Tuesday, June 21, 2011

Markets in Everything: Cash-Only Doctor

Renegade Minnesota doctor -- makes same-day house calls, spends 30 minutes with each patient, and accepts payment in cash, checks, eggs, wine, pork sausage, pickles, homegrown tomatoes, or homemade pies, but not insurance, Medicare or Medicare. 

116 Comments:

At 6/21/2011 2:27 PM, Blogger Larry G said...

We have an interesting thing going on in our area (and probably in other areas also).

That is the expansion of so-called doc-in-the-box urgent care centers that are being used for primary care on a cash/credit basis by many people.

This came to light recently when one of them closed and a howl of protest went up from those who had their medical records there and wanted them back.

So.. some people are not looking for primary care physicians.. not waiting to get an appointment ... just showing up at these urgent care places to take care of things including getting blood tests and periodic care.

Some of these places store your records electronically...

is this a market solution ?

 
At 6/21/2011 2:30 PM, Blogger Eric H said...

Note the careful wording on those "gratuities". Barter doctors are declared domestic terrorists by our government.

 
At 6/21/2011 4:03 PM, Blogger morganovich said...

my doc in SF was cash only.

it was reasonable, you could get in the same day, he remembered you and took all the time you needed.

it's a better model.

my parents have a "concierge doctor" who they pay an annual fee to and takes care of all their basic needs. he's great and they really like him.

it's a no brainer for doctors.

they get to provide the kind of care they went into medicine to do and at lower prices. the amount of money wasted making, adjudicating, fighting over, and fulfilling insurance claims is staggering.

 
At 6/21/2011 4:09 PM, Blogger Larry G said...

I'm not going to disagree except to ask what is the impediment to more of this instead of the current system which in many ways is not as good.

The only problem I have is the same old one about what happens when you see referred doctors with respect to your medical history.

In most cases.. what he/she gets is a one or two pager from the referring physician and whatever you fill out on the clipboard in the waiting room.

this is not a good model for good care in my view.

 
At 6/22/2011 7:52 AM, Blogger morganovich said...

"In most cases.. what he/she gets is a one or two pager from the referring physician and whatever you fill out on the clipboard in the waiting room.

this is not a good model for good care in my view."

what does any of this have to do with cash pay?

it seems to be that cash pay makes doc have to compete more on price and service. part of that competition is informational transparency.

all my records are available online. i just need to give any doc who needs them a password. he can then read and add to them.

if he does not put my records in, i get physical copied and scan them in myself.

also, a cash pay doc, unlike a harried, profitless insurance driven one, will take the time to speak to another doc if you ask him.

so i really don;t see what your issue is.

 
At 6/22/2011 7:55 AM, Blogger morganovich said...

"is this a market solution ?"

the real solution is for you to have control of your own records.

there is no reason at all you cannot get a copy of all your records, scan them, and keep them in the cloud making them accessible to any doc you wish.

you need to realize that YOU own your records, not the doc.

 
At 6/22/2011 8:04 AM, Blogger Larry G said...

cash pay means you are probably using an urgent care facility that are usually not as stable as primary care physicians/practices.

But even with primary care physicians/practices - if you get referred your entire medical history will not get sent but more likely a one or two pager describing the problem and preliminary diagnosis.

In the military, the VA, and many universal care countries - your medical records/history are electronic and usually more accessible by whoever treats you.

You say that all your records are online.

Does that include all of your records no matter which doc you see?

the reason I ask - is that even when my doc KNOWs that I had a test or x-ray done - they only usually have the latest... not the previous ones that would function as baselines.

The same goes with routine blood tests.

Most Doctors might have them as paper but few of them have a chart showing the trend data for each of the things tested.

Again.. no baseline.. no trend....

these are things that can become important when someone is looking at what is essentially a snapshot of your situation and wondering if ..for instance, your white blood count has always been a bit high or has it been historically low.

Many people keep better records of their cars service than they have of their own bodies but a few like yourself are more proactive.

 
At 6/22/2011 8:07 AM, Blogger Larry G said...

" the real solution is for you to have control of your own records.

there is no reason at all you cannot get a copy of all your records, scan them, and keep them in the cloud making them accessible to any doc you wish.

you need to realize that YOU own your records, not the doc. "

tis true but most folks have over their lives - a dozen or more doctors they see.....and that does not include the labs that do tests, x-ray/MRIs, etc.

Scanning them in would be a bear of a job for many people but even then the data is not integrated.

for instance, you may have 30 blood tests over a number of years but when you just scan them.. you're essentially back to paper to look for baseline/trend data.

 
At 6/22/2011 9:41 AM, Blogger morganovich said...

larry-

then enter the tests in table form.

still, it's your data. you would not expect every auto repair shop to share results, you'd keep a file.

why is it the responsibility of the doctor to gather your records?

you would not ask you contractors for unified records on home repair or your realtor to keep track of their effect on your purchase price for taxes.

scanning docs/keeping a file is easy.

if health records are important, then they are worth spending 5 minutes on every time you go to the doc.

i just don't see how pushing the responsibility out to the docs for keeping your records is in any way the path of least resistance here.

 
At 6/22/2011 10:40 AM, Blogger Larry G said...

I've done some scanning and I've actually come close to creating spreadsheets for blood test results but I have not figured out what I might do with things like xrays and MRI images....EKG paper, dental films, digital images readable only by special software, etc...

 
At 6/22/2011 1:03 PM, Blogger Ron H. said...

"but I have not figured out what I might do with things like xrays and MRI images....EKG paper, dental films, digital images readable only by special software, etc..."

I think you are just being argumentative here to avoid admitting that morganovich has overcome all your objections.

While most of the images you mention are now digital, and MRIs have always been so, how hard can it be to store a few xray images if you were so inclined? As to special software, you can probably safely assume that anyone qualified to use the data you are concerned with probably has the needed software.

You may also be overestimating the value historical images of this kind might have to a medical professional. Would it be of some value to know that that tumor that now appears on your xray wasn't there 2 years ago? How about that cavity in #14? It wasn't there last year. Four years ago your blood pressure was normal. How does that trend data affect your current course of treatment?

In any case, what connection can this possibly have with how you pay for a service?

Based on your previous comments, I think the argument you really want to make is that people are too stupid to be trusted with managing their own medical treatment, so that some central medical authority is necessary to manage it for them. Is that pretty close?

 
At 6/22/2011 1:35 PM, Blogger morganovich said...

ask for your MRI on a CD.

that's what i did.

a large percentage of radiology is now teleradiology.

their standards are pretty well set.

most docs will just want to see the report written by the rad anyhow.

 
At 6/22/2011 2:05 PM, Blogger Larry G said...

I actually agree with morganovich on the personal responsibility aspect of being responsible for your own records.

I just don't think the average elderly person or mom/pop have that ability and that is not a requirement for the Va, TRICARE (military care for soldiers AND their families), nor any of the worlds other heath care systems.

I know that GOOGLE and Microsoft (as well as others) are promoting online health vaults and I've tried to use them but it's not easy.

 
At 6/22/2011 2:37 PM, Blogger Larry G said...

and yes.. I've asked on occasion for the CD and was told they'd provide it but it would not be "readable" except by the same kind of equipment.

I've been to UVA in Charlottesville and to their credit - they store the images electronically AND they are available to other physicians in the same hospital/town but to physicians in other towns using standard software but access to the system was limited to Doctors.

collecting your own records will not help a new doctor because he/she will not have the time to go through them.

That's why I say the data has to be integrated - it's not only in electronic form but it accessible via database queries and keyword searches.

For instance, a physician might want to search your entire set of records for a keyword like "cancer" to see if there is any mention in it in the hundreds/thousands of records and if when, where how, in your past.

For instance, 4 years ago, I had a basal cell "dot" taken off but a different doctor seeing me - for example - a dermatologist I saw for another skin problem - he did not know that until I remembered to mention it to him - at which point he wanted the records sent to him.

He not only wanted to see the remarks of the physician, he wanted to see the report from the pathology lab.

I would doubt seriously that the average person could collect such an array of information and have it in a searchable database.

No Physician is going to plow through a thousand pages of your medical record - page by page - as part of your visit.

 
At 6/22/2011 3:19 PM, Blogger morganovich said...

"collecting your own records will not help a new doctor because he/she will not have the time to go through them."

then you have the wrong doctor.

no among of clever database structure is going to get a doc who has 8 minutes to see you to go through your records. it's just information overload.

you are making a silly straw man argument.

you seem really determined to make organizing and maintaining health care records someone else's responsibility and you make it sound like such an impossible chore.

it's actually really easy. you ask for a copy of your records every time you see a doc.

you take them home, and file them or perhaps scan them.

if you have some level you need to track consistently, you build a spreadsheet. inputting 30 test results to excel will take you 5 minute and give you nice, graphical output.

you are trying to substitute huge costs in databases and data input (keep in mind someone has to put it in the database) for a small expenditure of your own time.

the average person has nothing like 1000 pages of medical data. further, your implication that a doctor can only find it if it's in a database is ridiculous. just file your stuff in any sort of remotely intelligible format or title docs so you know what they are in electronic form.

hell, any sane person looks at their own records and knows which ones are relevant BEFORE they go to the doctor. it's a meeting you should prepare for like any other. if you fail to do so, you are not taking an active role in your own health. don't be surprised if that failure leads to poor outcomes.

you are assuming all kinds of problems that do not exist and recommending complex and expensive solutions to an easy problem because you think people are stupid.

that's a classic statist attitude.

the system you suggest would never be worth what it cost.

 
At 6/22/2011 3:29 PM, Blogger Larry G said...

I'm not really making a case of who should do it as much as I am making a case that there needs to be a unified approach that provides the ability to query and search information.

but someone who has 40 years of medical records may well have well over a thousand pages, guy.

and they come from dozens/hundreds of different providers....

and yes.. when you get referred to a specialist - how much he/she knows about your complete medical history IS important and it's NOT something you can tell him on a 2 page clipboard and it's not something you can hand him and expect him to read.

The military and the VA and other countries use electronic medical records to a great value... that helps reduce redundant tests, pinpoint problems and in general reduce errors in diagnosis.

Arguing against the value of putting that information on searchable databases would be like arguing that GOGGLE is not useful.

Would I like to see GOGGLE or some Medical - non-govt approach to this - yes.

but calling me a "statist" is wrongheaded and just plain dumb IMHO.

I'm for BETTER CARE - and I AGREE that there needs to be more personal responsibility and participation in one's own care.

but your approach would be like telling someone they can't use GOGGLE to search for information and instead must use paper or scanned in paper.

I simply do not agree and I don't need to call you names because I don't agree.

we can agree to disagree - right ?

and still be civil about it - right?

 
At 6/22/2011 7:19 PM, Blogger morganovich said...

"but calling me a "statist" is wrongheaded and just plain dumb IMHO."

you sure seem to be in favor of forcing a solution on the market through requirements. that is statism. i think you may be falling into the trap of thinking that others forcing you to do things is statism, but your forcing others to do things that you "know" are right is not.

i have called you no names at all. please point out one instance in which i have done so.nor have i been uncivil. you seem to be having a very emotional response here.

calling something "a silly straw man" is not a personal attack, it's a description of and idea.

i also think your google analogy is inapt. it does not fit the scenario.

you cannot support a health database with ads.

to have all the documents you want in electronic form and searchable requires a great deal of data entry. that costs money and takes time. the benefits are not clear.

as you say, there are solutions now. you could easily pay someone to enter all your records. why, if this is such a cost effective good idea, have you not done so? you say one things here, but your actions seem to demonstrate that you do not believe what your are saying when it comes time to put your money where your mouth is.

you are also using extreme cases. 1000 pages is nothing like a typical situation. i'm 39. i have maybe 15 pages of medical records that could be even remotely relevant and a disk of MRI's. i think you are vastly overestimating the amount of data in these records.

there are lots of good reasons to automate practice records including standard of care. paper records cannot do exception based reporting (missed appointment, did not get tests done, etc)

i'm not even arguing that it's a bad idea. but it's going to be useful to some and not others. forcing everyone to use a system that may not make any sense for them is wasteful and counterproductive.

you seem to be looking to push your preferences onto everyone and an entire industry. you seem to get upset when your ideas are described as statist, but that's precisely what pushing these sorts of things as a requirement is.

there are already lots of docs that do electronic records. pick one and go to him if it's important to you. there are whole systems (like kaiser) that standardize on it. if this system is better/cheaper/demanded by patients, the market will provide it.

honestly though, i would much rather see cash pay doctors who take the time to TALK to each other if there is a referral or will talk to a specialist if you ask them to. that is always going to be a better system than a database.

i think that your "database" solution suffers from expectations that are too low. you are thinking in terms of doctors that do not know you and will not speak to one another. the real goal ought to be getting out of that situation, not creating tools to make it easier.

 
At 6/22/2011 7:33 PM, Blogger Ron H. said...

"The military and the VA and other countries use electronic medical records to a great value... that helps reduce redundant tests, pinpoint problems and in general reduce errors in diagnosis."

That sounds good, and seems to make sense. One would hope that a large database of medical records would provide the benefits you claim, , but I don't think you can demonstrate that that is, in fact, what happens.

morganovich has described a simple system of electronic medical records that he uses to his complete satisfaction. He makes his medical information available to those he chooses, not anyone and everyone who might have access to a large central database.

"For instance, 4 years ago, I had a basal cell "dot" taken off but a different doctor seeing me - for example - a dermatologist I saw for another skin problem - he did not know that until I remembered to mention it to him - at which point he wanted the records sent to him.

He not only wanted to see the remarks of the physician, he wanted to see the report from the pathology lab.
"

This sort of destroys your own argument. By taking responsibility for your own medical care, and mentioning something you thought a dermatologist might be interested in, you showed that a central database isn't necessary.

If you had filled out a 2 page form on a clipboard, the doctor would have known to ask you about it. If he didn't check the clipboard form, no amount of data available in a database would have helped.

If you had your own records to show him, so much the better. You are building a strawman when you suggest that a person might bring a large box of paper records to a doctor's office and say: "Here you go, Doc, everything you might want to know about my medical history is in there somewhere."

By the way, a doctor is unlikely to use the word "cancer", unless talking to a patient, so such a search, as in your example, wouldn't likely show anything.

"but calling me a "statist" is wrongheaded and just plain dumb IMHO."

When someone calls you a statist, they aren't insulting you, it is an accurate description of your mindset and attitudes. Your call for a central authority to manage some part of our lives is the very definition of a statist. What's your complaint?

"but your approach would be like telling someone they can't use GOGGLE to search for information and instead must use paper or scanned in paper."

No, his approach prevents those who have no business with them from searching his medical records. Those who he wants to have access to his records, he grants access.

If neither doctors nor patients are in favor of such a central system, why are you?

 
At 6/23/2011 5:17 AM, Blogger Larry G said...

I think standards are needed the same way we have standards for interstate highways, building codes, seat belts, radio signal spectrum for gps, cell and airline communication, etc.

If you look up the definition you will see that the world in general does not apply the concept of statism to these concepts - only ideologues with an agenda.

I was not so much encouraging a GOGGLE-like approach as I was illustrating the VALUE of being able to have a searchable database rather than scanned paper.

You'll find private industry examples of databases where they did agree on standards - without govt dictate.

You'll find, for instance, that most doctors ALREADY have to key in data to insurance company databases and paper or scanned paper is not accepted.

Medical records HAVE been put into an electronic database BY THE GOVT and it has produced a much lower incidence of errors, redundant tests and prescription drug errors.

Are you saying that the govt wasted time and money doing this?

Would you instead believe that the VA and the military should go back to paper ?

My friend, if you are 39 you have way, way more than 15 pages of medical records. You only have 15 pages of them.

Have you actually gone to every doctor and lab that you've used and asked for the JACKET and had it scanned in?

I changed doctors at your age and I asked for a copy of my records (they would not give me the originals)). It took a couple months (they send them to a service) and when I got them back it was a folder almost an inch thick.

My "jacket" now at ONE doctor is over an inch thick.

My "jacket" at my dentist is almost an inch thick.

scanned images are not the same as data entered into a standard form.

why hasn't it been done?

depending on the source anywhere from 20 to 40% of doctors already have.

"standards" are not "preferences" .

standards are almost always a better step forward whether it be in specifying screw sizes or tire sizes or road width.

The bigger, more complex an industry, the harder and longer it takes to adopt standards universally.

the problem with picking a doctor that uses electronic medical records (which I think IS a good idea and one that I would use) is that the other providers and referrals either do not or they use an incompatible format.

I would compare this to cars sold that did not have standard tire or even windshield wiper or headlamp sizes.

standards are, in many respects, how the market produces better quantity and quality at a lower price.

The company that uses a special tire or part is going to charge more for it and it's going to be harder to get and the consumer - if they have a choice - is going to gravitate towards a standardized world.

I support a standardized world including the medical profession.

I do not think that is "statist" nor a "strawman".

 
At 6/23/2011 5:20 AM, Blogger Larry G said...

in terms of "benefits" Ron - the error rate in Va hospitals has dropped to far less than one percent.

It just makes sense guy.

If a doctor can look up your prescription history no matter who prescribed - they can have a much better idea of what NOT to prescribe to you.

Most doctors when they write prescriptions find out about your other prescriptions - how?

do you think they'd find out by reading scanned electronic images?

 
At 6/23/2011 9:57 AM, Blogger morganovich said...

"If you look up the definition you will see that the world in general does not apply the concept of statism to these concepts - only ideologues with an agenda"

here, i disagree with you mightily. people love to laud europe's cell phone system and it's central planning, but look at how poorly it has made the turn into smart phones.

you are looks for a top down, regulated solution and sound like you want to require doctors to participate. what would you call that but statism?

who is going to pay the costs to build the databases and take all the existing records and enter them? you? i doubt you are willing to pay $1000 for your data entered, but you do seem willing to force someone else to spend it.

that strikes me as hypocritical. "i wouldn't pay for it, but i'm happy to make you do it". what that really means is "i'd like to force you to buy me free stuff".

"Are you saying that the govt wasted time and money doing this?

Would you instead believe that the VA and the military should go back to paper ?"

and this is a totally flawed argument. god knows the government wastes tons of money. this may well have been some of it. you are not willing to spend this money yourself, but you want a service someone else pays for. that means that you value the service at less than it's cost. that is the definition of wasted money.

you have pretty much checkmated yourself there. you own actions prove that you think the money is a waste. having a ferrari is fun too, but few people think its worth it. you are just saying that a free one is great.

"You'll find, for instance, that most doctors ALREADY have to key in data to insurance company databases and paper or scanned paper is not accepted"

i think you'll fund that this is not true at all. you are mistaking treatment codes for medical records.

 
At 6/23/2011 10:07 AM, Blogger Larry G said...

"people love to laud europe's cell phone system and it's central planning, but look at how poorly it has made the turn into smart phones."

huh? Europe and Japan both are every bit as advanced and more so than we are - and they did do it with govt.

"you are looks for a top down, regulated solution and sound like you want to require doctors to participate. what would you call that but statism?"

tom down? ha ha ha. Really simple things guy like the size of a shipping container are done with uniform standards which is - any way you cut it - "top down" whether done by govt OR industry.

You seem to think it's okay if done by industry but not with govt, eh?


"who is going to pay the costs to build the databases and take all the existing records and enter them? you? i doubt you are willing to pay $1000 for your data entered, but you do seem willing to force someone else to spend it."

the same people who will do so with the money they save from not having redundant tests and prescription errors, and the like.

"that strikes me as hypocritical. "i wouldn't pay for it, but i'm happy to make you do it". what that really means is "i'd like to force you to buy me free stuff". "

but if I showed you a system that was cheaper WITH electronic records than without what would you say?


"Are you saying that the govt wasted time and money doing this?

Would you instead believe that the VA and the military should go back to paper ?"

and this is a totally flawed argument. god knows the government wastes tons of money. this may well have been some of it. you are not willing to spend this money yourself, but you want a service someone else pays for. that means that you value the service at less than it's cost. that is the definition of wasted money."

nope. I'm asking you if the govt wasted money in implementing electronic records for the military.

yes or no?

according to you it would be better if each military guy kept his own records, right?

"you have pretty much checkmated yourself there. you own actions prove that you think the money is a waste. having a ferrari is fun too, but few people think its worth it. you are just saying that a free one is great."

this is no "free" to it. It's MORE cost effective OVERALL. There is no question about it.


"You'll find, for instance, that most doctors ALREADY have to key in data to insurance company databases and paper or scanned paper is not accepted"

i think you'll fund that this is not true at all. you are mistaking treatment codes for medical records."

I think you will find that the CODES are ALSO a top-down standard and that the doctor's office help MUST key in the required data rather than submitting it on paper.

Have you thought about where medical codes came from guy? and what things would be like without them?

 
At 6/23/2011 10:15 AM, Blogger morganovich said...

"My friend, if you are 39 you have way, way more than 15 pages of medical records. You only have 15 pages of them.

Have you actually gone to every doctor and lab that you've used and asked for the JACKET and had it scanned in?"

note that i said relevant records. my healthy checkup at 25 is meaningless. do is my dentist appointment that year.

most medical records mean little. i save anything important. i have ever medical record since i graduated from college that has anything useful in it. i save them in a file, just like you would for a car or your house.

you don't save every gas receipt for your car. you save the major stuff.

perhaps i am just healthier than you are.

"depending on the source anywhere from 20 to 40% of doctors already have."

great, so what's your problem? the market is meeting a demand. why the rush to regulate?

"I support a standardized world including the medical profession.

I do not think that is "statist" nor a "strawman"."

1. you are missing what i am calling a strawman. what i am calling a straw man is your assertion that a) keeping and organizing medical records is too difficult for people and b) that having a search able database would fix the doctor inattentiveness problem, which it won't. it might even exacerbate it. the straw man is that docs have 8 minutes to see you and need this productivity tool. that is all based on the bad assumption that you cannot see doctors that have time to talk to you and each other about you.

regarding the statism, are you even listening to yourself?

you support forcing standards and practices (along with their expense) onto medical providers against their will and claim that is not state interference into their lives and livelihoods?

worse, you are looking to make them spend money on something that you are not willing to spend yourself.

i think you may need to take a hard look at your views. you seem to be falling into the "it's not statism if it's a good idea" trap so common amongst those who would force others to give them free stuff.

most of your arguments center around "but this would work better". perhaps it would. i'm not even necessarily disagreeing with you there.

where i disagree with you is you assumption that because it would work better, it's OK to force people to do it.

most people would likely be healthier if you ate more vegetables and got an hour of cardio every day. i doubt many would disagree with that.

does that make it OK to force them to do it?

many statists have good intentions. they think they are making the world better by helping/forcing the ignorant to do "what's right".

i think you are such a person and just don't realize it.

go back and read what you have written. people are too dumb to deal with their own records. there needs to be a standard forced on doctors to provide something you are not willing to spend your on money on. it will make medicine better, so we need to do it.

that's paternalistic and coercive, the hallmarks of statism.

the reason healthcare in this country is having so many problems is too much government involvement, not too little.

consider how many useful standards have emerged without government involvement.

what's your argument that it is need ed here and that there is something special about this market that requires coercive interference?

 
At 6/23/2011 10:53 AM, Blogger Larry G said...

"note that i said relevant records. my healthy checkup at 25 is meaningless. do is my dentist appointment that year."

baseline / trend info?

do you know yourself what is medically "relevant"?

would you know what drugs and treatments are contra-indicated based on previous history?

"most medical records mean little. i save anything important. i have ever medical record since i graduated from college that has anything useful in it. i save them in a file, just like you would for a car or your house."

I admire your confidence but not your judgment.

"you don't save every gas receipt for your car. you save the major stuff."

but you have to have enough knowledge to be able to know what is relevant, no?

"perhaps i am just healthier than you are."

maybe.. or maybe no.. but at some point in your future - you may encounter something that makes you less "healthier" as happens to most as they get older.


"depending on the source anywhere from 20 to 40% of doctors already have."

"great, so what's your problem? the market is meeting a demand. why the rush to regulate?"

no rush to regulate but incompatible standards are a problem - the same problem if one cell phone company decided to go their own way on frequency spectrum...

that's why we have standards.


"I support a standardized world including the medical profession.

I do not think that is "statist" nor a "strawman"."

1. you are missing what i am calling a strawman. what i am calling a straw man is your assertion that a) keeping and organizing medical records is too difficult for people and b) that having a search able database would fix the doctor inattentiveness problem, which it won't. it might even exacerbate it. the straw man is that docs have 8 minutes to see you and need this productivity tool. that is all based on the bad assumption that you cannot see doctors that have time to talk to you and each other about you."

my assertion is based on simple reality - worldwide.

there are no places where people substantially keep their own records.

it's true, there are some people who could key in the data or use OCR to populate their own personal database but not too many and zero doctors who would have access to it.

it's a dumb idea guy.

even the airlines and DMV are now charging you EXTRA for paper.

"regarding the statism, are you even listening to yourself?"

of course.

"you support forcing standards and practices (along with their expense) onto medical providers against their will and claim that is not state interference into their lives and livelihoods?"

the is a negative expense to patients who now pay more for redundant tests, prescription and treatment errors based on doctors who are not coordinating with each other that would be if they were seeing the same data.

"worse, you are looking to make them spend money on something that you are not willing to spend yourself."

the excuse being given is that they'll have to pass the costs onto patients... like they don't already with other things?

"i think you may need to take a hard look at your views. you seem to be falling into the "it's not statism if it's a good idea" trap so common amongst those who would force others to give them free stuff."

there is no trap here guy. It's understanding the role of standards and how they increase quantity and quality - productivity - and lower costs.

 
At 6/23/2011 10:54 AM, Blogger Larry G said...

you seem to think that standards equate to govt dictate... and that a bad thing...

your cell phone would be a paperweight if it were not for govt standards.

most of your arguments center around "but this would work better". perhaps it would. i'm not even necessarily disagreeing with you there.

"where i disagree with you is you assumption that because it would work better, it's OK to force people to do it."

horse manure.

the insurance company "forces" your doctor to provide data to them in THEIR DICTATED format - not his.

Your mortgage company "forces" you to buy homeowners insurance.

your state "forces" you to have insurance if you drive

etc etc etc

"most people would likely be healthier if you ate more vegetables and got an hour of cardio every day. i doubt many would disagree with that."

I could not agree more.

"does that make it OK to force them to do it?"

you mean like if you are a soldier or a policeman and they "force" you?

or do you mean when you apply for life insurance and they "force" you to pay more if you smoke?

or they "force" you to get frisked when you fly?

"many statists have good intentions. they think they are making the world better by helping/forcing the ignorant to do "what's right"."

i think you are such a person and just don't realize it."

many folks don't know their backside from a hole in the ground when it comes to statism - also.

Is there a govt - in the world that is not "statism" by definition?

does that mean you are opposed to govt - period?

or are you somewhat pragmatic - like me but you think you are more virtuous on the issue?

:-)

"go back and read what you have written. people are too dumb to deal with their own records. there needs to be a standard forced on doctors to provide something you are not willing to spend your on money on. it will make medicine better, so we need to do it."

see..here's my deal.

if YOUR philosophy is self-consistent in the way it works in the real world then you get points.

but if your philosophy has all sorts of dangling inconvenient truths when it comes to real world issues.. then you lose points.

Pragmatism is a virtue.

ideology is a crutch.

"the reason healthcare in this country is having so many problems is too much government involvement, not too little."

but you can't provide an example where less govt gives better results, can you?

"consider how many useful standards have emerged without government involvement."

and in general.. I support that over govt standards.

but when..for instance.. chemical companies can't agree on what a reasonable standard is for dumping kepone in rivers.. govt has to act.


"what's your argument that it is need ed here and that there is something special about this market that requires coercive interference?"

what you don't understand is that it is people who want standards and people who want others who won't agree to standards - to be regulated.

One company who disregards the rules for radio frequencies would bring down our cell phones and GPS.

so you can have 99% of companies agree to a standard and one will not.

what do you do then?

is that "statism"?

 
At 6/23/2011 11:18 AM, Blogger morganovich said...

"huh? Europe and Japan both are every bit as advanced and more so than we are - and they did do it with govt."

try using advanced 3g apps in europe.

try texting from germany to france.

try taking a prepaid card from one country to another.

i think you'll find europe's system has some real problems and that it has nothing like the vibrant 3g ecosystem we enjoy.

the 900 mhz spectrum is great for voice, but lousy for data.

"tom down? ha ha ha. Really simple things guy like the size of a shipping container are done with uniform standards which is - any way you cut it - "top down" whether done by govt OR industry.

You seem to think it's okay if done by industry but not with govt, eh?"

yes. that's precisely what i am saying and that you, closet statist that you are, seem not to understand.

if an industry standardizes on 1080p, that was the free choice of the industry. no one will make you comply. you can still sell betamax if you want.

the course you champion is completely different. it's coercive. you are forced to do it one way. even above the needless abrogation of freedom that that creates, it also tends to lead to poor results. you don't get competing systems and there fore you lack evolutionary pressure for improvement.

"nope. I'm asking you if the govt wasted money in implementing electronic records for the military."

given that i would be hard pressed to name a government program that does not waste money, yes that almost certainly did.

you are confusing "did it create improvements" with "was it worth it"?

you could hire michaelangelo to paint your kitchen ceiling eggshell white, and he'd do a great job, but i doubt the price would be worth it. that doen't mean you don;t have a great ceiling.

your whole argument is self refuting.

if it makes economic sense in terms of being cheaper and better, then industry will adopt it itself.

there is no need for government.

thus, if it makes sense, it will happen.

only if the benefits DO NOT exceed the costs would you need to mandate it.

thus, such government regulation is always either unnecessary or wasteful. (or both)

you are mistaking someone else paying for something you want with it being free and saying "i want it, but not paid for with my money".

"but if I showed you a system that was cheaper WITH electronic records than without what would you say?"

see above. i'd say that there is no need to regulate because if it's a better system, it'll get implemented anyway.

 
At 6/23/2011 11:19 AM, Blogger morganovich said...

"Have you thought about where medical codes came from guy? and what things would be like without them?"

you are operating under a number of misconceptions here. medical codes come from the insurers. they decide on them. they are also not consistent across the industry. the government is also an insurer and they have their own codes as a result, but they do not set them for aetna. aetna may have a code for a procedure that blue cross or medicare doesn't because the other 2 won't cover it.

there are companies (like athena - ATHN) that base their whole business on automating that input and dealing with the different insurers and their codes and submission procedures. what do you know, the free market solves a problem.

second, the whole "treatment code" issues is an artifact of insurance. they are used to set reimbursement rates.

in a cash pay world, you don't need them.

you are pointing out reasons that our insurance system sucks, not reasons to regulate doctors.

you ever do any work in healthcare? you seem to have a very flawed view of how the system works.

you also seem to feel that it's fine to be coercive if it's "helps".

that's the way most fascists speak.

they do things "to" you for "your own good".

you have yet to provide a single argument that if electronic records are a good idea that the market will not provide them.

if they save so much money, the health systems will be all over them.

so why do we need to be forced?

the only reason to do that is that you want to get other to pay for something you value (but pay more than you value it or you'd already have it) and give it to you.

it would be great if you gave me free beer too, but i think that if the government made you, you might feel a bit ill done by.

 
At 6/23/2011 11:39 AM, Blogger Larry G said...

" try using advanced 3g apps in europe.

try texting from germany to france.

try taking a prepaid card from one country to another.

i think you'll find europe's system has some real problems and that it has nothing like the vibrant 3g ecosystem we enjoy.

the 900 mhz spectrum is great for voice, but lousy for data."

isn't this because of a lack of standards?


"tom down? ha ha ha. Really simple things guy like the size of a shipping container are done with uniform standards which is - any way you cut it - "top down" whether done by govt OR industry.

You seem to think it's okay if done by industry but not with govt, eh?"

yes. that's precisely what i am saying and that you, closet statist that you are, seem not to understand."

I think standards are necessary and better if done by industry but at the end of the day have to be in place for things that industry will not do.

"if an industry standardizes on 1080p, that was the free choice of the industry. no one will make you comply. you can still sell betamax if you want."

if a company decides to sell cell phones that use GPS frequencies then is that their "free choice"?

"the course you champion is completely different. it's coercive. you are forced to do it one way. even above the needless abrogation of freedom that that creates, it also tends to lead to poor results. you don't get competing systems and there fore you lack evolutionary pressure for improvement."

My only champion is cost effectiveness and if we have to get there with the govt, so be it.


"nope. I'm asking you if the govt wasted money in implementing electronic records for the military."

"given that i would be hard pressed to name a government program that does not waste money, yes that almost certainly did."

see.. I see it as a benefit. Better care at a lower price... at an initial cost - AND some loss of flexibility and innovation... trade offs.

"you are confusing "did it create improvements" with "was it worth it"?"

did it result in better and more cost-effective outcomes for military personnel and their families?

Remember.. military families move - not infrequently.

I live in more than a dozen places during my fathers service.

"you could hire michaelangelo to paint your kitchen ceiling eggshell white, and he'd do a great job, but i doubt the price would be worth it. that doen't mean you don;t have a great ceiling.

your whole argument is self refuting."

cost-effectiveness is "self-refuting"? ha ha ha lord o'mighty

"if it makes economic sense in terms of being cheaper and better, then industry will adopt it itself."

history has proven you wrong guy.

the industry won't adopt something that improves the cost-effectiveness for customers - only their own profits.

"there is no need for government."

i d e o l o g y

"thus, if it makes sense, it will happen."

did it make sense to dump Kepone in the James River until govt stopped it?

 
At 6/23/2011 11:54 AM, Blogger morganovich said...

"the insurance company "forces" your doctor to provide data to them in THEIR DICTATED format - not his"

wow, that is some of the worst statist doublespeak i've heard in some time.

that's like saying "mcdonalds makes you order from their menu and pay cash"

no they don't. they offer an option. you take it or leave it.

no one makes you take it.

aetna says "if you want to take our insurance, this is what you must do".

doctors are free not to take aetna or any insurance at all.

there is nothing coercive. aetna offers an option, and you can accept or decline as you please.

you seems to have some very strange ideas about what constitutes free commerce.

"you mean like if you are a soldier or a policeman and they "force" you?

or do you mean when you apply for life insurance and they "force" you to pay more if you smoke?

or they "force" you to get frisked when you fly?"

this is just stupid. yes, like they forcibly take you money or imprison you if you do not comply.

an insurer is offering you a product. they don't force you to buy it. again, you are mistaking deal terms for coercion. buyers are free, sellers are free, they can set terms as they like and trades occur if they agree. you are not entitled to insurance.

you make the same error with mortgages and driving.

you only need insurance (or a license) on public roads. i sued to race cars on private tracks with no license or insurance at 12. it is perfectly legal. you only need to licenses and insurance for the state to let you use their roads.

then, you use a reality fallacy argument. just because something exists does not make it right.
he stole from her so i can steal from you is hardly valid reasoning.

"frisking to fly" is an example.

it's coercive and totally out of hand. it's extensive and does a terrible job.

you really want to cite that as an emulatable example?

 
At 6/23/2011 11:58 AM, Blogger morganovich said...

"Pragmatism is a virtue.

ideology is a crutch."

spoken like a true fascist.

Mussolini would applaud.

if you think notions of freedom, rights, and self determination are a "crutch" and that abrogating them in the name of "pragmatism" is ok, then you are way over the line into fascism.

rights you have unless the government thinks it might be pragmatic to take them away are not rights at all.

 
At 6/23/2011 12:02 PM, Blogger morganovich said...

"isn't this because of a lack of standards?"

no. it's because they have standards imposed from above that cannot adapt to the changing network needs.

"did it result in better and more cost-effective outcomes for military personnel and their families?"

if any system does this, why would it need to be forced on industry?

again, your argument is self refuting.

if it makes sense, it gets adopted anyway.

"if a company decides to sell cell phones that use GPS frequencies then is that their "free choice"?"

this is a senseless argument. spectrum is property. you can no more take someone's spectrum than you can build an addition to your house on their lawn.

 
At 6/23/2011 12:04 PM, Blogger Larry G said...

" spectrum is property. you can no more take someone's spectrum than you can build an addition to your house on their lawn. "

who says it is "property" that can be "owned"?

don't you have the right to use whatever frequency is available?

why not?

 
At 6/23/2011 12:05 PM, Blogger Larry G said...

is it "statism" for the govt to decide who can own radio frequencies instead of letting the industry decide?

 
At 6/23/2011 12:10 PM, Blogger morganovich said...

"history has proven you wrong guy.

the industry won't adopt something that improves the cost-effectiveness for customers - only their own profits."

this makes no sense at all. you seem to not to understand basic micoreconomics. (and what's this repeated "guy" crap "buddy"?)

if it lowers costs and improves outcomes, companies will adopt it without being forced. some have done so.

they do this to increase profits, improve service, and lower prices to take customers from those who don't.

if i have lower costs and better service than you do, i will take your customers. when you adopt the new tech to compete, we will both be forced to lower prices.

that's how business works. those who do not innovate to improve service and reduce costs die.

companies wind up doing the right thing for their customers in order to protect their profits.

it is you who history has proven wrong.

worse, forcing a standard onto an industry causes it to stagnate. there is no more innovation because regulations have eliminated it. this is how the EU missed the boat on mobile data.

you have some deeply flawed ideas about how business and innovation work.

 
At 6/23/2011 12:12 PM, Blogger morganovich said...

"who says it is "property" that can be "owned"?

don't you have the right to use whatever frequency is available?

why not?"

now you are just being deliberately obtuse.

who says that land is property and can be owned?

why can't i build a pool in your yard?

protecting property rights is a legitimate role of government.

 
At 6/23/2011 12:12 PM, Blogger Larry G said...

did industry stop dumping Kepone in the river because it improved quality and lowered costs for customers?

 
At 6/23/2011 12:13 PM, Blogger morganovich said...

"is it "statism" for the govt to decide who can own radio frequencies instead of letting the industry decide?"

the government does not "decide".

they own an asset. they hold auctions and sell or lease it to private companies. the government owns land too. how is selling federal land for development any different than selling spectrum?

 
At 6/23/2011 12:13 PM, Blogger Larry G said...

" protecting property rights is a legitimate role of government"

are you saying that govt decides what is and is not property rights and what people can do and not do with their property rights?

is that "statism"?

 
At 6/23/2011 12:14 PM, Blogger Larry G said...

" the government does not "decide".

they own an asset."

who says they own it rather than "freedom loving" individuals?

 
At 6/23/2011 12:17 PM, Blogger Larry G said...

" . the government owns land too. how is selling federal land for development any different than selling spectrum? "

well.."owning" all the spectrum is akin to "owning" all land and I don't think the govt "owns" all land.

but they do decide what you can do with your land - right?

isn't part of their "right" to tell you what you can and cannot do with your land have to do with what impacts you'd have in your activities with respect to other property owners?

Isn't govt, in fact, the "agent" for all property owners to decide what the rules are for owing land?

is that a "statist" top-down approach?

 
At 6/23/2011 12:22 PM, Blogger morganovich said...

"did industry stop dumping Kepone in the river because it improved quality and lowered costs for customers?"

you have committed ludicrous logical fallacies here.

study your coase.

poisoning a river harms the property and health of others.

protecting that property and health from assault is totally different from forcing me to spend money to buy something you want.

coase would argue that if the actions of a factory harm other, there are 2 means of redress. 1. the harmed sue them 2. you regulate compensation or cessation of harm.

the former makes sense if the harm is large and the number of harmed small, the latter the converse.

if you are doing $10 of harm to a million people, regulation to stop it makes sense. but its' still fundamentally a defense of your property rights.

forcing a doctor to adopt a system he does not want to defends no rights and takes away his.

what you call pragmatism is in fact, theft and coercion.

it seems you will do anything to get away from the basic issue here, so let's get back to it:

businesses are in the business of pleasing their customers. they do this by providing good service at a good value.

if the tools you would force them to adopt are as useful as you claim, they they will adopt them anyway to get an competitive advantage over their peers.

they need only be forced if the costs outweigh the benefits.

why would you want to force that sort of waste?

 
At 6/23/2011 12:26 PM, Blogger morganovich said...

"well.."owning" all the spectrum is akin to "owning" all land and I don't think the govt "owns" all land."

i never said they did. i said they owned some land. they don't own all spectrum either. there are several public access bands.

"but they do decide what you can do with your land - right?

isn't part of their "right" to tell you what you can and cannot do with your land have to do with what impacts you'd have in your activities with respect to other property owners?"

you are committing the same fallacy again and assuming that because something is, it is right.

 
At 6/23/2011 12:27 PM, Blogger morganovich said...

"who says they own it rather than "freedom loving" individuals?"

again, you are just being willfully wrongheaded here.

who says you own your lawn as opposed to freedom loving sunbathers?

you seem to be trying to abrogate the notion of ownership entirely.

 
At 6/23/2011 12:29 PM, Blogger Larry G said...

" 2. you regulate compensation or cessation of harm."

who is "you"?

if the govt "votes" via Congress to require seat belts in cars is that theft and coercion if people elected the representatives who passed the law?

is it "statism" for the Congress to exist as a representative body of individuals?

so I'm trying to get to the basis of govt here....

why does govt exist and why does govt "make" people do things they don't want to do?

is it to protect the property rights of others?

 
At 6/23/2011 12:30 PM, Blogger Larry G said...

" who says you own your lawn as opposed to freedom loving sunbathers?

you seem to be trying to abrogate the notion of ownership entirely. "

Nope.

I'm asking who decides the terms of it.

 
At 6/23/2011 12:33 PM, Blogger morganovich said...

"are you saying that govt decides what is and is not property rights and what people can do and not do with their property rights?

is that "statism"?"

you are confusing two ideas. you have a right to property. the government protects that right.

that is not statism, that is protection of the individual and his rights, which is the opposite of statism.

if the government tells you what you can build on your land, THAT is statist control. because it exists does not make it right. lot's of laws have existed that were wildly unjust and counter to out rights and freedoms. lots still do.

zoning etc gets a bit more complex (again along coaseian line) because things i may do on my property may harm you on yours, so my putting in a fat rendering plant next to your country club may intrude upon your rights to the peaceable enjoyment of your property, but this is a long and complex issue best left for another time.

the bottom line is you cannot point to one practice and say "they do this so i can too". your logic is flawed.

it's akin to saying "she punched him, so i can punch you".

 
At 6/23/2011 12:41 PM, Blogger morganovich said...

"who is "you"?"

one. whoever is attempting to design policy.

"if the govt "votes" via Congress to require seat belts in cars is that theft and coercion if people elected the representatives who passed the law?"

yes.

if an elected government decides to violate your rights, then they have still violated your rights.

(though seatbelts are a bad example, because that is only a rule if you chose to use government property. forcing me to buy healthcare is a better example. i cannot get out of that)

democracy is only a particularly pernicious form of tyranny. that is why inalienable rights are so important.

democratic governments committed the holocaust.

if they had adhered to notions of rights, they would not have dome so.

"why does govt exist and why does govt "make" people do things they don't want to do?

is it to protect the property rights of others?"

the government exists to protect our rights, uphold contracts, and defend the borders.

any activity it engages in beyond that is highly suspect.

but still, you seem like you will try to do anything to get away fro your failed reasoning on forcing an electronic records standard.

businesses are in the business of pleasing their customers. they do this by providing good service at a good value.

if the tools you would force them to adopt are as useful as you claim, they they will adopt them anyway to get an competitive advantage over their peers.

they need only be forced if the costs outweigh the benefits.

why would you want to force that sort of waste?

 
At 6/23/2011 1:21 PM, Blogger Ron H. said...

"You'll find, for instance, that most doctors ALREADY have to key in data to insurance company databases and paper or scanned paper is not accepted."

This is an argument FOR paying cash.

"Medical records HAVE been put into an electronic database BY THE GOVT and it has produced a much lower incidence of errors, redundant tests and prescription drug errors."

Well, that's the argument for having a database, but I don't think you can demonstrate that "a much lower incidence of errors" has, in fact, resulted. Do you have a reference supporting that claim?

"Are you saying that the govt wasted time and money doing this?"

Yes. And, it's my money.

 
At 6/23/2011 1:36 PM, Blogger Ron H. said...

"in terms of "benefits" Ron - the error rate in Va hospitals has dropped to far less than one percent."

Reference please.

"If a doctor can look up your prescription history no matter who prescribed - they can have a much better idea of what NOT to prescribe to you."

You don't understand what such a history would look like. Everything you have ever had prescribed will show up, and the doctor will waste time asking you "Do you still take this? How about this? And this? And this?"

You will answer "Yes, yes, gee I don't know what that is, no, no, yes."

A better question from the doctor would be "What medications are you currently taking?" You should really know the correct answers.

"Most doctors when they write prescriptions find out about your other prescriptions - how?"

By asking you. If you have seen that doctor before, he will also check his own records, preferrably before he sees you.

 
At 6/23/2011 1:37 PM, Blogger morganovich said...

larry-

it's really this simple:

if these databases makes medical are better and cheaper (and they may well), why do you need to force providers to use them?

they will adopt money saving technology on their own and, what's more, competition will constantly improve the technology and it will adapt to new developments, precisely the thing that government standards are so bad at.

if the cost of the system exceeds it's benefits, then it will not be adopted. that too is a rational business choice by the providers. forcing them to adopt such practices anyway is stealing their money to give you something you want. (and creating a deadweight loss as you are making them spend more money on the database than you value it at. if you valued it at what it cost, you would have already created one for yourself)

claiming that it is democratic is meaningless. if you and ron and i are in a bar, ron and i can vote that you pick up the tab, then go on a pertus drinking binge. that would be democratic.

would you call it fair?

of course not.

the purpose of rights is to ho0ld the tyranny of the majority inherent in democracy in check.

if we sacrifice such inalienable right on the altar of pragmatism, then they are no longer rights at all and certainly not inalienable.

they are just privileges granted by government fiat that can be taken away at whim.

the whole genius of our form of government is that rights are inalienable. the accrue to you based on your being human. they are not granted by a government nor can a government take them away. in practice, it's guys like you espousing pragmatism that wind up chiseling away my rights and liberty in the name of whatever you believe in.

if you are expecting plaudits for that, you have come to the wrong guy.

 
At 6/23/2011 2:36 PM, Blogger Larry G said...

reference:

http://www.usatoday.com/news/opinion/editorials/2006-07-31-letters-va_x.htm

" By asking you. If you have seen that doctor before, he will also check his own records, preferrably before he sees you. "

ha ha ha... that's HOW you reduce drug errors?

if you forget the name or misspell it or get the dose amt wrong?

how about you are unconscious in an ER?

 
At 6/23/2011 2:38 PM, Blogger Larry G said...

" if these databases makes medical are better and cheaper (and they may well), why do you need to force providers to use them?"

because they do not save the doctors money nor increase their profits.

they are a benefit to the people who are paying - for redundant tests, unneeded tests and needless referrals to specialists looking for people who "think" they need their services because the referring doctor did not have all the info needed to understand what was going on because he did not have the persons complete medical history.

 
At 6/23/2011 2:44 PM, Blogger Larry G said...

" the whole genius of our form of government is that rights are inalienable. the accrue to you based on your being human. they are not granted by a government nor can a government take them away"

the same no matter what government?

you guys say the govt is necessary to protect property rights.

But I'm asking you WHO decides what those rights are or are not - especially the ones you say are "inalienable".

In the end - isn't your choice between a dictatorship or a Democracy - and in a Democracy - the people themselves decide what "rights" are or are not based on who they elect and who the elected appoint to the courts?

If a majority of people want nutrition labels on food to protect THEIR RIGHTs to not eat things they don't want to - isn't govt how you accomplish that?

I'm quite sure you would agree that a company that puts a deadly toxin in a product that kills people and then the company goes broke is going to result in laws that stop any future company from doing it BEFORE they hurt people - right?

do you support that?

do you support the right of people to elect a govt that requires disclosure of the things that are in food?

 
At 6/23/2011 3:19 PM, Blogger morganovich said...

"and in a Democracy - the people themselves decide what "rights" are"

no.

you are totally wrong there. the constitution tells you that.

i cannot vote you into slavery or vote away you right to free speech. that's what "inalienable" means.

you whole argument about "conceptions of these rights change" is just apologist rhetoric for creeping statism, fascism, and the loss of rights.

making right subject to democratic whims makes them no rights at all, merely fiat granted by the government.

 
At 6/23/2011 3:21 PM, Blogger morganovich said...

that USA today article is meaningless to this debate.

we're not arguing about whether they can be useful, we arguing over whether it is correct to use the coercive power of the state to mandate them.

you have yet to produce even one valid argument in support of your proposition.

 
At 6/23/2011 3:23 PM, Blogger Larry G said...

" making right subject to democratic whims makes them no rights at all, merely fiat granted by the government."

the Constitution was written by FIAT - no?

 
At 6/23/2011 3:29 PM, Blogger morganovich said...

"If a majority of people want nutrition labels on food to protect THEIR RIGHTs to not eat things they don't want to - isn't govt how you accomplish that?"

no. the free market accomplishes that. if most people demand it and you provide it and i don't, they'll buy from you.

lots of organic foods used industry certifications. the imposition of government standards actually allowed more foods to be called organic, much to the detriment of the foods that really were. that's lobbyists at work. and you want to invite them into your medical records?

most people want air conditioning in their car too. do you need the government to mandate that?

you seem to have this curious delusion that companies will not address the desires of their customers without being forced.

that could not be more wrong.

"
I'm quite sure you would agree that a company that puts a deadly toxin in a product that kills people and then the company goes broke is going to result in laws that stop any future company from doing it BEFORE they hurt people - right?"

and this is just ranting. there are already such laws. let's try flipping it around: the overwhelming governmental regulation around creating new drugs makes the cost of taking a new drug from concepts to approval about $3 billion. this makes prices high and keeps companies from even bothering with smaller applications.

it's illegal for you doctor to give you an experimental drug EVEN if you ask for it. even if you are dying of pancreatic cancer and have zero survival chance.

it also means that if you have a rare disease, no one even bothers trying to find a cure.

see what happens when you over regulate?

 
At 6/23/2011 3:31 PM, Blogger Larry G said...

" that USA today article is meaningless to this debate.

we're not arguing about whether they can be useful, we arguing over whether it is correct to use the coercive power of the state to mandate them.

you have yet to produce even one valid argument in support of your proposition. "

I was providing the reference in response to Ron's request.

should the state use it's "coercive" power to tell someone that they cannot put Kepone in a river..... AND

more important - what criteria does a state use in determining whether or not to use it's "coercive" power?

Can it - REQUIRE seat belts and purity standards for food and drugs and can it BAN things it considers harmful to people?

can it REQUIRE govt-certified baby seats and baby food?

what I'm trying to get you to agree with is to admit that govt has a legitimate role (first) and that what govt does and does not do is determined at least in part in a representative government by what all "property owners" want verses SOME of them.

your view is your view but your view is going nowhere unless you convince a majority of the righteousness of it - at least in a representative form of govt.

I know of no where in the world where there is no govt at all and a population that is opposed to any govt.

At some point - ordinary human beings do get together and write a "Constitution" that in some cases, not all, "grants" "inalienable" rights.

but those "rights" are essentially determined by men.... in the first place.

agree?

 
At 6/23/2011 3:36 PM, Blogger morganovich said...

finally:

you keep ducking the question:

if these databases makes medical are better and cheaper (and they may well), why do you need to force providers to use them?

they will adopt money saving technology on their own and, what's more, competition will constantly improve the technology and it will adapt to new developments, precisely the thing that government standards are so bad at.

if the cost of the system exceeds it's benefits, then it will not be adopted. that too is a rational business choice by the providers. forcing them to adopt such practices anyway is stealing their money to give you something you want. (and creating a deadweight loss as you are making them spend more money on the database than you value it at. if you valued it at what it cost, you would have already created one for yourself)

ramming a standard and demanding compliance can only hurt.

you either take a market that would have existed anyway and make it hidebound and non adaptive through the use of coercion, or, you create a market whose price exceeds it's value.

so which are you in favor of, codified stagnation or wasted money so long as you get free stuff?

you are raising all manner of peripheral issues to try to get away from the fact that you cannot answer this simple question.

that sort of tactic may work on the easily distracted, but i am not letting you off the hook.

answer the question above that i have now asked you 4 or five times in various ways.

your silence is thunderous (and telling).

 
At 6/23/2011 3:38 PM, Blogger Larry G said...

" you seem to have this curious delusion that companies will not address the desires of their customers without being forced."

because we KNOW they will not.

Right now, the industry as a whole refuses to provide the level of mercury in fish.

they are opposed to it and they use the power of their lobby to stop it from being required.

similarly the coal/power plant industry fights to prevent restrictions on their ability to cause airborne deposition of mercury that in turn renders many river fish unsafe to eat by moms and kids.

Industry has fought against standards for slaughtering and processing meat... or using pesticides on apples ... or preventing mad cow disease.

all of these issues affect the profitability of companies who fight against regulation even when it is proven that people are harmed by their products.

this is way beyond "responding" to what consumers want.

nutrition labels help people to not harm themselves.

they are necessary disclosures for some people who suffer adverse reactions to some kinds of substances that are added to food.

industry has been uniformly opposed to disclosures.

so what is the role of govt?

you have one group of property owners who are concerned about harm to themselves and a second group concerned about harm to their bottom line.

who sorts it out and how?

 
At 6/23/2011 3:43 PM, Blogger Larry G said...

" you keep ducking the question:


if these databases makes medical are better and cheaper (and they may well), why do you need to force providers to use them?"

I haven't ducked it at all.

I continue to say that these improvements don't necessarily help the doctors bottom-line profits and at the same time it adds requirements to what they do.

The electronic database HELP the people who are PAYING for the service.

do those people have the right to require things that will provide them with better and more cost effective care - through govt action?

I think they do if they can convince a majority of the elected representatives to agree.

because I basically believe that govt is , in fact, the people.

it is their right to determine what their rights are and are not - as opposed to any individual who happened to posit their opinion in a document called a "Constitution".

The Constitution is an important document but it is a starting point not an inviolate document never to be changed.

 
At 6/23/2011 3:48 PM, Blogger morganovich said...

"your view is your view but your view is going nowhere unless you convince a majority of the righteousness of it - at least in a representative form of govt."

no. that is just tyrannical doublespeak. pure democracy is absolute tyranny. 51% can make the rest slaves, then 51% of the free men can do it again, and again until there are only 2 free people left and you will never have had an undemocratic act. you seem unable to get you head around this.

i can be the only one in america that believes in free speech, and i still win according to our constitution.

my rights are not subject to your approval nor that of the majority in any way. you just keep tossing out irrelevant examples of petty tyrannies and asking "CAN" which is the wrong question.

you should be asking "SHOULD".

that fact that they have mandated baby seats or motorcycle helmets is not the same as whether they should. i do not believe they should require either. i think that a sensible person should use both, but that is not a reason to impose law. such laws are a slippery slope. once you start abridging freedom "for their own good", you can really go off the rails.

your whole mindset is a case in point on this. you repeatedly say "they did this, so that is not different". you never seem to ask whether "this" was right in the first place. i fear that you are the poster child for the slippery slope larry, and you don't even see to realize it.

exposing me to a poison against my will violates my rights just as punching me in the face or stealing my wallet does. what is it about this that you find so difficult to grasp?

 
At 6/23/2011 3:53 PM, Blogger morganovich said...

"but those "rights" are essentially determined by men.... in the first place.

agree?"

no. i do not. nor did our founders. these are natural rights determined and established from first principles and not subject to negotiation and more than the Pythagorean theorem is.

that's the whole point.

the purpose of rights is to maximize liberty. it works like an equation.

if we all give up the freedom to kill, we gain more liberty than we lose. the sanctity of your person is worth more than that ability to harm others.

should you feel differently, well, you can act that way, but having given up the sanctity of your person, you can expect heavy reprisal. such folks quickly learn the value of rights.

you cannot have a right to healthcare. it violates other rights. to have a right to healthcare creates some kind of slavery for doctors.

you cannot have a right that forces others to do something.

you really seem to have no idea where freedom comes from.

 
At 6/23/2011 3:55 PM, Blogger Larry G said...

" what is it about this that you find so difficult to grasp?"

I understand it.

I just don't think it is reasonable or pragmatic given the realities of representative govt.

And as bad as representative govt is - it's better than by FIAT from an individual IMHO.

There are no govts in the world that function as you advocate.

it's a theory with no real world examples.

 
At 6/23/2011 3:56 PM, Blogger Larry G said...

" "but those "rights" are essentially determined by men.... in the first place.

agree?"

no. i do not. nor did our founders. these are natural rights determined and established from first principles and not subject to negotiation and more than the Pythagorean theorem is."

it that true around the entire world?

there are a couple hundred countries in the world right?

are there any that follow what you advocate?

 
At 6/23/2011 3:59 PM, Blogger morganovich said...

"do those people have the right to require things that will provide them with better and more cost effective care - through govt action?"

no. i'd be happier if i had a new roof. can i get a majority and force the government to make you pay for it? why not?

"I think they do if they can convince a majority of the elected representatives to agree."

see above. tyranny of the majority is still tyranny.

"because I basically believe that govt is , in fact, the people.

it is their right to determine what their rights are and are not - as opposed to any individual who happened to posit their opinion in a document called a "Constitution"."

no.

that is pure tyranny. rights make you free, not democracy. you seem unable to grasp that idea.

if 95% of americans vote that you should be stripped of all property and forced to live under an overpass until you grasp the concept of rights, that would be government of the people. hell, it might be the biggest voting majority ever.

is that good government?

how about if 51% vote to disenfranchise male voters? (remember the women outnumber us)

you just keep repeating that if 90% want to make 10% buy us free beer, then that's fine.

you are using the state to force other people to give you free stuff.

and you wonder why i think you are a statist?

 
At 6/23/2011 4:05 PM, Blogger morganovich said...

"it that true around the entire world?

there are a couple hundred countries in the world right?

are there any that follow what you advocate?"

yes. ours, the most successful country in history. that success is due in no small part to precisely these notions of rights and governance.

this incredibly successful system is, of late, under constant seige by people who think as you do and would trade freedom for statist notions of practicality.

our founders saw guys like you coming. they knew that you would try to take peoples freedom and property and call it "pragmatism". that's why they made the rights inalienable in the constitution and not subject to the vagaries of the greedy electorate and would be tyrannical majority.

that's why it has worked so well.

and who cares what the rest of the world does? what does that demonstrate? that bad forms of government are possible?

well duh. but that's certainly no reason to emulate them.

i think that if you look around the world at countries with strong human rights structures vs weak ones, you'll see a clear link to prospertity.

the sort of "pragmatic statism" you espouse has failed. it cannot compete with free men making free decisions.

 
At 6/23/2011 4:11 PM, Blogger morganovich said...

"I just don't think it is reasonable or pragmatic given the realities of representative govt.

And as bad as representative govt is - it's better than by FIAT from an individual IMHO.

There are no govts in the world that function as you advocate.

it's a theory with no real world examples."

you are totally wrong.

the most successful governments in the world are ALL based on rights.

you seem to think that because we have never reached the platonic form that we cannot tell anything.

that is not true.

we can look at countries with strong rights structures and compare them to those with weak ones and see who does better. we can look at individual countries that change the way they treat rights and see how their respect causes huge prosperity and well being in columbia and their neglect destroys venezeula.

what gives you the right to demand that your doctor give you free stuff that you do not value enough to buy yourself?

what on earth could lead you to believe that such is a good form of governance. you love the idea because you are getting free goodies.

how will you feel when it's you turn to pay for someone else's goodies that you don't think are a good idea?

then you'll squeal about your rights.

 
At 6/23/2011 4:20 PM, Blogger Larry G said...

" the most successful governments in the world are ALL based on rights."

but all of them are "statist" according to the definition you use.

correct?

are there any countries that are not "statist" according to your criteria?

 
At 6/23/2011 5:00 PM, Blogger morganovich said...

larry-

statism in governments exists as a matter of degree.

some are more statist than others.

to the extent that they are less statist and weild less top down control and respect the rights of their citizens as opposed to allowing tyranny, they succeed.

when considering a new policy, one can say "this makes the government more/less statist" choosing the latter tend to yield success, the former stagnation.

you are trying to make the perfect the enemy of the good.

we can never achieve perfect democracy, perfect respect for rights, perfect love, or a perfect cheeseburger.

that does not mean we should not aspire to make the ones we have closer to the ideal or that we cannot see the effects of doing so.

your whole argument is meaningless obfuscation and an attempt to substitute the concept of perfect for good or better.

that leads to the fallacies you seem to be stumbling over.

you do not need a perfect example of anything to have a good one or to see that one is better than another.

that fact that all governments exhibit some statist characteristics does not mean that they are all "statist" as we would describe a continuum. in the absence of a platonic form, such comparisons are relative.

if you had a bowl with 99 white marbles and one black one, would you call it a bowl of black marbles?

no. you'd call it a bowl of white marbles with a black one, just as you would say it is a state based on rights with a few flaws.

progress involves eliminating them. adding new ones is regression.

 
At 6/23/2011 5:09 PM, Blogger morganovich said...

however, we can make absolute judgments about statism when looking at individual policies.

if the government comes to you and tells you what to plant on your farm and what you can charge for it at market when before you were free to grow and sell as you pleased, that is a statist policy.

agree?

the country has come under greater control of the government and individual rights have been lost.

a policy that more towards greater statism is statist, one that leads to greater liberty and respect for rights is the opposite. (libertarian?)

forcing individuals (like doctors) under threat of force, incarceration, or confiscation of property to spend their money to provide benefits they do not wish to is clearly a statist policy.

i don't care how much benefit it creates.

it's the coercion that makes it statist.

dressing that up in a veneer of "democracy" does nothing to mitigate the fundamental coercion.

why is it OK to vote for that, but not for mandatory female circumcision?

 
At 6/23/2011 5:33 PM, Blogger Larry G said...

" you are trying to make the perfect the enemy of the good."

not at all.

my view is one of pragmatism... as a starting point.

I just don't see any govt in the world that is not fundamentally a statist top/down govt.

I'm not even sure what criteria you'd use to rate them much less provide the top 5 or 10 ranked.

so the concept is more subjective than definable.

and calling someone a statist who acknowledges that all govts are inherently statist is ... really subjective.

I do not buy the "natural rights" idea.

I think govt is what grants you rights and determines what they are and what they are not.

you can believe otherwise but it's not dealing with the realities.

your property rights are, in fact, what the govt of the country you live in - says they are.

there is no universal "rule" that any country in the world follows.

So basically you're supporting an ideology and looking for examples of it.

I would assert that the BEST examples of places where people have the MOST property rights are those places where govt is weak and ineffective and people take whatever rights they can get - and they protect them...

and they don't go running to some mommy govt to protect them...

so .. you and I both want "mommies" but you want a mommy that lets you do what you want and I want one that holds a tighter rein because people who do what they want - invariably don't know when they are treading on others rights.

and that's why we have an elective govt with statist regulations.

because people want it and they expect govt to protect rights even if it restricts theirs.

the old zoning deal.

you don't want the guy next to you slaughtering horses in the back yard and the guy next to you doesn't want you slaughtering chickens in yours.

so you agree.. you compromise...

and you both want a mommy government but for different reasons but compromise is necessary.

other folks don't want you or others selling them fish with mercury in it or cars with "pretend" seat belts or drugs that are not pure or hamburger with salmonella in it so they go to mommy govt to protect their "property rights"

where does it end?

I'm sure that's the $64 question and the source of angst for those concerned with "statism".

Just a question here.

Do you think corporations have the same property rights as individuals?

 
At 6/23/2011 5:42 PM, Blogger Larry G said...

" if the government comes to you and tells you what to plant on your farm and what you can charge for it at market when before you were free to grow and sell as you pleased, that is a statist policy.

agree?"

well.. in fact the govt does do that when it chooses to subsidize crops and ban others (like tobacco).

the govt determines what crops sell for when they provide price supports - right?

I don't think you pass a law that says that doctors - no matter what must use electronic records but the way that govt works is just like with the crops - they incentivize to encourage.

For instance, States are free to turn down MedicAid but none have because they want the money but if they get the money they have to do it according to the "strings".

So the way that medical records will likely work is that Doctors will receive grants - as long as they meet the requirements of the grants.

As long as there are enough votes in Congress to NOT APPROVE it, it won't happen.

But if the right proposal is made, a proposal explicitly designed to gain enough support by compromise, we get it.

And I think there are a number of Conservatives and Republicans who think if they reduce health care costs overall - including what the Federal govt is paying via Medicare/MedicAid/SCHIPS/TRICARE, etc then they may agree.

Your side will have to live with it unless you can convince enough others to be opposed to it.

that's the way the country works.

that's the way the founding fathers INTENDED (in my view) for the country to work.

 
At 6/23/2011 5:46 PM, Blogger Ron H. said...

"what you don't understand is that it is people who want standards and people who want others who won't agree to standards - to be regulated."

Although this isn't clearly written, if it means what I think it does, then one must ask: whose standards should prevail? Who should do the deciding? Again you suggest that someone knows what is best for everyone else and should decide for them.

 
At 6/23/2011 5:59 PM, Blogger Larry G said...

" Although this isn't clearly written, if it means what I think it does, then one must ask: whose standards should prevail? Who should do the deciding? Again you suggest that someone knows what is best for everyone else and should decide for them"

yup.

regulations come from property owners concerned about THEIR property rights via elective govt.

we keep discussing the govt like it's some monolithic and unresponsive statist beast (which it is in many respects, I agree) but as they say - elections have consequences.

I think the founding fathers FULLY INTENDED for govt to make laws and regulate according to the wishes of the people.

If they intended otherwise - they would have written a single paragraph document that said that the govt would ONLY defend the country and be done with it.

when you start talking about defending "property rights" - the discussion expands inevitably to a panoply of perceived "rights" - according to each individual.

the really hard-core libertarians do not believe that a person should be restricted by pollution restrictions as to what they can do with their property - that it's up to other to prove that they have been economically harmed.

And if they win - the guy just goes bankrupt... and those harmed do not get compensated.

The law started that way but eventually became proactive to prevent "presumed" harm as determined by the representative of all "property owners".

So NOW, you have to get a permit - a NDPES permit.

and the govt is the one who decides what you can do with your property in this regard.

is this statist "mission creep"?

some would say yes. Others would say we still don't restrict enough because there is still mercury in the rivers that renders fish unsafe to eat if you are a mom or kid.

others say the amount of harm done to mom and kids is theoretical and the govt has gone too far because there are no moms and kids who can prove that a particular company has harmed them specifically.

but my point here - is that govt exists to make these determinations.

and that govt is, by definition, statist.

 
At 6/23/2011 6:23 PM, Blogger Ron H. said...

"http://www.usatoday.com/news/opinion/editorials/2006-07-31-letters-va_x.htm"

Larry, get real. This is an opinion piece from a popular news source, written by the guy in charge of the program. It applies to patients admitted to a VA hospital. It only supplies one number, and doesn't compare it to previous error rates.

If I only wanted opinions, I could have used yours.

"if you forget the name or misspell it or get the dose amt wrong?"

Again, you are suggesting that people are too stupid to manage their own healthcare. They also may be too stupid to answer questions about the dozens of drugs listed in a database that they no longer take.

"how about you are unconscious in an ER?"

I might also be unidentified. If my condition is that serious, The attending will have to weigh the dangers of an adverse reaction against not administering something that could save my life. Information on my blood pressure or cholesterol medicine wouldn't be important at that time.

You can "what if" all you want, it doesn't change the idea that you're asking for a system that neither the providers or their customers want, and if they did, it would already exist.

This is an important point from morganovich. Reread it & give it some thought:

"You are not willing to spend this money yourself, but you want a service someone else pays for. that means that you value the service at less than it's cost. that is the definition of wasted money."

 
At 6/23/2011 6:35 PM, Blogger Larry G said...

http://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143553.htm

there are lots more guy.

http://nursing-resource.com/tag/prescription/

 
At 6/23/2011 6:38 PM, Blogger Larry G said...

" "You are not willing to spend this money yourself, but you want a service someone else pays for. that means that you value the service at less than it's cost. that is the definition of wasted money." "

I AM willing to pay for it though.

but I want it to be a uniform standard so that my records can be accessed by any doctor anywhere including in ERs if I show up there unconscious.

In the end, Doctors WILL pass the costs on to patients ANYHOW as they do with anything else that adds to their costs.

I want the service. I'm willing to pay for it.

The money I save from using it will more than pay for it.

 
At 6/23/2011 9:34 PM, Blogger Ron H. said...

"You'll find, for instance, that most doctors ALREADY have to key in data to insurance company databases and paper or scanned paper is not accepted."

As has been explained to you, these are treatment codes. They correspond to an amount the doctor will be paid for what he claism he did. They say very little about your condition or whether the treatment was appropriate.

You seem to be confused about this requirement. It is only required IF the doctor agrees to accept your insurance coverage as payment for services.

"Medical records HAVE been put into an electronic database BY THE GOVT and it has produced a much lower incidence of errors, redundant tests and prescription drug errors."

You haven't demonstrated that to be true. It seems intuitive, but that's not good enough. Where's the evidence?

 
At 6/23/2011 10:53 PM, Blogger Ron H. said...

"tom down? ha ha ha. Really simple things guy like the size of a shipping container are done with uniform standards which is - any way you cut it - "top down" whether done by govt OR industry.

You seem to think it's okay if done by industry but not with govt, eh?
"

You are missing an important point here. Shipping containers have evolved to become an industry standard, because shipping companies have agreed on a container standard that is best and cheapest all around for their needs. There has been no government involvement required.

Yes, industry standards are to be preferred, because they result in better efficiency which equals lower cost. They result from firms cooperating to maximize their own benefit, and minimize their costs. This isn't necessary with a government standard, as incentives are different.

 
At 6/23/2011 11:00 PM, Blogger Ron H. said...

"My "jacket" at my dentist is almost an inch thick."

And how much of that is important information, relevant to your dental treatment today.

As I asked before, what is the value of an xray showing no cavity last year, when this year's xray shows one? Will it change your planned course of action today?

Think more carefully about what you are being asked to think about.

 
At 6/23/2011 11:23 PM, Blogger Ron H. said...

This comment has been removed by the author.

 
At 6/23/2011 11:26 PM, Blogger Ron H. said...

[inalienable rights] "the same no matter what government?"

Yes, no matter what form of government. You should be aware that democracy is just a special form of tyranny.

Inalienable rights are just that. You have natural rights or rights granted by your creator, if you prefer, that are a condition of your being human. They exist apart from any government.

The US Constitution acknowledges those rights, and forbids government to infringe them. There are none granted by the Constitution. We each have them as sovereign human beings.

The 1st ten amendments to the Constitution, the Bill of Rights, describes some of the most important ones, as examples of our basic rights to life, liberty, and property.

Our rights are not granted by any government, group of other people, or constitution. You seem to have a poor understanding of this concept.

This experiment in self government, as practiced in the US, is rather unique in history. It would seem that people like you don't believe it can work, and constantly call for dictates from a central government to manage our lives, as we are too stupid to manage them ourselves.

 
At 6/23/2011 11:37 PM, Blogger Ron H. said...

"My only champion is cost effectiveness and if we have to get there with the govt, so be it."

You are still missing it. Cost effectiveness is the holy grail of business. If something is more cost effective, the industry will enthusiastically adopt it, and government involvement isn't required. Producing at a cheaper cost than your competitors is everything. You are suggesting that government should mandate standards and systems that industry doesn't adopt, because they are NOT cost effective.

 
At 6/23/2011 11:42 PM, Blogger Ron H. said...

"would you know what drugs and treatments are contra-indicated based on previous history?"

Yes I would. Don't you know what drugs you shouldn't take because of previous problems? Doesn't your doctor ask you?

By the way, treatment codes provided to insurance companies won't provide this information.

 
At 6/24/2011 2:04 AM, Blogger Ron H. said...

"the is a negative expense to patients who now pay more for redundant tests, prescription and treatment errors based on doctors who are not coordinating with each other that would be if they were seeing the same data."

You have not shown this to be the case. Having an opinion is fine, but where is the support for this claim?

You should be aware that redundant and unnecessary tests are often ordered by doctors who fear being sued if they miss something, not because they lack information.

 
At 6/24/2011 3:38 AM, Blogger Ron H. said...

"http://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143553.htm

there are lots more guy.

http://nursing-resource.com/tag/prescription/
"

You should read your own references more completely. Neither of these provide support for a central medical records database.

None of the errors listed in the FDA article would have been prevented by a central database.

While barcode scanning and electronic records are great safety and time saving innovations for patients admitted to hospital, as described in these articles, and cost savings likely accrue, there is no indication of benefit from a central national database.

It's tempting to consider the FDA a lifesaver and a valuable government agency when reading of the dozens or hundreds of lives potentially saved by the procedural improvements discussed in your references, but we should also consider the tens of thousands of lives lost due to delays in FDA approval of new life saving drugs.

 
At 6/24/2011 3:42 AM, Blogger Ron H. said...

"The money I save from using it will more than pay for it."

You haven't demonstrated any savings.

You have ignored morganovich's extensive explanation of why cost saving innovations will be adopted by markets without any government involvement.

 
At 6/24/2011 4:28 AM, Blogger Ron H. said...

"I do not buy the "natural rights" idea.

I think govt is what grants you rights and determines what they are and what they are not.

you can believe otherwise but it's not dealing with the realities.

your property rights are, in fact, what the govt of the country you live in - says they are.
"

It's too bad you don't know more about US history, and the founding of a federal government by thirteen independent states as their agent. You are really missing a lot of important concepts.

"because I basically believe that govt is , in fact, the people.

it is their right to determine what their rights are and are not - as opposed to any individual who happened to posit their opinion in a document called a "Constitution".

The Constitution is an important document but it is a starting point not an inviolate document never to be changed.
"

Your ignorance of this subject is really sad.

Are you really OK with others telling you what you can or can't do? That wearing a wool shirt is in your best interest, so you will be jailed if you don't wear one at all times?

Do you not mind that there are people who know better than you what is best for you?

"I think the founding fathers FULLY INTENDED for govt to make laws and regulate according to the wishes of the people.

If they intended otherwise - they would have written a single paragraph document that said that the govt would ONLY defend the country and be done with it.
"

Well, they did create a four page document that enumerated 17 things that government could do, and nothing more. They then added several more pages describing what government couldn't do.

There's an amendment process for changing the Constitution as needed, that has been used many times. are you familiar with any of this? Your writing leads me to believe you are not.

The concept of limited government acting as an agent of the people is fairly new in history. You, and people like you, seem to advocate for a return to tyranny, and the misery accompanying most of human history.

 
At 6/24/2011 4:54 AM, Blogger Larry G said...

" Well, they did create a four page document that enumerated 17 things that government could do, and nothing more. They then added several more pages describing what government couldn't do."

and where exactly does it talk about natural law?

"There's an amendment process for changing the Constitution as needed, that has been used many times. are you familiar with any of this? Your writing leads me to believe you are not."

and when did they add the part about "natural law"?

there is no country in the world that specifies "natural law" as it's Constitution and yet all the Constitutions have been written by men and differ in many ways with regard to what "rights" are.

It is a piece of paper written by men that connotes the "rights" - not "natural law".

those rights vary by country - not by "natural law"

I can see why you'd be presented with numerous cites about electronic medical records (or virtual any subject) and still choose to believe what you wish the same way you do with "natural law".

"don't get it"? ha ha ha

which country do we live in?

the one I'm telling you about or the one you are telling me about?

we don't live in the country you describe because it's in your mind and no where else on earth.

If there was a single place on earth that operated the way you say it should - you'd have a leg to stand on.

But there are NONE. Zero. Zip. Zilch.

And calling this country the "best example" is laughable.

We have more pages of laws and regulations than probably any other country in the world.

This country DEFINES the concept of Top-Down govt.

Every year - THOUSANDS of new laws and regulations are written by Congress and the States legislatures and to date - not a word about "natural law".


You are free to hold your opinions but you confuse what "freedom" really is.

Freedom does not give you the right to impose on others your beliefs.

That's why we have, as written in our Constitution by men and not "natural law", a representative form of govt.

You get one vote and a mouth.

nothing more.

make the most of it but don't get carried away

 
At 6/24/2011 8:27 AM, Blogger morganovich said...

"I want the service. I'm willing to pay for it."

no.

one, there are lots of services now. you could have a database/vault easily and either enter your data or pay someone to do it. anyone with a password and a net connection could enter it.

the fact that you have not done so proves you a liar.

what you are really saying is "i want to force other people to sell me something that they do not want to."

tge literal equivalent would be going to the city council and gettign them to pass a resolution that your corner store has to offer a pepsi soda fountain even though they don't want to have it.

what gives you the right to force other people to engage in commerce they don't want to?

 
At 6/24/2011 8:34 AM, Blogger Larry G said...

" the fact that you have not done so proves you a liar."

lord, you are such a moron.

wanna keep trading insults?

I bet I can outlast you.

if enough people want electronic medical records or nutrition labels or laptop belts in cars - it will happen.

what is it about representative government that you fail to grasp?

 
At 6/24/2011 8:35 AM, Blogger morganovich said...

"and where exactly does it talk about natural law?"

larry, your teachers should be ashamed.

the declaration of independence laid out the philosophy of the founders:

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights,"

that is natural law in it's pure form.

rights come from being human, not from government.

they are inalienable.

this was also expressed in the preamble to the bill of rights.

"THE Conventions of a number of the States, having at the time of their adopting the Constitution, expressed a desire, in order to prevent misconstruction or abuse of its powers, that further declaratory and restrictive clauses should be added: And as extending the ground of public confidence in the Government, will best ensure the beneficent ends of its institution."

in order to prevent government from overreaching it's powers at the expense of its citizens, rights were enumerated to specifically restrict government in order to keep its ends beneficent as opposed to tyrannical.

this was an extremely radical idea when this document was written and an important one. it has been the most successful concept in government in human history.

this makes it horrific to me that you seem to have so little respect for it (or even understanding of it).

democracy has nothing to do with freedom.

you appear not to understand the source of your own liberty at all.

 
At 6/24/2011 8:38 AM, Blogger Larry G said...

" that is natural law in it's pure form"

did it apply to women and blacks?

you are so full of it.. it's comical

 
At 6/24/2011 8:38 AM, Blogger morganovich said...

"We have more pages of laws and regulations than probably any other country in the world.

This country DEFINES the concept of Top-Down govt."

this is either a deliberate misframing or a sign that you live in a fantasy world.

you think the US is more top down that a european state? china? india? brazil? indonesia?

you have to be kidding.

we have a much more federalist system than any of them.

we also have better rights better enumerated.

that comment was just pure foolishness.

if you really believe that, then you are so deluded that i doubt any amount of reality will get through to you.

 
At 6/24/2011 8:41 AM, Blogger morganovich said...

larry-

"did it apply to women and blacks?

you are so full of it.. it's comical"

it does now.

it was imperfect in it's initial implementation (though not its ideas).

it has since gotten better.

i'd call that progress.

setting down a principle and adhering to it well are not always the same thing.

 
At 6/24/2011 8:42 AM, Blogger Larry G said...

" we have a much more federalist system than any of them.

we also have better rights better enumerated.

that comment was just pure foolishness."

out of 200 countries in the world - how many have an EPA or OSHA or Nuclear Regulatory with as many laws and regulations as we have?

How about you name the top 5 countries with the LEAST amount of regulation and laws and the most like "natural law"?

Yemen, Sudan, Lesotho?

 
At 6/24/2011 8:44 AM, Blogger Larry G said...

" it was imperfect in it's initial implementation (though not its ideas).

it has since gotten better.

i'd call that progress."

I call it a flawed document written by ordinary flawed men that proves the concept of "A" "natural law" is whatever you want to believe it is and guys like you ....do.

 
At 6/24/2011 9:11 AM, Blogger morganovich said...

"out of 200 countries in the world - how many have an EPA or OSHA or Nuclear Regulatory with as many laws and regulations as we have?"

any country in the EU has more of the above. canada, switzerland, singapore, many others. you are severely deluded lar.

"How about you name the top 5 countries with the LEAST amount of regulation and laws and the most like "natural law"?

Yemen, Sudan, Lesotho?"

you clearly have no idea what "natural law" means. you are confusing it with anarchy, non government, and a the war of all against all.

natural law is not a "state of nature" in the hobbsian sense.

natural law is law based upon the respect for natural (human) rights. the countries you name have less of this than nearly anywhere on earth. you are just demonstrating that you do not understand the concepts we are discussing. you equate natural law with "no law", when it is, in fact, it's opposite.

do not harm others or their property.

do as you have promised.

these are the bases for natural law.

good systems of law largely flow from those 2 precepts. natural law promotes the most justice. once you start taking away rights, such justice erodes.

 
At 6/24/2011 9:17 AM, Blogger morganovich said...

"I call it a flawed document written by ordinary flawed men that proves the concept of "A" "natural law" is whatever you want to believe it is and guys like you ....do."

unsupported gibberish.

the "flaw" you point out was not a flaw in the document, but one of implementation.

the rest of your comment is just gibberish. natural law cannot be "whatever you want". it derives from first principles that mean want as much liberty and justice as can be had and that all are equal. do you find fault with those aims? with what would you replace them?

from such principles, you can only derive certain rights. you cannot derive a right to free healthcare, but you can derive a right to free speech.

logic works like geometry. only certain proofs are valid.

it's clear you have no grounding in it based on the number of horrendous fallacies and non sequitors you commit, but your ignorance of facts does not alter them.

i'm not saying the constitution is perfect, but it is the best one humanity has yet created.

 
At 6/24/2011 12:00 PM, Blogger Larry G said...

there is no "natural law"

it's a figment of imagination of those who cannot discern between reality and ideology.

The same guys who say that Yemen has LESS natural law than the US claims that the US and Europe are heavily regulated and thus are statist governments that violate the rights of individuals and property owners.

which is it?

When I ask to rank the top 5 "natural law" countries.... what we do get?

name the top 5.

AND on a scale of 1-10 -, for EACH of the 5, give a score for how close to "natural law" that country comes.

 
At 6/24/2011 12:24 PM, Blogger morganovich said...

larry-

you clearly do not understand any of the discussion we have been having.

saying "there is no natural law" is like saying "there is no law of gravity".

both were there, waiting to be discovered.

you simply cannot seem to grasp where freedom comes from. it comes from rights and natural law, not democracy. i don't know how to get this through to you. i've given you about a dozen examples, none of which you can refute, but you persist in saying the same debunked tripe over and over.

"The same guys who say that Yemen has LESS natural law than the US claims that the US and Europe are heavily regulated and thus are statist governments that violate the rights of individuals and property owners.

which is it?"

this is just astounding. do you have any ability to think at all?

natural law concerns rights. i presume that you agree that the us protects rights better than yemen?

if you do not have even basic rights, regulation is irrelevant. you are a serf in a tyranny or in a war of all against all.

also, not all regulations violate rights. eg - a regulation preventing me from putting a hog rendering plant next to your house protects your property rights. it keeps me from harming your property.

such regulations may enhance liberty and rights rather than erode it.

you are taking a childish black and white view of the world. in a world of less than perfect forms, you have to weigh overall effects.

thus, the us has a strong basis of natural law and support for rights, probably the best in the world. this is mitigated somewhat by some bad laws and statist tendencies to overregualte. to go back to an earlier example, we are a jar of white marbles with some black ones in it.

yemen is a jar of black marbles with virtually no white in sight.

freedom is not liberty. if we are perfectly free, then i can shoot you and take your car. you get more liberty by establishing rights that prevent such behavior.

your stupid requests for a 1-10 scale are just obstructionist busywork driven by your inability to think in non black and white terms. the actual answer is irrelevant (and probably incalculable, how do you weigh a lack of freedom of speech in germany (illegal holocaust denial) vs an osha regulation in the US? you are just being deliberately difficult because you can;t address the substance of this argument.

is it so hard for you to grasp the difference between governance based on the rights of the individual vs one based on tyranny of the majority vs tyranny of a king or total lawlessness?

you seem to think that the only thing that matters is the majority.

that the the philosophy of an oppressor and a tyrant.

 
At 6/24/2011 12:37 PM, Blogger Ron H. said...

This comment has been removed by the author.

 
At 6/24/2011 1:21 PM, Blogger Ron H. said...

"and where exactly does it talk about natural law?"

You would have to refer to a previous document, the Declaration of Independence, for a discussion of natural rights. Exposure to the writings of John Locke and Thomas Aquinas might also help you understand the philosophies of the Founders.

I say "might", because based on your comments here, it's not evident that you comprehend or even pay attention to what you read.

It's really too bad that your education is so meager. Wasn't US history taught at the schools you attended? It's possible that you are the poster child for, and represent a serious indictment of the public education system in this country.

Or, if that shell of ignorance you now keep in place was present when you were in school, It's understandable why you missed a lot.

How can anyone penetrate it? Chink, chink. It's not serving you well.

If you were more familiar with the Constitution, for instance if you were to actually read it, even you might understand that the states established a central government as their agent, delegating some of their powers to that agent, and clearly limiting that agent to the powers listed.

Additionally, the document lists some of the rights that people as sovereign individuals have, and disallows interference with them by that central government.

If you were at all familiar with the times in which the Founders lived, and understood their deep distrust of government, you would see why others laugh at your ridiculous claims about the role of US government.

You only need to read and educate yourself to understand what you are being told. Willful ignorance isn't a virtue.

You continue to write about things you have little knowledge of.

Learn some history.

Learn to think logically.

Learn some economics.

 
At 6/24/2011 2:12 PM, Blogger Larry G said...

there is no natural law. We have over two hundred years of legislation and case law that say it's not a factor.

it is a concept and an ideology supported by some people but by no means a majority of people.

the folks who believe in it like to think of themselves as "enlightened" much like those singing hymns at a revival.

If a majority of people believed it, our elected representatives would not be routinely passing laws that violated it, not once, but hundreds/thousands of times and our Supreme Court would be striking most of it down on that basis.

but that's not the reality.

Ya'll are living in a self-imposed alternative reality that has almost nothing to do with the way most of the world operates.

I ask you to name the top 5 "natural law" countries and ya'll run away.

It's not that I don't understand it.

I REJECT it as a viable part of how the world operates.

You take it as a matter of faith. I don't see it as integral to how we govern. It's just not there.

but we can agree to disagree on this without being disagreeable.

try it.

 
At 6/24/2011 2:18 PM, Blogger Larry G said...

" Correct. Pretending that 51% of the citizens who vote support an act of theft does not justify that theft"

even if the 51% don't believe it is theft?

the same folks who you say believed in "natural law" also believed that a majority (even if wrong) would prevail.

was it dumb for the same forefathers who believed in "natural law" to set up a system were people could ignore it?

Now how IGNORANT would THAT BE?

 
At 6/24/2011 3:17 PM, Blogger morganovich said...

"even if the 51% don't believe it is theft?"

especially then, just as 51% of people wanting to suppress your political speech cannot do so even if they don't believe you have a right to such speech.

"the same folks who you say believed in "natural law" also believed that a majority (even if wrong) would prevail.

was it dumb for the same forefathers who believed in "natural law" to set up a system were people could ignore it?

Now how IGNORANT would THAT BE?"

this is just ignorant gibebrish.

our founding fathers gave rights primacy over majority rule because that is they only system that guarantees liberty.

 
At 6/24/2011 4:38 PM, Blogger Larry G said...

" our founding fathers gave rights primacy over majority rule because that is they only system that guarantees liberty."

did they?

words on a piece of paper verses 200+ years of elections?

If what you say about the 51% being ignorant thieves, do you think our forefathers missed that idea when they set up a government that would be ruled by the 51%?

 
At 6/24/2011 5:16 PM, Blogger Ron H. said...

"I REJECT it as a viable part of how the world operates."

You can reject whatever you wish, but that doesn't make it any less real.

You have a natural right to life, liberty, and property. If someone tries to take any of those from you, you will resist. You believe in those natural rights whether you admit you do or not.

Just because someone can use force against you to deny you those rights doesn't mean you don't have them.

"even if the 51% don't believe it is theft?"

Your relativism is breathtaking.

Your belief that the tyranny of the majority is justified is alarming. Have you considered a situation in which you are on the wrong end of that concept?

If I and 2 of my friends force you out of your car and take it from you, I hope you will believe that we have stolen it. It doesn't matter that we, as a majority, think it's OK to take your car. Theft is theft. A fairly simple concept to understand. The fact that you would resist indicates that you believe you have a natural right to your property.

 
At 6/24/2011 5:18 PM, Blogger Ron H. said...

" the fact that you have not done so proves you a liar."

"Do you want to keep trading insults?"

Look, if someone calls you a liar, or a statist, and those are accurate characterizations, you are not being insulted.

Get over yourself.

 
At 6/24/2011 5:26 PM, Blogger Ron H. said...

"was it dumb for the same forefathers who believed in "natural law" to set up a system were people could ignore it?

Now how IGNORANT would THAT BE?
"

You don't understand the system of government that was created, and you don't understand the constraints on government intended to prevent just the abuse and tyranny you are recommending.

The Founders didn't set up a system that could ignore rights. Just the opposite. But, that system has changed over time due to the efforts of people like you who are ignorant of history.

 
At 6/24/2011 5:28 PM, Blogger Ron H. said...

"I ask you to name the top 5 "natural law" countries and ya'll run away."

Surely even you don't believe that people will be inclined to respond to such silly and meaningless requests.

 
At 6/24/2011 5:36 PM, Blogger Ron H. said...

"If what you say about the 51% being ignorant thieves, do you think our forefathers missed that idea when they set up a government that would be ruled by the 51%?"

As you probably haven't read it, and you certainly don't understand it, you are unaware of all the obstacles the Founders included in the Constitution to thwart majority rule. Check it out. You might learn something.

 
At 6/24/2011 6:16 PM, Blogger Larry G said...

" As you probably haven't read it, and you certainly don't understand it, you are unaware of all the obstacles the Founders included in the Constitution to thwart majority rule. Check it out. You might learn something."

the bottom line is that they set up a system where 51% would rule.

their "obstacles" to it did not work.

look around you.

Are you saying that this country runs on "natural law" or are you saying that it should?

there is no natural law except in the minds of those who believe there should be.

In the real world - the Supreme Court has seldom, if ever, ruled that "natural law" was the basis of their decision.

http://www.nlnrac.org/american/u.s.-supreme-court

The Supreme Court is a creation of the founding fathers, right?

so if the founding fathers believed in "natural law" why did they choose to enumerate the "rights" set up a majority rule governance and a Supreme Court that does not recognize Natural Law in it's decisions?

 
At 6/24/2011 10:17 PM, Blogger Ron H. said...

"Decisions of the early Supreme Court were often forthrightly based on natural-law arguments. In Chisholm v. Georgia (1793), for example, Justice Wilson held that a South Carolina citizen could sue the state of Georgia, not just because Article III of the Constitution gave the federal courts jurisdiction in “controversies between a state and citizens of another state,” but because of what he believed to be the “principles of general jurisprudence” upon which the Constitution rested."

Do you even bother to read your own references? You are really pathetic.

 
At 6/24/2011 10:24 PM, Blogger Ron H. said...

"the bottom line is that they set up a system where 51% would rule."

No, they didn't.

Learn some history. It's pointless to discuss any issue with someone as ignorant as you are.

 

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