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Thread: Paying For Health Care

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    Default Paying For Health Care

    A federal soda pop tax. Higher levies on beer, wine and hard liquor. Taxing some health insurance benefits. Those are among the options the Senate is considering to pay for revamping health care. What ideas or solutions are practical to you?

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    Many economists and lawmakers confess they are fresh out of new ideas for slowing health spending. Nevertheless, in the next few decades, the United States must slam the brakes on rising health costs or begin slashing spending in other areas in order to afford health Hit care.

    Until now, rising health costs have seemed relatively affordable — at least for middle- and upper-income people — because prices have been rising from a relatively low base in the 1960s, says Michael Chernew, a professor of health management and policy at the University of Michigan. Today, however, with health spending already consuming more than 16 percent of GDP, rapid growth in health costs quickly translates into something the country almost certainly cannot afford, he says.

    Even if the growth of Previous HithealthNext Hit spending could be slowed through the year 2075 to a rate just one percentage point faster than GDP — about half as fast as it's grown historically — the United States still would spend a little more than half of its cumulative annual income increases on Previous HithealthNext Hit. That's steep, but not completely unaffordable, since nearly half of each year's income growth would still be left over to spend on other priorities. Footnote 73

    But if health spending continues to grow two percentage points faster than GDP each year — the historical average — big trouble looms quickly, Chernew explains. Under the 2 percentage-point scenario, 44.9 percent of the increase in per-capita income between 1999 and 2010 goes to health care. Then, from 2010-2050, health care eats up 87.8 percent of income growth. “You get to use only a little over 10 percent of your new raise for anything” else, Chernew says. Then from 2050-2075, things would get even worse: 165.6 percent of the increase in GDP would go to health care. “In other words, spending on everything but health care would actually drop” year to year, even though incomes kept going up, he explains.

    If that happened, the United States would have to resort to some kind of health care rationing, even though the U.S. Previous health care system currently has no idea how to use clinical evidence to parcel out health care rationally, says Aaron of the Brookings Institution. “We need to acquire a great deal of knowledge,” he continues. The nation will face choices that “will strain the democratic fabric” of society, because of the “emotional content and economic stakes involved.”

    On the bright side, says Chernew, the question is how to cut future growth in health spending, not how to give up current spending levels. “The prospect isn't as scary as some may think,” he says. “Things will still get better, just less better than they otherwise might.”

    Despite arguments that physicians and insurance companies make too much money, “this isn't a villain situation,” says Jack Meyer, president of the nonpartisan Economic and Social Research Institute. “Is it a problem that a neurosurgeon earns $500,000 a year?” he asks, pointing out that Yankee third-baseman Alex Rodriguez earns $25 million a year — “50 times what the neurosurgeon is making.”

    Rather than searching for a villain, Meyer says, we must acknowledge, “we have met the enemy and he is us.” Americans expect unlimited health care with little financial pain, he says. Generous insurance benefits enjoyed by well-insured people drive up premium costs for everyone, and many workers expect to retire early, even though Medicare would be easier to sustain if the eligibility age were nudged up by a few years.

    For the hard answers, “we have to look in the mirror,” says Meyer. “Americans don't like being told to wait, let alone being told, 'No.' ”

    In the end, we can't afford private health care, and we can barely afford universal, if even that. So we might as well suck it up and go universal.

    Thank you Congressional Quarterly.

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    the common sense fairy solecistic's Avatar
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    My question has always been - you don't mind paying for public school, why do you mind paying for health care? I just don't get it.

    (This is probably unrelated; did not read walls of text. Sorry.)

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    Hang on, you guys pay for public school?

    Is that how it is everywhere?

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    Wait, just figured out what you meant. Carry on.

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    Jem.

    We just raped this thread.

    CARRY ON.

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    Quote Originally Posted by solecistic View Post
    My question has always been - you don't mind paying for public school, why do you mind paying for health care? I just don't get it.

    (This is probably unrelated; did not read walls of text. Sorry.)
    Its fine, the entire wall was summarized by the line:

    "In the end, we can't afford private health care, and we can barely afford universal, if even that. So we might as well suck it up and go universal." And by the end I mean within 10 years tops.

    To pay for it? The liberals will raise taxes on the rich, and the GOP will...wait a minute...they want to lower taxes and further privatize health care. So basically they screw the entire idea over until they realize at the last minute what needs to happen. I'm not sure if the Dems realize that we have to go Universal yet, but hopefully they will figure it out, and hopefully this nation will stop being so scared of slight socialization in order to save its healthcare system.
    Last edited by Kittens!; 05-20-2009 at 03:54 AM.

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    Quote Originally Posted by solecistic View Post
    My question has always been - you don't mind paying for public school, why do you mind paying for health care? I just don't get it.

    (This is probably unrelated; did not read walls of text. Sorry.)
    Schools lead to productivity which leads to the creation of money. The creation of money leads to a higher standard of living. Honestly though, I do mind paying for public schools too. I have yet to see a government program/service that comes anywhere near the efficiency possible in a truly free market.

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    Quote Originally Posted by Trojan View Post
    Schools lead to productivity which leads to the creation of money. The creation of money leads to a higher standard of living. Honestly though, I do mind paying for public schools too. I have yet to see a government program/service that comes anywhere near the efficiency possible in a truly free market.
    Defense is probably an obvious example. There's no way that a private company or any other non-governmental group could ever possibly provide the services of national defense that the United States government currently provides.

    EDIT: On the topic of health care, government health care programs in various European countries provide medical care at a substantially lower per capita cost than does the US system of private insurance companies. I'm not sure what you mean by "efficiency", but they are cheaper and don't leave 15% of the population uninsured, so that's a plus.
    Last edited by Syme; 05-20-2009 at 01:01 PM.

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    Quote Originally Posted by Syme View Post
    Defense is probably an obvious example. There's no way that a private company or any other non-governmental group could ever possibly provide the services of national defense that the United States government currently provides.
    Well, the US government uses a lot of contractors for that work these days. Under normal circumstances though, I would agree that defense is one of the very few roles that the government should undertake.

    EDIT: On the topic of health care, government health care programs in various European countries provide medical care at a substantially lower per capita cost than does the US system of private insurance companies. I'm not sure what you mean by "efficiency", but they are cheaper and don't leave 15% of the population uninsured, so that's a plus.
    So, their shitty system is mildly better when it comes to cost than the shitty system we have now. How about we try a real free market health care system? One in which I can call around to clinics and hospitals and get real pricing information. I wouldn't take my car to an auto shop that wouldn't tell me their pricing, but I have to get my health care that way.

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    Quote Originally Posted by Trojan View Post
    So, their shitty system is mildly better when it comes to cost than the shitty system we have now.
    "Mildly"? US per capita health care costs are $6000 per year. For most developed European countries, it's around $3000 per year or less. They also don't leave nearly 50 million people uninsured, as the US system does.

    Quote Originally Posted by Trojan
    How about we try a real free market health care system? One in which I can call around to clinics and hospitals and get real pricing information. I wouldn't take my car to an auto shop that wouldn't tell me their pricing, but I have to get my health care that way.
    Are you saying that in this system, people would pay for their medical care out-of-pocket on an as-needed basis, rather than having medical insurance? That's what it sounds like you are implying when you talk about calling around and checking prices.

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    OK, Trojan really doesn't seem to understand healthcare so, instead of going down that road, I'll instead mention France's system.

    Basically they have socialised medicine in that it's paid for by the government only it works on a reimbursement process. Basically you go to your GP and etc. etc. and then you pay. Then you are pretty much immediately paid back (I think at least 80%) by the government. Also, with their system, you can have multiple GPs so if you don't like what one says you can always go to another one (this is why French doctors listen to their patients). There are many downsides to this system but, basically, it retains enough cash in the system to keep it afloat (and French public service workers tennd to be against changes unless they're striking for them).

    How about a system somewhat like that?

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    Quote Originally Posted by simonj View Post
    How about a system somewhat like that?
    It sounds great. Will the unicorns fart puppies or rainbows?

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    Lemon Sherbet. Which, until now, I had always spelt 'shebert'.

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    Quote Originally Posted by Trojan View Post
    Schools lead to productivity which leads to the creation of money. The creation of money leads to a higher standard of living. Honestly though, I do mind paying for public schools too. I have yet to see a government program/service that comes anywhere near the efficiency possible in a truly free market.
    I'm going to try to stay away from saying how cold this sounds, because I suppose it's not relevant to the discussion. So let's put it into your terms, where money is all that matters. If a person is dying or sick, they cannot be productive. They cannot contribute to the economy, and so cannot contribute to your standard of living. If anything, I'd expect you to be in favor of supporting their health rather than their education if you had to choose one (clearly, you'd choose neither, but if the choice were forced upon you).

    Quote Originally Posted by Trojan View Post
    How about we try a real free market health care system? One in which I can call around to clinics and hospitals and get real pricing information. I wouldn't take my car to an auto shop that wouldn't tell me their pricing, but I have to get my health care that way.
    So, in this "real free market health care system", you'd expect it to work how? Only those who can afford health care get it? Beyond the fact that this would leave more than half of all people without health care of any kind, what about the folks who can just barely afford it? Do they get to go see med students or quack doctors? Are there any regulations at all? With the "real free market", there is presumably no regulation, so now we're talking back-alley clinics and dirty surgery instruments unless you can afford to go to a real doctor and get real care. That's really a better alternative to you? Why? Because you happen to be one of the people who could afford real medical help?

    What happens to emergency rooms? Do they get to refuse treatment now to anyone without cash in hand? Do people start going to prison because they can't pay their medical bills? Forgive me if I'm starting to head down a slippery-slope argument, but I'm truly not sure what the hell you mean when you say that we should apply true capitalism to healthcare.

    Quote Originally Posted by Archangel View Post
    It sounds great. Will the unicorns fart puppies or rainbows?
    If it's already working in another country, how on earth is it the stuff of fantasy? What a useless post.

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    There are a many good reasons why American healthcare costs so fucking much. Here are a couple of them:


    • ridiculously high markups by insurance providers
    • prescription of expensive but unnecessary procedures by physicians
    • insane regulations that encourages physicians to become specialists instead of GP (more GPs means more preventative, cheaper care... more specialists means more expensive care after illnesses have progressed)
    • the end of home visits by physicians (many patients don't have to be transported by ambulance to an emergency room if doctors would just perform home visits, which are much cheaper on the system)
    • an over-reliance on emergency room care due to a lack of access to non-emergency medicine (emergency visits cannot be turned down by hospitals and are very expensive compared to standard care)

    There's just so much fucked up about the American system compared to that of other nations.


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    Can I just say, I don't think the issue should be providing Universal healthcare.

    I think the issue should be providing affordable healthcare to everyone.

    That includes making sure that all common procedures are available at the lowest cost possible and that major expensive procedures are available at a cost that can be borne over an affordable period of time, or defrayed (if necessary) from the public purchase.

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    I am from the UK, here we have the National Health Service (NHS), which is a socialised model. People pay national insurance in the form of tax and this money is then used to fund the healthcare system. The only time when you need to pay a bill is when you need entirely elective procedures, dental care and in some cases prescription charges (if you can afford them). The system has its flaws.

    Alot of people take it for granted, waste valuable time with minor complaints. There is a problem with waiting lists for operations. At the moment I am waiting to see someone, god knows how long that will have to take. But I will wait, and I won't complain, as this beats having to pay in full out of my own pocket, I just cannot afford it. Of all the possible uses of tax money, this is probably the least objectionable in my opinion. I feel comforted knowing that people in my country get taken care of when they need it.

    Trojan, the free market does not have all the answers. If I am lying injured, I don't have time to shop around, there is only one thing on my mind and that is getting medical attention. And I am glad I live in a country that recognises that. In the UK, healthcare is a right not a privelage. That will enrage alot of Americans, and it dissapoints me that it would, it is a very cold attitude toward healthcare, and indeed their fellow citizens when they would deny them healthcare if society as a whole needs to pay for it via very small deductions from their income that wouldn't cripple them. The idea of viewing healthcare as nothing more than a comodity as opposed to an essential service disturbs me to an extent. I find it exceptionally cold hearted.

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    Quote Originally Posted by gismo View Post

    Alot of people take it for granted, waste valuable time with minor complaints. There is a problem with waiting lists for operations. At the moment I am waiting to see someone, god knows how long that will have to take. But I will wait, and I won't complain, as this beats having to pay in full out of my own pocket, I just cannot afford it. Of all the possible uses of tax money, this is probably the least objectionable in my opinion. I feel comforted knowing that people in my country get taken care of when they need it.
    This is because you are not allowed to object to it, under pain of a prison sentence sentence.

    My problem with the NHS is that if it fucks up, you can't go somewhere else. You instead have to pay for the NHS AND for a private hospital if you're (understandably) pissed off with the NHS.
    well i mean

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    Quote Originally Posted by benzss View Post
    This is because you are not allowed to object to it, under pain of a prison sentence sentence.

    My problem with the NHS is that if it fucks up, you can't go somewhere else. You instead have to pay for the NHS AND for a private hospital if you're (understandably) pissed off with the NHS.
    NHS does have its (many) problems. America needs to learn from the UK's mistake and form a socialized system that is more efficient and effective.

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    Quote Originally Posted by Kittens! View Post
    NHS does have its (many) problems. America needs to learn from the UK's mistake and form a socialized system that is more efficient and effective.
    We also need to learn from what NHS does correctly, since our health care system is FAR more fucked up than yours, as difficult as it may be for you to believe.

    That said, I also believe that kittens should never, ever have to pay for their own health care.


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    Yeah, as many problems as NHS has, the American system has more--again, it leaves 15% of the entire American population (50 million people) totally uninsured, so NHS's problems like waiting lists or whatever are fairly minor in comparison.

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    Quote Originally Posted by Syme View Post
    Yeah, as many problems as NHS has, the American system has more--again, it leaves 15% of the entire American population (50 million people) totally uninsured, so NHS's problems like waiting lists or whatever are fairly minor in comparison.
    ...and god only knows how much of that 85% "insured" population is severely under-insured. I've heard horror stories of people who thought they had insurance not being able to get necessary medical treatment, and coverage of services by insurance is getting worse and worse.


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    The NHS has just become a massive black hole for investment; if each hospital was made independent and eventually privatised, but national insurance was actually used as insurance rather than 'a little bit more tax to go towards the nhs', then I reckon things would be a lot better.

    But obviously that has nothing to do with the American system so I'll shut up now.
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    Actually it is very relevant, because eventually America will be moving in that direction and we need to pay for it efficiently and effectively.

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    I thought Canada had a pretty good healthcare system. Can't you just rip off their system? Or just invade them and take it. It's practically the same country already.

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    Quote Originally Posted by benzss View Post
    This is because you are not allowed to object to it, under pain of a prison sentence sentence.

    My problem with the NHS is that if it fucks up, you can't go somewhere else. You instead have to pay for the NHS AND for a private hospital if you're (understandably) pissed off with the NHS.
    That isn't why I find it unobjectionable - I find it one of the least objectional uses because it helps people in need. I won't argue with you, we clearly sit on 2 different sides of the fence, but I just wanted to clear that one up.


    The UK is one of the top 5 richest countries in the world, the general idea behind the NHS (put crudely) is "we are gonna take care of our own". I think this is an important sentiment. And if you are rich enough to do something like this, I do think it is important to go for it. The US is richer than the UK. It has the resources, it can learn from other countries, what they do well and do wrong.

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    I think it would be interesting to see how smaller businesses would do without the burden of providing health care for their employees. I'd like to believe it'd lead to better wages, and that would propel the economy a bit further but I'm more of a realist then that.
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    Quote Originally Posted by no_brains_no_worries View Post
    I think it would be interesting to see how smaller businesses would do without the burden of providing health care for their employees. I'd like to believe it'd lead to better wages, and that would propel the economy a bit further but I'm more of a realist then that.
    Umm this is all ready happening. Not every business is required to carry health care even for it's full time employees. It only makes the rich richer & the poor poorer because they. (the poor) get stuck in a dead end job with no hopes of being able to afford health care.

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    Quote Originally Posted by Fectual~ View Post
    Umm this is all ready happening. Not every business is required to carry health care even for it's full time employees. It only makes the rich richer & the poor poorer because they. (the poor) get stuck in a dead end job with no hopes of being able to afford health care.
    Yes because everyone needs to get a fabulous job. No, I'm thinking about the working class family who could use $10 dollars an hour instead of $7. I'm not saying this will magically make everyone afford a corvette, but I do believe the quality of life would increase. I honestly don't care about the rich getting richer and I believe if the "poor" are happy to be able to provide for their family better then before, then it is all worth it.
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    Quote Originally Posted by no_brains_no_worries View Post
    Yes because everyone needs to get a fabulous job. No, I'm thinking about the working class family who could use $10 dollars an hour instead of $7. I'm not saying this will magically make everyone afford a corvette, but I do believe the quality of life would increase. I honestly don't care about the rich getting richer and I believe if the "poor" are happy to be able to provide for their family better then before, then it is all worth it.
    Sounds like you're talking about increasing the minimum wage... what does this have to do with healthcare?

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    Quote Originally Posted by Kittens!
    In the end, we can't afford private health care, and we can barely afford universal, if even that. So we might as well suck it up and go universal.
    This kind of misses the point. We can't afford the out of control insurance system; however, history implies that we could afford private care. Why don't we at least attempt to fix the insurance industry instead of hiking taxes and spending even more money we don't have? That just seems irresponsible given that current programs are either underfunded or dying.
    Last edited by coqauvin; 06-25-2009 at 09:42 PM.

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    Quote Originally Posted by ephekt View Post
    This kind of misses the point. We can't afford the out of control insurance system; however, history implies that we could afford private care. Why don't we at least attempt to fix the insurance industry instead of hiking taxes and spending even more money we don't have? That just seems irresponsible given that current programs are either underfunded or dying.
    This is the most sensible way to do things, but such clear thinking isn't what people want.
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    Quote Originally Posted by sycld View Post
    There are a many good reasons why American healthcare costs so fucking much. Here are a couple of them:


    • ridiculously high markups by insurance providers
    • prescription of expensive but unnecessary procedures by physicians
    • insane regulations that encourages physicians to become specialists instead of GP (more GPs means more preventative, cheaper care... more specialists means more expensive care after illnesses have progressed)
    • the end of home visits by physicians (many patients don't have to be transported by ambulance to an emergency room if doctors would just perform home visits, which are much cheaper on the system)
    • an over-reliance on emergency room care due to a lack of access to non-emergency medicine (emergency visits cannot be turned down by hospitals and are very expensive compared to standard care)

    There's just so much fucked up about the American system compared to that of other nations.
    2, 3 and 5 are byproducts of 1; care givers/insurance companies are largely able to charge/prescribe whatever they want, since someone will cover it. In the past doctors were able to make house calls and keep charges down because patients paid out of pocket, and doctors that charged high fees would lose business to the first guy to undercut them.
    Last edited by ephekt; 05-27-2009 at 04:54 PM.

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    Quote Originally Posted by solecistic View Post
    My question has always been - you don't mind paying for public school, why do you mind paying for health care? I just don't get it.

    (This is probably unrelated; did not read walls of text. Sorry.)
    What do you say if someone DOES mind paying for public schools? Hopefully not an ignorant statement similar to "oh well then you're just crazy."

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    the common sense fairy solecistic's Avatar
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    Quote Originally Posted by UnreasonablyReasonable View Post
    What do you say if someone DOES mind paying for public schools? Hopefully not an ignorant statement similar to "oh well then you're just crazy."
    No, I wouldn't simply say, "oh, well then you're just crazy." At the same time, people who really mind paying for public schools are probably more on the fringe when it comes to political opinions. That's not to say their opinion is totally irrelevant in a democracy, but someone that extreme probably isn't someone I have any reason to discuss this with because we're never going to come to any sort of agreement. Insisting that American government should be altered to exist only to protect the people from outside invasion is extreme libertarianism, and most people don't fall into that mindset.

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    Senior Member ephekt's Avatar
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    Quote Originally Posted by solecistic View Post
    Insisting that American government should be altered to exist only to protect the people from outside invasion is extreme libertarianism, and most people don't fall into that mindset.
    Well, to be fair, our govt has been exponentially expanded beyond it's original role; we've been insisting on paradigm shifts for years. Picking and choosing which expansions are 'good' is largely arbitrary.

    Although, I do agree that anyone holding contempt for public education, police etc is probably a bit fringe.

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    Quote Originally Posted by ephekt View Post
    Well, to be fair, our govt has been exponentially expanded beyond it's original role; we've been insisting on paradigm shifts for years. Picking and choosing which expansions are 'good' is largely arbitrary.

    Although, I do agree that anyone holding contempt for public education, police etc is probably a bit fringe.
    Yeah, they would be in agreement with people like Thomas Jefferson and Benjamin Franklin. Today their views are considered fringe.

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    Quote Originally Posted by ephekt View Post
    Well, to be fair, our govt has been exponentially expanded beyond it's original role; we've been insisting on paradigm shifts for years. Picking and choosing which expansions are 'good' is largely arbitrary.
    You do realise that the original role has expanded exponentially because the people have voted for governments based on the expansionist policies they promoted (or opposed). It's not arbitrary at all.

    Quote Originally Posted by ephekt View Post
    Although, I do agree that anyone holding contempt for public education, police etc is probably a bit fringe.
    Sure, but Benjamin Franklin and other framers also held any number of views which most people would consider fringe now. So what? Benjamin Franklin and other recognized that times change as does the opinions of the people; hence they created a Constitution which allowed laws to be created, modified and revoked, as well as which allowed itself to be modified.
    Last edited by MrShrike; 05-31-2009 at 03:00 AM.

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    Quote Originally Posted by UnreasonablyReasonable View Post
    Yeah, they would be in agreement with people like Thomas Jefferson and Benjamin Franklin. Today their views are considered fringe.
    I'm not sure exactly what views you are trying to attribute to Jefferson and Franklin here, but people who, for instance, hold public education in contempt are definitely not in agreement with Jefferson and Franklin. Both Thomas Jefferson and Benjamin Franklin were outspoken proponents of public education. Just google their names and the words "public education" and you'll find out all about it. As for police, I'm not sure what their views were, but would be quite surprised if they had contempt for the idea of the government organizing a force to prevent crime.

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