Taxing the young to pay for the old to dwell in sickness

One of the consequences of ObamaCare is that young families will pay higher taxes (via higher insurance premiums) in order to subsidize the sickness of old people.

Demographically, if you tax people for being young in order to subsidize old-age morbidity, you will have less young people and more sickly old people.

Specifically, young people will put off having families (because they have less income to support a family on), so that old people like Obama’s grandma can have a surgery days before she dies.

The only economically sensible reason to have “health care reform” is to allow more old people to die faster. (In military terms, increased old-age mortality under ObamaCare would be a LIHOP — let it happen on purpose.) Of course, when the American people realized this, they panicked (much of their youth is behind them, but their old-age care is still ahead of them).  This hurts those who already invested political capital in a bill that was originally intended to LIHOP eldercide.

So now, a bill whose initial goal was to shuffle the old and sick off the stage will subsidize the old and sick at the expense of the young and healthy.

This debate is out of control. Obama should “press the reset button” and try again in two years.

19 thoughts on “Taxing the young to pay for the old to dwell in sickness”

  1. The comments regarding the bill being intended to “shuffle the old and sick off the stage” is very Palinesque and very inaccurate. Until she started spreading her hyperbole, the concept of counseling the elderly on their end of life decisions to ensure their wishes were respected was a bipartisan discussion with active participants from both parties working to offer the service. This was fanned into a fury around “death panels” and was touted as the evil of health reform.

    Now, the concept of subsidizing the sick to receive health care and keeping the elderly alive longer is a problem? If you want a society that tries to allow everyone to have a moderately decent life, having a lottery for those who develop disease to risk financial ruin and bankruptcy is not acceptable and some costs must be spread about. Unlike many other costs that people incur, health is not always one that people can choose. Granted the whole obesity epidemic may be cause for some changes to the health reform bill, but there are still many who had no choice in the development of their condition and the costs that come with it.

  2. WHF,

    Thank you for your comment.

    The comments regarding the bill being intended to “shuffle the old and sick off the stage” is very Palinesque

    Certainly it’s more theatrical than to say it is intended to ‘shift the ratio of subsidizing morbidity to subsidizing health,’ but it’s less jargon field as well.

    Your comment of ‘Palinesque’ is of course an example of the genetic fallacy, and so is worse than irrelevent in any case.

    and very inaccurate

    Demonstrate this, or retract your statement.

    The rest of your first paragraph continues on your genetic fallacy, and so is worse than irrelevent.

    Now, [is] the concept of subsidizing the sick to receive health care and keeping the elderly alive longer is a problem?

    Are the benefits a problem? No, of course not.
    Are the costs a problem? Yes, of course.

    The same is true of any policy. Your rhetoric question is just that — rhetoric.

    ? If you want a society that tries to allow everyone to have a moderately decent life, having a lottery for those who develop disease to risk financial ruin and bankruptcy is not acceptable and some costs must be spread about.

    I don’t understand your sentence, but the important part seems to be If you want a society that tries to allow everyone to have a moderately decent life. Of course, that sentence should conclude with “, then you want to live in a dream.” This is true, if for no other reasons that you cannot keep everyone alive, let alone decently alive.

    On a macro scale, we have a basic choice between subsidizing morbidity (that is, keeping the sick from dying) and subsidizing health (that is, curing the sick). Given that the exploding costs of health care mean that basically everyone (Daschle, Obama, etc.) has concluded we need to cut the rise in health care spending, that means we must seriously ponder what we are willing to sacrifice.

    Unlike many other costs that people incur, health is not always one that people can choose.

    You have a more limited view of the risk factors causes of obesity, diabetes, heart health, cancer, death by misadventure, car accidents, suicide, etc., than I do.

    Regardless, the point is largely irrelevant to the broader policy dilemma we face (subsidizing health v. subsidizing morbidity).

  3. You have been called some kind of a Leftist at CB, and you have now been called Palinesque here.

    You seem to be establishing a full-spectrum presence of some kind, if not full spectrum dominance.

    Throw in the whole thing about modifying people’s genes so they behave more nicely and you will achieve previously unknown configurations not only not mappable onto the current political one-dimensional axis, but not mappable within four-dimensional space-time.

    But this only shows you keep your promises:

    http://chicagoboyz.net/archives/4215.html#comment-20108

  4. In a better world, the absurdity of the lavish treatment provided to the elderly well beyond what they put into Medicare would be a legitimate issue to discuss, as Obama almost dared to venture in when he talked about his grandmother’s debatable hip replacement with the NYT.

    Dan explains why this is simply untenable in today’s politics and society. The GOP seems to agree with his point but then takes it in a wholly different and sinister direction, by locking hand in hand with the Democrats in a staunch promise to the elderly that they will be given preferential treatment and benefits over the middle-aged and the young.

    A country whose government spends most of its money on its elderly is a country with little future. We will be that country very soon. We can blame LBJ for some of it, but we will have to thank the GOP leadership of today for denying the last treatment that could have prevented this parasite from taking over the host and killing it in time.

    They could have been adults about it, like a past great GOP leader 15 years ago was on a similar issue. Instead, they tasted unfathomable power (the newfound and growing loyalty of the elderly in the next 2-10 years) and in drinking this poisoned chalice, they drank the blood of our children and grandchildren, much as Pelosi and Reid have done in the past eight months.

  5. LG,

    When I am the elderly, there will be no Social Security, Medicare, or Medicaid. We will be lucky if we have anything besides an IRS and a few token diplomats still working in the gov’t. People will be on their own. They’ll have their Baby Boomer grandparents and parents to thank for that.

    If God grants me my wish, I will be like my father and probably work till I die doing something I am skilled at. Otherwise, I am a penny-pinching neurotic living in fear of a fraudulent insurance company claim if or my family ever get sick. I penny-pinch b/c I won’t put myself at the mercy of the gov’t needing to bail me out b/c I didn’t spend and save wisely in life as so many of the Baby Boomers and others have.

    It sounds heartless but I’m now 7 years into formal (volun-told to do it in the Navy for 4 years of 5) and informal community financial counseling (I know the ins and outs of the credit bureaus and how to help get the CC companies and banks off people’s backs from 2 years of working industrial body shop credit financing and debt consolidation), and most people I’ve counseled wasted way too much money. Its hard for me to feel pity for them for not saving or spending wisely.

  6. “When I am the elderly, there will be no Social Security, Medicare, or Medicaid”

    Agreed. I have always assumed that I will get nothing from Social Security, or at best inflated dollars that are essentially worthless. I have too many kids to be able to save much, so I will work hard, and then be ruined at the end by health costs, if the current situation were to continue. But it won’t. As a result, I have also always assumed that I will die by lethal injection as part of a mandatory euthenasia program in a government clinic.

    What we have now is unsustanainable, which has been obvious for many years. The GI generation built this contraption, and it is going to sputter out and die just after they are gone. Coincidence? Probably not. They built the world we know and did well out of it. Their kids, the Boomers, are their greatest failure.

    But if the government is making the decisions of whose care to pay for, the question will be decided politically. That means the elderly and their relatives will vote to keep them alive. Which kicks the problem down the road, but not only does not solve it, but probably makes it worse. The correct course would be to make the whole thing as much like a competitive industry, competing on price, innovation and service as much as possible. But it is too late to do it that way. The whole thing is path dependent and we are going to end up with Obamacare, which will be the end of all three (actual costs will rise, innovation will end, service will collapse), and probably a lot quicker than people think. Doctors I know, who are good, have always grumbled, but are now seriously talking about getting out of the profession. The quality of personnel will decline very rapidly.

    The very wealthy will still be able to buy good care privately, and I know people who are already planning to operate businesses to serve that market. That will be lucrative for the people who get into it early. That will be a ray of light for a small number of providers, patients and investors.

  7. Its interesting that you choose to dissect comments line by line…

    Unfortunately the whole commentary on “the genetic fallacy” sounds more dogmatic in nature rather than being a fact-based commentary. Please identify which genetic fallacy you believe I support.

    As far as the allegation regarding the “shuffle the old and sick off the stage” comment being inaccurate, the whole concept is a twisting of the idea supporting end of life counseling that was originally supported by the Republicans in the 2003 Medicare prescription drug bill. The whole concept is simply one of informing patients on their possible choices near end of life and allowing them to make plans that keep them in control.

    The attempt to split hairs on receiving benefits versus paying for them demonstrates little as everything has a cost. It is important to optimize the cost for the benefit provided rather than only looking at the cost. If cost is the only consideration, many beneficial undertakings will never be attempted and the level of service is constantly reduced for the services that are provided. Of course, choosing to pay for something means that to be sustainable, costs must be maintainable. It is important to not simply conclude that the existence of an already broken system means that all similar systems will be broken.

    With regard to the description of a lottery, there are those situations in which you benefit from winning the lottery and those in which the lottery results in you being stoned. In this case, I am talking about those who develop disease based on genetic factors and have little control of its development.

    The description of “moderately decent” is hardly a dream. It is not a statement of curing disease, which is at the far end of the spectrum of solution, but of making living with the condition bearable. Polarizing the decision into one of subsidizing morbidity or subsidizing health assumes that there is no spectrum to the decision making. As an example, providing medications to those with Rheumatoid Arthritis allows them to live longer lives which subsidizes morbidity, but it also provides medical research with broad based information as to the effectiveness of various medications over time which allows for better allocation of future research dollars toward subsidizing health and a cure. The two are not mutually exclusive.

    While cost cutting is necessary for the sustainability of the health care system, achieving this through effectiveness in spending is an extremely viable option considering that 16-17 of GDP is spent on health care versus approximately 10% in other first world countries with similar programs. If we first tackle this issue, then we save the additional $1 trillion and may be able to get past the “have not” mentality.

    Interesting debate, in any case.

  8. Lexington,

    It is striking that if I speak precisely people complain I use jargon, and if I speak clearly people complain of being theatrical.

    It’s also striking that almost no one wantsa conversation. Most people would rather just engage in monologue.

    *sigh*

    Eddie,

    There’s a really good piece on Chairman Steele’s hypocritical position.

    For better or for worse, the GOP now serves its purpose not by coming up with ideas, but by stopping ObamaCare. [1]

    Curtis,

    The difference betweeen Logan’s Run and ObamaCare is the difference between MIHOP and LIHOP 😉

    WHC,

    Unfortunately the whole commentary on “the genetic fallacy” sounds more dogmatic in nature rather than being a fact-based commentary. Please identify which genetic fallacy you believe I support.

    It’s only dogmatic if you think logic is dogmatic. [2] Your criticism of my argument as Palinesque was an example of this fallacy, because you criticized it for its origin, rather than its substance.

    As far as the allegation regarding the “shuffle the old and sick off the stage” comment being inaccurate, the whole concept is a twisting of the idea supporting end of life counseling that was originally supported by the Republicans in the 2003 Medicare prescription drug bill. The whole concept is simply one of informing patients on their possible choices near end of life and allowing them to make plans that keep them in control.

    My discussion is over reimbursement. I have not discussed end of life counseling, except to criticize what you would call the ‘Palinesque’ position [3]

    The description of “moderately decent” is hardly a dream. It is not a statement of curing disease, which is at the far end of the spectrum of solution, but of making living with the condition bearable. Polarizing the decision into one of subsidizing morbidity or subsidizing health assumes that there is no spectrum to the decision making. As an example, providing medications to those with Rheumatoid Arthritis allows them to live longer lives which subsidizes morbidity, but it also provides medical research with broad based information as to the effectiveness of various medications over time which allows for better allocation of future research dollars toward subsidizing health and a cure. The two are not mutually exclusive.

    You are certainly right that there are degrees of morbidity and degrees of health. However, your comment in context, ‘to allow everyone to have a moderately decent life,’ is a dream. People get sick and people die. You have a finite amount of resources. Whatever share of national wealth you put to health care, you need to determine basic questions, such as what fraction is right to spend on patients last day/week/month/year of life.

    There are real trade-offs, first in what we give up to subsidize both health and morbidity, and then second in how much we subsidize morbidity relative to health. The aging population makes this problem progressively worse with time.

    [1] http://prescriptions.blogs.nytimes.com/2009/08/27/republican-chairman-is-of-two-minds-on-medicare/
    [2] http://en.wikipedia.org/wiki/Genetic_fallacy
    [3] http://chicagoboyz.net/archives/8823.html#comment-326776

  9. “… no one wants a conversation …”

    It is generally unwise to use an unqualified superlative in this fashion, though I agree that you are generally correct.

    I think that what happens in your case is that you look at issues that are currently under heated discussion from an angle that is not typical, and thus you leave the reader puzzled.

  10. “The difference betweeen Logan’s Run and ObamaCare is the difference between MIHOP and LIHOP”

    Lol, that’s good.

    Dialogue is overrated, as anyone not named Quintin Tarantino can see.

    con- with; -verse turn: But turning with another is so painful, because in that system there must be some common focal point.

    Dia- “‘through, across, by, over’”; logue- speech: so instead of turning with, it is always possible to speak through, over, or across someone and hope some words get stopped, and stick.

  11. –I suppose a system of dialogue might appear indistinguishable from monologue, if nothing sticks. The problem is, Obama is not having a conversation w/ approximately half the nation, and to them the dialogue will appear to be monologue I suppose.

  12. LG,

    I don’t see Obamacare happening. I can only see a paltry version midway between doing nothing and the public option/co-ops. There will be a significant improvement with the insurance reforms included in the bill that gets passed with 75-80 votes in the Senate, but those insurance reforms and some degree of temporary help for those who lost their healthcare when they lost their jobs will be it. At least, that’s what the centrist Dems are going to agree to and they have enough Republican votes on just the insurance reforms of the existing system that they will get it.

    Dan,
    Your words depress. I don’t see how Obama can get something more in two years or tomorrow or five years. The old people have spoken. They will not be denied.

  13. Lex,

    Thanks for the kind words.

    My style doesn’t change, only my readership does. 😉

    Curtis,

    The problem is, Obama is not having a conversation w/ approximately half the nation, and to them the dialogue will appear to be monologue I suppose.

    Well, obviously he’s not having a dialogue with anyone of them. He’s using rhetoric to push a political agenda. Some like this rhetoric, some do not.

    Eddie,

    Progress has to be made behind the scenes, wrapped in kind words, when the old people are not paying attention.

  14. When unlimited demand meets limited supply, somebody is going to get less than what they want. There will be rationing. The only question is what mix of market and politics will do the rationing, and opinions on that largely depend on whether one is more powerful in the market or in the political system.

    The alternative is a general consensus on a limited, “moderately decent” program that sets what everyone gets (as individuals, and in total) at a level that can be accommodated indefinitely, benefits that never expand beyond the ability to pay.

    Is there consensus on what a “moderately decent” plan would cover? Pre-natal, probably. Catastrophic injury, probably, with overall limits to be supplemented by insurance companies (for a profit). Cosmetic surgery? I doubt it (is beauty a human right? It affects success.). Life extension? There’s the rub. I doubt we could all agree on what another six hours of life, let alone six months, is worth when we are talking about what could be somebody we love. Now we’re back to unlimited demand for limited resources.

  15. Dan,

    You hit it on the nail.

    We have been pretty close to a bipartisan plan for a while.

    We would have it already if Obama spent his cabinet-making capital on keeping Dashcle, rather than Geithner.

    Now, Obama’s soft on the public option, and appears to be pushing some version of the McCain-Romney plan. I suspect much house opposition comes from not trusting Obama to be able to hold together a reasonable plan, and a desire to see him fail.

    The hardest part of cost containment is the fact that much of the cost come in the final weeks of life. The way you clear up funds for all other priorities is to cease subsidizing morbidity for the near-death. This is obviously a very emotional issue.

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