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Classical Liberalism in 2017: The Best and Worst of Times?

It may be a bit of an exaggeration to say that 2017 was the best of times and the worst of times for classical liberalism in the United States but not much of one. Most of the important policies that the Trump administration implemented very substantially advanced classical liberalism. But President Trump’s association with those policies may well discredit them in the long run, because he violated political norms that themselves have a kinship with classical liberalism.

Begin with the positive side of the ledger in descending order of excellence. First, as has been detailed elsewhere, Trump’s appellate judges are superb. Almost to person, including most importantly Justice Neil Gorsuch, they are originalists. And the original Constitution with its structural checks on government power and protection of designated liberties is conducive to classical liberalism. Moreover, the methodology of originalism is itself the only judicial philosophy consistent with classical liberalism. Non-originalism necessarily gives arbitrary and discretionary authority to other governmental actors, mostly judges—the very kind of authority that classical liberalism abhors.

Second, the Trump administration generally performed well on both the substance and process of regulation. As to process, many cabinet officials, including the Attorney General and Secretary of Education, have made it clear that they will not issue guidance statements that have the effect of regulating citizens without requiring agencies to go through a notice and comment procedure that guarantees some measure of popular input.  This is an unprecedented counterpoint to the progressivism that wants to give ever more administrative power to the centralized bureaucracy. As to substance, the Trump administration has engaged in much appropriate deregulation and halted many unwise regulatory schemes of the previous administration.  One area where there may be overreaction is environmental regulation. Classical liberal governance should prevent businesses from imposing external costs, such as pollution, on third parties, and prudent regulation in this area is warranted.

Third, the tax reform just enacted is on balance beneficial. Our very high corporate rates made it harder for our businesses to compete given the rates abroad and the reform sensibly concentrated on reducing those rates as well as giving some more modest rate reductions to almost all individual taxpayers.  And the bill does close some loopholes for high income earners, like substantial deductions for mortgages and for state and local taxes. The latter change also promotes competitive federalism, our Constitution’s classical liberal gem.  Still even with substantial supply side effects that we can expect from tax reductions, the bill will not wholly pay for itself and thus adds to the debt.

And that reality highlights the greatest missed opportunity for classical liberalism this year—the complete failure to address our growing debt which is driven by burgeoning entitlements. And just as Trump deserves more credit than he is getting for the policy triumphs of the first year, he also deserves blame for taking entitlement reform off the political agenda. And he had the ability to take the lead by arguing that the most important reductions should be Social Security and Medicare for upper income tax payers like himself. Such cuts would have made it easier to sell rationalization of Medicare and Medicaid to get more bang for the buck.  Cutting taxes without reducing the deficit makes future tax increases or inflation more likely.

While Trump’s decision to exit the Trans-Pacific Partnership was also an economic policy debit (and a national security mistake as well because it could have helped knit together an Asian alliance against Communist China) it is of relatively minor significance. At least so far, the President has not substantially disturbed NAFTA or GATT—treaties that have both increased economic freedom and led to greater economic growth. Freer trade was historically a hallmark of classical liberalism and remains an important component.

But far worse than any policy error for classical liberalism, has been the President’s conduct in the office. He has told falsehoods via Twitter and through his spokespeople. He has written demeaning tweets, including a veiled threat against a broadcaster’s license, that are beneath the dignity of his office.  These are also affronts to classical liberalism. First, classical liberalism contains a commitment to truth seeking and empiricism. It is not an accident that the great founders of Anglo-American classical liberalism, Adam Smith and David Hume, were also proto-empiricists: openness to evidence promotes good policy.  Second, classical liberalism’s respect for the individual and distrust of authority makes it incumbent on leaders to treat their fellow citizens with respect, including of course respect for their constitutional rights.

Lest one think that my concern with the President’s public behavior represents an excessively intellectual prissiness on my part, this behavior also imposes concrete harms on classical liberalism’s prospects. Many citizens do not spend a lot of time following politics, and their respect for office of the Presidency creates an aura of good will for the occupant’s policies. But for many such Americans, the President is squandering that advantage.  As a result, they are more likely to think ill of his policies. Tax reform is a case in point. While almost all taxpayers will benefit from this reform, it is nevertheless polling very badly, and many think (falsely I believe) that these tax cuts have as their objective helping Trump personally. Low taxes and the economic freedom they bring are a cornerstone of classical liberalism and one of its few consistently popular policies.  It is measure of the President’s personal failure that he has contributed to public disdain for one of his great policy successes.

Reader Discussion

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on December 29, 2017 at 05:33:21 am

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Classical Liberalism in 2017: The Best and Worst of Times? – Top 100 Blog Review
on December 29, 2017 at 08:55:48 am

"Many citizens do not spend a lot of time following politics, and their respect for office of the Presidency creates an aura of good will for the occupant’s policies. "

REALLY?

I suppose the infantile rantings of Antifa, and PinkPussy Hats, and a thousand more evidence this deferential respect for the occupant of this High Office.

No, it is about time that someone from the Right side of the aisle refused to accept the countless slanders, distortions and invectives hurled against them BECAUSE as you say, John, ""Many citizens do not spend a lot of time following politics"; consequently, they are more likely to accept these slanders propagated by the organs of communication.

BTW: Have you ever heard of Harry S. (Give 'em Hell) Truman? Seems he got along just fine.

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gabe
on December 29, 2017 at 09:26:35 am

"Many citizens do not spend a lot of time following politics" exactly and thus get their information from television stations like CBS, NBC and CNN. Guess what they are all vehemently ( see recent studies ) anti-Trump and the public gets biased news. Hence the Twitters. All future presidents especially Republican presidents will use Twitter.

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otto
on December 29, 2017 at 10:35:03 am

Sounds like George Will complete with academic pretension and insipid historical analogy.

Wow: accusing Trump of 1) repudiating the "proto-empiricists" (what does that mean???) and 2) undermining Hume's and Smith's "openness to evidence... respect for the individual and distrust of authority (and respect for) their fellow citizens... including OF COURSE respect for their constitutional rights."

HaHa. There's a theory of moral sentiment for you. Downright newspeak. The Democrat's Ministry of Truth couldn't have used fewer words with less less meaning to distort more reality.

Of such stuff, all dressed up in George Willian ostentation, were the Bushes made.

And they gave us Bill and Hillary and Barack.

Get real, man. It's a war we're in.

Yes, Trump's a pig, but he's OUR pig, and he's (the only one?) fighting the bad guys.
For conservatives Trump's marching in the right direction, and he's "facing fearful odds ( fighting) for the ashes of his father and the temple of his gods.''

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timothy
on December 29, 2017 at 11:42:32 am

Certainly moralists should be empiricists, but morality does not depend on what does or doesn't exist. Whether or not there are gods, or atoms, or polar bears--or whether or not they've gone extinct even if they used to exist--does not change what is moral. We would still believe in equality, free speech, and prohibitions on rape and murder regardless of whether or not we believed in gods or atoms, or whether or not polar bears continued to exist or went extinct. Its these a priori moral principles that are the foundation of law. The court room requires empiricism to come to a just verdict, but it is a priori morality that requires that the it is a speedy, public trial by jury of one's peers. It is morality, not empiricism, that tells us that we must give people a lawyer and presume their innocent until proven guilty beyond a reasonable doubt (by empiricism!).

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Adam Hume
on December 29, 2017 at 11:51:41 am

John McGinnis writes that "the original Constitution with its structural checks on government power and protection of designated liberties is conducive to classical liberalism."

Over the past months, I have had several opportunities to discuss the evidence that the original Constitution was rooted in classical (Ciceronian) natural law philosophy, which would appear to be antithetical to classical liberalism.

For example, "liberty," in the natural law tradition as understood by the American founders, meant freedom from internal compulsions as well as freedom from coercive abuses of governmental authority. Liberty meant the ability to follow the law of nature, starting with the Golden Rule: Do unto others as you would they did unto you. Benevolence was the pathway toward happiness, and the "pursuit of happiness" meant developing the habit of doing good to others.

John Stuart Mill, who "inherited" his father's position as the intelligence chief of the genocidal, dope-peddling British East India Company (whose earlier parliamentary bailout precipitated the Boston Tea Party, setting the colonies on their course toward revolution and independence), followed in the footsteps of Adam Smith and John Locke (both toadys of leading British oligarchs), undermining the classical understanding of liberty.

Mill's definition of ability to do whatever you want as long as you don't harm others ignores sexual self-restraint as a fundamental component of liberty. Lust, in the Founders' Ciceronian natural law tradition, was one of the "four disorders of the soul" (together with distress, fear and ecstasy) that prevent the attainment of happiness. John Adams, at the beginning of his autobiography, commends "innocence" to his children because it enables a clean conscience, a prerequisite for happiness. A clean conscience is part of "internal peace," one of the elements of happiness that Adams wrote into the Continental Congress's May 1776 independence resolution, together with "virtue" and "good order" (being the absence of the above-mentioned disorders of the soul).

Classical liberalism, as opposed to John Adams once again in the 1780 Massachusetts Constitution, ignores or rejects the importance of the government in encouraging virtue in the population, as a way of "promoting the general welfare," and of course happiness, according to the Founders' legal light Sir Edward Coke, was the "summum bonum" or the highest good. The happiness of the people, according to Chief Justice Marshall in Marbury v. Madison, was the starting point for understanding the American federal system.

My point here is that an originalist approach to the Constitution seems to be antithetical to the British Empire's classical liberalism.

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John Schmeeckle
on December 29, 2017 at 13:30:22 pm

John:

Very, very well said.

It is the transformation from the *pursuit* of happiness, with the attendant self-restraint necessary for a fruitful and virtuous life, to the neo-Hippocratic oath of "do no harm" and any and every thing is not only possible but to be encouraged that has brought us to the sorry state in which we now find ourselves.
How often do we read in these pages that "so long as you hurt no one, you are free to do whatever you wish." This sentiment is expressed with little or no regard for the, at times, fateful consequences of an unbridled pursuit of the baser appetites. Indeed, those consequences, both to the self and those not deemed worthy of personhood, are to be willfully ignored / denied such that we now have legions of citizens, exalting, in their neo-liberal epistemology, the slaughter of innocents, the corruption of youth with theories / practices that seek to deny the natural limits of our nature, indeed, of the fixity of gender / family, etc.

No the Founders were better psychologists / sociologists than the best coming our of The New School BECAUSE they recognized that some limiting principle must obtain if the people are to prosper.

One wonders if the ensuing abundance emanating from the Smithian economic world view / practices may be said to be a contributing cause to the consequent denial of "self-imposed and recognized constraints upon behavior and appetitites.

One also wonders if McGinnis and his fascination with "free trade", the rallying cry of those who posture as the true liberals, is not in some way related to his inability to consider that to the Founders, "virtue" was an absolutely essential condition, a sine qua non, of effective and proper governance.

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gabe
on December 29, 2017 at 13:37:36 pm

Good post. If I may, a couple of observations:

There is an important subset of things the average citizen takes as true that affects liberty, and these are things taken for granted. It is, for example, taken for granted that the advantages that classical liberty provides are unaltered by recognizing the special pleading and identity politics that are contrary to them. It is taken for granted that ideologically driven regulation will not have unintended consequences that eventually will be to the detriment of its short-sighted proponents. One can only imagine the things that the Venezuelan Chavistas took for granted.

It is quite proper to discuss the role of reason and empiricism, and their relationships to the benefits of classical liberalism. However, there is another class of policy motives that are derogatory to to classical liberal principles: appeals to emotion. Whereas empiricism makes use of appeals to evidence and reason, it is in danger of being marginalized by appeals to emotion. This leads to silly but destructive notions such as feelings are more important than facts, that words are violence and vice versa, that "safety" is assessed with regard to self esteem, and that disagreement with a pleasant delusion can only be motivated by hate.

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z9z99
on December 29, 2017 at 13:41:10 pm

And speaking of morality versus "do no harm", here today, as EVERY other day for the past three weeks, there is a story of a "do no harmer" unable to control her appetities and engaging in relations with a minor:

http://www.foxnews.com/us/2017/12/29/substitute-teacher-23-accused-having-sex-with-two-students-including-14-year-old.html

What in the world has become of us?
Oh yeah, we "do no harm" - that must be it.
Then again, it has been almost four decades since I had any regard for the teaching profession - as they are the ones who inculcate this insipid and muddleheaded philosophy into the minds of our young. And if one has been following the news, Surprise, Surprise - it is female teachers leading the way in the exciting new field of "teen sexual introduction."

No, I am not a prude; I just think one should exercise some restraint and leave children alone. Hey what do I know - she (and the others) may have been sex-education teachers.

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gabe
on December 29, 2017 at 16:36:35 pm

If I might suggest here Harmonizing Sentiments. I don't generally push my own stuff, but when we start asserting that classical Liberalism is just about Mill, or that the Founders meant unalloyed ancient liberty, then I think it bears reconsideration.

Saying that the ancients were all about governing the passions is great. And it certainly is true that this notion was also part of what Smith and other Scots meant by self government. But the ancients hardly succeeded in fostering what they advocated.

What the Founders recognized as the crucial failure of Greece and Rome, including John Adams, was exactly what the great classical liberal historian Lord Acton would later put thus: Power tends to corrupt and absolute power corrupts absolutely.

If you wish to call it Old Whig thought, I'm fine with that, too.

The solution the Founders hit upon was not a one size fits all answer. Rather it was that different communities in different states should and could tackle these problems of self governance in their own ways.

This was both a recognition of the necessity to limit government and give space to voluntary associations and communities of all sorts.

I would also recommend two other essays: "The radical Double Entendre in the Right to Self-government" by Joyce Appleby, and Norms of Liberty by Doug Den Uyl and Doug Rasmussen.

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Hans Eicholz
on December 29, 2017 at 22:19:04 pm

JMc: "While almost all taxpayers will benefit from this reform, it is nevertheless polling very badly, and many think (falsely I believe) that these tax cuts have as their objective helping Trump personally."

That statement betrays an ignorance of both tax law and economics that is both breathtaking and willful. Everyone has already run the numbers, and you'd have to be living under a rock to not know the outcome. E.g., https://www.nytimes.com/2017/11/30/business/trump-benefit-tax-cuts.html

As for the people benefiting generally, that is equally ludicrous. Anyone can live beyond his means for a while by maxing out the credit card, but sooner or later, the bills come due. The promise that trickle-down economics will actually work this time has been conclusively disproven by history; all we have to show for it was the trebling of the national debt under Reagan, the quadrupling of it as a result of Bush #43-era policies that the Dems couldn't undo, and the recent failures of Kansas and Louisiana.

Bottom line, Republicans despise the poor, elderly, and unfortunate; they would much prefer that Grandma choke on dog food while freezing in the dark than provide a reasonable social safety net. And people get that. This bill polls so horribly because people are saying--and quite correctly: "My small tax cut will be used as an excuse to cut my future Medicare and Social Security benefits, and Medicaid might not be able to cover my parents' final years in a nursing home."

We don't have the money for badly-needed infrastructure or to care for the less fortunate because the donors who bribed the Republicans needed more money to buy French impressionist paintings. The Republican Party has systematically dismantled America, and there is nothing left but a rotting shell.

And John McGinnis calls this a win?

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Alana
on December 30, 2017 at 10:39:33 am

I think we need to try to understand the moral markers that each of us brings to discussion.

I hope always to attempt to do this at the very least, and resist the all too powerful temptation to partisanism of whatever sort. I know John and this is not him.

Perhaps in a later post we can explore the reasons for our different views of such basic issues.

And I wish to you all a better and more understanding New Year.

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Hans Eicholz
on December 30, 2017 at 14:58:25 pm

Really?

"As for the people benefiting generally, that is equally ludicrous. Anyone can live beyond his means for a while by maxing out the credit card, but sooner or later, the bills come due. The promise that trickle-down economics will actually work this time has been conclusively disproven by history; all we have to show for it was the trebling of the national debt under Reagan, the quadrupling of it as a result of Bush #43-era policies that the Dems couldn’t undo, and the recent failures of Kansas and Louisiana."

Your own comments should *permit* you to recognize that "income" and "expenditures" are not inextricably bound.

If the government, in particular, as during the Reagan Administration, a certain faction within the government, say Tip O'Neill and his spend-happy cohorts, control the purse, and proceed to extract "compromises" from the President, the nature of such compromises being promises to fulfill funding commitments, made by O'Neill and his ilk, to social welfare programs, THEN it is similar to YOUR comment re: credit cards. Just as the wage earner, in receipt of a tax reduction, may then, and separately decide to max-out her credit cards, so too our political masters, in service to some delusional notion that they, and they alone, know best how to handle the peoples monies AND solve the peoples problems, may decide (and historically have done so) to MAX OUT the government credit card.

The fact that revenues to the Treasury grew quite significantly (overall) during the period ONLY highlights the inability of our political masters to control BOTH their appetites and the PEOPLES appetities - but let us not assume that the former is the cause of the latter.

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gabe
on December 30, 2017 at 16:29:56 pm

Perhaps you would be happier if we didn't HAVE a country, Gabe.

Why should you spend MY money on a common defense? After all, l know how to spend my money better than you do. We really don't need a country, if what you say is true.

l take comfort in the fact that you know next to nothing about economics. Bruce Bartlett can explain it to you in "I helped create the GOP tax myth. Trump is wrong: Tax cuts don’t equal growth." https://www.washingtonpost.com/news/posteverything/wp/2017/09/28/i-helped-create-the-gop-tax-myth-trump-is-wrong-tax-cuts-dont-equal-growth/

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Alana
on December 30, 2017 at 16:32:21 pm

There are many reasons to go into debt. Some are better than others. This tax bill was nothing more than a train robbery.

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Alana
on December 30, 2017 at 17:34:54 pm

"Perhaps you would be happier if we didn’t HAVE a country, Gabe."

What in the world are you talking about? I simply state that "revenues" and "spending" are TWO different phenomena and that our political "betters", or perhaps, that should be "bettors", are unable to recognize that in their zeal to fix any and everything they perceive as a problem, have willfully ignored the overdrafts on the government credit card (again, YOUR example).

I may not know much about economics BUT I do know what is required to balance a checkbook AND I have stayed at Holiday Inn Express - Ha!

Have a comforting New Year!!!!

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gabe
on December 30, 2017 at 20:03:27 pm

I believe that the Democrat Party assigns one of its "strategists" to emerge from her safe space from time to time and take on the tasks of 1) monitoring every conservative web blog, 2) maligning its articles and 3) verbally assaulting its contributors. Perhaps Alana holds that Democrat Party assignment for Law and Liberty.

And, as Lenin and Alinsky would instruct, the Party's disruptive tactic is, invariably, to scorch the earth with rhetoric rather than clear the air with reason, knowledge or fact. Alana's verbal ideological excess over Professor McGinnis' article (which I disliked for its assumption that Trump would be better were he a "classical liberal") appears at times to be downright unhinged. Quoting just a few of her comments makes a res ipsa loquitur argument.

Alana said all of the following:

"That statement (by Professor McGinnis that the tax cuts DO NOT HAVE as their OBJECTIVE helping Trump PERSONALLY) betrays an ignorance of both tax LAW and ECONOMICS that is both breathtaking and willful. EVERYONE has already run the numbers, and you’d have to be living under a rock to not know the outcome."

( I ask: "All of us who disagree? or just McGinnis?")

"The promise that trickle-down economics will actually work this time has been CONCLUSIVELY DISPROVEN by history;"

( My thought: Alana is downright Gibbonian in her sweep. Keynes would blush. Only Paul Kruger MIGHT use such language.)

"Bottom line, Republicans despise the poor, elderly, and unfortunate; they would much prefer that Grandma choke on dog food while freezing in the dark than provide a reasonable social safety net."

(My thought: Alana's comment is Maxine Watersonian in its over-the-top personal hatred? of her political opponents.)

"The Republican Party has systematically dismantled America, and there is NOTHING LEFT but a rotting shell."
(My thought: "Never-Trumpian" in its ring and reflecting the eschatology of the "snowflake" generation.)

"l take comfort in the fact that (those who disagree with Alana) know next to nothing about economics."

(My thought: Hers is a so-predictable-its-boring Democrat tactic of elitism and soi disant expertise.)

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timothy
on December 31, 2017 at 07:33:30 am

Let me guess, Gabe. You are anti-abortion. Right?

You extremist conservatives are so precious! You love government, but only when it does your bidding. Wars get a blank check, but children can starve as long as they're not yours.

And since you mention it, balancing the checkbook doesn't seem to be a Republican thing.

What is wrong with paying for the government you want? Republicans control all three branches of government. They have been screaming about deficits for ten years (it never seems to bother them at all when they are in power). Why didn't they submit a balanced budget?

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Alana
on December 31, 2017 at 07:52:58 am

Alana, I am anti-abortion and I would wager you that if 99.999% of aborted children were permitted to live, they would not starve. Its your burden to prove otherwise.

You are the precious fool to believe abortion has anything to do with keeping children from starving. Grow-up and start thinking for yourself in 2018.

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Paul Binotto
on December 31, 2017 at 08:15:45 am

Are you saying that L&L is your Tribe's "safe space," Timothy? Townhall? Breitbart? Do you object to my intruding on your "safe space"?

God forbid that you should ever have to discuss issues with those who disagree with you.

The indictment against voodoo economics l referred to was that of Bruce Bartlett, who was one of its original architects--a Republican. Four decades of data proves this, and there are a few old-guard evidence-based Republicans still left. You've made up your mind, facts be damned! You won't even listen to other Republicans.

The tax bill was written, as nearly as possible, to benefit the donors who were blackmailing Republican legislators. And that class notoriously includes Donald Trump. Senator Graham publicly admitted as much, and no one seriously thinks that it is going to generate significant economic growth. As reported in The Hill:

"Sen. Marco Rubio (R-Fla.) said in an interview published Friday that Republicans “probably went too far” cutting corporate taxes in their just-enacted overhaul of the tax code.

Rubio said he expects corporations to pay out higher dividends to shareholders and buy back shares to increase their stock price with proceeds from the bill.

“You’re going to see a lot of these multinationals buy back shares to drive up the price,” Rubio told the southwest Florida-based News-Press.

“Some of them will be forced, because they’re sitting on historic levels of cash, to pay out dividends to shareholders,” Rubio said. “That isn’t going to create dramatic economic growth."

Duh!

As for the "everybody," that means "every publication with the requisite expertise to do the calculations," such as Bloomberg, the Times, and CNBC. Repealing the AMT is a handout to real estate developers, as it was enacted during the Reagan Administration to ensure that they pay at least some tax. The rates and pass-through entity treatment and changes to the estate tax all benefit the Trump clan personally. McGinnis was noticed on this, and ought to have known better. E.g., https://www.cnbc.com/2017/12/01/heres-how-trump-stands-to-benefit-from-the-republican-tax-bill.html

As for rhetorical excess, the proof is in the pudding. Which Party won't allow women who are on welfare to buy disposable diapers? And l challenge you to live on the $29/wk. food stamp allowance you so generously [sarcasm] provide. l judge people by their actions, and you have demonstrated a stunning contempt for the poor and unfortunate.

You're the one pounding on the table, Tim.

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Alana
on December 31, 2017 at 08:48:14 am

Alas, Mr. Binotto, it is in vain that you admonish Alana to seek the goal of liberation: "Grow-up and start thinking for yourself..."

To grow up and think for oneself, to be liberated, is to see with moral clarity, to bear the weight of moral responsibility and to walk the path of moral maturation. That way is far too arduous, that weight far too great, their moral imagination far too wooly for those, like Alana, for whom prenatal infanticide is sacred sacrifice to the god of narcissism.

Neither admonition, nor debate, nor shame can work toward the end you seek for Alana.

Only grace will work.

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timothy
on December 31, 2017 at 09:03:19 am

Yada, yada, yada.

To quote myself about you:
"Neither admonition, nor debate, nor shame can work... for Alana."

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timothy
on December 31, 2017 at 11:46:14 am

You missed my point, Paul. You love government ... when it does YOUR bidding. (lf men needed abortions, clinics would be as numerous as Starbucks.)

As for growing up and thinking for oneself, the words of Jesus are apropos: "Physician, heal thyself." You two "learned" gentlemen blindly parrot religious bromides and RW talking points, and have the temerity to criticize me?

Paul B. couldn't think logically on a bet. The burden of proof always lies with the person making the claim. And l would still like to see him live off the $29/week you Republicans so graciously allot to the children you starve.

And by what right, Timothy, do you impose your set of morals on me? My moral code is as clear as yours. lt has the added advantage of not being set by a bunch of child molesters in flowing robes. And you appear to have all the "grace" of a bull in a china shop.

l didn't really expect that l'd get an actual answer to my actual question. "What is wrong with paying for the government you want?"

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Alana
on December 31, 2017 at 11:48:33 am

Debate works for me just fine. But "facts" seem to be an undiscovered country for you. You won't even accept facts presented by fellow Republicans.

Hard to have a debate on those terms, Timothy.

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Alana
on December 31, 2017 at 12:07:49 pm

No, Tim:

She is insane or simply "stuck on" sucking up to her college professors, as she must have done during her university training, in the delusional belief that she still resides in the *comforting* world of the campus
where those in their "own flowing robes" perform a different form of abuse - the corruption of minds.
Repeat over and over the same tired worn out and historically incorrect assertions - and Presto! - they become reality.

And why is it that for these types everything comes down to abortion. Notice how alana responds to one of my comments with the query: You must be anti0abortion?
How is it that a comment I made, BTW not about economics, as she alleges, but about politics, becomes a launcging point for a diatribe against people whi disagree with her "sacramentalized" view of abortion.

It is the same tired rhetoric AND SHE gets to claim the moral high ground, such as it can be said that she has any understanding of morality.
And again, the same charge of L&L types wanting to impose *their* morality - when, in fact, it is the likes of Alana who are engaged in a continuing effort to "impose" their views upon average folks, i.e. bakers, florists, immature children subjected to LGBT-W-T-F? INDOCTRINATION.

Kindly keep your morality to yourself, Missy, as I will do with mine.
And do not conflate "difference" with evil.
I thought that was what all you Morally Superior *WOKE* types were all about - celebrating our differences.

Now, once again, Missy:

Have a *comforting* New Year. I am certain that my ignorance of economics (read: politics) will assure you that comfort.

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gabe
on December 31, 2017 at 12:45:06 pm

And , Oh BTW: re: THAT $29 / week claim.

1) what is often the most salient element(s) of an argument / statistic(s) is that WHICH IS LEFT OUT.
What else does this poor woman with child receive in the way of transfer payment? Is there not associated welfare payments? are there not additional supplemental transfers from State coffers? etc, etc. As an example, in my State, such a woman would be receiving an additional $1000 / month; would also have Food Stamps, be eligible for reduced housing rates, etc (Section 8, for one)

So let us dispense with this idiotic assertion that was "popularized by

2) I think it was that silly Gwenith Paltrow, who pulled off the *stunt* of pretending to live on $29 week, and had it publicized some years back. Well, Miss Paltrow, with her bony little ass, may try to live on that BUT your exemplar is sure to receive far more in transfer payments than the $29 / week, which you argue is for diapers. BTW: Just bought diapers at Costco for my own grandchildren - for less than $30, I purchased over a hundred diapers. And unless, the kids are as full of fecundity as are the arguments you herein advance, I suspect that the diapers will last us for quite some time.

The repetition of an absurdity does not make it any less absurd or inane.

Now raise a glass to a *comforting* New Year!

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gabe
on December 31, 2017 at 13:55:55 pm

Professor McGinnis' argues that Trump's first year had some worthwhile accomplishments (all disparaged by the Left for reasons of perceived political opportunism) but that Trump has damaged "classical liberalism." Agreeing with McGinnis' factually uncontroversial assertions of Trump's substantive achievements, I challenged McGinnis only on his dubious assertions that "classical liberalism" is the suitable political mode for our times and that Trump should embrace it in his politics.

I said of McGinnis' opinion as to the historical nicety and the current political propriety of classical liberalism, ''Get real, man. It's a war we're in."

And then, with numerous rants, Alana proceeded to prove my point: debating the neo-Jacobin arsonists who ignited the fire of revolution is not just futile and silly, it's dangerous and suicidal. It's ALWAYS what the ruthless Left (who embrace psychological and physical violence) want principled conservatives (who love tranquility and reason) to do, all the better to disarm or forestall the counter-offensive.

Argue ABOUT how to defeat the neo-Jacobins. Do not argue WITH them over the secular tenets of their revolutionary faith.

They are the mortal enemy. Their political defeat is the only option.

When a True Believer says she wants to destroy you, believe her.

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timothy
on December 31, 2017 at 14:01:46 pm

I do understand you; peace in the New Year, Alana.

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Paul Binotto
on December 31, 2017 at 14:09:04 pm

Yes, by Grace.

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Paul Binotto
on December 31, 2017 at 16:03:35 pm

Timothy: "Argue ABOUT how to defeat the neo-Jacobins. Do not argue WITH them over the secular tenets of their revolutionary faith."

You mean, like the need to balance the federal budget???

ln the immortal words of Bugs Bunny, "What a maroooooon!"

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Alana
on December 31, 2017 at 16:25:54 pm

Gabe, is your skull really that thick?

No, it's not about abortion. lt's about hypocrisy. YOU claim the right though government to control MY body, but God forbid that l should ever be able to control some of YOUR money through government???

lf hypocrisy is a Christian virtue, you are a virtuous man.

Gabe, the average newborn goes through about 10 diapers a day, of which you might have changed about one a week in your life.

http://www.politifact.com/rhode-island/statements/2015/feb/01/rhode-island-center-freedom-and-prosperity/do-common-welfare-programs-pay-equivalent-2083-hou/ We can dicker about the numbers, but you need cash to pay for diapers, and l doubt that you would debate the topic honestly. CATO and other hard-RW think tanks lie to the point where any number you might cite is suspect.

My point is that you and your ilk are spendthrifts when it comes to war, and Scrooge-class niggards (yes, that is a word!) on domestic matters.

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Alana
on December 31, 2017 at 16:27:50 pm

And l you, Ayatollah Binotto.

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Alana
on December 31, 2017 at 17:12:32 pm

Good to know that Alana's able to quote Bugs Bunny; his were among the better cartoons of The Greatest Generation, whose cultural legacy she would destroy.

Watching TV cartoons is good, Alana, but you must work your way up to reading. At first, try the better comic books of mid-20th century. ( I know, they're ''oh, so old!" but I recommend the highly literate EC Comics.) Then, perhaps, graduate to YAF. Soon your reading with comprehension may exceed the CNN level of Democrat talking points.

Perhaps one day you'll be able to read, understand and quote dead white males (other than Marx.) Then you won't be obliged merely to repeat the deconstructive remarks you've heard others say about real men with real moral values who were real smart and really important.

Come back and give us more of your penetrating commentary after you've read and understood, for example, Cicero, Augustine, Aquinas, Hayek and Friedman, all of whom have much to say about matters on which you have so loosely opined in the past three days. You might even try the Bible; with the greatest metaphors in literature, it's invaluable reading even for a pagan worshiper of the god of narcissism.

But in the meantime, little steps are good, if you're not fated to remain an "ignoranimus" for life. (Yeah, I know Bugs, too.)

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timothy
on December 31, 2017 at 18:00:56 pm

If I were an Ayatollah you would be speaking to me with great respect and deference, so I know you can't mean what you say. Bless you, Alana.

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Paul Binotto
on December 31, 2017 at 21:51:16 pm

Salus populi suprema lex esto. While l concur with Cicero, l note that your reading list is remarkably stilted. Surely, you have read The Republic, Locke's Second Treatise, Jefferson's Notes, and Montesquieu? Swift? DeFoe? Sidney's Discourses? Sun-Tzu? You are like the man in Plato's cave.

Unca Miltie wrote my Econ textbook. But if the entirety of your understanding is the works of useless ideologues like Hayek, you don't have the breadth of knowledge to even begin to grasp the subject. l would also suggest that you consider Ravi Batra's parable of the wolves and the caribou, or even read some (agnus Dei!) Robert Reich. lf you don't understand your opponents' arguments, you don't fully understand your own.

As for the Bible, as a repository of wisdom, it pales in comparison to the Tao Te Ching. For if brevity is next to godliness, the Bible is as demonic as it is contradictory. While l have read and studied them both, the works of Homer offer superior insight into the human condition. And then, there is the Bhagavad Gita. Like the Bible, the Noble Qu'ran loses a great deal of value in translation. What of the works of Carlos Castaneda? Aldous Huxley? Baba Ram Dass? You exude an arrogance which is comically unwarranted.

Bugs Bunny is more your speed.

You appear woefully unprepared to engage those who disagree with you. Understanding an Augustine is to understand that he was often wrong. Our best science fiction writers--Asimov, Bradbury, Huxley, and the incomparable Arthur Clarke--have contributed more of value than the superstitious primitives you revere.

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Alana
on January 01, 2018 at 08:52:22 am

Speaking of which, l just happened across this series of tweets from Nobel laureate Paul Krugman, making the case that our extreme inequality in wealth is literally killing us. https://twitter.com/paulkrugman/status/947523722491191296

Our insanely expensive for-profit medical system has real consequences for our poor. By way of example, a friend from the 'hood in her 50s was one of the many devastated by the 2008-09 BushCo Crash. Living hand-to-mouth, she and her artisan husband were forced to choose between food and shelter and medical care. They chose to eat, neglecting the signs of lung cancer. By the time she was diagnosed, she was Stage 4.

And l am sure that this post would give you, Friedman, and Hayek the warm fuzzies at night:

"The holidays are never easy for me - and all the recent news at the Dr's hasn't made them any easier. I have a tough choice to make and I find myself frozen in place, looking for a third option. Our insurance won't let me have the drugs we ask them to approve and the cytotoxic chemo they want to give me is only to "maintain" things - the thought of poisoning myself just to drag out time just doesn't make sense - just to spend more time being even more miserable than I feel now?"

'O, Blessed Capitalism! Our rapacious insurance companies sell coverage and deny liability, and their decision to withhold life-saving care is literally killing her. All Hail Gross Profit!!!

What WOULD Cicero do? Salus populi suprema lex esto. The people's interest is in putting those parasites out of business, nationalizing health care, and taxing the wealthy to pay for it. lt is, after all, what the rest of the world has had the good sense to do. And in so doing, they are providing superior care for far less money.

Even a good capitalist should see the profit in this.

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Alana
on January 01, 2018 at 09:17:39 am

What might a counter-intelligence analyst say of "Operation Alana"? Here are some possible questions:

1) Aristotle would first ask: "What is the nature of the thing?''
"Operation Alana" may be an "operative force" assigned the tasks of a) gathering and reporting data on conservative web blogs and b) undermining their functionality by deploying Leninist-style psych-ops. I use the phrase "operative force" to describe Operation Alana because we don't know whether "Alana" is a) actually a nasty-tempered, ill-informed, brain-washed, foul-mouthed human, sort of a Manchurian Candidate with a penchant for verbal vengeance, or b) simply a primitive form of Artificial Intelligence programmed with those Democrat characteristics or c) an ordinary computer virus or malware that, once executed, replicates by reproducing itself, then seeks to infect conservative intellectual software programs and modify them.

2) What is the source of funding?
Knowing is impossible. Wild speculations might include that Operation Alana could be funded a) by the Democrat Party (indirectly, of course,) or b) by "CryptoFa" ( "Antifa" is really "Crypto-Fascist;" why would an organiztion that is clearly Fascist call itself Anti-Fascist but for the NewSpeak purpose of perverting truth? ) or c) by the Russians. Or d) the psych-ops may simply be self-motivated and self-funded by a "lone wolf." Who knows?

3) What is the impact of such psychological operations?
Mere venting for the author if she's real, but for the rest of humanity: nada, nil, not even de minimis . Mere humorous diversion at best; a look on the dark side of human nature at worst; neither of any substantive consequence. Verbal imprints on the winds of time; forgettable words forgotten as they are spoken.

Hers (or its) and mine:)

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timothy
on January 01, 2018 at 10:45:29 am

Looks as if Timothy is a full-bird colonel in the Tin-Foil Hat Brigade! Amazing how far a man will go to avoid a dialogue that he knows he will lose. A paid DNC troll? SRSLY? He displays a level of paranoia so extreme, it has even been immortalized in song:

Destroyer (The Kinks)

Met a girl called Lola and I took her back to my place
Feelin' guilty, feelin' scared, hidden cameras everywhere
Stop! hold on. stay in control

Girl, I want, you here with me
But I'm really not as cool as I'd like to be
'Cause there's a red, under my bed
And there's a little yellow man in my head
And there's a true, blue, inside of me
That keeps stoppin' me, touchin' ya, watchin' ya, lovin' ya

Paranoia, the destroyer! Paranoia, the destroyer!

Well I fell asleep, then I woke feelin' kinda' queer
Lola looked at me and said ooh you look so weird
She said man, there's really something wrong with you
One day you're gonna' self-destruct
You're up, get down, I'll come work you out
You get a good thing goin' then you blow yourself out

Silly boy ya' self-destroyer. Silly boy ya' self-destroyer

Silly boy you got so much to live for
So much to aim for, so much to try for
You blowing it all with paranoia
You're so insecure you self-destroyer

(And it goes like this, here it goes)
Paranoia, the destroyer
(Here it goes again)
Paranoia, the destroyer

Doctor, Doctor help me please, I know you'll understand
There's a time device inside of me, I'm a self-destructin' man
There's a red, under my bed
And there's a little green man in my head
And he said, "you're not goin' crazy, you're just a bit sad
'Cause there's a man in ya, gnawin' ya, tearin' ya into two."

Silly boy ya' self-destroyer.
Paranoia, the destroyer

Self-destroyer, wreck your health
Destroy friends, destroy yourself
The time device of self-destruction
Light the fuse and start eruption

(Yea, it goes like this, here it goes)
Paranoia, the destroyer
(Here's to paranoia)
Paranoia, the destroyer
(Hey hey, here it goes)
Paranoia, the destroyer
(And it goes like this)

Paranoia, the destroyer
(And it goes like this.)

Poor guy. He made the fatal mistake of pretending to rely on Cicero. No way to save face.

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Alana
on January 01, 2018 at 10:52:10 am

"The Thing" speaks for itself.

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timothy
on January 01, 2018 at 12:28:57 pm

Well, we have built up quite a reading list through all of our back and forth. I take hope from that and still stand by my original point that we need to try to understand the moral markers from which each of us looks at these topics.

Alana's poignant example of severe hardship is a good illustration of what I mean. Here in the US we put a great deal of emphasis on the moral responsibility of the individual person.

Being of an age where I am now burying relations in both England and Germany in fairly regular succession, I can assure everyone that these tough choices are being made regardless of how socialized or unsocialized the medical system is.

The major difference is that we here are very conscious of all the options that insurance companies will cover and those that they will not. One does not generally get a full report of all possible treatments in either the English or the German systems. And, if you happen to be aware of those options, you will very likely not be permitted to avail yourself of all of them.

Perhaps it's best not to be plagued by what one can't have, less stressful. What I see among English and Germans is a willingness to put up with what is offered and not complain. They get less stressed out as a consequence.

Another aspect of the American system is that it places a huge amount of responsibility for self-maintenance on individuals who may not be in the best position to make informed decisions.

The European countries demand a great deal of conformity to overcome such problems. America provides often enough assistance to get into trouble, without the demand for conformity in those choices that might otherwise ameliorate personal outcomes. This is why there can be such great disparities in the comparison of the aggregates of the different systems.

And there is something else. Once you avail yourself of a particular choice, in those instances where you have one (in the various European systems), you are not generally allowed to change your mind later. We learned this from rather painful personal experience. I don't think many Americans would like that aspect.

And then there is the question of how National we wish our systems to be. Believe me there are costs to demanding national conformity, which admirers of those systems often regard as equality.

Yet, while I may disagree with peoples opinions on these policy matters, I don't generally see them as evil people.

Understanding the costs we are willing to pay and the ones that we are not, will go a long way towards our understanding of each other.

All human action strives towards the good, however misconceived we might consider it to be.

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Hans Eicholz
on January 01, 2018 at 13:30:45 pm

" And in so doing, they are providing superior care for far less money."

My Goodness, you REALLY believe this!!!

Having spent a good number of years in the medical imaging industry, I can assure you that *they* are not providing superior care. It is, as Mr eicholz comments below, a question of what *they* decide to provide (cover) AND also how "readily available" those services are.

Quick story:
A friend, in sales, made an interesting career from selling medical imaging equipment to all the small clinics / hospitals, along the US Canadian border. The number of units sold far exceeded the anticipated rate for those areas when considering population density, demographics (age, health, etc), and other econiomic factors.
Why?
Well it turns out that thousands of Canadians would shuffle across the border to receive diagnlostic imaging scans in the US BECAUSE in Canada, they had to wait up to six months for a service that was available within 10 days (or less) in the US.

In Great Britain, it is even worse, with recent examples, indicating that the wait for an MRI may be as long as 18 months. One may begin to understand why NHS, and other national systems, are alleged to be cheaper. They simply do not provide the level of access that a typical American enjoys.

And yes, it is expensive - but do not overlook the role of government in the escalation of prices. One more example. After an accident, I required an MRI. I could have had the procedure performed at the local hospital. Cost - $5,000 - or, I could have (and did) avail MYSELF of the services of a provider of diagnostic imaging services - Cost $1500 (but as low as $1000).
Why?
Well, it appears that the government has mandated that Hospitals may charge a "facility fee" in order to help hospitals offset the costs associated with all the free emergency care that hospitals must provide.

Lesson(s):

1) Don't always blame the providers of readily available services. The fault may very well be shared with other entities.
2) Again, as Mr eicholz states, in the US we tend to place a little more responsibility upon the INDIVIDUAL.
I chose to accept that responsibility AND found a provider who would perform the service for much less as it was not required to charge me for the FREE care that the government mandated it provide.

We must always remember that there is a cost for everything; oftentimes those costs are masked by intervention of a third party, in this instance the government; but, as in the case of the Canadian and NHS systems, the costs may simply be a delay of services.

Yes, drugs are too expensive. Yes, many are not able to afford them.
BUT - how many PhD's does it take to develop a drug? How much should a PhD be paid to conduct this research? How much should a drug maker factor in costs associated with prospective class action lawsuits?
AND, YOU will love this! How much should that same drug maker allocate for *lobbying* costs for both Democrat and Republican policy makers? (a small cost, but not insignificant to a discussion of healthcare policy). Also, how much must a drugmaker charge IN the US when he / she knows that foreign firms, with the assistance of their governments demand that the drugmaker sell to foreign markets at a price significantly lower than the price in the United States OR the foreign government will not honor the drugmakers patents. Canada does this and the whole talk about drug re-importation in the US revolves around this. Canada buys a US drug at below market prices; Canadian firms then re-sell in the US AT a profit
The end result is the US drugmaker must further mark up its price on drugs sold within the US as the foreign government has compelled the US drugmaker to compete against itself.

Ain't so simple, Alana as you would suppose BUT it does make it easier for the NHS / Canadian systems to claim that their prices are lower.
The trick is to know What the true costs are AND who pays those costs. In some sense, all the Canadians are doing is fobbing the costs off to their neighbors south of the border, and more importantly upon their own citizens by DENYING ready access to medical services.

Tell you what, let me see if I can arrange for you to live under the Canadian or NHS systems. while I get my medical imaging done with one phone call, a 7 minute drive, a three day wait and at a reasonable cost - you may get it for *free* but will have to wait several months while the damage the (as yet) un-diagnosed tumor festers.

Have a "comforting" New Year, kiddo!
Of course, since it does not look as we are going "to tax the wealthy" into oblivion as you and your ilk would like, you may find this year to be less comforting than you appear to think you deserve.

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gabe
on January 01, 2018 at 15:11:44 pm

One would have thought that a religious man who counsel others to read his holy book would have internalized 1 Pet. 3:15, but l guess that Timothy is a "Donald Trump Xian."

l merely applied Prov. 26:5.

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Alana
on January 01, 2018 at 16:02:42 pm

Gabe:

l had a spinal MRl overseas. Cost me $230. Had one here. The 20% deductible was almost $200. How do you justify the difference?

Harvoni (a top-selling hep C drug) sells for around $1,000 a dose here (total cost: $90,000). ln lndia, it can be had for $4. How do you justify the difference?

As anyone who has been to Mexico knows, a 100 mg. dose of Viagra sells for $5. Here, it is about $40. How do you justify the difference?

Here, doctors prescribe MRls like penny candy. Why? Because they own the machines, and the insurance companies have no incentive to control costs.

l can go on and on. For every horror story that you can produce, l can easily respond with Stephen King's lifetime work.

lf you are going to nationalize health care, you take the best of other countries' systems. lf France's system is the best in the world (most consider it to be), you emulate it. Capitalists steal their competitors' best ideas, and we should, too.

As for other countries doing it better, life expectancy data speaks for itself; in many areas of the country, our health care is at Third World level. https://vimeo.com/753559

As for countries fobbing off their costs, you can have your knee replaced in lndia for about $8,000, but here, it costs $40-50K. So if you don't have good insurance, it helps to know a good travel agent. And if we are paying 3x as much for the same drug, aren't we subsidizing them?

Let's say you have HepC and lousy insurance. What do you do? You get the doctor to write you a script, buy a first-class ticket to Mumbai (~$8,000), and live like a prince for a month (a top-of-the-line five-star beach-front hotel is roughly $250/night). You're still way ahead financially, as you aren't putting every last dime you have into the coffers of Gilead Sciences.

By any measure, we're not getting enough bang for the buck. Other countries have better outcomes under socialism. Why not do the obvious?

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Alana
on January 01, 2018 at 16:43:57 pm

Timothy's infantile behaviour notwithstanding, this is a discussion reasonable adults can have, and you have framed it with great skill.

Taking Cicero's bromide to heart, l would respectfully submit that there is a minimal level of care that we as a nation should provide to all of our citizens. Why? Because it actually benefits society as a whole. Having to treat Stage lV lung cancer that should have been caught at Stage ll is not only catastrophic for the patient, but it also raises OUR premiums. Enlightened self-interest.

lt is absurd that Medicare will not pay for preventative care, such as chiropractic.

Think of this like a seat belt law. We require compliance out of self-interest, as people who don't wear them suffer more catastrophic injuries, which all of us have to pay for in the form of higher insurance premiums. l wear a helmet when l ride because l like my brain, but these laws protect us all.

End-of-life issues are deuced more difficult. The religious oppose euthanasia, but the prospect of wasting away in a nursing home would constitute torture to me. lf you care about the rights of the individual (l have a DNR order on my license; you might not), why don't you let the individual make that choice?

The thought of a Great Nanny State telling us what to do should give anyone pause. But this isn't an either-or question. There is a sound argument for reasonable incursions into our liberty which do not constitute plenary ones.

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Alana
on January 01, 2018 at 17:12:35 pm

I I appreciate your points and I'm glad you're sticking to it.

One way to get better outcomes is of course to tie treatments to behavior.

Bad behavior will lead to denial of the more expensive and even ultimately life sustaining treatments. How far are we willing to take this though and who gets to decide? A moments time in any of the other systems will qiickly acquaint us with just such rules: www.telegraph.co.uk/news/2017/10/17/nhs-provokes-fury-indefinite-surgery-ban-smokers-obese/

The question is when does this become too much intrusion?

Those are fascinating points regarding prices you made earlier but not unanticipated.

Friedman frequently noted how market prices can go seriously haywire when price takers are not actively choosing and demand is unconnected to their more immediate budget constraints.

In many poorer countries where the vast majority can barely afford asprin, prices will be considerably less than in higher income countries. Even from state to state within the US, prices will vary. And the transfer effects that Gabe mentioned do you have there impact on pricing among developed countries. Prices are simply demand-driven and there's really no way to get around that.

But it would ultimately be self-defeating to blame markets, without consideration of these underlying dislocations that Friedman pointed to.

Without markets most of these drugs and treatments simply wouldn't exist. So we need them it seems to me.

Personally I'm quite willing to let each state have a great deal of leeway in deciding how to approach these issues.

By the way I hope you all do continue this inquiry. We've moved beyond the more heated expressions which are understandable and probably necessary. Now comes the difficult but vastly more interesting possibility of finding some common ground!

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Hans Eicholz
on January 02, 2018 at 05:13:44 am

Here, l am going to focus on areas where l think we can find common ground. While l don't attribute magical powers to free markets, and health care isn't an area where Adam Smith's simple analyses necessarily apply, these are ideas that don't run roughshod over them. The first is providing preventative health care to all.

Hans: "The question is when does this become too much intrusion?"

The contemplated reforms avoid the question. Specifically, if we set up a system by which basic preventative care--check-ups, mammograms, cancer screenings (not a doctor, so this isn't a complete list, but you get the idea)--was paid for by a national system like Medicare (already in place), we'd have a better chance to avoid tragic situations like my friend's Stage lV cancer. Obtaining health insurance would still be the citizen's responsibility, as long as everyone can sign up for Medicare. And as for rewarding good behavior, private insurers already do that, and there is no reason why a public system couldn't do so, as well.

By the by, NHS seems to be a blueprint for how NOT to do it. :)

Medicare has administrative costs of 2%. Private insurers would have to get much leaner to compete. You could still buy "Cadillac plans" with additional benefits, along the lines of what is done in France. And you would still need regulation to prevent the selling of 'junk' insurance, mostly because the consumers are not experts. (France's system is regarded as the best of the best, which is where you start when redesigning a system.)

[Personally, l would look for ways to strip the profit motive from the system, along the lines of Switzerland's. Walk into our local hospital, and you could be forgiven if you thought that it was a five-star ski chalet. Walk into a private hospital in Melbourne, and you might think you walked into your cousin's accounting office. But this is more about cost control, which is a separate issue. And more to the point, this is one of those places where we might not find common ground, so we don't need to go there.]

There is a surprisingly simple solution to drug price-gouging: excise taxes. We simply tell PharmaSis over at Mylan that if it charges Canada $100 for an EpiPen, it can charge $608, http://www.businessinsider.com/epipen-cost-increase-healthcare-insurance-2016-8, here, but we are going to slap it with a $508/pen excise tax if it does. They can make as much as they want on their drugs--the profit motive is left intact, as it should be--but they can't use the US to pad their bottom line.

We should not have to subsidize the rest of the world's prescription drug habit, but there is no need to sacrifice the benefits of capitalism in effecting a cure.

With respect to 10th Amendment experimentation, l'm usually not sanguine about states' ability to experiment, mostly due to economies of scale: Alaska's population is about that of San Bernardino. But California's GDP is twice that of Russia's. Would you have a problem with their socializing health care, and seeing how that experiment turned out?

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Alana
on January 02, 2018 at 10:12:37 am

Alana:

Now that is much more reasonable.

Agreed - that something akin to a catastrophic insurance policy should be (and I think could be) available to all comers PROVIDED that such an offering would not a) preclude the option of a "Cadillac" type plan, and also would not, as did the Obamacare fiasco, cause someone such as myself to incur an additional $3,000 -$5000 costs per year.

And Yep, some hospitals do resemble the lobby of a golf resort. As a young lad in NYC, I do recall the somewhat more austere lobbies of the local hospitals. Service was fine even if the reading materials were absent or slimmer.

I am not so certain about "stripping" the profit motive from the hospital system as the results to date (see NHS, etc) are not encouraging. First, I would look, just as in the University system, to strip Administration, or actually, severely reduce it. This may require change in Federal / State reporting obligations OR it may mean developing an accurate / reliable "cloud" based data system to reduce overhead (which is substantial). The *market* is not magical - but in cases where the Federal government has intervened to control (read: limit) the number of facilities or types of health service facilities in specific areas, we find that the market's leveling power cannot be brought into play and pricing dynamics, to the extent that healthcare is subject to such dynamics, will be distorted.

Don't know about the "epi-pen excise tax" The theory (of the manufacturer) is that it must charge the higher price to cover its costs plus a profit sufficient to maintain its operations and fund new drug research. Letting them charge the higher price BUT then giving that to the government would not appear to meet corporate funding objectives. (And epi-pen is an egregious case of a small time hustler gaining control of a patent and, well, quite frankly, screwing the consumer). Perhaps, if our government informed foreign governments that they are obligated to honor our patents - if not neither will the US honor their patents.

Anyway, as some of us have said, I hope that you understand that disagreement does not equate to evil-intent.

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gabe
on January 02, 2018 at 13:36:42 pm

Gabe:

l am consciously limiting proposals to those where we might find common ground. l am of the opinion that on balance, nationalized health care is optimal, and probably inevitable, but these modest reforms might garner your support.

A non-obvious benefit to the nationalization of preventative health care is eliminating the need to collect and finance receivables. lt costs about $20 to mail out a single bill, but a submission to Medicare could be done daily for less.

You are conflating PharmaBro Martin Shkreli with PharmaSis--the head of Mylan (NOT a small outfit) and daughter of Joe Manchin. Yes, THAT Joe Manchin. And this is not a one-off. There isn't a commonly-prescribed drug that isn't cheaper in Canada.

l don't see a problem with--as a general principle--a drug company charging whatever the market will bear, as long as they charge me the same amount that they would in Montreal, Manchester, and Melbourne. l would make an exception for parasitic companies that buy patents and hike the cost, such as Shkreli's.

l'd love to see us revisit HlPAA. The lack of a common database is behind the VA benefits mess, and re-inputting the same (quite often, irrelevant) garbage 37 times is wasteful and inefficient. How many times have you had to tell your dermatologist or orthopedist about your sex life?

Patent law is covered by treaty, and won't change much.

One's intent is deduced from one's actions. No blanket rules.

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Alana
on January 02, 2018 at 20:14:57 pm

https://www.youtube.com/watch?v=jLmfFDSVMB0

https://www.youtube.com/watch?v=4wY6RuO8EUY

You're not entitled to your own facts; in these videos, an expert debunks most of your urban legends.

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Alana
on January 03, 2018 at 12:24:38 pm

alana:

Yep, pricing is weird - no doubt about it.

Overhead costs in the US have skyrocketed over the past 40 years; still that does not explain all the cost increase. It is complicated.

and yes, my point was that WE were subsidizing THEM - and, I don;t especially like it.

As for frug pricing, here is one that will warm your heart wherein a drug, ostensibly capable of eliminating, or dramatically reducing the effects of a certain form of "blindness' costs $850.000. Outrageous, you say? Perhaps - but it provides relief to those few thousand people who are so afflicted.

http://www.foxbusiness.com/features/2018/01/03/this-blindness-drug-costs-850000.html
Questions:

1) How does the drugmaker cover the costs associated with research and development?
2) How does it do so when there are, AND can only be a few thousand people who CAN make use of this treatment?
3) SHOULD drugmakers devote time, effort and resources to such a problem when only a few thousand citizens will benefit?
4) Should the drug company decide to not develop such a drug, how should we respond to the several thousand people so afflicted?
5) Should the State (or Federales) mandate that insurance companies cover this highly expensive medicine. Recall, that insurance companies are subjected to numerous State MANDATED coverages.
6) What is the impact upon someone such as yourself who happens to have coverage with this insurer.

As I said, it's complicated.
As for me, I am somewhat more comfortable with allowing the market, with all it's frailties / imperfections determine what coverages will be provided and to permit the individual citizen to make informed choices rather than a group of "alleged" experts determine who will be served and who will not AND what price they shall pay.

And oh BTW, they ain't no urban legends I was discussing.

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gabe
on January 03, 2018 at 18:31:57 pm

Alana:

Keep trying with all your YouTube evidence - about as valid as Wikipedia.

In short: Am I to believe you or my own lying eyes (apologies to Groucho Marx - the more intelligent of the two most famous Marx's - Ha!). The examples I cite are from FIRST HAND, ACTUAL EXPERIENCE in the business - not from some left wing (or right wing) think tank commentariat types.

Here is some info for you on drug re-importation and the Canadian system of patent infringement.

https://www.heartland.org/news-opinion/news/the-pros-and-cons-of-importing-drugs-from-canada?source=policybot

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gabe
on January 04, 2018 at 10:22:04 am

Gabe: "Here is some info for you...."

...from an extreme RW pundit's perspective. At least, the Canadian doc is an expert in her field.

The reason l am skeptical is that the drug company would have effective recourse under international patent law, unless the price-gouging was unconscionable (as was the case in the Shkreli incident). And l'm not sure there is any factual basis for what appears to be an urban legend:

"Canada has the third-highest prescription-drug prices in the world, behind only the United States and Germany. That's because our regulatory regime for pricing drugs is outdated and ineffectual, a self-inflicted wound that costs taxpayers and employers billions of dollars annually.

Canadian prescription drug prices are 35 per cent higher than the average among other developed countries. To put that in more digestible form, consider that $13.7-billion in patented medicines were sold in this country in 2014; if Canadians had paid the OECD average instead of our own inflated prices, the bill would have been $3.6-billion less."

https://www.theglobeandmail.com/opinion/canada-must-and-can-take-control-of-drug-prices/article34999078/

Your evidence is anecdotal, at best. The Canadian doc is an expert, with countervailing evidence. At this point, the weight of the evidence is on her side.

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Alana
on January 04, 2018 at 11:11:13 am

lt is complicated ... and made even more complicated by the fact that the government subsidizes development of these drugs. We've sort-of answered Question 3, as we have an "orphan" program that incentivizes work on new treatments for rare illnesses.

Take ClDP (look it up), an autoimmune disorder. According to the NlH, 25,000 Americans (at least 100,000, worldwide) are afflicted. The only known effective treatment is lVlg, which costs upward of $50,000 a year. Over a 30-year average lifespan, that is $1.5M per patient. lt is insidious (difficult to easily diagnose). lf you get it in a Third World country, you die slowly and horribly. There is no cure--only treatment.

Breakeven for society for an alternative treatment would be $1.5M x 100,000 = $150B, but what if it costs $1.5B to develop, and most of the resources are provided by you and me? Say that it costs the drug company $500M, net net. What is a fair price under that scenario, factoring in the risk?

The Law of Large Numbers manages the risk. Say that 9 of 10 projects fail. lf so, the drug manufacturer would have to earn $5B from the new ClDP treatment, plus a reasonable markup for return on investment. But should they be allowed to charge $150B/100K per dose?

Whatever the answer is, it seems self-evident that a drug company should not be allowed to charge five times as much here as it does in Canada, as that constitutes a subsidy to the Canadians.

The conceptual problem with free market economics is that it only works when everyone plays by the same rules. By imposing an excise tax, we prevent competitor nations from taking advantage of us, while not impairing their ability to make a profit. Why wouldn't this make sense?

As for insurance, l'd like to see a system where certain catastrophic coverage is optional. lf you have a DNR order on your license, you should pay lower rates than those who want Terri Schiavo-type care. Add a rider for experimental care such as stem cell treatment, (which would be cheaper than knee replacements if it works).

Another thing we could do is limit public advertising. Keytruda (the drug my friend needs, in a cocktail with other drugs) costs $2400 a vial (one month's dose) in lndia, and $12,500 here. How much of that is attributable to relentless television advertising? The US market for that drug is roughly 15,000 people, and it buys you about 1-2 years. Why should they need to tell me about it on the freakin' Super Bowl? And why should ad payments to Bob "Viagra" Dole be built into the cost?

Only the US and NZ allow advertising of prescription drugs.

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Alana
on January 04, 2018 at 11:33:09 am

Alana:

I actually agree with you on "advertising issues". My Gawd, the amount of money spent on ads is astronomical. I would also add (based on some industry exposure) that commissions to sales reps, certain gratuities to prescribing physicians, etc also ought to be eliminated. Note: There was an "alleged" settlement of these "gratuity" issues some time back between DOJ and some drug companies - don;t know how well it has worked. But the two, advertising and "physician inducements" go hand in hand. Would you or I, or your poor friend have ever known of Keytruda had not the drug been advertised on TV?

We also agree on the rather peculiar *pricing* dynamics of some drugs. I do not know the specifics of each drug, nor the operational costs for each drug company, nor the "pipeline" drugs coming (or hoped to be) onstream. It would seem appropriate to allow for a pricing structure that encourages continued research and development. Most drug initiatives / research fail; thus, one must factor that in to the equation.

what the number should be is beyond me; however, I am less than sanguine about the government's ability to properly determine the correct pricing structure. Moreover, we may find "political" considerations will enter into any governmental pricing determination and / or decision to pursue certain research on drugs.

seeya
gabe

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gabe
on January 04, 2018 at 23:46:29 pm

As a coda, Gabe:

Sounds as if they have written her off. And she had insurance. Ain't capitalism grand?

"It's one thing to decide that the idea of maintenance chemo treatments are repugnant, or at least a choice I have to weigh carefully. It's another to have that choice taken out of my hands.

Just found out that not only does our insurance want to deny our preferred treatment. Come to find out that they are denying ANY chemo. Which basically means that they are allowing bare minimum palliative care to keep me comfortable and nothing to possibly prolong my life.

Wow. To be told I have a tough choice is one thing. To be given no choices - that's a whole different ball game. Give me time to cry this out and sort my head out..."

Socialized medicine couldn't be much worse.

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Alana

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