We, or “the people.”

National Review published a fascinating interview with Kevin D. Williamson: “Utopian political movements — and all totalitarian movements are basically utopian — love the world, except for all the people in it. They all are antiliberal and they all seek to degrade the individual and individualism. Their liturgy requires an object of adoration, and it’s usually the same object: the People, or, as American populists like to put it, We the People. For traditional nationalists, it’s the Nation in abstract and idealized form; for socialists, it’s always been the proletariat, who apparently are the only people included in the People. If you’re acting in the name of the People, you can brutalize persons. The interests of the People require a gulag, the interests of the People require a death camp, and if the people have to suffer for the People, then so be it.

Madeleine Kearns: For the purposes of your reporting, you were in and amongst the Portland mob. Did you get any sense of what might attract someone to join them? Kevin D. Williamson: “Loneliness. Almost none of this is really about politics at heart. Younger people have lives disproportionately involved with sterile social-media relationships, and relationships in the real world are increasingly informed by the social-media sensibility, which is one of mutual instrumentation. We could choose any metric of success and happiness we want, and we’ve settled on the crude quantification of love and human connection. The people suffering under that particular boot-heel don’t realize that they are wearing the boot, and that they have the power to take it off of their own necks at any time they want, that they can take a little freedom out for a spin and see if they like it. They don’t need a revolution. They need Jesus.”

I started with an adaptation of the phrase “We the people…” from the preamble of the United States constitution. “We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.” NOW THAT’S AN AGENDA!

Thankfully, there was no social media, especially Twitter, or we would not have ended up with a constitution. The “We the people” preamble referred to the people of the separate states, not the United States, representing many different interests. There was plenty of disagreement and rancor behind the scenes of the Constitutional Convention, but their main thing was coming up with a constitution that could be ratified by at least 9 of the original 13 states. The primary difference between a convention and a mob is commitment to a goal. Twitter and other “social” media, or antifa masks for that matter, allow cowards to hide behind anonymity to promote their own animosities. Instead of defining and working towards a worthy goal, creating chaos is their result, regardless of what they think their agenda is.


I remember a woman I knew back in 1984, who defined herself as a revolutionary, had all sorts of Workers Party and Communist posters in her apartment, participated in violent clashes with police…..when she wasn’t at her day job, as an high salaried executive with AT&T before their breakup. She loved the people, but hated actual people. Your typical armchair–or should I say aeron chair revolutionary.

When squishiness becomes gospel.

Doug Wilson knows how to put things in perspective: “Scripture is a mountain range with granite boulders, and some places that are tough to climb. You can get hurt there, as the apostle once observed. But if you get high enough, above the tree line, you can see everything. By contrast, humanistic sentimentalism is a gigantic muck swamp, artificially augmented by about thirty percent through our legal system’s massive production of green Jell-O, and a diseased pop culture that is positively malarial.” However, in his post he claims the “high moral ground.” Compared to whom? No human being occupies the high moral ground on anything.

Nevertheless, I liked his comments about the “old guard” Christian Reconstruction writers like Gary North and Rushdoony, and I think the following is what he meant by his unfortunate claim. “For example, if confronted with the “angular” truth that God’s people in the Old Testament were allowed to buy slaves from pagan nations roundabout (Lev. 25:44-46), the likes of Rushdoony or North would say that paganism is slavery, and so a pagan is a slave by definition. Being brought as a slave into the covenant people offered a (long term) prospect for liberty, but in the meantime, it did not increase the amount of servitude in the world, but rather placed boundaries on it. And over generations, it created an off-ramp from that condition of pagan slavery.”

I bemoaned the lack of a unifying and effective worldview for our foreign policy/war making, in my last post. The firmly resolute nation I was born into in 1946 has become a quishy mess of “humanist sentimentalism”. Feelings reign, ugh. My daughter took me out to dinner Christmas Eve, and while I was outside, leaning on my cane, waiting for her to bring the car around, a couple approached me. The wife asked me if I was okay, and if someone was coming to get me. I assured her I was fine, just waiting for my ride. I related the incident to my good friend and former business partner, and said to him, “I realized she saw me as a decrepit old person, probably suffering from Alzheimer’s, who wandered away from the nursing home.” Before I could make my point, he hastened to reassure me that it’s not important what others think of me, that I am still okay despite her opinion.

He knows me well enough to know that I don’t care what others think of me, yet he immediately assumed that her questions and the underlying opinion were hurtful to me. No, that’s not at all the point I was trying to make. I realized that I still think of myself as strong and able, not at all as I appear to others since the stroke I suffered in 2016. If someone wants to hold the door for me, or return my shopping cart, that doesn’t wound my self esteem. What the heck, it makes my life a little easier and allows the other person to feel a little jolt of attaboy! What I feel about myself is entirely related to who I am in Christ, NOT a bit of how others treat me. That’s the opposite of modern humanist squishiness.

It’s natural, I suppose, for someone who cares about me and knows how much that stroke took out of me, to worry about how a random, kind stranger’s questions could hit my self esteem. Excessive concern for self esteem is the zeitgeist of modernity. But for people who profess faith in Jesus Christ, like me and my friend, self esteem based on anything other people say is a non starter. I am perfect in the Father’s eyes. The real gospel is that blessing is freely available, by grace. Why then, does that message have to compete with all these “social justice” and “self esteem” gospels emanating from church pulpits and home groups? I suggest you reread the second paragraph, then read Leviticus 25:44-46, then reread the paragraph again. You may say, “ah ha”. Or you may be part of the problem.

Speaking of which Brown University “is investing in creating safe spaces for men to unpack all of the things they have learned about masculinity and what it means to be a man. The goal is to help those socialized as men to unlearn some of the notions that have led to such profound harm being enacted toward others and toward themselves.” The College was founded by the Reverent James Manning, a Baptist minister. Probably a toxic male. Brown University costs $73,000 per year to attend. Gee, where’s the line form?


FOR THE REAL GOSPEL, CHECK THIS OUT  EMPOWERED


The lesson: Worldview determines commitment.

Kurdish forces

Osama bin Laden predicted it and his prophecy appears to be coming true. In his book, “The Looming Tower: Al-Qaeda and the Road to 9/11,” Lawrence Wright quotes bin Laden as saying: “Look at Vietnam, look at Lebanon. Whenever soldiers start coming home in body bags, Americans panic and retreat. Such a country needs only to be confronted with two or three sharp blows, then it will flee in panic, as it always has.” “Such a country….” What does he mean? Osama was guided by a worldview: A worldwide permanent caliphate will be established when Muslims all over the world unite and overthrow the decadent and unreliable westerners….like us. In the minds of his followers and other jihadis, their war will never end until their caliphate is established. No sacrifice is too great, no suffering is too long.

The country we are today is guided by no unified worldview, even though we once were. Our citizens actively pursue their own pleasures and plans, our, ahem, “leaders”, pursue their careers and popularity, so what can you expect if you are an ally trying to survive in a hostile society, while depending on our strength and our resolve? Ask the Kurds, the Montagnards, the Free Syrian Army, and other indigenous allies which we abandoned when we experienced those “sharp blows.” I was a soldier in Vietnam and spent some time in a Special Forces camp, watching the dedication that our soldier professionals had towards their partners, the Montagnards, a Vietnam mountain tribe of fighters loyal to us and avowed enemies of the communists. I hate to think of their fate when we left, but I imagine it was similar to that of the Kurds in Iraq-Syria.

Our indigenous enemies, and their foreign fighter allies, have a worldview which thinks long term and is dedicated to victory regardless of the cost…to them or anyone else. Am I saying we should become more like our enemies? No, their worldview is, dare I judge, wrong and evil. Their attitude towards “collateral damage” is that everyone who gets in their way is fair game. In fact, everyone anywhere who doesn’t espouse exactly their beliefs is fair game. But yes, we should be like them in our commitment to the victory of our worldview….except, we don’t have one, or don’t know if we do, or we aren’t sure what we believe, and who are we to judge???

Enough of that already. If you can’t think of anything worth fighting for or dying for, get out of the way. If you are a politician rather than a statesmanperson , if your commitment is to your career and your popularity rather than to principles or future generations, you should have the grace to recuse yourself from making military or mission decisions. The Constitution grants Congress the sole power to declare war. Congress has declared war on 11 occasions: war of 1912, war with Mexico 1846, war with Spain 1898, war with Germany and Austria-Hungary 1917 (WWI), war with 6 combatants-Germany, Italy, Bulgaria, Hungary, Romania, Japan (WWII). Notably missing are declarations of war with North Korea, Vietnam, Iraq, Afghanistan.

Congress approved its last formal declaration of war during World War II. Since that time it has agreed to resolutions authorizing the use of military force and continues to shape U.S. military policy through appropriations and oversight. The last sentence was a direct quote from the United States senate! B.S.!! What you call “oversight” is cowardly meddling. Before I suggest an effective and appropriate worldview for war, I want to render my opinion about political oversight. When you send our military to fight, your oversight has ended. Let the military decide how to pursue the mission and get the hell out of the way!

What was the worldview of the United States after WWII? We were the only nation capable and willing to be the guarantor of liberty to the oppressed and the rebuilder of destroyed nations, including former enemies. We saved many German people from starvation by the communists via our Berlin Airlift, we saved ordinary Japanese citizens from domination by the militaristic imperial culture of the elite. Then there were the war crimes tribunals in both Germany and Japan. Our worldview said that targeting non-combatants was a crime, not a method of waging war, that a just war was waged against tyranny and aggression by the stronger against the weaker.

How things have changed. Since WWII, we have not fought nation states, but movements, insurgencies or amorphous groups and networks. There is no longer a clear stronger or weaker. We have spilled much blood trying to bring “democracy” to places like Iraq, Syria and Afghanistan, without recognizing that such places are dominated by a worldview–Islam–that is fundamentally hostile to the idea of individual liberty and freedom of expression, religion and speech. When that hostility results in too much of our blood, we disengage, without admitting or even understanding that it was a foolish errand to begin with. Is there anymore an effective and appropriate worldview for war?

We have to articulate, the way ISIS effectively does, what we believe, before we can commit to helping long term. Our dedication to liberty should be expressed by our supporting insurgents who are against tyranny in their own countries, and who would not oppress others if they gained power; Whomever that would be, if anyone. Perhaps the Kurds are a good example, perhaps not. We won’t know until they get the upper hand. Whatever we decide to do, it needs absolute commitment, or don’t start.

My journey through progressive rock.

prog rock album covers

As you know if you’ve read a few of my posts, the word “progressive”, when applied to politics or religion, is a dirty modifier, but when applied to music, specifically rock music, it’s a beautiful thing. My very first listening experience with prog rock was in 1969, when my mother, of all people, sent four cassette tapes to me in Vietnam. I guess she got advice from a record store clerk, but however, I loved the albums–the Jefferson Airplane, Santana, Blind Faith and The Cream. Just incredible. I wore the tapes out, and now, 49 years later, I still listen to those groups. But the real prog rock royalty were the British groups like Emerson Lake and Palmer, King Crimson, Deep Purple, Colosseum, The Cream, Jethro Tull, the Moody Blues and my favorite, the Mahavishnu Orchestra!

Until today, I secretly thought that this kind of musicianship and creativity was inherently superior to what passes for rock today, but I never confessed (what I thought was a personal preference prejudice) to my grown children or other young people. Now I am convinced I was right all along. Why? I watched separate interviews with Greg Lake, Carl Palmer and Keith Emerson on YouTube, and clips of the Regis and Kathy Lee show with Emerson Lake and Palmer, and another with Jethro Tull. Greg Lake said “in our day, you had to be original, or you wouldn’t have a following. These days, because of how corporate music companies make decisions, you have to sound like someone who is popular to get any airplay.” Keith Emerson said his two sons are in bands, and one day he came home to find his albums all out, and his son and friends were all listening to his music. His son said, “dad, we’ve listened to your music, I never knew it was that good.” Carl Palmer talked about classical musicians in his family going back three generations. Kathy Lee said she can’t listen to modern rock, after growing up with ELP and groups like that, like I did. I gleaned from other YouTube videos that professional and classical training was the norm for many of the prog rock musicians! Even guitarist Ritchie Blackmore of Deep Purple, the loudest musician of the loudest of the groups!

So I guess I’m not a snob after all, I am discerning. Thankfully, with Amazon Music or Spotify, I can listen to those greats, even though some of my favorites–Jack Bruce, Greg Lake, Keith Emerson–have died. LONG LIVE PROG-ROCK!

AC DC? No, BC AD! It’s Christmas Day!

Are we discussing a rock band, two forms of electric current, or the dating system of the Western world?  For unto us a child is born, unto us a son is given: and the government shall be upon his shoulder: and his name shall be called Wonderful, Counselor, The mighty God, The everlasting Father, The Prince of Peace. Of the increase of his government and peace there shall be no end, upon the throne of David, and upon his kingdom, to order it, and to establish it with judgment and with justice from henceforth even for ever. The zeal of the LORD of hosts will perform this.” (Is. 9: 6-7).

I cribbed the following two paragraphs from https://dougwils.com/the-church/s8-expository/%EF%BB%BFchristmas-a-basic-review.html  

Douglas Wilson is far more eloquent than I, so here goes:

“There are many things to note in this glorious text, and it is right that we are reminded of them on many Christmas cards. The message of Christmas is politically incendiary, when you think about it, and it is not for nothing that secularists are trying hard to get us to forget Jesus with their new dating system of C.E. (Common Era) and B.C.E. (Before Common Era), and seasonal conifers instead of Christmas trees. Nice try, but we aren’t buying any.

“We were not given a son who aspired to have the government be on His shoulder, and good luck to Him. The result of His coming is promised just as surely as His coming was, and that result was that the “government shall be upon his shoulder.” According to the prophecy, this government will be established in fact (as it was 2,000 years ago), and the growth and increase of that government will necessarily be inexorable. “Of the increase of his government and peace there shall be no end.” Another way of saying this is that there will be no stopping it. His government will not be manifested all at once because the prophecy describes it as needing to be ordered and established with judgment and justice. That is done gradually. But this necessarily will happen, and we have the assurance that God is zealous to accomplish this.”

One sign of Christmas season is the Salvation Army kettles. Zealous does not seem to describe how that organization relates to Christmas. Do people NOT know that the Salvation Army is a Christian organization? I am particularly distressed whenever a Salvation Army “bell ringer” says “happy holidays” rather than “merry Christmas” or “happy Christmas.” If that expression, “happy holidays” is merely a sop to unbelievers to avoid offending them by mentioning the word that contains the reason for the “holiday”, Christ, so much the worse for them. If the greeting is left up to each bell ringer, that’s equally sad. On the Salvation Army North Division website, it says “bell ringers are the difference between a full kettle” and has a FAQ about volunteering as such. None of the questions address this issue. This Christmas, I put money in at least six different kettles. Not one volunteer said the word Christmas. Unless that changes, I won’t be contributing to that charity next year.

Universal and government healthcare, part 3: advantages and alternatives.

From https://www.verywellhealth.com/is-universal-healthcare-the-same-as-socialized-medicine-3969754: Politicians and pundits may toss out terms like universal health care and socialized medicine as if they were synonyms, but the terms represent fundamentally different political and economic approaches to providing for health services. Although doctors in the United States may refuse to treat people who can’t pay for their services, under the Emergency Medical Treatment and Labor Act (EMTALA), hospital emergency rooms cannot even ask about a person’s ability to pay until after the person has been medically stabilized by a physician. However, most experts do not believe that EMTALA in itself signifies “universal health care.” In a strict sense, universal health care is all about access to emergency and preventive health services. Under this definition, the United States enjoys universal health care. However, the term is often constrained to reference access to health insurance—in which case, the United States does not enjoy universal health care.

Socialized medicine in its strictest sense, is a single-payer government-run and delivered system. In a socialized medicine model, the government provides all services from your doctors and providers to the hospitals and other facilities, and all payments for those services. Some looser translations of socialized medicine–hybrids–allow for private providers and facilities, but that practice is not usual; typically, private payment and independent for-profit providers are either discouraged or forbidden. The National Health Service (NHS) in the United Kingdom is an example of a system in which the government pays for services and also owns the hospitals and employs the doctors. Funding for the UK’s National Health Service (NHS) comes from tax revenue. Residents can purchase private health insurance if they want to. It can be used for elective procedures in private hospitals or to gain faster access to care without the waiting period that might otherwise be imposed for non-emergency situations. This is hybrid rather than pure single payer.

In most cases, universal coverage and a single-payer system go hand-in-hand, because a country’s federal government is the most likely candidate to administer and pay for a health care system covering millions of people. However, it is very possible to have universal coverage without having a single-payer system, and numerous countries around the world have done so. Denmark, France, Australia, Ireland, Hong Kong, Singapore, and Israel each have two-tier systems. While Medicare operates similarly in the United States, the supplement Medicap coverage if offered and managed by a private health insurer rather than the government. In Canada, which also has a single-payer system with universal coverage, the hospitals are privately operated and doctors are not employed by the government. they simply bill the government for the services they provide.

Today, 18 countries offer true universal health coverage: Australia, Canada, Finland, France, Germany, Hungary, Iceland, Ireland, Israel, the Netherlands, New Zealand, Norway, Portugal, the Slovak Republic, Slovenia, Sweden, Switzerland, and the United Kingdom. In addition, several other countries have achieved near-universal coverage with more than 98 percent of their population insured, including Austria, Belgium, Japan, and Spain. In contrast, only a little over 91 percent of the U.S. population was insured in 2016, and Gallup tracking indicated that the percentage of Americans with health coverage had dropped to under 88 percent by late-2017. 

Germany has universal coverage but does not operate a single-payer system. Instead, everyone living in Germany is required to maintain health coverage. Most employees in Germany are automatically enrolled in one of more than 100 non-profit “sickness funds,” paid for by a combination of employee and employer contributions. Alternatively, there are private health insurance plans available, but only about 11 percent of German residents choose private health insurance.  

Singapore has universal coverage, and large health care expenses are covered (after a deductible) by a government-run insurance system called MediShield. But Singapore also requires everyone to contribute between 7 and 9.5 percent of their income to a MediSave account. When patients need routine medical care, they can take money out of their MediSave accounts to pay for it, but the money can only be used for certain expenses, such as medications on a government-approved list.

ADVANTAGES OF SINGLE PAYER BASIC HEALTH INSURANCE



Universal health care simply means that every citizen has a realistic ability to access basic health care services. Furthermore, in most cases, the providers and facilities are privately owned services. Contrast universal care with a single-payer system. In a single-payer system, everyone gets coverage that fully pays for all services and the government provides for this access. The disadvantages are obvious: 1. Can you trust government bureaucrats to make viable long term decisions rather than politically expedient fixes? 2. Unless individuals are allowed to pay extra for services they want, and professionals are allowed to market their services outside of the single payer, both patients and professionals are hostages. 3. But if there are no restrictions on #2, and enough people are willing to pay extra, the best professionals will leave the system, and those who remain are likely to be less competent. 4. What happens whenever and wherever there are price and wage controls, both of which are necessary for single payer to survive? Shortages of goods and services, longer waiting lists, thriving “black markets”, general decrease in quality of what’s controlled happens. The NHS gets around this with a hybrid system.

What, if any, are the advantages of single payer over a hybrid system: 1. Theoretically, when everyone is covered, the population will be healthier IF people who are sick seek help early AND preventative care is sought by almost everyone. In reality, neither outcome is guaranteed no matter who is covered, because there’s still the issues of waiting times, inconveniences and resistance to treatment. 2. If #1 happens enough to overcome the caveats, medical costs should go down due to earlier intervention. 3. People will have more job mobility and entrepreneurship might flourish when no one is constrained in their job by fear of losing health insurance, and no one will go medically bankrupt (something like 60% of bankruptcies are due to medical bills). 4. Presumably, paperwork and administrative overhead will go down when providers have only one entity to bill rather than a variety of insurance companies, and a government entity has lower administrative costs than a private insurance company. The major caveat here is that whenever proponents of single payer (hi Bernie Sanders) cite the cost differential, they use the ratio of administrative costs/overall treatment costs. This is misleading, especially when using Medicare as an example, because Medicare patients are older and sicker than private insurance patients, so that drives the denominator way up and the ratio down. A more accurate measure of cost is the ratio of administrative costs per beneficiary. Private insurance companies pay about $453 vs. Medicare $509 per beneficiary, according to the Heritage Foundation. (The fact is that, in recent years, Medicare administrative costs per beneficiary have substantially exceeded those costs for the private sector, this despite the fact that, as critics note, private insurance is subject to many expenses not incurred by Medicare. Contrary to the claims of public plan advocates, moving millions of Americans from private insurance to a Medicare-like program will result in program administrative costs that are higher per person and higher, not lower, for the nation as a whole.)

THE BOTTOM LINE Single payer has only one unequivocal benefit over hybrid or multi-payer systems, #3 above, while the disadvantages are real. Countries which have either hybrid or multiparty systems depend on citizens either obeying requirements or being forced to enroll in insurance or be heavily penalized. That’s fine for Germany, Japan or Singapore, with obedient populations. The United States’ frontier mentality means that a certain proportion of the population will remain uncovered by health insurance no matter what (see paragraph 4 which indicates that proportion covered actually went down from 2016-2017 even under the requirements of the ACA. “Universal” coverage here could only happen under a single payer system, which has more disadvantages in our political system than the advantages of a fully covered population would confer. There are myriad ways to make our present system better, more efficient, more effective, but I don’t have the space to lay them out here. Read these five great ideas.  

https://nypost.com/2012/06/10/5-ways-to-solve-health-care/

The problem of subsidized healthcare, part two.

In part one, I introduced the term “subsidizer”, the people who overpay in order to help provide free services to those who don’t pay. You mean can’t pay, right? No, I mean don’t pay. If someone can afford cable tv or a car payment beyond their means, or cigarettes or drugs, but not health insurance, that’s not a “can’t” issue, it’s a spending priority issue. While I am not saying that everyone could afford health insurance, there are many people who can afford it but choose to spend money on other things. An example is the Earned Income Tax Credit, or EITC. People who earn money from work but meet income limits can not only get a refund of all taxes they paid, but get an EITC worth many times their tax refunds, as an additional tax giveaway. It’s not really a refund, since they didn’t pay the tax to begin with, nor is it a tax credit, despite the name, because a credit assumes a tax liability. Let’s take an example: a couple filing jointly with three children can make up to $53,390 annually and qualify for the EITC. The amount they get, in this example, is up to $6,318. That’s $526/month that they haven’t earned and get in a single lump sum. In most states, that would pay for decent health insurance for the whole family. I worked at H and R Block for three years doing tax returns and saw a lot of these gimmes go to people who paid no tax. I didn’t have to ask what they intended to do with the money, they were only too glad to share with me. Everyone was going to buy health insurance, right? Yeah, if it came in 60″ diagonal HD with chromecast built in, or started with i followed by either pad or phone. No one said “health insurance”. In Washington, they didn’t need to.

A Tale of Two States

My middle daughter, who lived and worked in Idaho for three years while going to college, now lives and works in Washington. When the Affordable Care Act–ACA or “Obamacare”–passed, states had the option to run their own health insurance exchanges or expand Medicaid. Idaho did the exchange, Washington expanded Medicaid. In Idaho, my daughter was making around $19,000/year, and was able to buy a good Blue Cross plan for about $190/month, and ended paying $91/month after a tax subsidy of $99/month. Not bad, but when she moved back to Washington, she qualified for Apple Health, the name for our state Medicaid plan. She paid no premium at all, paid nothing for meds, or any medical services and even got free dental. It’s a REALLY good deal….too good. Someone has to pay. Kinda like the families who scored the EITC. If they qualified for Apple Health, they get everything paid for, if they don’t, that’s another story!

My daughter will make too much money to qualify for Apple Health this coming year. To buy health insurance in Washington, the cheapest plan for an individual is $290/month, and it pays nothing until the deductible of $7,900 is satisfied. That’s $100/month more than a plan in Idaho that covers almost everything! Need a visit to urgent care? In Idaho, that’s $25 after insurance. In Washington, it’s whatever the clinic fully charges–typically about $150–until you’ve paid out $7,900! Hospital overnight stay? Idaho, under the Blue Cross plan, $150. Washington, $7,900. Can you guess the main reason why she will pay so much more here than in Idaho? She is now a subsidizer. I was self employed most of my life, and was a subsidizer for 40 years!!

Do I have the right to resent EITC recipients? Medicaid recipients? How about those who get both AND a big screen 4K tv? I really hated doing tax returns AFTER my full time occupation hours, especially when I had to smile at a $6,000 EITC. So why did I do it? I had to pay enough for my health insurance so others could get theirs for free, that’s one reason. What do excessive premiums or out of pocket costs have to do with financing the rich benefits of Apple Health? A.H. coverage is provided by a limited number of managed care/insurance companies, who bill and are paid by the state and federal governments. Because the payment rates are so low, professional providers have to charge higher rates to “private pay” and privately insured patients. Insurance premiums and coverage gaps reflect this. Even with soaking the subsidizers, the government still has to soak the taxpayers to offer such largesse to those who pay nothing.

My daughters benefited from the ACA, for a few years. Now they are in their 20’s and have no employer paid insurance. They might be subsidizers for many years. This is not justice. If you demand universal coverage and are already covered by your employer, shut up. If you have no health insurance under ACA at this point, that’s practically prima facie evidence that you are making enough to afford it, because otherwise, you would be under Medicaid or getting government-subsidies for buying insurance. But if you are a subsidizer–paying exorbitant rates–you are the heroes, and have earned the right to complain. 

To summarize and simplify, justice in the healthcare financing realm has to do with: 1-who pays, 2-who benefits, 3-quality of care delivered and 4-sustainability. The next post in this series will consider different alternatives for answering the first two questions.