Lars Larson on Health Care as a Right

Would you believe health care as a constitutional right? I don’t!

Yah, the idea has come up again. It will probably be presented to the voters. The Oregon legislature in its illegal special session seems ready to send to the voters this choice, “Would you like to have health care guaranteed as a government provided constitutional right in Oregon?”

Well, who’s going to say “no” to that? Free stuff, with somebody else paying the bill. Of course, that’s the problem with government programs. It’s always somebody else paying the bill. The problem is, a lot of the people who were the “somebody elses” have decided to leave Oregon and if you put this kind of burden on them, more will leave. It’s a bad idea.

Look, health care is important, but health care as a constitutional right? Why don’t we include housing? How about food? How about water? How about all of those things guaranteed as a constitutional right and somebody else pays the bill? We’d probably all sign up for it if we believed in turning Oregon more Socialist than it already is.

  • Anonymous

    Lars said

    “The Oregon legislature in its illegal special session seems ready to send to the voters this choice”

    Lars, I need to get a little picky on your comment. A choice is when you can decide to do something or not. I believe the legislature is looking at a mandate. The majority may choose it but if you don’t you will be mandated to join in.

    Don’t you love living in a free country where more choices usually means you have to support something you may be oppose to!

    I support real choice where I can decide if it is best for me and my family.

  • Jerry

    I firmly believe that a free and easy transportation is necessary for any free peoples. In that light, I demand state government get me a new car. I will even take one of those puny little hybrids, as long as it is new.
    This is my right. I am an American. I deserve better than what I am getting.
    And I deserve it now!
    Lars – you are mean, selfish, and obviously hateful if you don’t agree with me.
    Thanks everyone. When can I expect my new car! I hope it has GPS.

  • Steve Buckstein

    Beyond the philosophical argument that health care is not a right at all, this resolution (HJR 100) raises intriguing political implications:

    Since neither education, transportation, criminal justice, or any other state government service is defined as a “fundamental right” in our Constitution, then funding for these services might be cannibalized to fund the one “fundamental right” in that document, health care. But voters won’t be presented with this reality when marking their ballots in November. This potential clash of essential services may make for strange bedfellows in future election battles. Will the teachers union, for example, want to lose funding to the health care providers?

    The unintended consequences of this proposal are almost endless. But that’s the way the game is played for now, and the next inning will play out in the Senate as it decides whether to follow the House down this strange path.

  • Bob Clark

    This proposed legislation is goofy. For instance, would healthy sex become a fundamental right in the context of healthcare? So, what do you get with government healthcare? You get higher salaries and benefits for government employees administering the service mostly. You, also, get tax dollars diverted to things like sex counseling, treating people who routinely overdose on drugs/alcohol without any penalties for irresponsible behavior, treating people who come to the state mostly to be wards of the state, and generally the 80% plus part of the population now having good access to healthcare would have to wait, wait, wait for healthcare services.

    How about a constitution admendment saying it’s a fundamental right of individuals to be free of government healthcare programs and corresponding taxes/restrictions? That’s one I would favor.

  • Margaret Goodwin

    I think it’s about time we enacted an amendment to the Constitution saying that food is a fundamental right. After all, you can’t live without it. What could be more fundamental than that? So the government should provide everybody with three meals a day, with appropriate servings from each of the basic food groups.

    Exercise is important, too. Mrs. Clinton assures us that the best way to cut health care costs is to make sure “preventive health care” is avaliable to everybody. Exercise is one of the most effective means of preventing all sorts of expensive medical conditions. So the government ought to provide everybody with a free membership to a convenient gym, and perhaps even a personal trainer for those who are really out of shape.

    And what about shelter? Don’t we all require some form of shelter? Why should I have to pay for my own home? Shouldn’t all the citizens of Oregon pitch in to provide a roof over my head?

    And, maybe, once the government is providing for my food, shelter, and healthcare, I can quit my job!

  • rural resident

    In general, I agree that this idea has not been carefully considered by the Dems in the legislature. You can’t do universal health care at the state level; too many sick, poor, and/or low-skilled people will enter the state to take advantage of quality health care at, to them, very low prices.

    This is especially true in budget-challenged Oregon, which intentionally limits tax revenues needed to finance such programs by putting straitjackets on growth and development.

    That said, Margaret, if Hillary Clinton actually is saying that, “the best way to cut health care costs is to make sure ‘preventive health care’ is avaliable to everybody,” she’s right on the mark. Curing illnesses and catching other conditions before they progress to the critical (and expensive) stage certainly reduces total health care costs and improves the health of the general population. Are you saying that you disagree with her about this?

    • dean

      Since I don’t think it has ever happened before, I have to take a moment to at least partly agree with Margaret. Two recent credible studies, one from the Netherlands, the other I don’t know from where, make the case that keeping people healthy does not reduce health care costs.

      This seems incredibly counter intuitive. But the finding was that reducing obesity, diabetes, and smoking ends up costing MORE in health care dollars for the simple reason that unhealthy people die at a younger age, and from conditions that are essentially not terribly expensive to treat, like lung cancer and heat disease. The older we live, the higher the chance we get Alzheimers and other debilitating diseases that end up costing a lot more to treat over a longer term.

      Both the Clinton and Obama plans for health care, which I support, probably understate the costs if these studies turn out to be accurate. Senator Wyden’s plan may be better all around, but is not getting much attention yet.

      The larger question is: what do we want, healthier, longer lived people or cheaper health care? We can have both if we adopted a single payer system, but neither Clinton nor Obama propose this. So if one of them wins in 08, we will probably get better health care access, healthier people, but the same or higher overall costs.

      Or we could just let poor and working class people die in the gutter and save money that way.

      And I agree all around that a constitutional amendment just on health care is not wise policy.

    • Margaret Goodwin

      RR, my main issue with the government being in the business of preventive health care can be found here:

    • Stephen Gregg

      Joanne, we probably could achieve a lot more agreement about health care reform if the “plan” had equally credible strategies to cover more or all people and control costs. Obama, Hillary, Wyden when challenged about the cost control component of the problem, lead with a response of “prevention”, “electronic medical records”, and “regulated insurance premiums”. Wyden to his credit proposes the “delinking of the employer” as the provider of health care benefits. The shared problem of these proposals is that none of them have a credible strategy of controlling costs, and I think far more people appreciate this than are willing to admit. Pretty obvious to me that nothing works if it is not economically sustainable.

      So what’s wrong with “solving the uninsured first and dealing with costs more honestly later?”

      1. Invariably “phase 1” (uninsured) will introduce more irreversible complexity, heighten personal expectations.
      2. We will seek to “hide” the underlying cost problems by “spreading them around” as insidious burdens to the different players, probably to the consequence of even greater inflation. These “taxes or mandates” will take away from other vital investments.
      3. The interests of the health care industry will “win”. What could be better than laws and regulations that require everyone must buy my services and conform to the way you must buy them.
      4. Most likely we will “max out” our ability to spread the burdens of these costs around, then we will defer this matter to the Federal level, where we all appreciate politics will be willing to undertake vast amounts of debt before “getting honest” about this subject.

      I fear that the dark side of this debate, is that it will continue to be hounded by the view that the uninsured trumps costs and that argument will either win to the adverse consequences of above, or it will lose due to its lack of credible cost control. If it is the latter it probably, like tax reform, it will tend to defeat the prospects of an eventual credible approach.

      • dian

        So what’s wrong with “solving the uninsured first and dealing with costs more honestly later?”

        Good question, but what are you going to do with the person who refuses insurance? I know a lot of people who won’t buy their own, nor sign on the the Oregon Health Plan. Please don’t say the employer can take care of it, because lots of them are not employed, but self employed, or whatever.

  • Joanne Rigutto

    Health care isn’t a right until you’re dying. At least that’s probably how many people who don’t want universal health care would probably feel if they were faced with a situation in which they were dying and couldn’t afford treatment.

    I’ve faced death without the money to treat the illness I had. Obviously I did find a funding solution, and fortunately I am alive, but when I went to the doctor I was probably 2-3 days away from being dead from blood poisoning.

    Unfortunately, as much as I’d like to see healthcare for everyone, it isn’t going to happen. As our government and society is currently structured, there is no way to provide it and no way to fund it, at least not in the way that many who lobby for universal health care seem to thing it should be. Some are going to have to die so that others can live. Of course, even with universal health care, the situation would be the same through rationing, it would just be different people dying and different people living.

    Who was that kid who needed the triple transplant? Heart, lung and kidney was it? Or maybe heart, lung and liver? I forget. You all may remember her, the girl from a few years ago, the girl who Mark Hemmstreet was going to help with her medical bills. The girl who the state of Oregon, via the Oregon Health Plan I think it was, would pay for the transplant series done in two surgeries but not all three transplants at the same time? But her doctors said she couldn’t survive two surgeries but could survive one? The one who died waiting for the state of Oregon to figure out what it was going to do and who was waiting for an organ match? Yah, you all remember her don’t you?

    • Stephen Gregg

      Please elaborate on your own assessment as to whether you could have purchased catastrophic insurance during the periods when you had no insurance from your employer? Could the parents of the child your have referred to been able to purchase health insurance for the kid? If not could they have acquired public assistance in this regard? I am 63 years old, buy my own insurance, and pay a combined premium of $227 per month for my wife and me. Not great on the pocket book but not bad either and this is with NO incremental reform. Understandably we must address issues related to pre-existing conditions, but even that should require a balanced commitment between insurer and insured.

  • Anonymous

    Who’s freedom are you willing to take away
    so you can have a right to health care?

    • Joanne Rigutto

      Annonymous, the complementary question to yours is ‘Who are you willing to kill in order to keep your freedoms?” Is it better for that person to die so that you can have more money in your bank account? Of course this is only a theoretical question. I doubt that anyone would enjoy standing by and watching someone else die so they could have more money or the right to chose which health care plan they are paying for.

      In reality, irregardless of whether there is a public, single payer health plan or a private multiple payer health plan or some combination of the two systems, there will be people who bennefit and those who loose out, just as there are with this system.

      I’ve heard the ‘access’ to health care argument before. Let me tell you the particulars of my situation. I had a tooth that had absessed. I worked for an employer who did not provide insurance. As soon as I knew somethign was wrong with my tooth I made an appointment with a dentist. My employer, who I had told the severity of my condition, kept scheduling work for me, asking that I reschedule the dental appointment as the work was emergency work. The impression I got from my employer was that I do the work or loose my job. I wound up rescheduling 3 itmes which delayed my treatment by almost 3 weeks. All this time the infection in my tooth was growing. Wen I finally did get to the dentist he put me on antibiotics to knock down the infection which was necessary before he could do a root canal.

      While on the antibiotics the infection increased in severity instead of getting better and I woke up with one side of my face twice a big as the other. I didn’t have insurance and didn’t have the money so I figured I shouldn’t go to an emergency room – I have to pay for all of this out of my own pocket and I can’t afford that kind of bill. I went to an immediate care clinic and was prescribed stronger antibiotics. He also gave me a list of ’emergency’ dental clinics which, when I called them told me that they would see me if I was already a petient, so no emergency help available there. So some times you have access to emergency care and sometimes you don’t because there isn’t any.

      Over the years there have been times when I had medical insurance and times when I haven’t. What I’d like to see, is some kind of plan where major medical was covered but medical education was provided so that people could take care of themselves for minor things. One of the problems, with public health care, and private too, at least that I’ve seen, is that people use it for things they really should be doing themselves. I had a friend once who’s daughter’s thumb got cut. The whole top of her thumb got cut almost off, the tissue was hanging by a flap. It was only a soft tissue injury and her monther cleaned the wound and popped that flap back in place right away and put a butterfly type bandaid on nice and tight, just as she should have. That should have been the end of things, but because she had medical insurance – private, not public insurance now – she figured she should go to a doctor. She went to the emergency room at Bess Kaiser hospital. We waited for 1 1/2 hours for someone to see the little girl – the waiting room was almost empty. Finally a doctor walking by asked what they were there for and the mom told him. He took a look at the kid’s thumb and sent them home. The doctor did absolutely nothing to the kid, and told the mom that she had done exactly what he would have done. That was an example of what I would call abuse of the system. In this case the doc just stopped as he was walking by, and because the kid wasn’t admitted to the ER there was no charge.

      On the other hand, my hand got flipped up into a chop saw, while the saw was running. Cut one of my fingers almost off, destroyed the joint capsule, etc.. That one I went to a doctor for. But there have been other times when I’ve had blood poisoning and various other injuries. Those I treat myself, as long as the blood poisoning isn’t in the skull or body cavity, and use an immediate care clinic for antibiotics, etc.. I think if people were trained to be a bit more self sufficient, then we could have something like a public health insurance program with out so many of the abuses, and with out so much expense.

      • Stephen Gregg

        Joanne, seems like you have at least two problems in your story…an abusive employer (time to look for a new job or file some kind of lawsuit), and then the stresses of not having insurance. If you could buy health insurance at a reasonable price and don’t, I can’t see how this should involve “shifting the blame” to the system or others who are buying insurance. I do agree that if in the view of the State one has insufficient income to buy health insurance, discussion of subsidy is appropriate. However, I think it has been well documented that even with the most nominal cost sharing requirement on the part of the individual, it causes great numbers of people to continue to go without insurance. When people exercise that “free will”, is that someone else’s fault or simply the painful consequences of making an irresponsible personal decision? Then that dilemma leads us to the “obvious requirement” of a personal mandate irrespective of the underlying cost or well recognized inefficiency of our system. Choices are not great.

      • dian

        I completely agree with your assessment that people should be taught to take care of their own minor ailments. I believe major medical is affordable, I have a high deductible insurance because I’m on the Oregon risk pool because of a health condition. I chose the high deductible because that was the only way I could get coverage and that costs me 390 dollars a month. Sounds really high, ans I think it is. It allows me to either pay for help or take care of my own minor ailments, but in the case of major illness, I only have $7000.00 out of pocket. Sure that sounds high, but dying takes a lot more out of you.

        In my opinion, it should be a high priority to make major medical more affordable, even with risk. Illnesses that can be taken care of my your self should be done.

        When my child was a baby, I didn’t call the doctor, I called my mother in law. Unfortunately so many today don’t have that advantage which makes self care education that much more important.

        Then when the emergency room is required, it won’t be so full of people with cut fingers and colds.

  • Steve Buckstein

    I agree with Margaret and Dean above on the point that prevention seems not to reduce overall health care costs. The recent Netherlands study Dean refers to is discussed at

    Another reason why prevention may not reduce overall costs is that the providers won’t just sit still and accept lower incomes if healthier people spend less on their services. Providers will find other services to offer that continue generating income.

    Of course, arguing that prevention doesn’t reduce costs is NOT an argument that on the individual level prevention is a bad thing. Each of us might very well be better off both health-wise and cost-wise if we prevent ourselves from contracting serious illnesses. It’s just that this is not the same thing as claiming that some grand health care reform scheme will save costs by encouraging prevention. I haven’t heard any politicians acknowledge this likelihood, or say how they might overcome it in their plans.

    • dean

      Steve…I would argue that it is in society’s interest, and in our individual interest, to have healthy people. Having healthy people means we have more economically productive people, and probably better socially adjusted people.

      Being healthy is partly a function of our own lifestyle decisions, but also a function of genetics, age, and income level. The girl who needed the triple transplant, as I recall had an inherited genetic disease. And because she had this, and because her parents may not have been wealthy, she needed assistance from the Oregon Health Plan, which was structured to ration expensive treatments in order to keep more total people healthy.

      20% of Americans are using 80% of the health care spending, public and private, at any given time. And none of us are getting out alive, even if we do everything possible to stay healthy. We could still end up with a debilitating condition once we age.

      Joanne…we already have health care for everyone. We just have very uneven access, delivery, and costs. Poor people get Medicare, but working people at jobs with no benefits have no insurance. This leads to emergency room overload and very expensive treatments, when screening or occasional doctor visits could have led to prevention.

      Prevention won’t save health care costs. But it might result in more productive people, with more overall money available for health care costs.

      • Stephen Gregg

        Dean, it seems to me that it would be possible to achieve more sharing of the goal of universal coverage, as you very much want, if you did not seemingly signal a willingness to accept “costs will be whatever they end up being”. To me it is asymmetrical thinking to believe that one side of the issue(uninsured) requires an explicit strategy while the other can just “run free”. My fear is the “left” will win its argument about the uninsured and simply take a hike on the downstream cost implications. If the “left” were to have us follow a “regulated model” to the ends we need (regulating premium increases; prescribing the benefits we must buy; rationing our access), then it probably needs to regulate the take home pay and numbers of people making a living from the health care industry. In theory this could be embraced, but I don’t know that the left is really willing to do this, which means a lot of pain to other sectors long before we do anything.

      • dian

        It costs much more to go the emergency room than to make a doctor appointment. Whey then is the ER the method of choice.

        My friend is a nurse, she tells me it takes so long to get in for an appointment because of the number of people who come in for minor ailments. Because it takes so long they go to the ER for their minor ailment.

        Vicious circle, much more reason to educate people about taking care of themselves. I don’t mean the hysteria that surrounds us now because we have an owie, we must go to the dr. People need to learn to recognize the difference between an owie and something serious.

  • Jerry

    I guess I could put in for shag carpeting in my new car, then, if healthy sex is a right, too.
    I love this country!!!!

  • Anonymous

    Most of us can afford health insurance but choose cell phones, cable tv, alcohol cigarettes, eating a fast food or at restaurants, buying luxuries such as name brand clothes etc.
    For most people health care is a choice.

    I have had an uninsured operation in the 1970’s when I thought it was the duty of my employer to provide insurance. It took me years to pay that debt off but I did. I have had my own insurance sense then it cost $35.00 a month then. Today my son pays $70 dollars a month for his major medical insurance.

    You can’t afford not to have insurance but people choose not to have it every day and expect others to buy it for them.

    Then they accuse you of killing people, Joanne Rigutto .

    • Joanne Rigutto

      All of the different medical insurance systems wind up killing people. They just kill different people in different ways and for different reasons. The system we have now kills people by failing to provide care to people who need it but who either can’t afford private care or who are under the existing public system but don’t meet either the survivability criteria for the care that the public system will provide or have to wait too long because care is being rationed, and rationing happens in both the private and public healthcare sectors.

      If we had a single payer, public system those who have better care right now under a private system would have their care removed by the state in favor of a less efficacious, single payer system. Those people who are able and are completely willing to pay for their own insurance, would see a drop in quality and some of them will die.

      Either way, someone is going to die so that others can have insurance and health care. That’s why I say there is no solution, at least not one that will serve all people.

      I had medical for $40/month through Kaiser 27 years ago. Major medical for someone my age at 38, the last time I had insurance, with a deductible of $5,000 was costing me $150/month. That was 8 years ago. I just checked on insurance for my age group now – 45 – and it’s around $300/month for major medical, no prescription, no dental, no vision, and with a cap on total payments of a bit more than one million over my life. If I have a medical problem that eats up all of that limit, then I don’t have medical and perhaps wouldn’t even be able to get medical because of the illness.

      I will be making enough money in 2-3 months that I will be purchasing a medical insurance policy once again. If anyone knows of one that’s less I’d love to hear about it.

      There are people who don’t have cell phones, don’t drink, don’t smoke and still don’t have enough money to purchase health insurance on their own, there are a lot of people out there like that. I have a friend who has several kids. I think she said that her husband makes around $50,000/year gross. They have insurance through her husband’s employer. If they didn’t it would probably cost them $15,000-$20,000/year for insurance for the whole family. They are Mormons, and don’t smoke, don’t drink, etc. They don’t live in a fancy house, don’t drive fancy cars, and the mom stays home to take care of the kids. She is able to supplement the family’s income by doing light veterinary work out of her home for members of her church – neutering, emergency first aid, vaccinating, etc. If it weren’t for her husband’s employer, they would have to purchase medical insurance on their own.

      My older brother is married to a Quaker. They had medical insurance through the Briclayers union, which was essentially paid by the employer through wage deductions. They didn’t drink, didn’t smoke, didn’t drive fancy cars, didn’t live in a fancy house, and didn’t even drink soda.

      My younger brother is in business for himself and has two employees. He provides insurance not only for himself and his wife, but for his employees. He can buy it for less because he’s got a business plan with multiple insured. He can also afford to provide the insurance because as a corporation, it’s all deductible as a business expense. He charges more for the services of his business in order to pay for these things for himself and his employees. People ask him about his high prices sometimes, but he holds his ground because if he drops the prices on his services he’ll no longer be able to pay for the medical insurance.

      So you see, not everyone is going with out insurance because they are blowing their money on other things. I doubt that the majority of people who want insurance are blowing enough money on frivolous things that they can’t afford insurance.

      If your son is paying $70/month for major medical, I wonder if his age isn’t under 25, because as far as I know, you’re not going to get insurance at those rates unless you’re very young. Lars was talking about insurance for children a few weeks ago. You can get insurance for a kid for around $30/month. There is no way you’re going to get any kind of insurance for that kind of money if you’re in your late 30’s or older.

      • Stephen Gregg

        Joanne, if you go on the web to “”, you will find locally available health insurance for a female, age 45 (Portland, Zip Code) ranging in price from $80 to $404 per month depending on the benefits you elect. The $80 is obviously “catastrophic” which by definition means you get nothing back, unless you have a pretty expensive and unpredicted happening. If you want to pay more to get more, there are lots of graduated options available. I tend to be a fan of catastrophic insurance as I don’t anticipate needing to call on it, and it makes little sense to pay the estimated 30% or so load on the costs of services to get a claim paid by an insurer.

        Good luck.

        • Joanne Rigutto

          Thanks, I will definately check that out. I’m not looking for something that can fix a scratch or even what others would think are fairly severe wounds. There is a lot I can do myselfe, I’m used to doctoring livestock and a biological system is a biological system, be it human or horse. It’s the big things that I need to have insurance for – like cancer, which is the traditional way for everyone in my family to die of, or if I get kicked in the head by a horse and my head’s caved in, or if I fall off a scaffold while working. I’m self employed and so I don’t qualify for Workers Comp, at least no so I could afford it.

          • Stephen Gregg

            If you run into a “brick wall” on this, let me know as I am as interested in “harsh realities” as you are. Not knowing where you live in Oregon, I just put a Portland zip code in…so there could be some differences. Hopefully, if you are outside the more expensive Portland market, it might be less expensive…but there may be less competition.

          • dean

            Stephen….I am willing to support the Democratic approach to universal insurance access now, within our faulty mixed delivery system, suspecting that the “cost savings” will not end up as advertised. That’s not the same as saying I am willing to accept the costs as whatever they will end up being. I’m a pragmatic person, and I know that what we ultimately spend on health care/insurance competes with what we spend on food, housing, transportation, environmental protection, and security, among other things.

            Being a pragmatist, I accept what is doable now, even though it is likely to be less than perfect. Finding additonal ways to hold down costs are going to be needed if health care inflation continues to outpace everything else. But…I still see the ultimate wild card as an aging population, which is much more expensive to care for than a young population.

            The Dem proposals make affordable health care/insurance available to all at what initially is an affordable cost. There are some measures to manage costs, and more are going to e needed. At some point we and nations that have single payer systems will all have to face the unpleasant question of how much we are willing to spend to help 85 year olds with debilitating conditions stay alive another 6 months or a year. This is going to be a divisive, ethical and even religous debate as well as an economic one.

            Covering everyone under say 65 would be easy, low cost, and not controversial under almost any scenario. But a working class person, earning say $30K a year ina job with no insurance is right now paying a significant amount to pay for health care for seniors who may be much wealthier. If he/she could take that same amount to fund insurance for himself/herself it would go a long way to solving the problem wouldn’t it?

          • Stephen Gregg

            Dean, if this were a negotiation, and in large part it is, not having a credible cost containment strategy in “the deal” would be a “deal breaker” for me. As for the aged, lot’s of countries have an older population than we do, longer stays in the hospital, etc. etc. and still manage to operate at half the cost. The second on the list is usually the inflationary consequences of technology…which for almost all other industries is applied to reduce costs…or it simply doesn’t get to market. As I have said before, there is nothing to the cost issue in addressing it now, rather than the familiar convenience of deferral. I realize at this point you are “locked in” to the Democratic proposals for better or worse. I speculate it is highly likely to be a lose-lose scenario. If passed, it will render inflation far beyond our expectations and great pain to other sectors. If rejected, it will harden the resistance to the very cause you say you want. I don’t see “pragmatism” as usually associated with engaging unsustainable economics and highly predictable failure.

            The third option is the most likely. Pass something, anything, and define it as “profound” or “what can be done”. The latter is always the self rationalizations of the policy makers.

            We agree to disagree.

            I choose to hold out for doing something better than that.

          • Joanne Rigutto

            Thanks for the link. I went over to the website and sure enough I can get a catastrophic plan for $80/month. I’m close enough to the Portland market I can use any agent or insurance company that’s in the Portland metro area, I only live about 20 miles from Portland. I will be calling the company or filling out an application this week. With a $7,500 deductible I would still have to pay out of pocket for something like when my finger got mostly cut off or the blood poisoning from a tooth, but I don’t have a problem with those kinds of bills. At least I can finance something like that. The dentist took me in on a down payment and I arranged a payment plan with them that I’m still paying down.

          • Stephen Gregg

            You are probably joining the same plan I am in…so we will gain or suffer together. You can enroll yourself if you wish through ehealthinsurance, as they are supposedly the nations largest health insurance broker. That said, you may get additional insights from a local broker. Although in many cases they just don’t willingly provide you with the spectrum of choice or knowledge about all the available plans.

            Good luck.

          • dean

            Joanne….I totally agree with you on that point. Its impossible to unionize industries if they can rely on undocumentetd workers.

  • Margaret Goodwin

    One thing many people neglect to consider is that, while healthcare was a lot less expensive just a few decades ago (even adjusted for inflation), the level of healthcare available even a few decades ago was much lower than it is today. A few decades ago, if you had cancer, you died. If you had a heart attack, and didn’t die right away, the odds were that you’d be dead within a few years. People accepted that, because there was no alternative. People also accepted that, when they got older, they would have all sorts of ailments. Nobody liked it, but that was just the way it was.

    Now that it’s possible to treat many conditions that were not treatable in the past, people feel they have a fundamental right to treatment of those conditions, whatever the cost. And the cost of performing what would, not long ago, have been considered a “medical miracle” is often more expensive than the average person can afford.

    Back in the day, when everybody could afford healthcare, everybody accepted that they had to pay for it. People also accepted that, even if there were some medical miracle that might be able to save their lives, they might not be able to afford it. Nobody thought they had a right to a miracle. Now that miracles are common, everybody feels they have a right to them. And that, if they can’t afford them, somebody else should have to pay.

    Healthcare _is_ a lot more expensive than it used to be. But I don’t know why anybody expects miracles to be cheap.

    • Stephen Gregg

      No question that people’s expectations escalate with the “possible” irrespective of its cost. What was once a knee replacement, is now at about ten times the cost, a “bionic” knee replacement. Radiation therapy can now be replaced by high speed proton accelerator therapy, even without any particular evidence as to merit. “Politics” will not have the courage to say “No”, without getting clobbered. Even private insurers have largely recognized that simply saying “yes” (as long as the rule applies to their competitors) achieves greater self interest. It is a real pickle we have created for ourselves.

  • Anonymous

    A major medical Health Saving Account HSA will be less expensive and allow you to save up for your deductible and you can also use you HSA for dental prescription and any other medical need you have.

    If I didn’t have heath insurance, I would get a second job to cover a Major medical insurance plan.

    • Stephen Gregg

      Unfortunately the content of HSA “qualified plans” are regulated to a fairly rich and “non catastrophic” nature. The premium of a qualified HSA plan offering for me from the same carrier is about 2-3 times more expensive than “catastrophic coverage” without the “mickey mouse” requirements. The HSA concept and universal “defined contribution” from all sources is the way to go, but not going to help much if it is overly prescribed what we must buy and from whom.

      • dean

        Stephen…the methods most other advanced nation uses to control health care costs are unique to single payer systems no? Canada sets a global budget, and only reimburses what it reimburses. In effect, they do deny some expensive treatments. France does the same, but with supplimental private insurance for extras, I see no way for us to go to a single payer system, so that option is out.

        I’m not “locked in” if something better is put on the table. Wyden’s plan might be that something better, but he had better move it faster than he has so far.

        I don’t see how the rate of medical inflation will increase under the Clinton or Obama plans. Covering more people and subsidizing policies at the lower end does not in and of itself increase the inflation rate, though it could increase the amount the nation is dedicating to medical insurance and care. It might not decrease the inflation rate, and that is its own problem.

        • Stephen Gregg

          I recently examined data from the National Center for Policy Analysis that represented the rates of inflation of these more “desirable” systems were now inflating as rapidly as ours. You might be able to find the information on their web site… This organization is conservative in ideology, and considered the “father of MSAs and HSAs”. I am sure there is conflicting data out there in this regard.
          In Canada, I believe the hospitals are operated as budgeted cost centers and do not bill as we would know it. In Germany, the government negotiates en mass with the physician organization. When I was in London a few years ago, the nurses were threatening a strike as a means of equalizing their 20% deficient salaries to those of school teachers and firemen. In theory I don’t have a conceptual problem with the credibility that IF a system aggressively gains control over its compensation of health care professionals, it would likely be mitigating to inflation. I just don’t see that the politics in this country would touch that with a ten foot pole in the context of a single payer system. That said an organization such as Kaiser can do things that control compensation and expenses system wide and get away with it, because it functions largely in a “free will” situation. As a physician or member I elect to be a part of Kaiser among other competing alternatives. As you know, rather than simply dismiss “single payer” as unachievable (because we ironically don’t buy the “hope” hyperbole), my view is that we should allow, nurture, and encourage its development as an option….but it must be on a level playing field. One of the large barriers government has in just absorbing the whole lot of us, is that the financing of its existing constituencies depends greatly on significant cost shifting to the private sector. If there is no private sector than there is a big hump in the road.

          The one significant characteristic of the Wyden plan is its call to “delink” the employer as the provider of health benefits, presumably migrating to defined contribution…which I favor. However, as said before, when challenged about cost constraint, Wyden’s response is “prevention”, which you have already accepted as marginal if not bogus.

          To keep this simple, if we did nothing else other than insure more people, I believe most economists would suggest this would be pretty inflationary, as you are both subsidizing and removing financial barriers to access. Plus there is an unknown amount of pent up demand that presumably would release itself. Then of course there is the discussion of a likely mandatory increase to the benefits I must insure myself to meet the new national standard that satisfies all the vested interests. Nowhere in the Democratic platform is there a whisper about catastrophic coverage. And if you think this is a wistful possibility, I don’t think you understand the political dimensions of benefits. I spent years as a hospital administrator. If there is not a rigorous commitment to control costs, I have a bridge I am willing to sell you.

          From a strategic perspective, the problem I see with a relatively monolithic interest in the uninsured, is if you muscle that card against those who care as much or more about costs, you could very well lose the cause and harden the longer term resistance to talking about the subject. At best it is probably a 50-50 bet as to which way it will go. If it were me, I would want to settle up on the cost issue to gain more universal acceptance from those who might come to the table if costs were more honestly dealt with. If I were to propose to you, “let’s manage costs now, and I promise we will address the uninsured later”, what would be your reaction? Not to suggest the Republicans are smart, but the Democratic position is either: 1) Pretty dumb; 2) Has little expectation of passing anything close to what is being proposed; or 3) just wants to throw something on the table to look interested and be in a position to rationalize mediocre action.

          We shall see.

          • Joanne Rigutto


            I have to agree with you as far as the cost of universal health care, and the behavior of the democrats/progressives as far as passing and implementing such a program. They want to look like they’re doing something, and they talk a good talk, but they never deliver on the goods.

            I would love to see a universal health care program, but I don’t think there is any way to fund it, and I think that both parties actually realize this.

          • Stephen Gregg

            There are a number of people who hold your same belief Joanne. I don’t see the money working either. The most likely scenario are more nominal changes after “hard fought” politics and a declaration that “it was the best we could do”. Some minority, the rich or smokers will be hit to come up with more money to feed a system which most acknowledge should not get more money when compared to other nations.

  • Anonymous

    The same politicians that want to give you universal health care are also the same politicians that put so many mandates on Health insurance and doctors.

    Then wonder why it is so expensive

    • Stephen Gregg

      It is an intellectually bankrupt debate in many respects. We deserve what we get if so many of us are willing to facilitate and enable the falsity of it all.

      • dean

        Stephen…unfortunately I tend to agree with you. By and large, the Clinton and Obama health plans are political necessities for them to win the nomination. But…if they can achieve a universal coverage, yes, at some cost to the wealthiest taxpayers, in and of itself that will be a big breakthrough. Over the longer run, which isn’t very long, they or their successors will have to seriously tackle cost inflation, whether we get unversal program next year or not.

        Your British example is telling. Britain is pretty unique in having completely socialized medical delivery. All health care workers are civil service employees, like teachers. They have superior results to the US (according to the WHO) at les than half our costs, in large part because they control salaries and expenditures. Lots of legitimate complaints about their system, as there are here over public schools, but they manage to deliver.

        I am coming around to your arguments on catostrophic coverage. But…here is my question. Since 20% of us use 80% of the costs and services at any given time, assuming we went to a completely catostrophic only system, what would we get? Poor people would avoid going to the doctor or dentist as much as they do today because they could not afford the visits. There would be far less money in the total system ($100 premiums from the 80% instead of $400 is a big difference). Who would actually pay for the cancer treatments, the cystic fibrosis treatments, the severe injuries, the alzheimers patients, and so forth? It seems like the system would be starved of capital.

        • Stephen Gregg

          Just don’t agree with the short term programmatic solution of creating more money from some “deserving source” in someone’s politically correct view, to feed a system which almost no one is willing to defend as effective. Better in my view to do “nothing” and wait out the pain until we get to the right threshold of intolerance. I have thoughtful friends that speculate that despite all the whining and complaining, the issue may need more ripening.

          As for the “catastrophic” issue. I am of a view that public policy should seek to reduce dependency on insurance rather than increase it, at a risk tolerance that is appropriate to the circumstances of the individual. We need to look at “where the puck” could be rather than the immediacy of what could happen tomorrow morning. In my case, I spend $227 per month for my policy. I would be attracted to putting $400 a month into a dedicated health savings account, with a monthly premium withdrawal. I would embrace a presentation that showed me the benefits of seeking a progressively higher deductible as my savings increased, given me the “double” advantage of the tax free accumulation of interest, and the prospects of a declining premium obligation. (My personal goal being to increase my deductible from $7500 a year to $15,000). If the government needed to “mandate” that I allocate at least 20% more than premium costs to the savings account that could be a possibility. It is my understanding that current HSA offerings are enrolling a significant fraction of people who are not electing to save anything and yet participate in the program. This inability to save is directly linked to the requirements of the underlying costs of a “qualified” HSA benefit design. In year one, the healthy person with modest income starts with a less aggressive deductible and moves up the ladder over time. My guess is the political problem would be “how much” would the powers permit one to save, vs. what to do with someone confronted with early on demands. If that were our concern, we could probably work on a solution to that eventuality. To further soften the harshness of this change, I would offer it as an option for people to elect in lieu of the defined benefit programs of employers, Medicare, and Medicaid.

          • dean

            Stephen…1 comment and 1 question.

            First, taxing the rich a bit to pay for expanded health care for lower income working Americans is not hitting up a “deserving source.” It is hitting up the one economic level that has seen a significant increase in income over the past 20-30 years. In other words, statistically the welathiest 1-10% among us have receieved the benefits of downsizing, off-shoring, de-industrialization, loss of unions, and productivity growth while workers in the bottom 50% have had stagnant wages, lost pensions, and now lost health care benefits. So this is redistribution, not punishment. (If the tax is on smokers only, I tend to agree with your statement).

            One reason I back the Democratic proposals is that I think this limited income redistribution is just and necesary, given what has happened to our economy.

            Now for the question. You laid out how a catostrophic plan plus health savings accounts would work to your benefit, and I’ll presume for the sake of argument that most of us would equally benefit from this approach.

            But you did not address the issue of capital loss in the medical sector if we had a massive switch to catostrophic plus health savings accounts. Who would pay the frieght for the 20% sick and increasing number of) old who are eating the 80% costs in the meantime, while the individual health savings accounts built up? It seems this presents the same challenge as Bush’s proposal for private individual retirement savings allowing a reduction in SSI benefits paid out. The problem is not the long term economics, which favor savings, but the shorter term need to continue sending checks to increasing millions of seniors. In each case the “short term” could be decades, requiring massive deficit spending or huge tax increases to finance the bridge. Am I wrong on this point? Or have I finally found the Achilles heel in your otherwise attractive health care reform program?

          • Stephen Gregg

            I guess under most standards, I would be considered “rich” and even more uncomfortably having made my “riches” off the health care system. My personal view is that the “rich” could be taxed more aggressively conditioned on the money being reallocated to “effective” purposes which almost all acknowledge cannot be applied to health care. Wasting money is wasting money. And more money invariably reinforces the inefficiency vs. confronting it. I tend to favor a tiered flat tax system and running public expenditures vigorously within those constraints. If we want to increase the top marginal rate from 34% to 39%, not sure I care that much personally. However if the proposer comes to you and says I need more of your money such that it can be allocated for the maintenance of highly ineffective services and I promise we will deal with that later, all sources of funds should have a lot of push back. I don’t see how I am doing anyone a favor by cooperating with with a bone head deal. Further I don’t understand the logic of attempting to divert the discussion to smokers, rich people, fat people, those who ride motorcycles, fast food chains, bungie chord enthusiasts or any number of folks who inflate my costs. As another dimension of the “shared civic obligation” that needs to be extended to those in need, I don’t understand why we extend a “free pass” to Medicare beneficiaries in this regard. This age group has the highest disposible income, consumes the most health care, and arguably cannot be seen as any more essential to our long term than children. So why is it they have no “pound of flesh” in this mix…obviously because politicians of both stripes fear them.

            As for your question on catastrophic coverage, let’s assume that reducing “unnecessary” reliance on inherently more expensive insurance is a “good” goal. A person age 25 years who puts away $50 a month in an interest bearing account and does not spend it until age 65 can accumulate over $100,000 in savings. A Portland school teacher currently costs over $1000 per month for health insurance, so $50 would seem to be achievable without breaking a sweat. If that modest income school teacher looks “forward”, and stays healthy he/she can aspire to perhaps buying a currently unheard of $25,000 deductible policy without being declared as “rich”. The vast majority could only modestly reduce their current benefits to achieve similar ends if permitted.

            So the “gotcha” question always occurs…what happens to the few that get seriously ill or are chronically ill such that the savings plan is under attack. First of all those people who are chronically ill, potentially save less and buy a more expensive policy with reduced deductibles. If that still falls short and all resources are tapped out, then this population reverts to a “safety net” program of some nature, much of which is completely available in the present market. The most obvious is Medicaid, but there are many others as you know. Should a Medicaid participant be able to participate in a savings program? My view is they should but perhaps with authorization of the funding source. If the funding source were the employer or Medicaid, or Medicare, it is not unreasonable for that source to set conditions for funding the HSA….the most likely requirement would be that the funding source insists that you have “some kind of catastrophic insurance” as a condition of getting this money. I am not sure the government needs to prescribe those conditions to Intel or Joe’s coffee shop beyond real basic stuff. Let’s assume all that financing exhausts itself and an individual must throw himself on the “mercy” of the system. In this case they go into some kind of saftety net system where all of the revenue streams are “assigned” to that system and is further subsidized as necessary via premium taxes or underwriting adjustments applied to the rest of us. Where we have matters “ass backwards” is allowing the very few to define a more healthy system for the vast majority. Better to get that majority properly incentivized and pulling in a common direction.

            This is not tough stuff to work out, if we wanted to do it. That’s why much of the real agenda, is not about sustainability, but rather control and power.

  • Chris McMullen

    “First, taxing the rich a bit to pay for expanded health care for lower income working Americans is not hitting up a “deserving source.”

    Well hell Dean , the rich already pay the vast majority of all taxes, why not tax them even more? Why don’t we just charge them at a 90% tax rate and see how well the economy goes from there?

    Good god, the speciousness of your arguments is mind-numbing.

    • Stephen Gregg

      Chris, I empathize with your views, but the “left” and “right” have to come to terms with each other. As a “rich” guy, I would gladly agree to modest increase in taxes if the “other guys” would make a sincere and fairly iron clad commitment to controlling costs and increasing effectiveness. Of course it is fairly apparent that they will jump over the moon to avoid that commitment and thus we have a national stalemate. It is absurd that a state as small as Oregon can’t come to grips with this.

      • dean

        Stephen…thanks for the enlightenment, as usual.

        Chris…when the top marginal tax rate was at 70-90% the united States economy had its longest period of economic growth, and the lowest income disparity in our history.

        And when Clinton 1 raised the top marginal tax rate a few points, the economy boomed.

        Next question?

        • Stephen Gregg

          Dean, when the top marginal rate was 70-90%, no one paid it, because we had a “little thing” known as “tax shelters” which allowed an investor to gain an outstanding return by investing in ventures that insanely were never intended to make money. It was bizarre at best. Fortunately all that stupidity changed. As for Clinton, I believe folks like Greenspan suggest the time to increase taxes is during an economic upturn and the time to decrease them is during down turns. I remember having fears that the Clinton tax increases would dampen the up turn but, you are right it did not. I don’t know perhaps the insanity of the era simply overshadowed the modest tax increases. All that said, we seem to be on a slope of depending on fewer and fewer people to support the financial requirements of the country, and an increasing number of people whose vested interests are dependent on entitlements paid by someone else. I harbor a view that our rich vs. poor dilemma unwittingly may be aggravated by tax policy in its pursuit of narrowing the income gap. Clearly, reducing capital gains taxes seems to stimulate the economy which helps everyone, but in your view enhances the benefits of the rich. Difficult subject, but somewhat of a sidetrack to defining a responsible future for health care.

          Perhaps we should revisit the sensitive subject of an investment policy that favors feeding performance and starving non performance.

          • dean

            Stephen…yes, off topic for health care. Like I’ve said, I’m a left leaning pragmatist, not an ideologue. It may be true that fewer people are paying a larger load, certainly that is true with respect to one particular tax, federal income. But it is also true that our lower 50% have been stuck in place or are declining for 30 years now. The next 40% above them have barely seen any income gain, and what they have gained appears to be from working longer hours. The top 10%, but particularly the top 2%, have gained a huge amount over the last 30 years.

            What this suggests is that tax policy has to skew to the top, probably much more so than at present, UNLESS, and I think this is a better way to go, we can find a way to lift incomes at the bottom through work. ANd the only way I can see forward there is increasing the minimum wage a bunch, and unionizing the service and retail industries.

            All of which is a long way back to the health care debate. It is essentially those in the 2nd lowest quintile, that is working people in non-union service adn retail jobs, and their kids who are without health insurance. Those of us in the upper 50% or lower 10% are covered.

            And you are right. Upper income elderly people are getting away with murder tax and benefit wise.

          • Stephen Gregg

            Keep in mind Dean that neither of us probably know a lot of people who are willing to identify themselves as ideologues or without pragmatism. And yet we seemingly have lots of those around. There are three personas: how you view yourself; how others view you; and how you really are. I am not convinced that you are without ideology (which doesn’t bother me but may be important to you), nor would either of us see the other as entirely “logical” (pragmatic?).

      • Joanne Rigutto


        I think you’ve hit on the root of the cause for 90% of the base argument against publicly funded/provided health care. I think it’s not that most people don’t want it, its that there is so little trust in government that people would rather stay with the current system we have rather than go to something that in theory would be a wonderful system and help many, but in practice would not do much more as far as making health care available to everyone and would wind up enriching those who work in the public domain either with money or through gaining prestige in the political arena.

        I’ve never been ‘rich’, at least not in money. The most I’ve ever made in one year was around $40,000 before taxes, and most years I’ve made between $12,000 and $20,000 before taxes. I can imagine, even those people who make $100,000, $500,000 or more per year probably value their money as much as I do every penny of mine, and don’t want to see any branch of government take it and not use is wisely.

        • Stephen Gregg

          I believe your analysis is correct Joanne. One of the most striking assumptions that dominates health care reform is the apparent willingness of virtually all the proposals to have the capriciousness to suggest that any proposal should be imposed on the nation without “experimentation”….just do it as legislative debate concludes. From the minds of a largely scientific and self proclaimed rational community of policy advocates, it is rather breath taking behavior.

          I have been in this industry for more than 30 years. The “cost” component of this problem has bugged us throughout and has much older standing than the uninsured. I ran across a quote one time from the Democratic platform in the late 1950’s expressing great complaint about the costs of health care of the day, and “blamed” the root causes as being that we had too few hospitals and doctors, which set up the policy of greatly expanding medical school enrollment and hospital capacity, on the theory that more “supply” would have the benefit of driving down prices and cost. Subsequently we discovered that there was considerable elasticity to the number of conditions this expanded provider community could treat at someone else’s expense.

          Don’t think the “smartest” people have grasped the true nature of health care costs, and we will not find a sustainable solution until we do. As you point out the larger public senses this and thus the reservation about reform.

  • Steve Buckstein

    Stephen and Dean: your discussion of whether the “rich” should pay more taxes to pay for “others” health care misses a key point:

    According to IRS data released last year, “people in the bottom fifth of income-tax filers in 1996 had their incomes increase by 91 percent by 2005. The top one percent — “the rich” who are supposed to be monopolizing the money, according to the left — saw their incomes decline by a whopping 26 percent. Meanwhile, the average taxpayers’ real income increased by 24 percent between 1996 and 2005. “

    These data contract the claim that the rich are getting richer while the poor are getting poor. Why? According to economist Thomas Sowell, “most Americans do not stay in the same income brackets throughout their lives. Millions of people move from one bracket to another in just a few years. What that means statistically is that comparing the top income bracket with the bottom income bracket over a period of years tells you nothing about what is happening to the actual flesh-and-blood human beings who are moving between brackets during those years.”


    This reality, coupled with Stephen’s point above that the economy did well when marginal tax rates were 70-90% because nobody actually paid those rates says a lot about what’s wrong with the current debate about who should pay for some shiny, new national health care reform plan.

    • Stephen Gregg

      Very interesting. Nothing is what it seems or what we are instructed to believe.

      • dean

        Steve…Sowell’s use of the IRS stats to counter the Census stats is a stretch. Yes, some people are temporarily poor until they get their degree or get a business up and going. And some rich people blow or squander it.

        But the story of growing income inequality can’t be dismissed that easily. Wherever they come from, and however they get there, the median income in America is about the same as where it was, adjusted for inflation, in 1973. Half the population of America (statistically) has seen no gain in over 30 years. This is a rather unique period in our history. National productivity went up 50% over that same period. Some of that productivity gain should have raised median and below incomes, but it did not. A relatively small amount went to the 50-90% group, and a whole lot went to the upper 2%.

        What happened? I think Reaganomics happened. The top marginal tax rate went from 70% to 35%. Industrial unions were broken and new ones have not expanded much into the service industries. A wave of undocumented workers has made organizing very difficult. We raised college tuitions and expanded prisons.

        However Sowell wants to spin it, we have an increasing percentage of poor people to deal with on our hands. We can ignore them, blame them, imprison them, let them die in the gutter, subsidize them, or come up with policies that give them a boost to where they can better fend for themselves. But we can’t spin them out of existence. We also have a stagnant middle class with declining prospects.

        I don’t pretend to have the answers. But I think pretending the issue is not really there is a big mistake.

        • Stephen Gregg

          Dean, you seem to me to have a conflict between viewing yourself as “very open” minded and yet simply select the data you want to hear and dismiss what you don’t want to hear as “spin”. Somewhat paradoxical with an open mind and a microcosm of the intractable attitudes of too many. As a Democrat in a State led by Democratic governors for a very lengthy time, it is interesting to me that there is virtually no accountability for Oregon’s slippage in state rankings on average personal income. If all states function under roughly the same Federal constraints, why is Oregon under Democratic leadership losing position on average income? I know in your mind it is someone else’s fault and certainly never, never, at the doorstep of a Democrat. The old “bait and switch” game. We are severely off subject, philosophizing and talking about nothing that will offer Oregon a game plan to solve its own problems and take responsibility for it. The “crappy” Republicans in Washington DC have been signaling flexibility and practically begging for actionable State leadership on health care to the consequence that about a dozen or more states are much further down stream on this subject than your party has executed on here. Your party wants to set the agenda as philosophizing about health care as a right deferring on all the realities to no productive end, other than a statement of philosophy and more contentiousness. I think the leadership absolutely stinks; it has for sometime; and it is on your party’s watch. Is that a “pragmatic view” or do we shift the blame somewhere else?

          Respectfully Dean, it is “BS” behavior.

          • dean

            Stephen…you are right, we have drifted. But what the heck. I don’t know why Oregon’s “average” income has slipped relative to other states. It could be policies of our Democratic governors. It could be the tax cutting initiatives we passed that have allowed our schools to slip, particularly our higher education, which is a key prerequisite to higher incomes. I could be the decline of our timber industry, which was very unionized, with well paying, good benefit jobs for people without much education. I’m a liberal Democrat, but that doesn’t mean I think elected Democrats have all the answers, or that every policy they adopt is a good one.

            When I look around nationally, I see generally higher incomes, higher education levels, and lower prison rates in the higher tax, more unionized northeastern and upper midwest states. I see lower incomes, lower education, and higher prison rates in the lower tax, less unionized south. Oregon used to be more like the northeastern states tax and spend wise, but is now more like the south, so income slippage should not be unexpected.

            Honestly Stephen, I have heard zilch from national Republicans on health care. During the recent campaign, I listned to the REpublican debates and heard a lot about deporting illegal immigrants, sealing the border, continuing the Iraq occupation, threats against Iran, and cutting taxes. I heard next to nothing on health care other than “free market” bromides. Romney all but ran away from his own state’s initiative, which had been held up as a possible model, but appears to be floundering on the lack of cost containment.

            When Kitzhaber was governor he put the Oregon Health Plan forward, over the objections of most Republicans if I remember correctly. They stripped the employer mandate that would have resulted in near universal coverage. In the years since, I have not seen any serious proposals on health care from state republicans. Other than “free market.”

      • Steve Buckstein

        Stephen (and Dean), with regard to “what we are instructed to believe” I’m reminded of a comment by that famous dead economist John Keynes:

        “…the ideas of economists and political philosophers, both when they are right and when they are wrong, are more powerful than is commonly understood. Indeed the world is ruled by little else. Practical men, who believe themselves to be quite exempt from any intellectual influences, are usually the slaves of some defunct economist. Madmen in authority, who hear voices in the air, are distilling their frenzy from some academic scribbler of a few years back. I am sure that the power of vested interests is vastly exaggerated compared with the gradual encroachment of ideas. Not, indeed, immediately, but after a certain interval; for in the field of economic and political philosophy there are not many who are influenced by new theories after they are twenty-five or thirty years of age, so that the ideas which civil servants and politicians and even agitators apply to current events are not likely to be the newest. But, soon or late, it is ideas, not vested interests, which are dangerous for good or evil.”

        Fortuately, Dean, Thomas Sowell is still very much alive.

  • Stephen Gregg

    Dean, as I stated before I think Republicans are guilty as charged, but they are not the party in charge in Oregon. “Trying harder” and “doing things” does not constitute legitimacy as if this is a game of accumulating points. As is the case in medicine, sometimes there is wisdom in doing “nothing” as frustrating as that might be. This could make the Republicans “right” for entirely the “wrong” reasons.
    Republicans will rationalize that it delivered drug coverage to seniors, and at least gave us the programmatic option of HSAs. Not sure what Clinton delivered in 8 years, nor do I treat any of the current pontification as anything more than a setup for more incremental tweaks to status quo. Again, Dean, it seems to me that you are more interested in rationalizing your support for the Democratic party line, than dealing critically with the task of sustainable reform. Look at your own notes, as others for their interpretation of your thoughts. You clearly do not want to deal with the cost issue.

    OHP failed not because it fell short on the employer mandate which its remaining advocates wish to blame, but rather because its tepid and overly promoted imagery of cost containment did not deliver the goods. Obligating more people to play the game does not change the underlying economics. If anything, the naked truth would probably disclose was that an ever increasing cost shift by OHP on to the private sector since its inception had more to do with its perpetuation than its “world recognized rationing”. The adoption of OHP has complicated our ability to deal with the future, and make no mistake most Oregonians have not come to terms with the real causes of its failure, as it is such an affront to our “bragging rights”.
    Forget our respective “arm chair” analysis of OHP, why after spending billions of dollars for program, has not the current governor called for an arms length, independent, and qualified analysis of “what we should have learned”? The unvarnished “truth”. Probably have spent about $10 or $20 Billion over the life of the program. How about a first rate, $500k consulting study? Would scare the b-jesus out of too many people.

    • dean

      Steve…did I imply Sowell is dead? I did not mean to if I did.

      I’m very much with Keynes statement. But it cuts in all sorts of directions, don’t you agree? Any party could use it to advance any idea, well baked or half baked.

      Stephen…I’m no historical expert, but Clinton managed to get the SCHIP (sp?) program and portability passed through a quite hostile Republican majority. Other than that…nothing I can remember. But lets also acknowledge that the R strategy in 93 was to defeat the Clinton health care proposal at all costs so as to use the defeat as a club to win a House majority. And it worked. They would not accept a single compromise, if I recall correctly. And after a 12 year reign, including 7 with the Presidency, what did they put forward? Health Care Savings Accounts as another tax break for the upper middle class and wealthy.

      I appreciate that you feel “trying” is not good enough. Fine…but not trying and blocking others while the ship flounders is callous politics, in my opinion.

      You are right that the current proposals by Clinton and Obama are esentially further incremental reforms, though they are significant in a few respects. They represent what is probably the outer limit of what can be done at this time, unless we get a big wave in 08, increasingly possible if Obama is the nominee.

      You mischaracterize my position by saying I “do not want to deal with the cost issue.” My position is that I don’t believe the present Dem proposals adequately deal with the cost issue over the long term. They probably will have some short term cost savings, i.e. low hanging fruit like allowing Medicare and Medicaid to negotiate drug prices.

      The problem of longer term cost control, as you have pointed out so well, is that at the end of the day it means restricting the cash flow into a whole lot of deep and greedy pockets. Politically, if one attempts too much restriction at the front end of reform, one gets too much resistance and nothing gets done. I look for a slower cost squeeze to happen, bit by bit over time. What shape this takes, and how quickly it happens depends on the extent to which medical inflation continues its rampage through our economy.

      I’m no expert on OHP. It seems to me it was never adequately funded or implemented. It did initially expand coverage to many more people, but medical cost inflation combined with flat spending has gradually bled it to death. I just don’t see how any individual state can effectively slow health care cost inflation unfortunately. Maybe California could, given its size. But not Oregon.

      I’m fine with spending money on an audit of the OHP if it would do us any good. I’m just not sure it would do us any good, particularly if the solutions ultimately lie at the national level.

      • Steve Buckstein

        Dean, no you did not imply that Sowell is dead. I made the comment that Sowell is alive simply to contrast with Keynes’ self-described “defunct” status, and to contrast with other “defunct” economists whose views, in my opinion, carry too much weight with the left.

        • dean

          Interesting. I’m trying to find an economist who carries any weight with “the left” these days other than Paul Krugman.

          • Steve Buckstein

            Dean, that’s an interesting observation. Doesn’t Karl Marx carry any weight with the left these days?

          • dean

            Steve…I suppose it depends on how far left you want to go. But seriously, as I think about it, there seems to be a coalesence around a group of moderate to liberal economists like Krugman and Robert Reich among others. In summary: free trade policies need to be better calibrated with labor & environmental rules, taxes should be raised at the upper ends a modest amount, much more spending is needed for education at all levels, unionization of service and retail industries needs to be made easier, and we need to mend the tears in the social safety net, particularly health care.

            Its not socialism. Just a moderation of hyper capitalism. Nothing to get too worked up about. Just a modest rollback of some aspects of Reaganomics.

          • Joanne Rigutto


            You can unionize all you want, but in the end we’ll still be competing with other countries that pay less in the manufacturing end of things, and the service industry providers will still be competing against employers who hire illegals, or who are hiring legal workers but aren’t unionized. And here’s a new twist to the service sector – I’m involved in a joint venture with another contractor for some public money construction. We teamed and bid against other contractors some who are union and other contractors who are nonunion, but they all have employees. We were able to beat their bid because we don’t pay workers comp, unemployment comp, etc. as we are exempt contractors – no employees – and don’t have their overhead. This is a situation similar to what we’re in with international trade. We have all these requitements over here and higher hourly wages to boot, and over in most of the countries we import goods from they don’t. When we import from the EU member nations or Canada, we’re playing on a more even field as their wage and benefit levels are closer to ours, some perhaps even higher. But when we compete against some Asian, South/Central American or African countries, we’re toast.

            You can’t even the playing field with terrifs, WTO won’t let you do that and it would violate a lot of other trade agreements that this country’s officials have signed for us. The only thing I can see to fix the trade imbalance and it’s associated drawbacks for workers and others in this country, would be to withdraw from the WTO – ain’t gonna happen, just like people say we should withdraw from the UN, that ain’t gonna happen either – or take the social issues regarding workers and the environment into consideration when writing or negotiating new trade agreements. I think that the environment angle will fly, I believe that environmental hoops are already in some of our trade agreements anyway, but on the labor issue, how are you going to do that? And then there’s the matter of enforcement. You know we have strict requirements for food, feed and their components what are imported into the USA. Unfortunately we also accept other countries’ inspection and regulation standards as equivelant to our own. Which means that we don’t find out about something going south until a problem occurs. We don’t have enough inspectors to bird dog all of our trading partners so it’s real easy for our trading partners to pay lip service to our regulations and go about business as they always have. Remember the melamine contamination in the Chinese products?

          • Stephen Gregg

            Dean, getting the subject back to health care, how would you feel about solving the financing of the uninsured by “normalizing” the tax dollars allocated to health benefits for public employees? Reallocating the “savings” to those with “nothing”. As I understand it, Oregon is one of only four states nationally that elects to pay premiums for the employee and dependents. Not suggesting that they be cut off at the knees, just brought in line with the rest of the world. Wouldn’t this have the makings of an interesting referral to the voters for approval? On a more constructive note, wouldn’t it be something to see public employees lead on this matter departing from a position of self sacrifice to achieve the goal? Perhaps with that kind of break out leadership, others could be brought to the table, rather than just evilized.

          • dean

            Stephen…I’d feel fine about it, except not through an initiative. It should be negotiated contracturally. And I would expect initially we would have to be willing to raise pay to get that deal done. If we can make it part of a larger health care proposal, like your approach, then it is a good basis. But as a Sizemore style bash the public unions ballot measure, forget it. Dead on arrival.

            Joanne…very good analysis. No argument, except that most service, construction, and retail jobs can’t be off-shored, which is why it is so important to either unionize, or find other means to get wages and bvenefits in those sector high, so that the rest of us can stop subsidizing large companies who make their profits on the backs of low wages and benefits while we have to deal with the social problems of poverty.

            On balance I support free trade, but we have to get better agreements done that set labor and environmental floors and ratchet them up over time. he Europeans and US have the economic and political clout to easily accomplish this if our leaders choose.

          • Stephen Gregg

            Time out. So we would have to “buy out” the deal with public employees to get them down to a level of parity with all the other stiffs, just as our Governor and public employees offered smoker’s a salary increase or tax credit in exchange for the proposed assessment on cigarettes to finance children’s health care? You must be a public employee or at least a PERS beneficiary. The point of this straw man is to point out the bankrupt view of simply identifying some highly select group to finance your desires to feel good at someone else’s expense. We could also apply an income tax to all the non profit hospitals in the state who would no longer have much of a “charitable” purpose with the adoption of universal insurance. “Administer the pain to anyone but me” seems to be the philosophy. It is a hopeless discussion as it is just endless rationalizations and deferral. Don’t see that you would be someone who the “right” could work something out with. As long as there is a Bill Gates in the world, you would always feel there is an incremental tax that can be applied. If you are a public employee, why not start off by expressing the pain you would advocate to be applied to public employees as their share of solving the uninsured AND what they should absorb if costs go up 10%?

          • Chris McMullen

            Raise spending on education?? What are you nuts, Dean? We already spend more per student than almost every industrialized nation — with worse results!!

            As Einstein said, the definition of insanity is doing the same thing over and over again, expecting different results.

            Our public schools are run by the largest labor union in the world, and we have inefficiency and under educated students to show for it.

            We don’t need a ‘rollback’ of Reaganomics, we need an increase in Reaganomics. Do you know Dean, that government regulation adds over a trillion dollars a year to the cost of doing business?

            Just how is paying our labor base more money — adding to the largest cost of production — going to make us competitive in the global marketplace??

            I swear you must be starved for attention. No one can actually believe such inane statements.

          • dean

            You answer is to pay Americans LESS so we can compete with China? That is a winning political strategy Chris. Mazeltov.

          • Chris McMullen

            Great idea Dean. Let’s all pay $500 for a clock radio so union members, and especially their union bosses, can get paid more than market rate. That’ll really help all those unwashed masses you keep blubbering about.

            In case you haven’t noticed, Ford and GM are on the verge of bankruptcy mainly because of their continual bending-over for labor unions over the years.

          • dean

            Okay Chris…if that is your program…I’m cool with it.

            But some might argue Ford and GM screwed up when they decided that gas guzzlers were the wave of the future. Others might say tying health insurance to employment instead of having a single payer system like our competitors has something to do with it. We are down to what…9% of our private work force unionized, so lets make the auto workers walk tehhplank next. Meanwhile Canada still has 30% unionized and they seem to be kicking our butt of late.

            But I like your program Chris. its a political slam dunk. More free trade, lower and lower wages, no health care, cut school funding, and save money at WallMart. Make it your party platform and you will sweep in 08.

          • Chris McMullen

            How typical of Dems like you, Dean — pander to the under class with promises of ‘free’ health care and high paying union jobs. Pay no mind that our ‘entitlement’ social programs have been abject failures — just make people more dependent on big gummint and they’ll have nothing to worry about. Don’t concern yourself with market trends or human endeavor, just succumb to the Danish way of thinking and be happy with abject mediocrity.

          • dean

            Chris…the Danes? What’s not to like? What is their poverty rate? Crime & imprisonment rate? Health statistics? Union membership %? Median income? Why get your undertoj (Danish knickers) in a twist over the freindly, peace loving Danes?

            Small correction. I never said “free” health insurance. Universal health insurance will not be free.

            Whether union jobs are high paying or not depends on the union and the industry they are in. I would like to see us make it easier for workers to organize, and leave it to them to cut their own deal, free of the fear of being fired for organizing. In cities where hotel workers are organized, like Vegas and SF, chamber maids earn $20 or more an hour with benefits. In cities where they are not organized, they get minimum wage and no benefits.

            Chamber maid jobs cannot be off shored. Ask yourself, aren’t we better off as a society if we have maids earning enough that they don’t need welfare or food stamps or subsidized health insurance for themselves and their kids? We can have this at the cost of a few extra bucks for a room, usually paid by business travellers.

            Extend that to WallMart and so forth and you can have a society of economically self-reliant people. Isn’t that what you want at the end of the day?

            Afsked Chris (Danish for goodbye).

          • Chris McMullen

            Denmark is a very homogeneous society of only 5 1/2 million people with the GDP equivalent to the state Indiana. Comparing, or worse-yet modeling, the U.S. (with our 3rd largest in the world population, huge landmass, world-leading GDP and super-diverse culture) is just plain stupid. Compounding the fact those “peace-loving” Danes were run over by the Germans in WWII and subsequently rescued at a great cost to the U.S. should keep them humble and kissing our butts. And don’t forget our investment in the cold war that kept them from being invaded by the USSR.

            Cleaning hotel rooms is, and always will be, a no-skill job. If maids in Vegas get paid more through market-forces (ie the willingness of Vegas hotel owners to pay them more) then so be it. The big difference is businesses are free to choose how much they pay employees without the gummint mandating compensation or union involvement.

            Once again Dean, do you compensate your employees with prevailing wage rates and insurance? Or are you once again hypocritically going to dodge the question?

          • dean

            Chris…was I mistaken or were you the one who brought up Denmark in the first place?

            We (the US) bill ourselves as the richest nation on earth. Yet you are afraid to compare us with others on results? I find that interesting. Plus…before you diss Demark any further, I believe they were among the “coalition of the willing.”

            Assembly line work is also low skill, but as you pointed out, our diminishing number of auto workers make good money.

            About 50% of the total jobs in the US cannot be off shored. Many of these are non-union, low skill, and low paying, but often hard and tedious work. To the extent we are locked into completing the transition away from manufacturing to a service and retail economy, we should support policies that raise wages and benefits in those sectors.

            I did not say the government should unionize hotel workers. I did say they should make it easier legislatively for those workers to organize themselves, and then the hotel owners can negotiate with a union rather than a bunch of individuals who are stuck with what they are given.

            The alternative is increaasing poverty and/or subsidies. Many Wallmart employees qualify for Medicare, so in effect you and I are subsidizing the profitsof the largest corporation on earth. Are you okay with that?

            It is not hypocritical to not answer a question that is none of your business in the first place Chris. So once again…I’ll let you and Rupert keep guessing whether (a) I have any employees, and (b) if I do, how much I pay them. Its great sport. You can keep asking the same question, and I can keep not answering, and you can draw any conclusions that you want.

          • Steve Buckstein

            Dean, you say “Many Wallmart employees qualify for Medicare, so in effect you and I are subsidizing the profits of the largest corporation on earth. Are you okay with that?”

            Fact, only 4.5% of Wal-Mart employees are on Medicare. Remember, virtually everyone over 65 years of age is on Medicare whether employed or not. Another 1.9% of their employees are on Medicaid, and 1.2% are on some other form of state health insurance; not exactly the massive income transfer from us them that big box opponents would like us to believe.


          • Chris McMullen

            The conclusion I draw from you Dean is that your a typical hypocritical liberal that talks the talk, but refuses to walk the walk. Your refusal to engage in reasonable questions just lowers your credibility even more.

  • Joanne Rigutto

    Dean, a lot of the jobs that can’t be offshored are subject to other forces that drive the wages of employees down just as severely as offshoring and the two biggest ones are …..

    Illegals and/or people who are legally able to work in the US but who are willing to work under the table. This is very common in construction and farming both.

    Look at the Fresh Delmonte raid last year. Those were jobs that couldn’t be ‘offshored’ so the offshore labor was brought into the plant.

  • Steve Buckstein

    Update: the special legislative session closed yesterday without passing this flawed resolution. The Senate never even held a committee hearing on “health care as a fundamental right.”

    • dean

      Steve…I’ll accept your figures on WallMart, but will stand by the broader critique that a low wage, low benefit workforce costs the rest of us in multiple ways: higher taxes, higher crime, lower productivity, and more expensive schools (that have to deal with social problems of poverty). We need to come to grips with the decline of the industrial economy and the rise of the service and retail economy. If that is our lot, then we have to find a way to make this more even handed.

      By the way…Senator Wyden is finally making a public push for his health care reform. You should have Stephen post an anlysis of this approach, which attempts to satisfy Democrat goals (universal access) AND Republican goals (freer market with more individual responsibility) at the same time. It could change the whole debate.

      Joanne, I agree with what you say. The question is how to best reduce the number of easily exploitable undocumented workers in our midst. For humantiarian and practical reasons, I support a broad, comprehensive style of reform that allows those already here with family ties and clean records to become documented and to eventually become full citizens if they choose. Massive deportation and border sealing only are impractical and unecessarily punative to people who only came here to work and get ahead.

      • Stephen Gregg

        Dean, I can do a full review of Wyden’s plan, but the short strokes of it, is that it offers the positive quality of “delinking” the employer (code for migrating to defined contribution from defined benefits). It’s critical failures from my perspective is that it attempts reform without including Medicare in the mix (he will attempt to argue otherwise). His second lead proposition is that we should all have a right to the same benefits “as we get in congress”…common democratic refrain. Thirdly, when asked about how costs will be contained, his lead response is “prevention”. It seems to me his willingness to “preserve” private insurance, is more of a concession “to getting something done” than any conviction about it being a more “value promising” proposition. Forgotten what his position on mandates are.

        As contrasted to Wyden, I believe Medicare must be “invited to participate” in a common strategy, which is another reason why “voluntary” is a more essential starting point than “mandatory”….as none of these guys have the “nuts” to impose anything on Medicare. If Medicare is NOT in the mix, its economic influence on any “savings” achieved for the non Medicare world would be profound and likely exploit any of those savings by means of increase cost shifting (reduced provider compensation.

        I believe strongly that policies should encourage reduced dependency on insurance because of its unavoidable costly overhead. That reduction should be appropriate to individual circumstances and not expressed as an entitlement. It is an incredible mistake to codify the private “insurance model” as the only way business will be conducted. Markets organized around exclusive insurance oligopolies is not conceptually sound. As you know, a large part of “my plan” is the creation of a “civic segment” in competition with the private insurance market. I also believe private insurance should be threatened with “self funding” models as contrasted to conventional insurance. What congress has rewarded itself with is hardly a comforting national strategy. I hate to see the concept of “catastrophic” insurance being foreclosed.

        Lastly, as with all Democratic proposals, Wyden’s is remarkably shallow when it comes to a credible cost containment strategy. When challenged about this in Brainstrorm Magazine, the response (same for Obama), was “Prevention” as the lead strategy. That is total “baloney” to me, and I believe you have even conceded to that same view. The difference being that when pushed you accept that, and I would not.

        Those are some of the most salient points.

        • dean

          Stephen…I appreciate that analysis. I would say Wyden’s plan is not “Democratic.” It has equal sponsorship from Ds and Rs, or at least did last time I looked.

          I agree, from what i have read that prevention is not a cost savings. It is a good policy however, if we want to have healthy people, not just insured people.

          But doesn’t Wyden’s plan rely more on “smart consumers” rather than prevention for cost containment? I thought that was why he had gotten Republican support in the first place.

          A good article (liberal persective) on teh Wyden plan is at:

          • Stephen Gregg

            Let me explain the futility of much of the reform posturing currently on the table. Let’s assume you are the principal “reformist” sitting in McMinnville, Coos Bay, Astoria, Medford…name your community. Much hype and expectation has been lent to your cause and you have been given considerable latitude to your efforts…except you have been told that Medicare, all public employees, and all large self funded employers, are to be given a “pass” on your efforts. Your efforts are to be focused on the “others”. And in some models, if the “others” already have insurance, you are to ignore them as well. If it were me, I would not take that job, because it is so patently doomed as “system reform”, and requires hopeless naive tee to “hope” the intent is to capture the others later. This is in effect the “reality” of most reform today. To get where I recommend we should be, I suggest we must commit ourselves for now to a largely voluntary, free will effort that attracts people to a superior mouse trap which they must see as such. After all, if our existing stinks as much as we say it does, should be relatively simple to replace manure with sugar. How wonderful of a constraint to put on architecture…the users must see the “new model” as superior to what they have now. That vital chemistry is missing from all of this. To me at least it is such a profoundly obvious missing ingredient, I never cease to be amazed particularly by the inadequacies of the “smart people”. And I am not steeped in any personal arrogance. Not sure if this makes basic sense to you or not.

  • Stephen Gregg

    I am aware there is bi-partisan support for Wyden’s plan. Let’s put it this way, at a higher altitude, I really do not have confidence in a process centered on “congress as architect”, irrespective of party. Republicans led the way on HSAs while almost totally emasculating through regulation the worthiness of the concept….probably because of the lobbying of private insurance carriers and Dems who hated the concept. It is my view that there is a substantive difference between playing a role of architect vs. enabling innovative initiatives with good prospects. Perhaps the best example of this failure of positioning is the Oregon Health Plan where the state performed the architectural and execution duties and to this day the leadership can’t cope with much other than defending its own errors to the consequence that we will never know what reality is with OHP. Far healthier exercise if the “Wyden-types” put out RFPs for competitive alternatives; picked some most viable alternatives; and helped get the barriers out of the way; and then set up dispassionate and independent evaluation protocols. As a “pragmatist” you might understand that government, when you consider Medicare, Medicaid, public employees, and other interests might be as much as 60% of the cash flow to a provider community. If that government is not going to bring its “client” base to the reform table, you are whistling in the wind. Other than the few major urban markets, without this volume being at the table, it is questionable you can achieve a critical mass, let alone believe that “success” with this small subset could eclipse the status quo of the rest of the market.

    Beyond allowing / insisting on consumers making elections among private health plan alternatives, which most of us do today, I would have to be brought up to speed on what “new smarts” the consumer had to have. I can recall during the HillaryCare hype, Wyden expressing at a small private luncheon, “how wonderful it would be if Portland had 3-4 large systems of care” having systematically removed the more “marginal” players…..that is called an oligopoly and in large part what we have today to little great satisfaction to anyone. In this recent cause, it reminds me that the same mentality shows in that he seems to imply that the smaller players are black hats doing bad things. All of this is a reach, but I guess someone has to be evilized in politics.

    At the bottom line, rather than pick his plan apart, the universal response to all “worthy” proposals should be: PROVE IT in a credible pilot. Then we will talk about expanding.

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