Jim, I agree that you are correct that taxes are a price we pay for a civil and safe society. However, that in no way suggests that all taxes are good ideas, or that taxes necessarily result in a civil and safe society.
Maintaining a society is a complicated affair. Each of us is an optimizer, we work to make our personal situation as likable as possible, each according to his own tastes. All logical entities do that, no matter if an individual, a corporation, or a government. If a person accumulates great power he is likely to use it to adjust the world to his liking, reasonably enough. The same is true of a corporation or a government.
Corporations will try to gain monopolies that enable them to profit and to stay in power. This tendency is supposed to be countered by the two factors of competition and government. In situations where the government gains monopoly power, the same effect tends to occur (consider the struggles of the various world governments to stay in power). The USA is, in this regard, little different.
I think that this suggests that there is no possible single entity that should be permitted to gain monopolistic power, not corporations, and certainly not government. The only possibility is some precarious balance of power between multiple, self regulated branches of society. We have seen how corporations act when they become too powerful. Likewise, we've seen that the greatest number of citizens who became victims have been killed, tortured and otherwise abused by their own governments. Bernard Madoff is a recent but not a unique example of what can happen when an individual gains excessive power. We line on a "slippery slope". It requires constant attention and effort to maintain our personal freedom, since most other forces work towards reducing it.
Sorry, I'm jumping in late here, but I'd like to ask you something.
You wrote: "Of course I know that "thousands of people die a year because they lack access to reasonable care". I also know that is not my fault and so feel no obligation to pay for their misfortune"
I assume you would agree with the phrase "your freedom to swing your fist ends at my nose". Meaning, of course, that we have no freedoms that might cause harm to others.
Does not the "employer based health insurance system" cause harm be elevating the cost of medical services and drugs beyond the reach of the uninsured?
You and I have great insurance. I hardly pay anything for medical services and drugs for my family and I certainly never check price tags on these services. What incentive is there for doctors/hospitals to control costs so they can be more competitive? Thus we have the most expensive health care in the world - by far.
Does not the employer based health care system "cause harm" that should be remedied?
The phrase you evoked, "your freedom to swing your fist ends at my nose", is a popular suggestion as to the limits of personal freedom. However, it is often not true. If your nose is where it has the right to be, the phrase is valid however if your nose is in "my space", it's in harm's way. Societies define personal and property rights to try to delineate the borders between entities. If an intruder breaks into your house carrying a crowbar, you may be legally correct in shooting her dead. Her "nose" being within the arc of your "fist" does not protect it when it's in your turf. The major problem with catchy little homilies like this one is that they are usually (maybe always) very limited in application (i.e. they are "wrong" ).
When a resource is available in limited supply, any consumption of it makes all further consumption more difficult. This is the basis of the "supply and demand" relationship of economics. So, you buying food very slightly raises the price of food for everyone else. Of course this is "at the margin" so that the effect of one person is immeasurably small. Of course, insurance is not limited in quantity. Increasing consumption of insurance may even reduce its price by encouraging more suppliers to enter the market. It seems to me that there are plenty of insurance providers.
The ubiquity of medically insured consumers may increase the cost of some drugs beyond what it would be if those people paid their own bills directly. It seems likely that without insurance, many of the more expensive pharmaceuticals would not exist since the market for them would have been too small to justify their development. The effect of third party payers has had the opposite effect on some of the most efficacious meds. Indeed, these are frequently distributed for token fees that partially cover their distribution costs by grocery store pharmacies (eg, antibiotics ). Because of this there are a large number of diseases that were usually fatal in 1900 but are only trivially annoying today.
Having insurance does not reduce costs for the average person, it increases them. The insurance pays the costs of medical care plus the cost of administration plus some profit. What insurance is designed to do is to share the very small risk of overwhelming expenses that each of us faces, among a large group of us. So, instead of having a small risk of a huge expense, each of the insured gets a guaranteed cost of a much smaller expense. The price each of us should pay for insurance, under a perfect system, would be our individual risk multiplied by the cost of that risk plus the overhead costs of administration and profit. So, a person with a known weakness would pay more than an apparently healthy one because that person adds more risk to the insured pool. This is not rocket science, it's Econ 101. If you're considering starting an insurance company, you want to estimate your risk and expenses and to be certain that your income exceeds those.
Because having insurance increases the cost of medical care, I do not carry insurance for routine affairs, only for the extremes. My policy is called a "High Deductible". It pays nothing below that deductible and most of the cost above it. Specifically, I carry a deductible of $10K. Everything below that I pay 100%, everything above that it pays 90% to $25000 and 100% above that. This insurance is relatively inexpensive since the risk to the company is small. I see no reason to pay that company an extra fee to make routine payments for me when I get a yearly physical or maybe break a finger (not yet, so far, knock on simulated real wood-appearing Formica). If you have insurance that routinely pays more for you than it costs you, that means you're making your neighbors pay for your affairs. That seems rather unsocial to me!
"Supply and demand","econ 101" and employer based heath care insurance have given the US the most expensive, most inefficient and one of the least effective health care systems in the world, while other countries, that must have different economic text books than we have, are getting more heath care value at far lower costs - while providing health care to all of their citizens.
I am in Canada and lived in the states for 20 years. I cannot BELIEVE the things Americans have allowed to happen that happen in no other 1st world country. The insurance companies have been drooling all over themselves. Nowhere else can they so raze a country with no opposition.
No cap on premiums. Co pays, deductibles AND premiums. No public option as a safety net. MEDICAID ESTATE RECOVERY ACT which drains all you have if you are in nursing home past 100 days (Medicare cuts off), fines if you refuse to sign up for Medicare when it is available, spend downs for Medicaid......no incentive to work on disability (you lose health care), can't marry on Medicaid, must stay married if on abusive husband's health plan, yes insurance co's may now have to take you with pre-existing however, no cap on what they can charge! None of these things happen in other countries. Maybe one or two, but all these? Pure gold for insurance co's!......pure idiocy!
In Germany there are caps on private insurance premiums relative to your income and all those making under a certain amount are automatically in the public pool.If you are disabled, you are not locked into a system.
USA bitches about our wait times, but in USA I waited 9 months to see a Neuro and 8 to see a derm! The only reason we have wait time lists is because we are working to fix it. We live longer and spend far less on health care.
Yes, USA has Johns Hopkins but how many people get to go there?!!