But the "wretched of the earth," the spat on billions, the peons whose penury you cherish, are going to bash you, beat you, and bring Hades down upon your heads to get what they need.
Good article! Double those bubbles in the diagram and you’ll have the picture. There are so many sections of each company, it’s astonishing. The original Obamacare diagram was a nightmarish maze of bureaucracy. Have worked in health insurance x 30 years—it’s not us! It’s the hospitals. The minute the insurance caps were removed, costs for bone marrow transplants were doubled. I wish I could say the organs go to the right people, but as a transplant case manager I can tell you they don’t. Centers will transplant anyone if there’s insurance to pay for it. 😕
There's a good post over at Noahpinion by liberal economist Noah Smith about the economics of health care. Insurance companies are secondary middlemen. The providers, especially hospitals, are the biggest cost center by far, much bigger than insurers or drugs/technology. Hospitals are a particular culprit because they, like US universities, have very bloated and costly administrations.
That's true, and the level of government mandates on the system certainly help to bloat the bureaucracy here, like in universities. Not sure that's the whole explanation, though. There's defensive medicine as well, because of our extravagant tort system.
Ironically third world countries may soon end up with the best healthcare because they where left out of the mid-20th century push to nationalize/bureaucratize it.
Thomas -- One issue I have with your otherwise informative post: the problem of starting your essay with a specious argument.
Speaking as a Liberal, I naturally find it very tiresome that you include in your essays comments derogatory towards people whose political views clash with your own. I try to overlook such irritants in order to understand your real message, which in this case is a question about what constitutes 'human rights', and whether access to healthcare is one such right.
Back to my first issue. You opened with a catchy but suspect argument -- which would have been a total "show-stopper" (or "screed stopper") for me, except that I wanted to read more of what you were really writing about - healthcare as a right/non-right.
My problem is with the assertion you make early on, "...statements as I don’t condone Brian Thompson’s murder, but… Well, sorry, but your but tells me that you do condone his murder: You think that he got what was coming because insurance companies are evil deniers of healthcare to the toiling masses."
Do you see the fallacy behind this argument? It is the part where someone's words "tell you" their hidden meaning despite apparently saying the direct opposite..
Obviously, only a mind-reader can look behind what a person says and determine whether that is what they really think. I do not for a moment assume that you are claiming to be an ESP adept, but in this opening paragraph you have not established a fact, you have made an assumption. Your assertion relies on your assumption about the meaning of two separate ideas in juxtaposition.
Assumption No. 1: That people (in this case, "The Left") don't mean what they say, and Assumption No. 2: That being highly critical about private health insurance really means they'd like to see Healthcare executives shot.
If your intention is to portray everyone "on the Left" as condoning murder, you haven't made a convincing argument for a critical reader (ahem, moi, in this case). And I wonder, why bother making such an outlandish claim in the first place?
Opening statements often include the writer's thesis, and following that will come the evidence in support (I realize this is your Substack and you are free to express your opinions, but you are not helping your case here). 'Nuff said - I hope I made my point clear.
To your main issue: what is a 'human right', and is "Healthcare" part of it? I think there is not unanimity of opinion on this question as a philosophical matter. So, I would express the question in another way with more specificity: what are we Americans entitled to expect from our government?
My take is that, at a bare minimum, government "healthcare" consists of providing information about health issues, and restricting or excluding free access to things which are harmful Public Health Departments identify hazards -- condemning sources of tainted drinking water, quarantining people with contagious diseases, etc. -- as part of their mission to protect the public. Laws restricting sales of liquor, tobacco and (in some areas) cannabis to persons 21 years or older are other widely accepted restrictions on personal liberty as part of providing 'healthcare' in this broad sense.
Yet even these very basic steps have been fought by both commercial interests (tobacco companies fighting battles against warning labels on cigarets, e.g.) and Constitutional literalists (see Jacobson v. Massachusetts (1905): which upheld the authority of states to enforce compulsory vaccination laws, a court ruling that individual liberties could be restricted to protect public health and safety).
Of course, this has recently become a hot-button political issue. I think your readers (e.g., moi again) would be very interested to read your take on the subject, especially in relation to Trump's nomination of RFK jr.
Look there were plenty of people on the Left who expressed a greater to lesser degree of satisfaction over the assassination, e.g. the insufferable Taylor Lorenz—supposedly a journalist. So I think that the point I made was quite fair.
On your related point, I’ve been denigrated by plenty of progressives here on Substack’s and elsewhere: the whole fascist/racist/homophobe/blah, blah, blah litany. Therefore, as ye sow, so shall ye reap. That’s my motto.
Circling back to my original comment -- the "main issue" part about Healthcare (last 4 'grafs) -- I am interested in your view as to what a democratic government's responsibility is to providing healthcare and public health in general.
There is of course a role for government in the US healthcare area, public health being one example, Medicaid another. Unfortunately, as we saw during the pandemic, this country’s public health agencies are politicized and none too competent. The same is true of Medicaid, which provides mediocre healthcare insurance at high cost to the American taxpayer.
But Medicare is the truly problematical government healthcare program, due mostly to its cost, which bids fair along with other entitlement programs to bust the federal budget. In fiscal year 2023, that single program cost $848 billion: 14% of the federal government budget. And there’s nowhere to go but up. Total 2023 entitlement or mandatory federal government spending was $3.8 trillion of which Social Security and Medicare consumed half. That’s why the federal government is now running a trillion-dollar deficit.
Given these fiscal realities, there’s absolutely no point in talking about “Medicare for All” or any kind of “single-payer” healthcare system for America.
I agree on Medicare for all being too costly for our current system (how we tax and spend). In principle, however, I feel that government-provided insurance for healthcare should be available to everyone, not just to older folks. The ACA (‘Obamacare’) is a stop-gap measure that is helpful but overly complex. And while our current patchwork of private, for-profit health insurance provides access to great healthcare for those lucky enough to afford it or to get coverage by their employer, it adds administrative complexity and expense for providers and insurers alike. The main indictment of our healthcare ‘system’ as presently constituted is that it is a patchwork that does not ensure that everybody has coverage.
But, alas, government-provided healthcare for all Americans is unaffordable without broad-based tax increases that the American people would never tolerate. The Bernie Sanders argument that “millionaires and billionaires” can be taxed to pay for all the goodies that people would like to get for free is b.s. And of course, there’s the additional fact that the federal government is (1) none too competent and (2) overstuffed with activist progressive bureaucrats who’d love the opportunity to infect American healthcare with their social justice ideologies.
We have to be careful when speaking about what "the American people" would tolerate. If you ask the proverbial "man on the street" if he wants to pay more in taxes, I would imagine the answers would be mostly "No".
Ask the question differently -- say, "What percent of EVERYBODY's income should go to pay for healthcare FOR EVERYBODY?", and give a range of choices fro say 1% to 15%, you'd have a better idea of what the public would accept. Pew may have done such a poll - I'll check that later.
Yes to that. And "just to be clear" (hoe I dislike that phrase when uttered by politicians, whose default position is often to be as unclear as possible), what I am advocating for is avoiding sweeping generalizations and "straw man" arguments in our communal political discourse. Specificity -- quoting what someone has said, rather than generalizing what we assume "everyone" is saying -- usually makes for a better, more focussed argument.
If healthcare were not important then the constitution would not have specified that “health” be left up to the states. It would not even be mentioned, like privacy.
You also cannot have a productive citizenry without them being healthy. The only way democracy survived is if the population is healthy enough to be educated.
In fact it was Benjamin Franklin who brought up the idea of a national healthcare system for that reason.
Also what r u going to do with all the unhealthy people? Shall we leave them to die in the gutter? Or perhaps once someone is sick we take them out back and shoot them?
While healthcare relies on the acts of another so does all our rights. Our rights rely on the acts or inaction of our government. To maintain those rights we rely on lawyers and courts. We rely on police and first responders to keep the peace and to maintain order.
Simply because the world has gotten it wrong in how to provide healthcare doesn’t mean it isnt something people are entitled to. It’s how it’s implemented that needs improvement not the concept of healthcare for citizenry
Arguments about the perceived benefits of this or that healthcare system are beside the point. The question is whether healtchcare can be established as a positive human right. I say no.
Positive rights, such as the so-called right to healthcare, are bogus because they promise an unlimited right to finite resources. As I mentioned, in practice healthcare is bundle of defined benefits, an entitlement like Social Security, regulated by the law of supply and demand. No amorphous definition of health care as a right can ever repeal that law.
Incidentally, where in the Constitution is health or healthcare mentioned?
Article 36(3) all citizens are protected by the state in relation to health.
Also there is no question that eventually you run out of other people’s money. But we already have a national healthcare plan and it is Medicare, with Medicaid for the poor. Now Medicare is not free, which I just learned because we are about to be Medicare recipients, but it is reduced. Only Medicaid if free.
And of course it’s not free because there are taxes which go toward it.
But there has to be a happy medium between my sons premiums are $1000 a month each with a deductible of $5000.
And we have had issues with our health insurance for my husbands heart operation. They finally agreed to pay for the operation and then decided afterwards that his hospital stay was unnecessary so they are fighting with them over that. It is asinine. And our healthcare is United Healthcare
This has to be rectified. The cost. There is no way it can continue.
So I found the answer. The constitution doesn’t mention health but welfare which some take to include health.
So here’s my next question. If the constitution doesn’t mention health how come SCOTUS can then say under the constitution health is to be regulated by the states to invalidate Roe and throw abortion back to the states. If regulating abortion falls under health then the states can regulate healthcare and make it a right if they want. And I bet under the commerce clause they can do that with federal legislation too
That’s in the Preamble to the Constitution, which has not the force of law. Merely, it’s a statement of intent.
Abortion is not, in and of itself, healthcare. Very few abortions are medically necessary.
Whatever Congress and the President could do under the Commerce Clause does not invalidate my argument. Proclaiming a positive right does not establish that right. At the end of the day, the human right to healthcare would be reduced to a bundle of defined benefits, based on availability.
Perhaps health care is not a right.
But the "wretched of the earth," the spat on billions, the peons whose penury you cherish, are going to bash you, beat you, and bring Hades down upon your heads to get what they need.
https://davidgottfried.substack.com/p/in-praise-of-luigi-mangione-slayer
Beating and bashing people won't make their health problems go away, in fact it's likely to make them worse.
Good article! Double those bubbles in the diagram and you’ll have the picture. There are so many sections of each company, it’s astonishing. The original Obamacare diagram was a nightmarish maze of bureaucracy. Have worked in health insurance x 30 years—it’s not us! It’s the hospitals. The minute the insurance caps were removed, costs for bone marrow transplants were doubled. I wish I could say the organs go to the right people, but as a transplant case manager I can tell you they don’t. Centers will transplant anyone if there’s insurance to pay for it. 😕
There's a good post over at Noahpinion by liberal economist Noah Smith about the economics of health care. Insurance companies are secondary middlemen. The providers, especially hospitals, are the biggest cost center by far, much bigger than insurers or drugs/technology. Hospitals are a particular culprit because they, like US universities, have very bloated and costly administrations.
Right!!
And a full-scale government takeover of American healthcare would no doubt expand that bloat. Bureaucracies exist to perpetuate themselves, after all.
That's true, and the level of government mandates on the system certainly help to bloat the bureaucracy here, like in universities. Not sure that's the whole explanation, though. There's defensive medicine as well, because of our extravagant tort system.
Ironically third world countries may soon end up with the best healthcare because they where left out of the mid-20th century push to nationalize/bureaucratize it.
https://substack.com/profile/14685655-eugine-nier/note/c-56987127
Thereby freezing in place medical practices from decades ago.
https://open.substack.com/pub/noahpinion/p/insurance-companies-arent-the-main
Thomas -- One issue I have with your otherwise informative post: the problem of starting your essay with a specious argument.
Speaking as a Liberal, I naturally find it very tiresome that you include in your essays comments derogatory towards people whose political views clash with your own. I try to overlook such irritants in order to understand your real message, which in this case is a question about what constitutes 'human rights', and whether access to healthcare is one such right.
Back to my first issue. You opened with a catchy but suspect argument -- which would have been a total "show-stopper" (or "screed stopper") for me, except that I wanted to read more of what you were really writing about - healthcare as a right/non-right.
My problem is with the assertion you make early on, "...statements as I don’t condone Brian Thompson’s murder, but… Well, sorry, but your but tells me that you do condone his murder: You think that he got what was coming because insurance companies are evil deniers of healthcare to the toiling masses."
Do you see the fallacy behind this argument? It is the part where someone's words "tell you" their hidden meaning despite apparently saying the direct opposite..
Obviously, only a mind-reader can look behind what a person says and determine whether that is what they really think. I do not for a moment assume that you are claiming to be an ESP adept, but in this opening paragraph you have not established a fact, you have made an assumption. Your assertion relies on your assumption about the meaning of two separate ideas in juxtaposition.
Assumption No. 1: That people (in this case, "The Left") don't mean what they say, and Assumption No. 2: That being highly critical about private health insurance really means they'd like to see Healthcare executives shot.
If your intention is to portray everyone "on the Left" as condoning murder, you haven't made a convincing argument for a critical reader (ahem, moi, in this case). And I wonder, why bother making such an outlandish claim in the first place?
Opening statements often include the writer's thesis, and following that will come the evidence in support (I realize this is your Substack and you are free to express your opinions, but you are not helping your case here). 'Nuff said - I hope I made my point clear.
To your main issue: what is a 'human right', and is "Healthcare" part of it? I think there is not unanimity of opinion on this question as a philosophical matter. So, I would express the question in another way with more specificity: what are we Americans entitled to expect from our government?
My take is that, at a bare minimum, government "healthcare" consists of providing information about health issues, and restricting or excluding free access to things which are harmful Public Health Departments identify hazards -- condemning sources of tainted drinking water, quarantining people with contagious diseases, etc. -- as part of their mission to protect the public. Laws restricting sales of liquor, tobacco and (in some areas) cannabis to persons 21 years or older are other widely accepted restrictions on personal liberty as part of providing 'healthcare' in this broad sense.
Yet even these very basic steps have been fought by both commercial interests (tobacco companies fighting battles against warning labels on cigarets, e.g.) and Constitutional literalists (see Jacobson v. Massachusetts (1905): which upheld the authority of states to enforce compulsory vaccination laws, a court ruling that individual liberties could be restricted to protect public health and safety).
Of course, this has recently become a hot-button political issue. I think your readers (e.g., moi again) would be very interested to read your take on the subject, especially in relation to Trump's nomination of RFK jr.
Look there were plenty of people on the Left who expressed a greater to lesser degree of satisfaction over the assassination, e.g. the insufferable Taylor Lorenz—supposedly a journalist. So I think that the point I made was quite fair.
On your related point, I’ve been denigrated by plenty of progressives here on Substack’s and elsewhere: the whole fascist/racist/homophobe/blah, blah, blah litany. Therefore, as ye sow, so shall ye reap. That’s my motto.
Circling back to my original comment -- the "main issue" part about Healthcare (last 4 'grafs) -- I am interested in your view as to what a democratic government's responsibility is to providing healthcare and public health in general.
There is of course a role for government in the US healthcare area, public health being one example, Medicaid another. Unfortunately, as we saw during the pandemic, this country’s public health agencies are politicized and none too competent. The same is true of Medicaid, which provides mediocre healthcare insurance at high cost to the American taxpayer.
But Medicare is the truly problematical government healthcare program, due mostly to its cost, which bids fair along with other entitlement programs to bust the federal budget. In fiscal year 2023, that single program cost $848 billion: 14% of the federal government budget. And there’s nowhere to go but up. Total 2023 entitlement or mandatory federal government spending was $3.8 trillion of which Social Security and Medicare consumed half. That’s why the federal government is now running a trillion-dollar deficit.
Given these fiscal realities, there’s absolutely no point in talking about “Medicare for All” or any kind of “single-payer” healthcare system for America.
I agree on Medicare for all being too costly for our current system (how we tax and spend). In principle, however, I feel that government-provided insurance for healthcare should be available to everyone, not just to older folks. The ACA (‘Obamacare’) is a stop-gap measure that is helpful but overly complex. And while our current patchwork of private, for-profit health insurance provides access to great healthcare for those lucky enough to afford it or to get coverage by their employer, it adds administrative complexity and expense for providers and insurers alike. The main indictment of our healthcare ‘system’ as presently constituted is that it is a patchwork that does not ensure that everybody has coverage.
But, alas, government-provided healthcare for all Americans is unaffordable without broad-based tax increases that the American people would never tolerate. The Bernie Sanders argument that “millionaires and billionaires” can be taxed to pay for all the goodies that people would like to get for free is b.s. And of course, there’s the additional fact that the federal government is (1) none too competent and (2) overstuffed with activist progressive bureaucrats who’d love the opportunity to infect American healthcare with their social justice ideologies.
We have to be careful when speaking about what "the American people" would tolerate. If you ask the proverbial "man on the street" if he wants to pay more in taxes, I would imagine the answers would be mostly "No".
Ask the question differently -- say, "What percent of EVERYBODY's income should go to pay for healthcare FOR EVERYBODY?", and give a range of choices fro say 1% to 15%, you'd have a better idea of what the public would accept. Pew may have done such a poll - I'll check that later.
Thanks for your response.
Not at all. We agree to disagree without being disagreeable.
Yes to that. And "just to be clear" (hoe I dislike that phrase when uttered by politicians, whose default position is often to be as unclear as possible), what I am advocating for is avoiding sweeping generalizations and "straw man" arguments in our communal political discourse. Specificity -- quoting what someone has said, rather than generalizing what we assume "everyone" is saying -- usually makes for a better, more focussed argument.
"how" not "hoe", typing not being my superpower today.
If healthcare were not important then the constitution would not have specified that “health” be left up to the states. It would not even be mentioned, like privacy.
You also cannot have a productive citizenry without them being healthy. The only way democracy survived is if the population is healthy enough to be educated.
In fact it was Benjamin Franklin who brought up the idea of a national healthcare system for that reason.
Also what r u going to do with all the unhealthy people? Shall we leave them to die in the gutter? Or perhaps once someone is sick we take them out back and shoot them?
While healthcare relies on the acts of another so does all our rights. Our rights rely on the acts or inaction of our government. To maintain those rights we rely on lawyers and courts. We rely on police and first responders to keep the peace and to maintain order.
Simply because the world has gotten it wrong in how to provide healthcare doesn’t mean it isnt something people are entitled to. It’s how it’s implemented that needs improvement not the concept of healthcare for citizenry
Arguments about the perceived benefits of this or that healthcare system are beside the point. The question is whether healtchcare can be established as a positive human right. I say no.
Positive rights, such as the so-called right to healthcare, are bogus because they promise an unlimited right to finite resources. As I mentioned, in practice healthcare is bundle of defined benefits, an entitlement like Social Security, regulated by the law of supply and demand. No amorphous definition of health care as a right can ever repeal that law.
Incidentally, where in the Constitution is health or healthcare mentioned?
Article 36(3) all citizens are protected by the state in relation to health.
Also there is no question that eventually you run out of other people’s money. But we already have a national healthcare plan and it is Medicare, with Medicaid for the poor. Now Medicare is not free, which I just learned because we are about to be Medicare recipients, but it is reduced. Only Medicaid if free.
And of course it’s not free because there are taxes which go toward it.
But there has to be a happy medium between my sons premiums are $1000 a month each with a deductible of $5000.
And we have had issues with our health insurance for my husbands heart operation. They finally agreed to pay for the operation and then decided afterwards that his hospital stay was unnecessary so they are fighting with them over that. It is asinine. And our healthcare is United Healthcare
This has to be rectified. The cost. There is no way it can continue.
The body of the Constitution is divided into seven Articles. Additionally there are twenty-seven Amendments. But no Article 36 (3).
That didn’t make sense to me either but when I looked for it that is what google AI said.
So I found the answer. The constitution doesn’t mention health but welfare which some take to include health.
So here’s my next question. If the constitution doesn’t mention health how come SCOTUS can then say under the constitution health is to be regulated by the states to invalidate Roe and throw abortion back to the states. If regulating abortion falls under health then the states can regulate healthcare and make it a right if they want. And I bet under the commerce clause they can do that with federal legislation too
That’s in the Preamble to the Constitution, which has not the force of law. Merely, it’s a statement of intent.
Abortion is not, in and of itself, healthcare. Very few abortions are medically necessary.
Whatever Congress and the President could do under the Commerce Clause does not invalidate my argument. Proclaiming a positive right does not establish that right. At the end of the day, the human right to healthcare would be reduced to a bundle of defined benefits, based on availability.