Canada does Health Care right even if they do Dental Care Wrong

Posted by PITHOCRATES - March 9th, 2013

Week in Review

Canada does health care right.  They have a single-payer system.  Which is not quite national health care like the National Health Service in Britain.  But it’s the next best thing.  Sort of like Obamacare.  It’s not the national health care the Left wants.  But it’s the next best thing.  And a stepping stone to getting what they want.   So they can do health care right.  Like in Britain.  And like in Canada.  Where they put people before profits.  And everybody has everything they could ever want (see Bite out of dental program will hurt, says dentist posted 3/6/2013 on CBC News Health).

The president of the Newfoundland and Labrador Dental Association says cuts to the adult dental program will cost the province more in the long run.

In a news release Tuesday, the government said it is putting a per person cap of $150 on basic dental services and $750 on denture care, starting on April 1. Dentists will have to get approval from MCP before treating most patients.

“One hundred and fifty dollars is not going to cut it for people that need pain management,” said Dr. Jason Noel.

Valid point.  So why in a country where they do health care right would they do dental care so wrong?

The government set up the Adult Dental Program in January 2012 for people on low incomes, including seniors. At that time, dentists praised the program for its accessibility…

“The program budget was for $6.7 million. In actual fact, it ballooned to something that we never anticipated at all – it was closer to $21 million…”

That’s why.  Because free health care is very expensive.  And government bureaucrats are very bad at making cost projections.  For what government program didn’t exceed government projections?

Just something to think about as Obamacare starts paying the bills.  A potential 213% cost overrun.  Or more.  Because Canada has been doing health care right for a lot longer than the United States.  So if they miss a target by 213% you just know a novice at doing health care right will do a poorer job.  But one thing we’ve learned from the recent sequester debate government doesn’t like cutting spending.  They don’t even like reducing the rate they will increase spending by.

So will the Americans be as responsible as the Canadians in fixing something they screwed up.  Probably not.  Instead they’ll rely on raising taxes.  And when they can raise taxes no more they will resort to rationing, longer wait times and denial of care.  As in those death panels that aren’t technically in Obamacare.  But a government bureaucrat deciding who gets health care and who doesn’t is a death panel.  Even if you don’t call it a death panel.  Something else to think about as Obamacare starts paying the bills.

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In the NHS all Britons are Equal only some Britons are more Equal than Others

Posted by PITHOCRATES - February 23rd, 2013

Week in Review

One of the driving forces behind Obamacare was equality.  Everyone was to have equal access to quality health care.  Not just the rich.  That’s why the United States needed to move towards what the British have.  Their National Health Service (NHS) provides equality.  In Britain it doesn’t matter if you’re rich or poor.  Everyone gets access to quality health care (see Ministers pledge to reduce child mortality by Press Association posted 2/18/2013 on the guardian).

A new national pledge to reduce child deaths is to be announced by the government.

The all-cause mortality rate for children aged between 0 and 14 years has moved from the average to among the worst in Europe, figures show, while more than a quarter (26%) of children’s deaths showed “identifiable failure in the child’s direct care”…

New measures include increasing data so the NHS and local authorities can obtain better information to improve the health of young people; piloting a survey to generate details of local health problems such as drug and alcohol use; and launching colour coded health maps to highlight trends for conditions such as asthma and diabetes.

The health minister, Dr Dan Poulter, said: “For too long, Britain’s childhood mortality rates have been amongst the worst in Europe when compared to similar countries.

“In particular, there is unacceptable variation across the country in the quality of care for children – for example in the treatment of long-term conditions such as asthma and diabetes.

Apparently some people are more equal than others in Britain.  With children being the least equal.  Apparently.

Now does this show Britain hates children?  No.  They don’t.  Remember the 2012 Summer Olympic Games?  In London?  Where they celebrated their NHS with lots of happy kids in hospital beds?  Britain loves their children.  It’s just that national health care is not as great as people think it is.

Britain’s aging population is producing great cost pressures on the NHS.  As it will on Obamacare.  Forcing the British to do more with less.  Just as it will force the Americans to do more with less.  And when you try to do more with less people fall through the cracks.  As these children have.  As American children will.  For one thing for certain is that the more government is involved the worse things tend to get.  Just compare renewing your driver’s license to going to the store.  Which is a more enjoyable experience?  Which provides a better value for the money.  Which has more courteous people?  Which satisfies your needs more?  The answer is the one with less government.  Going to the store.  For many people love shopping.  While no one enjoys renewing their driver’s license.

People don’t like dealing with their insurance companies.  They don’t mind seeing their doctors.  But they hate fighting the insurance companies to pay for their health care.  Now imagine your doctors and nurses becoming more like the insurance companies.  Which they will under Obamacare.  For they will all have to answer to a government bureaucrat.  And one thing for certain is the more government is involved the worse things tend to get.

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The NHS may be letting Elderly Patients Die to Help Cut Costs

Posted by PITHOCRATES - October 21st, 2012

Week in Review

There are few things more difficult than watching a loved one die a slow death.  Nothing prepares you for this.  Even if you work in the health care industry (see My diary of mum’s awful death on the Liverpool Care Pathway: Nurse’s heart-rending account of how doctors decided  to put her mother on ‘pathway to death’ by Tom Rawstorne posted 10/19/2012 on the Daily Mail).

As a nurse and health visitor with 25 years’ experience, Carole Jones thought she knew the workings of the NHS inside out.

But when her 85-year-old mother Maureen was admitted to Addenbrooke’s Hospital in Cambridge last year having suffered a stroke, she was totally unprepared for what followed.

Her mother’s chances of recovery having been written off by medics, a decision was taken — without Carole’s knowledge — to place Maureen on the controversial Liverpool Care Pathway (LCP).

This is a plan ostensibly designed to ease the suffering of the dying, which can involve the heavy sedation of a patient and the removal of tubes providing food and fluid.

Over the past week, families have contacted the Daily Mail saying they believe their loved ones were wrongly put on the LCP by hospitals when they were not in fact close to death, fuelling the suspicion that it is used to hasten deaths to save the NHS money and free up beds.

In June this year, Professor Patrick Pullicino, a consultant neurologist for East Kent Hospitals, and Professor of Clinical Neurosciences at Kent University, told a conference the LCP had become an ‘assisted death pathway’.

‘Very likely, many elderly patients who could live substantially longer are being killed by the LCP,’ he said.

It is so difficult when the roles reverse between parent and child.  When a parent consults with a doctor about his or her child you usually don’t have to worry whether the doctor is doing what’s best for the child.  When it is a daughter or son of a parent discussing an elderly parent’s treatment with a doctor it’s a different story.  Especially if that parent is suffering from dementia.  And the National Health Service is dealing with cost pressures from an aging population.

More people are leaving the workforce than entering it in the UK (as well as the US).  Which means two things.  Tax revenue is falling because of fewer workers (which means fewer taxpayers).  While at the same time a larger number of retirees are consuming a large share of health care services.  So that’s less money coming into the health service.  While the health service is spending more money on providing health care services.  Which is a problem.  If you spend more than you receive you will run deficits.  And if you can’t increase tax rates anymore that leaves only one other option.  Cost cutting.

Is this the reason why they are placing elderly patients in the controversial Liverpool Care Pathway (LCP)?  To help cut costs by having them die more efficiently?  Whether they are or not it would help cut costs.  Probably the largest cost savings they can make.  By removing the largest consumers of health care resources from the health care system.  A death panel, if you will.  Where some government bureaucrat makes a cold and calculated decision to let a person die because it’s the cost efficient thing to do.

It’s something to think about as they fully implement Obamacare.  For if the NHS is doing this it would follow that Obamacare will, too.  For both nations have aging populations.  Only the US has about five times the population of the UK so the US will probably have five times the cost pressures.  And will likely place five times the patients into the US equivalency of the Liverpool Care Pathway (LCP).

This is the bleak future of Obamacare.  Real death panels.  Despite what the proponents of Obamacare say.

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Rationing of Health Care Resources leaves those with Rare Diseases without Treatment in NHS

Posted by PITHOCRATES - October 21st, 2012

Week in Review

So you think Obamacare care will provide everyone the same level of high quality health care?  Think again.  Or take a look at the UK.  For even though the UK has national health care under the NHS everyone still does not receive equal health care treatment.  Especially those with rare diseases that will be costly to treat (see Patients with rare conditions face postcode lottery by Denis Campbell posted 10/20/2012 on the guardian).

Seriously ill patients with life-threatening rare diseases are being denied vital drugs because of a postcode lottery across the NHS that campaigners say is frustrating and unfair.

New research reveals that patients with a rare condition have much less chance of accessing “orphan” medication if they live in England rather than Scotland or Wales. “Orphan” drugs treat patients with a condition affecting fewer than five in 10,000 people.

While the European Medicines Agency (EMA) has approved 68 drugs for use with patients with rare conditions such as unusual forms of cancer and epilepsy since 2000, the National Institute for Health and Clinical Excellence (Nice) has assessed only 18 of them, recommending that seven become available on the NHS in England and Wales, and another five under certain restrictions…

Nice insisted the low number of such drugs it had examined was due to a lack of referrals from the Department of Health, as it can only assess the cost effectiveness of medications which ministers there ask them to look at.

But the DoH denied patients with rare conditions were missing out and insisted that the absence of a Nice appraisal should not stop them getting what they need. “There is no evidence of a ‘postcode lottery’ in access to these drugs”, said a spokesman.

First of all why do they have a government agency (Nice) even doing this?  One reason.  Costs.  So they must ration their limited health care resources.  For if they just give anyone life-saving medications regardless of costs it will limit what other treatments the NHS can provide.  Costs are real.  Just because you have a national health care system doesn’t make them go away.  Of course, in a national health care system costs take on a whole new meaning.  For they fund health care with tax dollars.  Tax dollars controlled by bureaucrats, not health care professionals.  So instead of a doctor deciding what’s best for the patient (as it is in America until Obamacare fully kicks in) a doctor must balance doing what’s best for the patient with what’s best for the state.  For spending too much money on someone who is just going to die in a short period of time is just not an efficient use of tax dollars.

Yeah, no doubt you’re thinking about that ominous phrase some say they included in Obamacare but they did not call out by name.  Death panels.  Where some government bureaucrat (or a panel of bureaucrats) makes life or death decisions in determining a patient’s care.  Not by consulting with the patient’s doctor but by consulting a table of acceptable health care treatments for someone based on the expected return of that health care investment.  They may not call these death panels but if the expected return on the health care investment does not meet the minimum acceptable return for that investment then the patient doesn’t get that life-sustaining treatment.  And will die.

So what can we expect in the future of Obamacare?  Well, it will probably have something like Nice.  A panel that makes decisions with assumptions and math like this (see Measuring effectiveness and cost effectiveness: the QALY from the Nice website).

Having used the QALY measurement to compare how much someone’s life can be extended and improved, we then consider cost effectiveness – that is, how much the drug or treatment costs per QALY. This is the cost of using the drugs to provide a year of the best quality of life available – it could be one person receiving one QALY, but is more likely to be a number of people receiving a proportion of a QALY – for example 20 people receiving 0.05 of a QALY.

Cost effectiveness is expressed as ‘£ per QALY’.

Each drug is considered on a case-by-case basis. Generally, however, if a treatment costs more than £20,000-30,000 per QALY, then it would not be considered cost effective.

How a QALY is calculated

Patient x has a serious, life-threatening condition.

•If he continues receiving standard treatment he will live for 1 year and his quality of life will be 0.4 (0 or below = worst possible health, 1= best possible health)

•If he receives the new drug he will live for 1 year 3 months (1.25 years), with a quality of life of 0.6.

The new treatment is compared with standard care in terms of the QALYs gained:

•Standard treatment: 1 (year’s extra life) x 0.4 = 0.4 QALY

•New treatment: 1.25 (1 year, 3 months extra life) x 0.6 = 0.75 QALY

Therefore, the new treatment leads to 0.35 additional QALYs (that is: 0.75 -0.4 QALY = 0.35 QALYs).

•The cost of the new drug is assumed to be £10,000, standard treatment costs £3000.

The difference in treatment costs (£7000) is divided by the QALYs gained (0.35) to calculate the cost per QALY. So the new treatment would cost £20,000 per QALY.

During an ABC News’ June 24 special, Questions for the President: Prescription for America, there was the following exchange (see Lungren says Obama would have government require a centenarian to get a pill, not a pacemaker posted 7/28/2009 on PolitiFact):

The exchange began when Sawyer introduced Jane Sturm, who takes care of her mother, Hazel, now 105. When Hazel was 100, Sturm said, the doctor told her she needed a pacemaker. Both mother and daughter said they were game, but an arrhythmia specialist initially said no, before seeing Hazel’s “joy of life” in person.

Sturm asked the president, “Outside the medical criteria for prolonging life for somebody elderly, is there any consideration that can be given for a certain spirit, a certain joy of living, quality of life? Or is it just a medical cutoff at a certain age?”

After joking that he’d like to meet Sturm’s mother and “find out what she’s eating,” the president said, “I don’t think that we can make judgments based on peoples’ spirit. That would be a pretty subjective decision to be making. I think we have to have rules that say that we are going to provide good, quality care for all people…”

Obama continued, “And all we’re suggesting — and we’re not going to solve every difficult problem in terms of end-of-life care. A lot of that is going to have to be, we as a culture and as a society starting to make better decisions within our own families and for ourselves. But what we can do is make sure that at least some of the waste that exists in the system that’s not making anybody’s mom better, that is loading up on additional tests or additional drugs that the evidence shows is not necessarily going to improve care, that at least we can let doctors know and your mom know that, you know what? Maybe this isn’t going to help. Maybe you’re better off not having the surgery, but taking the painkiller. And those kinds of decisions between doctors and patients, and making sure that our incentives are not preventing those good decisions, and that — that doctors and hospitals all are aligned for patient care, that’s something we can achieve.”

This is the kind of information Nice provides.  Cool, calm, bureaucratic number crunching to determine what the proper medical treatment should be.  Balancing those two factors.  What’s best for the patient.  And what’s best for the state.  For spending too much money on someone who is just going to die in a short period of time is just not an efficient use of tax dollars.

So what can you expect from Obamacare when it’s your mother or grandmother in the hospital desperately needing treatment?  Well, the doctor may come out to the waiting room where you’re sitting scared and distraught and say, “I’m sorry.  But the National Health Efficiency Board has calculated your loved one’s quality-adjusted life years.  Or what we in the health biz call QALYs.  Sadly, her treatment would only result in a net gain of 0.18 additional QALYs.  While our guidelines clearly state that this number shall not be less than 0.22 for such an investment of health care resources.  I am truly sorry for your soon to be loss.  So here’s a prescription you can fill on your way out for a pill to manage her pain until she dies.  Thank you and good day.  Next!”

This is the problem when someone else pays your bills.  That someone else has a say in your treatment.  Whether they are called death panels or not.

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The NHS does not provide Long-Term Elderly Care just as Obamacare will not provide Long-Term Elderly Care

Posted by PITHOCRATES - September 29th, 2012

Week in Review

The Liberal Democrats in Britain don’t care much for the elderly.  For they are just too costly.  And there are other social programs that are competing for these valuable but limited government funds.  Which can be put to far better use buying votes (see Reforming elderly care is not the biggest priority, says Danny Alexander by Rowena Mason posted 9/25/2012 on The Telegraph).

Reforming elderly care is not the biggest priority and just one of many problems on the “long term horizon”, Danny Alexander, a Treasury minister, has said.

The Liberal Democrat denied reports that the Treasury is “blocking” elderly care reforms but fuelled fears it is being kicked into the long grass.

Mr Alexander said the Coalition will “take forward the Dilnot plans” for an individual cap on costs to stop so many elderly people having to sell their homes to pay for care.

This no doubt comes as a shock to most Americans.  Who thought the National Health Service (NHS) provided all British health care needs.   All the way right up to the grave.  But even in the utopian world of national health care the NHS cannot afford long-term elderly care.  Just as Obamacare will not be able to afford long-term elderly care.  Which the Americans will have to provide for themselves just as the British must provide for themselves.

Not only will Obamacare not provide long-term elderly care it will be rationing out health care to the elderly.  Where some callous bureaucrat will say that someone’s loved one will not qualify for anything other than a pill to manage his or her pain.  The so-called death panels included in Obamacare.  Though not called death panels.  But for all intents and purposes are death panels.  As some callous government bureaucrat will have the power of life or death over you.

However, he stressed there are “lots of other social care pressures” and competing priorities, including the needs of vulnerable people with low incomes.

In other words, British death panels.  That will choose when and where they will spend limited government funds.  And when it comes down to a dying old person versus a younger worker who, if he or she survives, will pay more income taxes, guess who they will spend those limited funds on?

The Chief Secretary to the Treasury was speaking at the Liberal Democrat conference in Brighton, where delegates are pushing for more wealth taxes and a crackdown on tax avoidance.

Mr Alexander said the taxman could raise huge amounts of money by making Britons with offshore accounts “play by the rules”. Recovering cash due from accounts in Lichtenstein alone could raise up to £3 billion, Mr Alexander said.

He also said the Liberal Democrats would like higher taxes on the rich to pay for tax cuts for the poor.

Classic class warfare.  Cut down on tax avoidance so more people can avoid paying taxes at the lower end.  Tax the few so the many don’t have to pay taxes.  And, of course, the many will vote for those who further raise the taxes on the few.  Or put in another way, buying votes.

Of course, this doesn’t help the elderly with their long-term care.  But it will provide more benefits for the masses that will vote for Liberal Democrats.  Just as a good policy of class warfare should do.  Buy votes as efficiently as possible.  For there is only so much money available to buy votes with.  Especially when health care consumes so much of these precious, limited, government funds.

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Free Market Competition

Posted by PITHOCRATES - July 2nd, 2012

Economics 101

Competition makes Everything Better for Consumers

Let’s go back a hundred years or so.  When the railroads were making their way west.  Through barren and unforgiving country.  Where a depot is built in the middle of nowhere.  One day it will become a city but now is just a shack or two.  And a water tower along the tracks to replenish the steam locomotives.  This is the closest thing to civilization for hundreds of miles.  Railroad building supplies head west on the new track to continue the track further west.  And the trains stop to fill their locomotives with water.  You look at all that traffic passing that depot and decide to open up a diner/saloon to replenish all those people.  Who are earning wages.  But have nothing to spend them on for hundreds of miles around.

There’s no electricity yet.  Or ice.  So the meat shipped to the diner may not be the freshest.  But you can cook it with a lot of spices to hide any bad taste in case the meat is rancid.  Liquor comes out without any spoilage.  It’ll last so long that you can keep watering it down to make more money per bottle.  Your diner/saloon can be dirty and overrun with bugs.  You can just throw the bugs into the pot to make the meat go further.  It doesn’t matter.  Because for most of your customers this is the only place to come to eat and drink.  Even if they get ill from eating bad meat they’ll keep coming back.  Because where else are they going to go?

Your costs are low.  And your prices are high.  You’re doing very well.  It’s nice being the only diner/saloon at this depot.  But then a town starts growing around the depot.  And another diner/saloon opens.  It’s cleaner.  They serve fewer bugs in their food.  Their meat is less rancid.  Their liquor is less watered down.  And their prices are lower.  Everyone who eats and drinks at this depot-town eats and drinks there.  Not at your filthy shack.  You quickly go from making a lot of money to making nothing at all.  Because this new competition in town took away all of your business.  For competition makes everything better for consumers. 

When the Government Interferes with the Free Market there is no Incentive to Please their Customers

Competition is key to the free market economy.  And it’s the most important thing.  Even more important than government regulation.  Because with competition you don’t need regulations.  You don’t need inspectors.  You don’t have to file complaints.  You don’t have to wait for corrective action.  Because if you have competition you have something that works better.  And faster.  Pleasing customers.  If you don’t please them more than your competition then you will lose your customers to your competition.  This is a powerful incentive to lower your prices.  Improve the cleanliness of your establishment.  And to improve your quality.  Competition makes businesses try harder to please their customers.  On their own.  Without compulsion.

In the above example the first diner/saloon owner could have appealed to the government.  Asked the government to prohibit the second establishment from opening.  Saying that it was destructive competition.  That they were dumping lower-priced food and drink onto the market to put the first establishment out of business.  So they could raise their prices higher and lower their quality when they do.  That the market wasn’t large enough to support two businesses.  That their lower prices mean they will pay their employees less.  And a whole host of other bad things that will follow if this second business opens.  Of course the second business has none of these complaints.  Because they offer better quality at lower prices.  They don’t need the help of government.  Just a competitive free market.

If the first business should prevail in their request for government help the government will take action.  Force the second business to shut down.  Make them sell their food and drinks at higher prices.  Charge them a special excise tax on all their sales to raise money to transfer to and help the first business.  Or some other action to make the market ‘fair’ again.  Which means allowing the first establishment to continue to sell lower quality at higher prices.  Which they would.  For with the power of government helping them they have no incentive to please their customers.  So they don’t.  So people with no choice have to pay more for lower quality.  And this is what happens when the government interferes with the free market.

Free Market Competition delivers High Quality at Low Prices with the Most Efficient Allocation of Resources 

Competitive free markets also guarantee that businesses use resources in the most efficient manner.   As they try to sell the highest quality at the lowest price they will buy very carefully.  They will buy only the things they can sell.  And only enough of them to meet their demand.  For if they buy more than they can sell it will only raise their prices.  As those prices have to pay for the things they sell.  And the things they can’t sell.  So there is a very strong incentive to buy only what they absolutely need.  Leaving things for others to buy.  Which is much better than having some government bureaucrat allocate resources.

Suppose the government owned the railroad and all the depot-towns along the line.  And each depot has a diner/saloon.  Each depot-town is about the same size.  So the government bureaucrat ships the same supplies to each depot.  One barrel of flour.  One barrel of cornmeal.  One barrel of salted pork.  Two sacks of beans.  Four sacks of coffee.  Five cases of whisky.  And so on.  But the people don’t eat and drink the same in each of these depot-towns.  Some drink more liquor than others.  Some drink more coffee than others.  Some eat more meat than others.  Some eat more beans than others.  Depending on the season.  The cattle drives.  Whether the farmers are sowing or reaping.  The religious pilgrimages.  The weather.  Etc.  The local diner/saloon owners are in tune with the rise and fall of demand.  But the government bureaucrat 2,000 miles away isn’t.  So some receive more than they can use.  Others run out before the next shipment.  Making the allocation of resources inefficient.  Leading to waste.  And higher prices to pay for all of that waste.

Free market competition always works best.  And the more problems that we solve by creating more competition the better the solutions are for the people ultimately paying the prices.  The consumers.  As free market competition delivers high quality at low prices with the most efficient allocation of resources.  Giving us things like the high-definition television.  The smartphone.  The tablet computer.  And our morning coffee.  Where quality just keeps getting better while prices keep falling.  When we don’t use free market competition we get high prices, poor quality and inefficient resource allocation.  From cable television that increases rates while lowering quality (we’ll be at your house either sometime in the morning or sometime in the afternoon tomorrow or the day after.  Please have someone available at your home to meet our technician).  To waiting in line to renew your driver’s license.  Which is about as enjoyable as a root canal.

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The Invisible Hand

Posted by PITHOCRATES - April 16th, 2012

Economics 101

A Command Economy Reduces the Overall Economic Output because those Managing the Economy don’t Understand It

Command economy?  Or free market capitalism?  Which works better?  Well, let’s find out with a little experiment.  Let’s go back in time.  Say ancient Mesopotamia.  Just after they developed mass farming.  And produced some of the first food surpluses.  Allowing the rise of a middle class of artisans.  Now let’s look at what could have been the first two of these artisans.  A potter.  And a winemaker.  Who probably weren’t the first two artisans.  But will suffice for our little experiment.

The winemaker needs some pottery vessels to store and sell his wine in.  And the potter enjoys drinking wine.  They each have something the other wants.  And because we’re so far back in time there is no money yet.  We’re still only bartering at this time.  Trading the goods we make with each other.  But in our experiment the high priest of the civilization is also the economic planner.  This priest communicates to the civilization’s gods.  And guides the civilization in pleasing their gods.  Which he is very good at.  For he knows all of the old teachings and rituals.  But he doesn’t know a thing about pottery or winemaking.  But he looks at an empty pottery vessel and a pottery vessel full of wine and sees that the vessel volume equals the volume of wine.  And deems the price of one pottery vessel is the amount of wine one pottery vessel holds.

Well, the potter is quite happy with this price.  Because he is skilled.  And can dig up some clay.  Throw it on the potter’s wheel and knock out vessel after vessel.  Glaze them and fire them in the kiln.  Even working by himself he can achieve some economies of scale.  By repeating this process every day.  Something the winemaker isn’t quite able to.  For he makes wine by the batch.  Because each step in the process takes a lot of time.  Maintaining his grape vines.  Then picking the grapes.  Carrying them back to his winery.  Putting them into his winepress.  Squeezing the juice out of the grapes.  Putting the grape juice in large vats to ferment.  Monitoring the process.  When he determines the process is complete he fills the small pottery vessels with wine.  When it was finally ready for ‘sale’ and consumption.  Considering all the work it took him to make one vessel of wine the winemaker was not at all happy with the price the high priest set.  And instead builds his own potter’s wheel and kiln to make his own vessels.  Greatly increasing his workload.  And reducing his winemaking output.  While the potter loses a potentially large customer.  Thus reducing the amount pottery he makes.  Reducing overall economic output in the command economy.

The Invisible Hand makes sure we use our Limited Resources Efficiently to Make the Things People want Most

In this command economy the civilization suffered a deadweight loss.  Economic resources went unused.  They could have created more economic benefits with the available resources.  They could have made more pottery.  And made more wine.  Perhaps even creating some jobs to help with the economic output of efficiently using the available resources.  But they didn’t.  Because of the fixed prices economic resources went unused.  Thus creating a market equilibrium lower than where it could be.  Hence the deadweight loss.  Now let’s look at the same example with only one difference.  The high priest does NOT set prices.

In a barter economy people agree to trade the goods they make.  And now the potter and the winemaker are free to determine what they think is a fair trade.  That is, they set the price of pottery in wine.  And the price they agree on is one they find mutually acceptable.  Where the potter agrees to trade an amount of his pottery for an amount of wine.  And the winemaker agrees to trade an amount of his wine for an amount of pottery.  Everyone wins.  For the potter gets an amount of wine he values more than the pottery he traded for the wine.  The winemaker gets an amount of pottery he values more than the wine he traded for the pottery.  And the civilization wins because at this mutually agreed upon price both the potter and the winemaker increase their production.  Providing the civilization with more of their goods.  The potter and the winemaker may even hire people to help them produce more goods to meet this higher demand.  Thus increasing the level of happiness in the civilization.  By increasing the amount of economic activity.  Moving the market equilibrium to a higher level of economic output.  And thus reducing the deadweight loss.  By using the available resources in the most efficient manner.  As determined by these mutually agreed upon prices.

This is the Invisible Hand in action.  An economic concept put forth by Scottish economist Adam Smith (1723-1790) in his The Wealth of Nations (1776).  In a competitive market place where traders set the price for their economic trade (not a command economy) two things happen.  First, resources flow to where we demand them most.  That is, to the buyers willing to pay the highest price.  Second, because of the competitive market place only those companies that sell at the low prices the market demands stay in business.  Which means that they have to use those resources as efficiently as possible.  Especially when they’re paying the highest prices for them.  And all of this happens because of the Invisible Hand. 

History has Proven that no Government Bureaucrat can do a Better Job than the Invisible Hand

Those who favor a command economy (or more government intervention into market forces) say the economy is too complex for us to leave it to its own devices.  That without a smart government bureaucrat managing this complex thing we cannot reach a market equilibrium that maximizes economic output.  Whereas Adam Smith says it is because the economy is so complex that no one is smart enough to manage it.  Just as a high priest doesn’t understand pottery or winemaking a smart government bureaucrat cannot hope to understand all the intricacies of a complex economy.  Nor can they ever hope to understand what millions upon millions of consumers want to buy most.  But the beautiful thing is we don’t have to.

The multitudes make individual decisions just like our potter and winemaker.  Where everyone is looking to maximize their own value.  And when they agree on a mutual acceptable price all parties in the trade win.  While making sure our resources flow to where they are demanded most.  And that we use these valuable and limited resources most efficiently.  Thus maximizing overall happiness in our country.  Reducing deadweight losses to a minimum.  And obtaining a market equilibrium that maximizes economic activity.  All of which happens with no one in charge.  As if an Invisible Hand guides us in the market place to make all the right decisions to maximize this economic output.  And our happiness.

So which is better?  Command economy or free market capitalism.  Well, if you’re being honest you have to choose Adam Smith’s Invisible Hand and free market capitalism.  For history has proven that no government bureaucrat can do a better job than the Invisible Hand.  Not the Soviets.  Not the Chinese Communist (under Chairman Mao).  Not the Cubans.  Not the North Koreans.  Even the Americans failed when their government actively intervened in the private economy.  Something that President Jimmy ‘one-term’ Carter knows only too well.  So based on our hypothetical Mesopotamian example, and history in general, free market capitalism is, and always has been, and always will be, better than a command economy.

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The International Fight against Universal Health Care

Posted by PITHOCRATES - April 16th, 2011

The Most Effective Cost Control Mechanism is Market Forces

They keep saying that they’re not trying to nationalize our health care.  In fact, Obama promised that if you liked your doctor you could keep your doctor with the new Obamacare.  Of course, that decision won’t be entirely yours.  For your doctor may choose to drop you.  And if they keeping cutting Medicare doctor reimbursements, doctors will finally say enough is enough.  I’m outta here.  No more Medicare patients.  Which could force you to find another doctor.  Even though Obama promised that wouldn’t happen.

There’s a lot of talk about controlling costs in Medicare.  And there’s only one way to that with the current system.  You pay doctors less.  Which they are always trying to do.  Is that fair?  Put yourself in their position.  Would you keep seeing patients?  After doing what so few other people do (go to college, medical school, serve an internship and a residency after racking up huge student loan debt that has to be paid back at the same time you have to pay ever rising medical malpractice insurance premiums leaving you with little money to enjoy the first decade or so of your new medical career)?  Because some government bureaucrat says you’ve earned enough money?  All the while no government restrictions are placed on public sector pay and benefits?  To add the ultimate insult to injury, a lot of those same bureaucrats telling doctors that they’ve earned enough money and should be happy with what the government deems is appropriate will no doubt make more than the doctor.  With far less training.  And far less responsibility.  Which just ain’t right.

They like to blame the doctors for the runaway costs.  But they’re not the lone scapegoat.  They also blame the pharmaceutical companies.  The hospitals.  And, of course, the great ‘big bad’ in the health care industry, the insurance companies.  Whose costs keep going up.  Greater than the rate of inflation.  So the runaway costs in the health care system must be their fault.  Because they’re greedy.  It can’t have anything to do with the system we force them into.  Where third party payments shut out all market forces (the person receiving the service isn’t paying the bill), thus eliminating the only effective cost control mechanism.  And introduces government.  Making health care a public good.  Where non-health care government bureaucrats determine fair pricing, supply and demand.  And you know where that will lead to.  To the here and now.

Labour fights against Market Forces for the NHS in the UK

Government bureaucrats don’t like privatization.  Or market forces.  They’d rather manage things.  Because they’re smarter.  Narcissistic.   And they covet that money and power.  They want all those tax dollars funding health care to go through their fingers.  And having people dependent on them for their health care makes that a whole lot easier.  So when conservatives try to introduce effective cost mechanisms, liberals push back.  In the US.  In Canada.  And in the UK (see NHS bill to ‘substantively’ change, says Oliver Letwin posted 4/16/2011 on the BBC).

Labour wants the plans for the NHS in England, which encourage more private sector competition, to be scrapped.

Under the shake-up, GPs are also to be given control of much of the NHS budget.

To cut costs, reduce wait times and improve quality of the NHS, the UK is trying to decentralize the NHS.  Give more decision-making authority to the general practitioners (GPs) in the local communities.  Letting the local health care providers in the communities they serve determine how to best spend the NHS money.  Which, of course, is anathema to Big Government liberals.  Such as Labour in the UK.

Liberals fight against Market Forces for the CHA in Canada

Wherever you find national health care, you’ll find bitter partisan debate over the money paying for that health care.  Except in Cuba.  Or North Korea.  Luckily, for them, there are no opposition parties.  And no one complains about anything.  For they know better.  But Canada has a national funded health care system.  And opposition parties.  Which can get pretty nasty when they’re trailing in the polls (see Liberals drop gloves with attack ad on Harper’s ‘secret’ health agenda by John Ibbitson posted 4/16/2011 in The Globe and Mail).

Conservatives are reacting with fury to a Liberal attack ad that accuses them of harbouring a secret agenda to cut health care funding if they obtain a majority government.

“The Liberal ad uses some of the dirtiest tricks in the book — including twisting words out of context and deliberately altering dates to make old words appear recent,” Tory campaign manager Jenni Byrne wrote to party supporters in reaction to the new attack ad.

In America, the go-to strategy is to threaten Medicare.  In the UK it’s the NHS.  In Canada, it’s the Canada Health Act (CHA).  The reason is, of course, the sheer size of this budget item.  If you’re trying to cut a budget deficit, that’s where you do it.  Cuts elsewhere just won’t be big enough to matter.  And everyone knows it.

If Mr. Harper is given “absolute power,” the ad warns, he plans to cut $11-billion from the federal budget. “Where would Harper’s cuts leave your family’s health?” the narrator asks.

“The stakes are too high. Vote Liberal.”

So you threaten certain death for you and your family should the opposition get elected.  While all the time promising yourself to cut the deficit.  Which, of course, you won’t.  For it will require cuts in health care funding.  And you’re not going to do that.  For there will be another election.  Eventually.  Sure, it makes you a hypocrite.  But a hypocrite with a job.

The Conservatives do plan to cut government spending as part of their own plan to balance the budget, but they promise to do so without reducing transfers to provinces, including health transfers.

It is true that the Liberal government of Jean Chrétien cut funding for health care in the 1990s as part of its efforts to eliminate the federal deficit. Once the budget was balanced, the Paul Martin government signed a ten-year accord to increase funding by six per cent a year. The Conservatives, when they came to power, honoured that commitment, and pledge to continue the arrangement, as does Mr. Ignatieff.

Anyone living near the Canadian-US border only knows too well the consequences of painful health care cuts.  When doctors and nurses get pay cuts, they scoot across the border for higher paying jobs in the US.  Which makes Canadians’ long waits for health care even longer.  This is the ultimate consequence of national health care.  Cost problems you solve by rationing services.  Whether in the UK.  Canada.  Or the USA.

Massachusetts:  Blueprint for Obamacare

We have Obamacare now.  Maybe.  We’ll see.  There’s a popular movement to repeal it.  After it was snuck through Congress.  By the time people learned what was in it (long after Congress voted it into law), the majority of the population didn’t want it.  It’s a big reason why the Republicans won back the House of Representatives in the 2010 mid-term elections.  For the people felt betrayed by their representatives.  So they fired a bunch of them.  Except Nancy Pelosi.  Who the good people of San Francisco reelected with like 80% of the vote even though her national approval numbers as Speaker of the House were closer to 10%.  Which makes it clear that the San Francisco district she represents is an anomaly in the American fabric.  Where the people think against the national grain, so to speak.  But I digress.

Anyway, before Obamacare there was Massachusetts.  And their little experiment in universal health care.  Which now covers every man, woman and child.  Well, almost.  Only 98% are covered.  That other 2% are the state’s Republicans.  I’m kidding, of course.  I don’t know who that 2% is.  Except that they must be the most unlucky sons of bitches ever to live in Massachusetts.  To live in a state where everyone gets free health care and they still get bupkis.  Imagine how that would make you feel.

But even there, in that universal health care utopia, they have a problem.    They gave health care to everyone (except that unlucky 2%, the poor bastards) but they never figured out how to pay for it (see Massachusetts, pioneer of universal health care, now may try new approach to costs by Amy Goldstein posted 4/15/2011 on The Washington Post).

Massachusetts Gov. Deval L. Patrick (D) is trying to “shove,” as he put it, the health-care system here into a new era of cost control. He is proposing a new way of paying for care that would try to propel changes in the way it is delivered. It would give lump payments to teams of doctors responsible for almost all the care of a group of patients, with bonuses for saving money and dispensing high-caliber services that keep people healthy.

Interesting.  Sort of going the route of the GPs in the UK.  Decentralizing the health care system.  After they just centralized it.

Massachusetts in 2006 created a health insurance exchange, a requirement that most residents carry coverage and subsidies to help them pay for it — central elements now in the federal law. As a result, 98 percent of the residents here are now insured, the highest rate in the nation. But the state’s first round of health-care changes devoted far less attention to medical costs.

“We did access first,” said state Senate President Therese Murray (D). “Now we have to figure out how we afford that.”

Oops.  No doubt during the debate for universal care the opponents said something like, “Are you out of your minds?  You have any idea what something like that will cost?”  Which, of course, the proponents replied, “Don’t worry about it.  We have a plan.”  And that plan was apparently to get the law passed first then figure out how to pay for it.

Fee-for-service medicine “is a primary contributor to escalating costs and pervasive problems of uneven quality,” the commission unanimously concluded in 2009.

Despite the consensus, huge questions loom: Who should be part of the new medical teams? How would the idea work for most doctors who practice alone or in small groups? How much clout should the state wield to blunt the ability of powerful local health systems to drive up costs? And, importantly, how heavy a hand should the government use to compel change?

Fee for service is NOT the problem.  It’s never the problem.  If I want to hire a contractor to build a deck in my backyard, I’ll ask some contractors to quote their fee to build a deck.  If the prices are $15,000, $10,000 and $5,000 for identical services, guess who I’m going to hire.  Now, for the sake of argument, let’s say that each of these prices are fair prices for each of these contractors because of their cost structure (e.g., one may have his office on the beach and pays ten times as much in property tax as the others and therefore has to charge more). 

Now in a system where the government steps in to make prices fair, let’s see what happens.  Say a bureaucrat gets three quotes and determines the fair price is $10,000 (the average of the three).  So the contractor who quoted $15,000 now has to build decks at $10,000 and lose money, eventually going out of business.  The contractor that quoted $5,000 will get rich making over a 100% profit on each deck.  And me?  I’ll end up paying twice as much as I had to for the deck.  This is what happens when you don’t let the market set prices.  You get a mess.

In the pressure-cooker of medical costs in the United States, Massachusetts offers a particularly vivid example. The spending per person on health care is 15 percent higher than the national average — even taking into account the comparatively high wages here and outsize role of medical research and training. The move to near-universal coverage, state figures show, accounts for a sliver of recent increases in insurance premiums, which have soared above inflation. The main reason has been a rapid escalation in prices.

“The growth is outstripping every single measure of society’s ability to keep up,” said Glen Shor, executive director of the Commonwealth Health Insurance Connector, which runs the insurance exchange.

So much for the theory of an insurance exchange being the panacea Obama claimed it would be.  For whenever has a bureaucracy been cost efficient?  Never.  It’s impossible.  You can’t manage an economy and do better than market forces.  It’s never happened yet in human history.  So why do some people (i.e., Big Government liberals) still think they can do a better job?  Oh, but we must remove filthy, nasty profits from health care.  This ‘public good’ deserves better.  It deserves the tender love of a caring government bureaucracy.  Not some evil corporation trying to maximize profits.  Of course, look at what happens when these corporations do just that.  Stuff we like and want to buy is plentiful and inexpensive.  But God forbid if we do that to health care.

Some doctors are embracing the new way of working. David C. Pickul is the medical director of the physicians group affiliated with Lowell General Hospital, in an economically bruised community about 30 miles northwest of Boston. The group is in the third year of a five-year “alternative quality” contract with Blue Cross involving a hub of 70 primary care doctors and a looser group of 200 specialists who are responsible for 20,000 HMO patients. The team now has a financial incentive, Pickul said, to track down patients when it is time for their mammograms or for eye exams for those with diabetes. Under Blue Cross’s quality rating, Lowell has soared the past two years.

Blue Cross is not alone. At Partners HealthCare, the famous Boston-based medical system that dominates health care here, Massachusetts General Hospital has been conducting a Medicare experiment in which nurses are assigned to coordinate care for about 2,500 older patients with multiple ailments. The experiment, which began five years ago, so far has reduced hospital re-admissions by one-fifth and cut medical spending by 7 percent.

“Frankly, the market has already . . . responded,” said Gary Gottlieb, Partners’ president and chief executive. “There is enough momentum for us to do this without instrumental regulation” by the state.

The governor and some other officials disagree. The need to lower costs, they say, is urgent enough that the government should step in, and they have been laying groundwork.

Financial incentive?  Isn’t that another word for profit?  And this pursuit of profits has done what?  Improved patient quality?  Reduced hospital readmissions by one-fifth?  And cut medical spending by 7 percent?  Amazing what will happen when you let the market respond.  What a success story.  But they want to do what?  Step in?  To lower costs?  After the market lowered costs already by 7 percent?  You got to be kidding me.  Whatever happened to if it ain’t broke don’t fix it?

And Alice Coombs, president of the Massachusetts Medical Society, is especially concerned about physicians who work alone or in small groups, older physicians who might choose to retire rather than switch or new doctors who might leave for other states.

And how do you solve that problem?  With compulsory medical service.  Which universal health care coverage gives you.  If you worry about doctors opting out of a new cost-contained system, you make it impossible to opt out.  You simply nationalize health care.  Letting the doctors know, yeah, they may be miserable and unhappy with the new system, but you’ll be just as miserable and unhappy where ever you go.  So why move out of state?  For any where you go, we’ll be there.  Understand?  So just keep curing the people and stop your bitching. 

Sure will make all that medical school, internship and residency worth it, won’t it?

The Song Remains the Same

Liberals everywhere want to expand the size of government.  And a national health care is the holy grail of government expansion.  But everywhere it’s tried the same thing happens.  Cost and wait times increase.  Quality decreases.  And services are rationed.  Most people (especially liberals) want to blame the greed of those who work in health care.  So they come up with new ways to manage and control costs.  Which inevitably adds yet more layers of bureaucracy.  Which benefits liberal governments.  At the expense of the taxpayer.  And patients’ health.

But nothing they try works.  Costs keep going up.  For good reason.  Because the problem is not the greed of the health care people.  It’s the health care system.  There are no market forces in it.  Which is the most efficient cost control mechanism.  Of course, admitting this is an admission that Big Government has failed.  And liberals can’t have that.  So they fight.  Demonize.  And scapegoat. And try to scare the bejesus out of everyone by saying conservatives want to cut health care funding so they can kill your family.

Whatever the name, whatever the country, the song remains the same.  Conservatives will try to cut deficits by reforming the biggest budget item.  And liberals will fight them every step of the way.  Ultimately giving us a health care system with greater costs, longer wait times, lower quality and rationed care.  As demonstrated everywhere in countries with a national health care system.

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LESSONS LEARNED #44: “Liberal Democrats have to lie because there are more taxpayers than tax consumers.” -Old Pithy

Posted by PITHOCRATES - December 16th, 2010

Lying to Make Future Liberal Democrat Voters

Ask anyone some questions about the Great Depression and they’ll probably get them wrong.  Why?  Because their history teachers revised history to make government look better.  Government wore the white hats.  And business wore the black hats.  Because their teachers were public school teachers.  And the teacher unions are one of the strongest unions in the country.  The government takes care of them.  And, in return, the public school teachers takes care of government.  By turning out as many future liberal Democrat voters as they can.

So what did our teachers teach us about the Great Depression?  Evil rich people caused it.  By speculating in the stock market.  And it was their speculation that caused the Great Crash which caused the Great Depression.  Rich business people bad.

Then Franklin Delano Roosevelt (FDR) rode into Washington and saved the day.  FDR expanded federal power and went to work to fix things.  He punished the rich (raised taxes).  Created a huge federal bureaucracy to manage the economy.  And spent money like there was no tomorrow.  Public works programs.  Even gave us Social Security.  He made everything better.  Big hearted government people good.

That’s the history in our history books.  The only problem is that it’s wrong.

Tax Cuts and the Roaring Twenties

This is the story told because it favors those who favor expanding government.  Big Government wants to tell us what’s best for us.  And our public schools want to shield our children from their parents.  Because they (and Big Government) are smarter than parents.  So they revise history.  And lie to our kids.

Really?  Come on, they’re not really lying to our kids.  I mean, what reason could they possibly have to lie to our kids?  Just look at the demographics.  The far Left, those in government who like to spend money and tell us how to live our lives, are about 20% of the population.  The other 80% have real jobs and pay taxes.  And this is a problem.  How do you convince 80% of the people (who pay taxes) to pay more taxes so the government can spend it against their wishes?  All the while having the government telling these taxpayers how they should live their lives?  Easy.  You lie.  And you lie to their kids.

There was an economic boom before the Great Depression.  The economy was roaring so strong that they called it the Roaring Twenties.  And it had nothing to do with speculation.  We were building automobiles.  Electrifying the country.  Selling electrical appliances.  And building radios.  This was no speculative bubble.  It was real and strong economic growth.  And guess what kicked it off?  Tax cuts.

Higher Tax Rates Shelter Wealth instead of Creating Jobs

They don’t talk about this in the history books.  Because no public school teacher or government bureaucrat likes tax cuts.  Because economic growth created by tax cuts sends a very simple yet powerful message.  We don’t need Big Government.

Following World War I, government was a bureaucratic behemoth.  With a huge federal debt.  Fighting world wars can do that.  The Progressives, who gave us Prohibition and other nanny-state-like things, liked that big bureaucracy.  They liked activist government.  But even they knew that a high debt was not good.  And being the zero-sum economists they were, they knew only one way to reduce that debt.  Higher taxes.  And their candidate for the 1920 election, James M. Cox, promised to do just that.  And he lost the election.  Proving that Progressives don’t understand economics.  Or the American people.  Those Americans who have jobs, at least.

Warren G. Harding won that election.  And his secretary of the treasury, Andrew Mellon, understood economics.  To find a better secretary of the treasury you have to go all the way back to our first one.  Alexander Hamilton.  Mellon understood business.  And understood rich people.  High tax rates did not bring in more tax money.  Why?  Because rich people know how to shelter their wealth.  But give them a lower tax rate where they can make and keep what they earn, they’ll invest that money and create jobs.  They’ll pay more in taxes (even at a lower tax rate) because they’re not sheltering their wealth.  Their employees will pay more in taxes because they’ll have jobs.  And this is what happened during the Roaring Twenties.  People were working.  Making durable goods (cars, electrical appliances, radios, etc.).  Times were good.  Very good indeed.

Government Activism Gives us the Great Depression

The United States became an economic juggernaut during the 1920s.  The Americans were eclipsing the Europeans.  We were not a superpower yet.  But the Europeans saw the writing on the wall.  They wanted to form their own union of European states to compete against the economic powerhouse that was the United States.  We were kicking ass and taking names.  And no one could hold a candle to us.  We were unstoppable.

Then Herbert Hoover became president.  He was a progressive republican.  He liked activist government.  Hoover was a Big Government Keynesian and wanted to use the powers of government to end the business cycle.  He believed high wages meant high prosperity.  And in parity between farm and nonfarm prices.  He was everything FDR would become.  In fact, the Hoover administration started a lot of the FDR New Deal programs.

Farmers had mechanized their farms.  They plowed more fields than ever.  And grew more than ever.  With bumper crops prices fell.  Normally not a problem.  You just sold more.  But the war was over.  European farmers were farming again.  Not only did they not need our crops, they slapped tariffs on our exports to protect their farm prices.  So farmers couldn’t sell enough to make a profit at the lower prices.  Farmers went bankrupt.  Farm loans went unpaid.  Farm banks failed.  The Federal Reserve failed to provide liquidity to help other farm banks in trouble.  More failed.  This rippled into the nonfarm banks.  Which contracted the money supply.  Business started to hoard their cash because of the tight credit market.  They cut back on production.  Laid people off.  Then the Smoot-Hawley Tariff went to committee in Congress.  Business responded, knowing that that higher tariffs on imported goods they used would increase their cost of production.   They hoarded more cash.  Cut back on production.  Congress passed the Smoot-Hawley Tariff.  Other nations respond by imposing their own tariffs.  This resulted in a trade war.  Business sales fell.  Production fell.  More banks failed.  Hello Great Depression.

Tax Cuts Stimulate Economic Activity

This is the part they don’t teach you in history class.  It was government involvement that killed one of the strongest bull markets in history.  And would prolong the Great Depression.  The growth of government and the anti-business climate created great uncertainty.  And that didn’t go away until World War II.  When James Byrnes (head of the Office of War Mobilization) allowed business to make fat profits if they could deliver the vast quantity of war material needed to defeat Hitler, Mussolini and Tojo.  And they did.  The Arsenal of Democracy won World War II.  Private business doing what they do best.  Business.

But liberals like to spend money.  Our money.  And tell us what’s best for us.  To do that, though, they need us to vote for them.  And telling us that they want to take more of our money while telling us what’s best for us won’t make us vote for them.  It didn’t help Cox to tell the truth in 1920.  And no other presidential candidate since.  Because the 20% of the population that agrees with them isn’t enough to win an election.  You need some of the 80% who have jobs and pay taxes.

History has shown tax cuts stimulate economic activity.  They did when Warren Harding cut taxes.  When JFK cut taxes.  And when Ronald Reagan cut taxes.  This truth doesn’t make a good argument for raising taxes, though.  So our public schools and Big Government revise that part of history.  And lie to our kids.  Until they bleat “Business bad.  Government good.”  Like good future liberal Democrat voters.

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