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But Where’s the Tort Reform?

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Rand Paul, the true progressive alternative in the 2016 race, finally offers a blueprint for heathcare “reform”:

What should we replace Obamacare with? Perhaps we should try freedom:

1. The freedom to choose inexpensive insurance free of government dictates.

2. The freedom to save unlimited amounts in a health savings account.

3. The freedom to buy insurance across state lines.

4. The freedom for all individuals to join together in voluntary associations to gain the leverage of being part of a large insurance pool.

Shorter Rand Paul: “Under the majestic equality of my law, the rich and poor alike will be able to save unlimited amounts of money to pay for health care, and healthy people and people with pre-existing conditions alike are welcome to try to purchase worthless insurance that meets the standards of the state that offers the fewest protections to consumers.”

I can see why the GOP leadership prefers the “repeal and…look, it’s Halley’s Comet!” approach.

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  • Breadbaker

    This “inexpensive” insurance he describes, where can you find that exactly?

    • Murc

      Oh, prior to the ACA, it was absolutely possible to find dirt cheap health insurance on the individual market.

      It just didn’t cover anything worth a damn. But it was a product called health insurance, and you could purchase it cheaply!

      • BobBobNewhartNewhartSpecial

        Yeah, pretty sure that is a reference to all of the catastrophic plans that are no longer available under the ACA.

        • DAS

          Frankly, though, a souped up version of those catastrophic plans (coupled with the ready availability of low cost health clinics for more routine care) is all a healthy young person needs, and all someone making (for example) a post-doc’s salary can afford, no matter what the ACA says they can afford.

          The ACA on the other hand forces such people to overinsure themselves in order to subsidize the health care costs of others. Why not just provide more subsidies directly to people who truly need better health coverage so they could get it?

          Spreading the risk makes sense in terms of insurance. It makes sense for health insurance to be more than just insurance, and to also cover routine health care whose timely delivery can prevent experience insurance payments for later catastrophic care. But once health insurance moves away from purely being insurance, the “spread the risk” logic of the mandate makes less sense.

          • Solar System Wolf

            My first job out of college only offered a catastrophic plan. I was golden if I got hit by a truck, but couldn’t see anyone for routine preventive care. Planned Parenthood was my health care provider and I benefited from the sliding scale discount. Oh, but they want to get rid of them, too.

            • DAS

              As you imply, the hypocrisy of the GOP lauding exact the health care model provided by PP while simultaneously railing against them is staggering.

              I guess what I’m suggesting is that the ACA include a “steel plan” geared to young, healthy people who don’t qualify for much in the way of subsidies but who don’t have much money between paying for rent, food, student loans, etc. The plan would cover major medical and a limited amount of routine care. And the premiums would only be set to cover the risk pool of other young, healthy people.

              • Vance Maverick

                And the shortfall in revenue would be made up by a tax increase, right. (pause for bitter laugh broken off by smoker’s cough)

            • Katya

              Not to mention, you are “young and healthy” right up until you are not. While in my 20s, I had friends who developed breast cancer, thyroid cancer, depression, schizophrenia, asthma, migraines, etc. At which point, you had a preexisting condition and could not get insurance that didn’t cost a small fortune. Not to mention more common ailments like the flu, pneumonia, mono, sinus infections, STDs, strep, even pertussis. One can debate the contours of the mandate, but young people just aren’t as bulletproof as they think they are.

              • CP

                you are “young and healthy” right up until you are not.

                I’m not even thirty, and there aren’t enough “likes” in the world for this.

              • Linnaeus

                you are “young and healthy” right up until you are not.

                I think some guy made this point, using more technical language, around 1960 or so. Hm. Funny, that.

                • ASV

                  Actually, Cinderella’s “Don’t Know What You Got (Till It’s Gone)” didn’t come out until 1988.

                • Linnaeus

                  I bet that they read his paper.

          • aturner339

            As a first best solution why not just give the poor and working class cash so they have the freedom to do as thy choose with it?

            But of course we all know how popular freedom really is when it’s actually on the table.

          • Bruce B.

            This isn’t actually true. Young healthy people benefit a lot from reliable routine checkups and preventative care, and having that available free makes it vastly more likely they’ll go do it. I have a lot of friends around my age (51) who would have less medical woe now if they’d started tending pre-diabetic conditions, cardiac conditions, vulnerable joints, then-mild mood disorders, and the like, in our twenties. But for many of them, it wasn’t life-impairing much at all then, and so things built up while they seemed and thought of themselves as healthy.

          • altofront

            The ACA on the other hand forces such people to overinsure themselves in order to subsidize the health care costs of others. Why not just provide more subsidies directly to people who truly need better health coverage so they could get it?

            Here’s an example of why I think this is a really insidious argument.

            My wife and I make good money (in the top 10% for household income, though barely), and we have good health insurance through work: it costs about $23K a year, of which we pay about $2500, to insure us and our son. No government program would ever supply us with a subsidy, nor should one.

            Here’s the catch: our son is on the spectrum, which means he gets a lot of therapy hours each week. I’d put the annual cost at maybe $150K a year. Under the ACA all insurance plans must cover such therapy, which means that everyone else on the same plan as us who doesn’t have an autistic child is paying more to make up the six-figure shortfall between what we’re paying and what it costs. Thanks, everyone! (Seriously, thank you.)

            Under the logic of your position this is wrong because people are being forced to subsidize my family by overinsuring themselves; after all, this is coverage that very few people will ever need. Instead, we should just select an “autism-inclusive” plan. But no such plan would ever exist, or would be prohibitively expensive, because the only people who would select it are people who are going to need tons of expensive care. Nor could we afford to pay for all this therapy, or even a substantial fraction of it, on our own. If health insurance becomes more “free” in terms of what it covers (as will almost certainly occur), my son will inevitably get substantially less therapy than he needs.

            Under the logic of the ACA, by contrast, there are a wide range of things that we as a society agree should be covered by health insurance, and the care of children with special needs is one of those things. I had believed that this was the kind of society we were becoming.

        • Denverite

          You can still buy catastrophic policies under the ACA if you’re young enough (I think 30 but I haven’t looked in a long while).

          The real scam is supplemental insurance. They’re plans that pay up to a small amount (often $10k or under). You’re supposed to only get them if you have a catastrophic plan — though you’re probably better off just depositing your premium amount in an HSA and hoping you don’t get sick for a few years. Pre-ACA, scammers would sell them to people as a standalone plan under the guise of “it’s better than nothing.” Then people would get in a car wreck, go to the ER, and find out that their insurance paid for the first 16 hours of their three week stay.

          • DAS

            So if you buy catastrophic coverage and supplimental insurance, you’ve satisfied the health care mandate? Perhaps this is something that should be publicized? One of the problems with the ACA is few people actually know what it does. The Obama administration didn’t actually do a good job selling it.

    • ColBatGuano

      I’ll be offering coverage through my new insurance company “The New South Health Insurance Cooperative”. Policies will be offered only in counties that voted >75% for Trump. It will only cover whites and will deny all claims.

      • Dr. Acula

        The Bishop will be after you, mate.

      • Snarki, child of Loki

        I’ll be offering coverage through my new insurance company “The New 2nd Amendment Insurance Cooperative”. Policies will only be offered in counties in swing-states that voted for Trump. It will only cover non-whites and registered Democrats, and upon receiving that catastrophic terminal diagnosis, will provide powerful firearms, copious ammunition, and maps to locate Trump voters.

    • Warren Terra

      As far as I can tell, under these rules I could sell you the rotting carcass of a deceased marmoset and label it “health insurance”.

      • N__B

        Put the marmoset on a hoverboard and you’ve got a deal.

        • Warren Terra

          Congratulations! Happy Marmoset Inc I’d proud to have you as a customer and delighted to cover you in our insurance!

          Please note that we are aware our high deductible is cause for comment, but we are happy to reduce the annual deductible by nearly ten dollars for every one dollar increase in the monthly premium! And the lifetime benefits cap is very nearly guaranteed not to be smaller than the deductible!

          Pre-existing conditions such as genetically inherited mortality may necessitate the canceling of your coverage. Your children will be covered until the twenty sixth minute after conception.

          Sign-up fees are one year’s premiums. In advance. Plus, in this case, a hoverboard.

    • Removing the mandate to buy insurance while leaving in place the dictate that people can wait to buy insurance until after they are ill will only accentuate the bankrupting of the insurance industry.

      My fear is that if you leave part of Obamacare in place (the dictate that insurance companies must sell insurance to individuals with pre-existing conditions) then you will see an acceleration of adverse selection and ultimately mass bankruptcy of the healthcare insurance industry.

      First of all, “accentuate the bankrupting” is actually much shittier language than I expect from Rnad Pual. That’s Dubya caliber. He apparently lost his best writers to The Leader.

      Second, yeah, it looks like “inexpensive insurance” is code for “suck poison cock and die quickly, sick people”.

      • Mac the Knife

        I’m sure some half-wit staffer probably wrote that, but it bears repeating…Rand Paul is almost certainly evil, but Rand Paul is definitely not very intelligent. At all.

        Like…seriously, so stupid that I’m not sure he’s actually evil.

      • Heron

        Someone needs to ask Paul how exactly the insurance industry is going to collapse when it’s the heart of international finance, owns most of the hospitals(and has a major stake in the Catholic ones it bypasses ownership of for PR’s sake), and originates most of the derivative products on the investment market.

        Given all the wealth it generates off of insurance plans, a sensibly run insurance provider ought to be able to offer full coverage at sensible prices and still turn a healthy profit. Hell, PP’s been doing just that as a primary health-care provider, in the face of unconstitutional Republican-backed governmental interference and discrimination no less, for decades.

    • JBC31187

      My first job as a data entry temp offered discounts for visiting CVS minute clinics- I ended up taking one of the Mass Health plans. Coincidentally, that’s when I grew out of my “both parties have valid points” phase.

    • egg

      Inexpensive equals low value to the purchaser. High value to the insurer.

      Prior to the ACA mandate that the loss ratio for qualifying plans be set at a minimum of 80% (meaning that 80% of premium dollars be spent on healthcare) there were many inexpensive plans that had loss ratios of 40% or less. That means that 60% of premium dollars were available for management bonuses and corporate profits.

      My former employer had a division that sold short term (6 months or less) “catastrophic” coverage focused on the recent college graduate market. It had a deductible of $5,000 and a max of $50,000. It’s called a POM or Peace of Mind product. It allowed parents or the students to fool themselves into believing they had purchased a bridge between student health service insurance and the expected group coverage when employed. One could keep buying 3 or 6 month extensions until you were employed. Easy to make cheap because risk to the insurer was extremely low with 20 somethings with no pre-existing conditions (oh yes, it was not guaranteed coverage).

      Needless to say this division could not figure out how to adapt to providing a product that is valuable to both purchaser and insurer and was closed down a year after the mandate went in to place.

    • For the record , tort reform is in the GOP bill.

  • Bootsie

    “Perhaps we should try freedom” is going to be my go-to response to getting asked to do things I don’t want to do.

    • Mac the Knife

      + 1776

  • weirdnoise

    “Freedom”‘s just another word for “Nothing left to lose.”

    Except health. Or life.

  • jim, some guy in iowa

    seems to have left out “the freedom to have your friends scrounge items from local businesses to sell at the charity auction when you burn through your savings”

  • Dr. Acula

    What should we replace Obamacare with? Perhaps we should try freedom:

    I have an auto-immune condition that requires a very expensive drug to effectively treat. I guess Rand Paul thinks that I should have the “Freedom” to to suffer.

    • dsidhe

      Of course not. You also have the freedom to become wealthy enough to pay for it yourself. Not the opportunity, just the freedom. Rand can’t do everything for you.

      /sarcasm

      “Perhaps we should try freedom”? Does the man have any idea how very Scrooge-like that sounds? Child labor, contaminated food, poisoned water, untested pharmaceuticals, unsafe work conditions? Perhaps we should try freedom! Ugh.

      • ColBatGuano

        He didn’t say “Let them eat cake.” so it’s all good.

  • Gizmo

    I don’t think Rand actually understands this whole “Insurance” thing, or how those “Insurance” companies want to be free of oversight so they can better rip off their customers. In other words, he’s a typical libertarian.

    • N__B

      Given that Rand created his own fake accreditation for his medical practice, i suspect his patients were not paying with insurance.

    • CrunchyFrog

      He understands it very well … from the point of someone born wealthy who runs a medical practice in which he wants to see only very wealthy patients who don’t question how much he charges them.

      Like all conservatives, he doesn’t give a flying fuck about most other people – just a few who he sees as part of his tribe – and is full of rationalizations to justify whatever happens to them.

  • AMK

    The Chait article is very good, but I disagree with the conclusion–that a majority of congressional Republicans in fact know that repealing Obamacare will be a disaster and are cognizant of the political ramifications, so they will make a great show of passing repeal legislation while putting off the effective date of the repeal forever. The problem with this thinking is that it requires a majority of them to be in at least occasional touch with social, economic and political reality, all evidence to the contrary.

    • Steve LaBonne

      I also, sadly, don’t agree that there will actually be political fallout. Between the fecklessness of our “journalists” and the blind tribalism of white voters, how would that work exactly?

      • humanoid.panda

        Well, the fact that they are trying to punt the whole thing 3, maybe 4 years ahead means that the Republicans disagree re: lack of consequences.

        • Domino

          I mean, they obviously will try to blame Democrats for their failures, but honestly, I don’t see how that works –

          “Yes, we have control over all 3 branches, but you can’t blame us for policy and legal failures!”

          Obviously some people will buy it, but right now I’m highly skeptical that will work come election time.

          • mds

            I mean, they obviously will try to blame Democrats for their failures, but honestly, I don’t see how that works –

            “Obama wrecked it. Obama gave all the money to coloreds less economically-anxious people. Despite our own heroic efforts, we’ll be a long time dealing with the disastrous fallout of Democrats’ government takeover of what used to be the best healthcare system in the world.”

            Seriously, why not just lie flagrantly some more? My father received a book from Theocratic Shitnozzles of the Week or whatever, direly warning that 2017 is the year the “death panels” finally kick in and seniors no longer get any healthcare past [insert latest horseshit number > 65 here]. This was no doubt already in the works when they probably thought Clinton was going to win, but now that it’s 2017, will you see any Obamacare death panels? (Well, you might see worthless vouchers, depending on the details of Paul Ryan’s plan, but if he exempts the current olds, it won’t matter.) Thanks, Republicans, for saving us from the consequences that you fucking made up in the first place.

            • humanoid.panda

              Thing is that this sort of complex explanation only works for highly partisan voters. For the median voter, the kind of person who has no idea who passed what and when, it will all be about blaming the guy in charge.

      • GeoX

        See, I don’t agree with this. I think that if, all of a sudden, in a very visible way, they lose health coverage en masse, they’re going to be pissed off at the republicans. You’ve seen the articles with Trump voters going, surely he’s not ACTUALLY going to take away my health care? Tribalism is a powerful force, and it’s helped by the inability of most people to think abstractly, but I don’t think republicans would be able to escape the fallout from such inflicting such obvious, totally direct pain.

        • Steve LaBonne

          I sure hope all of you guys are right, but I can’t remember the last time any non-rich Republican voters blamed the true sources of their problems. Or that the press made those sources clear. I suppose there’s a first time for everything.

          • Snarki, child of Loki

            Yeah, it was just TERRIBLE how Obama caused the 2008 financial meltdown, wasn’t it? I hear he screwed up the Iraq “status of
            forces” agreement that required the US withdrawal from Iraq also, too.

            When a significant part of the public and media have the long-term memory capacity of a mayfly, would you expect otherwise?

            • Steve LaBonne

              And why wasn’t he in the Oval Office on 9/11/01?

              • humanoid.panda

                Um, guys, you do realize that Obama and the Democrats won the 2008 election in a landslide? You are just reinforcing my argument above: partisans tend to blame the other party, and low information voters tend to blame the party in power whatever goes wrong. Starting in 2009 it meant Republicans plus mushybrains blamed Obama. The game changes in 2017.

  • waspuppet

    Perhaps we should try freedom

    Oh fuck RIGHT the fuck off, you little fucking ponce. Work in a coal mine for 20 years and then talk to us. Or one fucking week, even.

    I’m so glad people will soon have the freedom to choose between treating their cancer or sending their kid to college, rather than having to suffer under the tyranny of doing both.

  • Steve LaBonne

    Free to die, you and I.

  • DAS

    I can actually see this plan turning into a concrete policy. They will set up exchanges to facilitate joining “voluntary associations” for purchasing this inexpensive health care. They will provide subsidies to help lower income people afford to join those associations. Heck, there will even be penalties for those who fail to take advantage of their “freedom” to purchase health insurance. And there will be a website that will serve as the primary interface for the aforementioned exchanges.

    I wonder what they will call this plan? Randcare? Ryancare? Trumpcare?

    *

    BTW, I wonder what the GOP’s response would be if the ACA included provisions for health savings accounts and purchasing insurance across state lines?

    • malraux

      The ACA allows states to set up interstate compacts to allow insurance to be sold across state lines but avoiding the race to the bottom of credit cards.

      • Warren Terra

        Well, sure, but in Rand Paul’s plan the race to the bottom is the point, as is the frenetic burrowing that will follow.

      • Cassiodorus

        Also, nothing under current law prevents states from allowing policies from other states to be sold in their state. If they really believed what they’re trying to sell, Texas is perfectly free to allow Wyoming insurers to sell policies right now.

      • StellaB

        Of course the premise behind selling across state lines is that economíes of scale will lower costs. That means that if you could have a combined population bigger than Canada, insurance/health care costs would be lower than Canada. Surprisingly, we have a single state that _is_ bigger than Canada and health care costs are still higher in California. Weird, huh? It’s almost like the GOP doesn’t know what it’s talking about.

        It’s hard to talk about Canada (CA) and California (CA) and use abbreviations.

        • Bill Murray

          wouldn’t a set of policies that are valid in the entire US in the same form and done by the federal government work well for policies sold across state lines? Wait, I so often get tyranny and freedom confused

  • witlesschum

    I’m not gonna try to tell anyone Republicans are dumb. Or even significantly dumber than Democrats.

    But Rand Paul is dumb. People don’t notice it because there are a lot of pretty intelligent people who think libertarian ideas sound great, which shows that intelligence isn’t everything, but Rand Paul is not one of them. I think think the old visiting professor of Civil Rights Movement history at Howard University says this shit because he believes it.

    • Steve LaBonne

      Freedom’s just another word
      For Rand Paul is a fucking idiot.

    • q-tip

      It would be unethical to run the experiment, but I believe any male child* raised by Old Man Paul would have at least a >75% chance of turning out a fucking idiot.

      *(A cursory googling seems to show that Rand’s sisters are, if not actual fucking idiots, true believers in the Old Man’s crusade. Which probably means idiots.)

  • drpuck

    4. The freedom for all individuals to join together in voluntary associations to gain the leverage of being part of a large insurance pool.

    This is the key to the entire enterprise of amping up freedom and oligarchy.

    Scratch a certain kind of libertarian and you’ll eventually get to the salutary community provided by churches and their wonderful ability to create both insurance pools and, by tithe, spontaneous pools of money in response to catastrophic events. They do funerals too.

    It does no good to point out that the metaphysical laws undergirding libertarianism are freely enjoined by true believers whereas everybody just has to freely suffer their imposition.

    There are, somewhere, justifications for every Libertarian demand, and all are anchored to owning your body and voluntary association. It is a dystopian philosophy based in the idea that the necessary ends are the result of the essential principles.

    In the Libertarian second order are:

    Consumption tax
    Cheap labor
    Industrial self-regulation

    And, in the fantasy: compliance and obedience are voluntary, but, you know. . .


    Wait, somebody should ask Paul about his own health insurance.

    And, bonus, there exist today countries living the libertarian dream! They are hellholes, but still…

    • Derelict

      The voluntary associations are totally a thing. I can see myself getting together with 10 of my friends to form our own pool. Just think of the bargaining power we would have!

      And then, two years from now when “Steve” develops cancer that that causes our pool rate to double, well, we can just kick Steve right the fuck out and save ourselves a bundle. Now that is freedom!

      • Steve

        I thought I knew you man!

      • Snarki, child of Loki

        You can still get bulk discounts on beer, right?

        That’s gotta count for SOMETHING

    • Solar System Wolf

      Oh yeah, owning your own body is a libertarian ideal. Unless you have a uterus. Someone else owns that.

      • leftwingfox

        Can’t evict a fetus, but you can throw a family out into the cold. That's what freedom's all about.

      • Just_Dropping_By

        You do know there are pro-choice libertarians and that two of them just ran for president, right? In fact, one of the main criticisms of Johnson/Weld by conservative media outlets was that they were pro-choice: http://www.nationalreview.com/article/438787/gary-johnson-abortion-pro-choice-candidate

        • q-tip

          Given his (small, late) advocacy of voting for Clinton, I’m prepared to believe that one of those candidates actually takes choice semi-seriously!

        • Solar System Wolf

          Rand Paul is pro-life. Ron Paul is pro-life. Gary Johnson is against late-term abortion, he wants parental notification, and does not believe there is a fundamental right to abortion. Harry Browne believes abortion is wrong and that there is no fundamental right to abortion.

          But, you know, legalize pot.

    • Oddly enough, there is good mobile phone service from competing providers in both Somalia and Eastern Congo. I suppose it works because (a) people who don’t pay can be cut off remotely at no risk, (b) the service is more valuable to warlords in terms of control of troops, access to tax havens, and warning of attacks than the possible profits from extortion of the telcos. Somebody should write a novel about the telco engineers making a living in such places.

      • q-tip

        I feel like Eric Ambler could do it justice.

    • bender

      Voluntary associations to provide medical insurance are not imaginary. They were common and popular in the USA in the late nineteenth century and early twentieth century.

      Fraternal organizations like the Elks, the Odd Fellows, the Foresters, the Knights of Pythias, etc. had a huge membership among working class and middle class people (early TV sitcoms like the Honeymooners made reference to this). Nowadays people assume that the main attraction of fraternal organizations was social, or business networking, and don’t realize that one of the benefits of membership in many of these organizations was that a portion of the dues went to group medical insurance and in some cases to operating old folks’ homes that aged members could move into.

      Besides being voluntary, these associations were non-profit and elected their officers, so members had control of how their dues were spent.

      They couldn’t compete after WWII with employer and government sponsored health plans, and that is one reason why membership in fraternal organizations collapsed in the second half of the twentieth century.

      People also formed voluntary associations to pool money for funeral expenses.

  • The freedom to learn no provider in your vicinity takes the Fly-By-Night health insurance you purchased from Utah.

    • BigHank53

      A vile fabrication! Here at Uncle Dave’s Discount Doctorin’ and Used Cars we’ll accept any and all health insurance plans! Now, we may not have all the fancy equipment those expensive hospital places do, but the 74-year-old school nurse we coaxed out of retirement will give you all the expired Tylenol and Band-Aids you might ever need, and at amazing prices too! While you’re here, check out the late-model SUVs we just got in!

    • Denverite

      If Wyoming determines that reserves and admitted assets are unnecessary in this day and age, well, by gosh, that’s surely good enough for the fine people of Massachusetts!

      • After all, the consumer didn’t HAVE to buy that plan. #FREEDOM!

        • Denverite

          Look, if you don’t have the common sense to subscribe to the NAIC database and, prior to purchasing a policy, research the statutes, regulations, bulletins and administrative opinions of the state where your insurer is domiciled to make sure that they adequately regulate the finances of such insurer, then you really deserve what you get, right?

          • Now, now. Have a little sympathy. That’s too much effort for many people.

            However, if they don’t pay a knowledgeable consultant a few hundred bucks to do that research and explain it to them, then yes, to hell with them.

            And if they don’t feel competent to gauge a consultant’s expertise, they can hire a consultant who specializes in vetting consultants …

  • Denverite

    “Under the majestic equality of my law, the rich and poor alike will be able to save unlimited amounts of money tax-free to pay for health care, and healthy people and people with pre-existing conditions alike are welcome to try to purchase worthless insurance that meets the standards of the state that offers the fewest protections to consumers.”

    FTFY

  • AchillesNotes

    When I think of freedom and healthcare, I think of…
    https://www.youtube.com/watch?v=lLCEUpIg8rE

  • NewishLawyer

    One thing I’ve noticed about a lot of libertarians is that they take non-coercion extremely seriously and to extreme ends.

    There is a good amount of value in non-coercion as being part of civil rights and societal rights. There is a lot of liberalism that is based on non-coercion as well.

    Yet the libertarians take this so far that any good is ultimately tainted if someone has to do something that they don’t want to do. There is always going to be some coercion in human relationships and social events. When I was in Singapore, I made my girlfriend’s nephew eat his vegetables before we went to ice cream. He was trying to cutesy his way out of it but I was not falling for it. Was I being coercive? Probably. If there are libertarians who are parents, would they do the same? Also probably.

    But in the libertarian mindset seems to think that the good 18-20 million people getting insurance is destroyed by the small number of people who are required to get insurance against their will because of the mandate.

    I can’t wrap my head around how you take non-coercion to this extreme.

    • aturner339

      If you believe that when left to its own devices society naturally empowered the virtuous and punishes the unworthy then it’s easy.

      Or to put it another way it’s the same thing that motivates conservatism in general. A firm belief in hierarchy.

      • N__B

        If you believe that when left to its own devices society naturally empowered the virtuous and punishes the unworthy

        Of course it does, as long as we define the virtuous and unworthy retroactively.

        • Warren Terra

          God can do that for us. If he’s so virtuous, why did God give him cancer?

          • Domino

            If they win, they have the mandate from heaven.

            If they lose, well they obviously didn’t have the mandate!

      • witlesschum

        If you believe that when left to its own devices society naturally empowered the virtuous and punishes the unworthy then it’s easy.

        Or to put it another way it’s the same thing that motivates conservatism in general. A firm belief in hierarchy.

        Oh, yeah. This spells out the connection between right wing libertarians and authoritarians better than I’ve been able to put into words before.

    • efgoldman

      the libertarians take this so far that any good is ultimately tainted if someone has to do something that they don’t want to do.

      The best argument to use against glibertarians (most of whom are either college kids or young, white, wealthy dudes) is: OK you don’t pay any taxes. Fine. You are hereby freed from using any and all public services. No police, fire, ambulance; no library; no driving on public roads or walking on public sidewalks; no water or sewer service; no electric, gas or cable TV; no post office services; no trash pickups; nor taking your own garbage to a public facility (have to use public roads); no travel through public airports; if you can afford a private airline and a place to keep it, no use of air traffic control…..
      Welcome to Galt’s Gulch!

      • mamculuna

        If only there were a way to get some of them to read this.

      • witlesschum

        “Okay. Don’t let me catch your unlicensed truck on any of my roads, then.”
        – my dad to some sovereign citizen type, in a tone of voice that suggested the consequences to the catching would not be nice.

      • Just_Dropping_By

        You’re obviously not arguing in good faith, but I’ll still point out that (a) that’s really a critique of anarcho-capitalism, of which only a small part of lower case “l” libertarians are advocates, and (b) your examples include many things that are actually already privately provided or were privately provided in the past before largely being superseded by government services.

        • Rob in CT

          Those things were often superceded because they were provided badly and/or could not/would not serve the entire community (just like charity cannot do what social security can, even though there are many excellent charities out there doing great work).

        • bender

          As I commented above before getting down to your comment, in the late nineteenth and early twentieth century a lot of Americans got medical insurance via dues-paying membership in fraternal organizations.

    • MPAVictoria

      “One thing I’ve noticed about a lot of libertarians is that they take non-coercion extremely seriously and to extreme ends.”

      Very much disagree. Private property is coercion and libertarians LOVE themselves some private property. Libertarians are fine with coercion as long as it is enforcing the society they want.

      • Steve LaBonne

        Yup. Let’s see them defend their property without police and fire protection or recourse to the courts to enforce contracts. If they want to stuff all their gold (no fiat money!) in a mattress and stand over it 24/7 with shotgun in hand, good luck to them.

        • Linnaeus

          enforce contracts

          Coercion!

      • Bill Murray

        yeah libertarians only take governmental coercion seriously. They think private coercion doesn’t exist because all private interactions end as contracts entered or rejected voluntarily

    • Snarki, child of Loki

      “Was I being coercive? Probably. If there are libertarians who are parents, would they do the same? Also probably.”

      TRUE libertarian parents have their sprogs in indentured servitude, until they pay off the cost of birthing and raising them.

    • The end game of libertarianism is the rich owning the air and charging us to breathe.

    • q-tip

      I can’t wrap my head around how you take non-coercion to this extreme.

      My pet psych-theory is that being really good/lucky at traditional board games and the like has something to do with it? “Why you such a sore loser, Steve?”

    • wengler

      Rightwing libertarians like to ignore that their whole philosophy is based on coercion. When you make ownership of property the basis of a society, it can’t help but turn every relationship into a coercive relationship. You can’t cut off a person’s ability to survive and then call them out for violationg the principle of non-aggression.

  • Rob in CT

    [Warning: OT ranting]

    So. My 2016 ended in fitting fashion.

    Christmas Eve – youngest daughter to ER, stiches.

    Thursday of the following week, while guests were visiting, the stomach bug hit our house. It got 9 out of the 10 of us who were there when it started. Some of those people left and infected others before they showed symptoms. The only one to escape the wrath of Montezuma was the little one w/the stiches. Who then came down with an ear infection. So I missed the first work day of 2017.

    And now my ancient (~14 yrs old) lab is rocking a fever, so I’ll be leaving early to get him to the vet.

    SEK would’ve written this up better (though John Cole might be an even better choice).

    The only silver lining is that being sick for several days appears to have taken off some of the holiday-season weight I’d packed on. Woohoo.

    • witlesschum

      Sorry, man.

      Maybe we can cheer you up by calling diarrhea what it is: Trump shits?

      • We had something like that go through the entire unit on a deployment to Incirlik Turkey. It was bad enough that some people (myself included) needed antibiotics.

        We named it the “SMA” for “Screaming Monkey Ass”.

    • NBarnes

      Your holidays would have been cheered by having the Freedum(tm) to go through all that with no health insurance, right?

      • Rob in CT

        Think of the harm suffered by my moral character because I didn’t have to agonize over whether to send the 3 1/2 year old child with the nasty cut under her chin to the hospital.

        Side note: the copay was $150, so it’s not just having insurance, it’s being able to not sweat $150.

        Side note the second: Connecticut Children’s Medical Center remains great.

        • ColBatGuano

          You could have waited a day to see if it healed up all on its own. That’s the Republican way.

        • NBarnes

          Full bellies but empty souls, indeed! Paul Ryan weeps for what you’ve lost.

    • mds

      Thursday of the following week, while guests were visiting, the stomach bug hit our house.

      That settles it. I’m not leaving this basement safe room until this current Connecticut plague has finally moved on. (It’s striking households all around us, and we have a child in elementary school, so I’m really not liking our odds.)

      The only silver lining is that being sick for several days appears to have taken off some of the holiday-season weight I’d packed on.

      This is a depressingly compelling upside at the moment.

      • Rob in CT

        Yeah, you’re probably fucked, what with that school kid and all. Little disease vectors, the lot of ’em (though to be fair, I may have brought the thing home from work – the kids may be innocent this once).

        The number on the scale this morning (first time I’ve dared step on it in a couple of weeks) was at least a nice surprise. But it’s a lie, really. I haven’t been exercising. I probably lost as much muscle as fat. If/when I get my act together, I’ve got more work to do than the number on the scale would seem to indicate (in order to get back to where I was in June).

  • DrDick

    Rand Paul’s “freedom” is the freedom to suffer and die if you are not one of the wealthy MOTU, as our Lady Rand decreed.

    • Steve LaBonne

      But only for people other than herself, of course.

      • DrDick

        Of course!

  • Crusty

    On the way out of my doctor’s office I told them I’d be paying my bill in freedom. They keep sending me bills, with bigger and bolder print. Why do they hate freedom?

    • Bill Murray

      do you send the freedom back in bigger and bolder fonts?

  • Jonas

    I don’t understand the conservative obsession with HSAs (I mean, I understand, it means you pay directly for your healthcare rather than pay a certain amount each year and pool your money with others for those that need it in any given year-something we could call insurance).

    Why is that freedom? The freedom to fill out paperwork to register a government-approved pre-tax salary withholding account and get a debit card for that account that can only be used on specific things? Why not just allow all healthcare related spending to be tax deductible and take HR and all the administrative BS out of it? Whether it is an office copay or buying ibuprofen at the grocery store or an out of pocket expense or all the things that are allowed for HSAs, you fill in a line for deductibles on your 1040 with the total. That would be easy, rather than predicting the amount of money you will spend next year, taking that as withholding, then buying whatever is allowable to buy in December because you withheld too much and need to spend the money.

    • JKTH

      I don’t understand the conservative obsession with HSAs

      Because it’s a tax shelter for rich people.

      • Jonas

        But not a very good one! Why not just increase IRA limits or something if that’s the goal?

        • Rob in CT

          The justification for HSAs (help people save to pay for healthcare!) make them easier to pass than an increase to IRA contribution limits.

  • Linnaeus

    Slightly OT:

    My father had an infection in his foot that required daily treatment with antibiotics and ultimately, about two weeks ago, amputation of one of his toes. When my father complained about the financial impact that the copays for the treatment had on him, as a retiree on a fixed income, the doctor said to him, “That’s what insurance is for!”

    There’s a winning bedside manner, right there.

    • Domino

      My grandparents doctor retired a couple of years ago (at the age of 85). My parents were able to get their current doctor to agree to see my grandmother, because otherwise I don’t know if there is a single doctor who would. That also meant that my grandfather no longer had a doctor.

      His health has noticeably declined, and my mother said to take him to the clinic where their doctor works after 6, since then they have to see him. My grandmother tells my mother “your father doesn’t like to see a doctor that won’t schedule him”.

      They told them for years this was going to happen. When people don’t want to care for themselves, there is a point where you need to stop caring as well.

  • Halley’s Comet can be relied on.

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