. A number-cruncher’s nirvana I imagine
34. Capt. Deacon Warren wrote:
[blockquote]Actually, the fundamental meaning of the constitution is probably best determined by trying to understand the intent of its framers.[/blockquote]
That’s nice in theory, but it has rarely worked in practice. Even as far back as Marshall’s [i]Marbury v Madison[/i] decision the Court claimed “implicit powers” for itself not explicit in the Constitution and essentially found Madison’s actions as Secretary of State to be unconstitutional, so even the “intent of its framers” is decisive.
I still notice that those who are holding that the power “to…provide for the common Defence and general Welfare of the United States” is somehow greatly restricted by the Constitution (in spite of the Courts interpreting that power quite broadly) avoid addressing the various violations of explicit restrictions of the Constitution by the previous administration. If we are going to be strict constructionists, then be strict constructionists on everything.
A notable example is the 14th Amendment which was clearly intended to protect “citizens” and “persons” (particularly former slave citizens and persons) from [i]de jure[/i] denial of due process and life, liberty and property. That was the clear intent of the authors. However, for nearly a century the Courts held that it did not apply to citizens and persons, but did apply to corporations–which was something that the writers never intended.
[blockquote]Now this whole health subject sure has some legs, so while I was out sailing today, I missed a lot, but this gem from Ken Peck caught my eye………….“I’m not exactly sure what your point here is, except that new treatments and technologies contribute to the rising costs of medical care in generalâ€.
Ahhhhh, the heart of a true Stateist or bureaucrat. The focus is budgets and comparative costs: if a new drug costs more, a new machine costs more, or a new procedure costs more, we have to limit it or deamonize it. And why is that? Because the Stateist or the bureaucrat cannot look to the value that is delivered.[/blockquote]
I have no idea how you come up with this rant from anything I said. I was responding to a post about rising medical costs. And that person mentioned new treatments and technologies contribute to rising costs. That is simply an indisputable fact. I’m not demonizing new treatments or technologies.
My dad’s mechanical calculating machine was less expensive than my modern computer and provided less functionality. Big deal. Now if I were Bill Gates and came down with some major disease, I might very well weigh cost/benefit to determine whether or not to undergo a new treatment or technology. But I’m not Bill Gates.
The fact of the matter is that insurers engage in cost/profit analysis; and health decisions are made for me on the basis of that analysis, not on the basis of which treatment plan is best for me. Cancer patients are, for example, denied some of the latest drugs for the treatment of their cancer because of the high cost of the new drug. That is a fact of life–and death.
[blockquote] You have convinced yourself of what you “irrefutably pointed outâ€. Not everyone is so convinced. Your opinion and several dollars will buy you a drink at Starbucks.[/blockquote]
I’ve pointed out what the author said it meant, along with others who took part in the drafting of the document. Are you suggesting they didn’t know what they were talking about, as participants in the drafting process?
That modern courts have permitted the federal government to slip its Constitutional leash is of no import, really. If we want to understand the Constitution, we must do so with original intent. To to otherwise is to say that we have no Constitution, and we are a government of men, not laws…a legal anarchy, TGC’s General Convention inflated to a $3.5 trillion Frankenstein’s monster.
While we can do our best to determine original intent, that only solves lingering 18th century problems. To say that we can apply original intent to problems that could not have even been contemplated is nonsense. To do so would require us to determine what people who lived 220 years ago would do if we plucked them out of their 18th century world and dropped them in the 21st century without the benefit of modern knowledge and asked them to solve our problems.
Some strict constructionists believe we should look to the writings of those who attended the Constitutional Convention to discern original intent. However, that is also nonsense. We are a nation of laws not of men. Which is exactly why we cannot look to what an individual was thinking at the time he penned a particular phrase that ended up in the Constitution. As James Madison said, “The Constitution was not, like the fabled Goddess of Wisdom, the offspring of a single brain. It ought to be regarded as the work of many heads and many hands”.
What the author of the phrase “promote the general welfare” was thinking at the time he penned that phrase, is no more relevant to a determination of original intent than what John Doe, legislator from Georgia, thought that phrase implied when he voted for ratification. Both were necessary for the document to become the law of the land. There were tens of thousands of people involved in drafting and ratifying the Constitution. We simply do not know how all these people interpreted each phrase, much less what they would have thought of issues they could not have even contemplated. All we have are the words.
In the end all we can do is assume that our forefathers did the best they could to come up with language that would guide us through the centuries, and keep us anchored in general principals. Consequently, we must look at the words, interpret those words as best we can, and given our modern knowledge, apply that interpretation to the facts we are given. That means there will be some disagreement, because knowledge changes, but we can’t look to the brain of James Madison to solve that disagreements. James Madison was only one man, with very limited knowledge by today’s standards.