How the Republican budget plan is "Obamacare" but worse

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    May 01, 2011 2:18 AM GMT
    For those people who think that the ACA ought to be repealed while the Ryan budget plan is gospel, think again.
    http://healthpolicyandreform.nejm.org/?p=14336In sum, both plans would create a health care system in which many Americans purchase private health insurance using partially means-tested public subsidies through an exchange-based, information-rich competitive market, which is (more or less) open to all regardless of health status. Those who choose to remain uninsured will incur a penalty, and those who purchase insurance will often be responsible for significant costs.


    Specifically, with regards to the individual mandate, they're not so far apart:

    http://healthpolicyandreform.nejm.org/?p=14336Fifth, both plans penalize Americans who choose to remain outside the insurance market, undermining the risk pool. The “individual mandate,” which imposes a tax penalty on Americans who can afford health insurance but choose not to buy it, is one of the most controversial provisions of the ACA. The Republican tax credit, however, is offered only to Americans who purchase health insurance. An incentive available only to those who comply with a condition is the exact economic equivalent of a penalty imposed for noncompliance with the same condition. Indeed, the price of remaining uninsured imposed by the Roadmap will in most instances be greater than that under the ACA.


    http://healthpolicyandreform.nejm.org/?p=14336Similarities

    Reliance on tax credits to purchase private insurance

    Managed competition through state-based exchanges

    Guaranteed issue and risk adjustment

    Assistance for at least some people who cannot afford insurance

    Penalties for Americans who choose to remain uninsured

    Cost sharing for most Americans for health insurance and health care services

    External controls on Medicare cost growth

    Institutions to provide information on health care services effectiveness

    Differences

    Extent of assistance offered to lower- and moderate-income Americans

    Degree of protection against health-status-based discrimination

    Extent of coverage that insurers must provide

    Approaches to controlling federal health care expenditures

    Role of the federal government in guaranteeing access to health care

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    May 01, 2011 3:45 AM GMT
    The Ryan plan, while being a noble effort in that it has forced the Republicans to concede that cutting spending actually will cut services [this is a milestone] is absolutely silent on cost control.

    If American health costs per capita were those of the UK, or most other western nations [which have similar or better outcomes!] THERE WOULD BE NO DEFICIT.

    Quite a thought, no?

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    May 01, 2011 4:49 AM GMT
    Maybe the exposure of Ryans Plan and more attention on Obama's Plan now that the two are being compared, will re-ignite interest in the Public option. Slim chance though, because both parties are so dependent on political donations from big pharma and Insurance Co's, so whichever side takes them on will be big losers.

    Ryans plan will end up costing the elderly a lot of money if it ever gets passed, The Repubs are certainly straining the truth in trying to pass it off as similar to the plan Congressmen have. LOL !!! What a stretch that one is !!!
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    May 01, 2011 5:07 AM GMT
    TigerTim saidThe Ryan plan, while being a noble effort in that it has forced the Republicans to concede that cutting spending actually will cut services [this is a milestone] is absolutely silent on cost control.

    If American health costs per capita were those of the UK, or most other western nations [which have similar or better outcomes!] THERE WOULD BE NO DEFICIT.

    Quite a thought, no?



    Yes. And we have worse outcomes than the UK.
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    May 01, 2011 7:28 AM GMT
    It's just boggles my mind how some people would fulminate and deride anything Obama-ish or Democratic, just for the principle of being against Obama, while they unapologetically accept a similar (if not worse) plan when presented by Republicans. Either they're
    a. Uninformed
    b. Inconsistent
    c. Malicious for the sake of being malicious, or
    d. just plain dumb.
  • musclmed

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    May 01, 2011 8:00 AM GMT
    q1w2e3 said.

    Fifth, both plans penalize Americans who choose to remain outside the insurance market, undermining the risk pool. The “individual mandate,” which imposes a tax penalty on Americans who can afford health insurance but choose not to buy it, is one of the most controversial provisions of the ACA. The Republican tax credit, however, is offered only to Americans who purchase health insurance. An incentive available only to those who comply with a condition is the exact economic equivalent of a penalty imposed for noncompliance with the same condition. Indeed, the price of remaining uninsured imposed by the Roadmap will in most instances be greater than that under the ACA.



    Your logic would say, if I dont buy a hybrid car and do not get a tax incentive . I am getting penalized for buying a regular car or no car?

    Therefore we might as well just make everyone buy a hybrid car?


    How is the same principle, only because the end price would be the same?

    Equating a fine for not fulfilling a required mandate with a tax incentive?

    Thats dumb. ( as you say it above). A mandate with a small fine today, can become a huge fine in the future at the whim of a bureaucrat. A tax incentive of course cannot have the same effect.

    As for your assertion that anything democratic would be "opposed" for the sake of its being from a democrat is absurd.

    Frankly both plans are inadequate. I believe there has to be a re definition of what insurance is. Insurance is for a health calamity. Not a massage and a health club membership.

    No one talks about catastrophic insurance alone for the masses. Its always this HMO half breed that has driven up the costs to date.
    To be fair, this HMO beast was a Nixon creation.

    By the way in the closest incarnation of "Govt run healthcare" "the VA"
    they still track Thiazides as the preferred anti-hypertensive of choice. No matter if its a diabetic, or a patient with Chronic Renal Failure it doesn't matter. To the point where each VISN is ranked on hypertensive patients on a thiazide and by provider prescribing rate of thiazides.


    Sleep on that one q1w2e3, I know you will understand the thiazide part.



    btw, if Howard Dean had written that NEJM opinion I would not be saying this. But shame on the NEJM for defaulting to a Lawyer before any other medical professional first. Physicians are lectured enough by "J.D", we do not need them to invade our esteemed periodicals.

    Howard Dean at least did something constructive within Vermont, and has a health care background.


    The author is supported by several think tanks. This is not a peer reviewed article. Its as good as a blog entry.
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    May 01, 2011 3:21 PM GMT
    http://blog.ometer.com/2011/04/16/individual-mandate-and-the-power-to-tax/Cer­tainly the credit and the penalty are a dif­fer­ent “spin” — I’m sure peo­ple have a dif­fer­ent reac­tion if the tax forms say “you must do this or pay a penalty” vs. “you can do this to get a credit.” There’s a psy­cho­log­i­cal dif­fer­ence. But if peo­ple were com­pletely ratio­nal and didn’t look at the word­ing, the fact is that it doesn’t mat­ter to their pock­et­book what the tax forms call the rule. The rule is sim­ply “you pay less if you buy X and more if you don’t.”
    ...
    In fact there’s a pop­u­lar argu­ment “can the gov­ern­ment make you buy GM cars?” — and yes, there have been tax cred­its for buy­ing cer­tain kinds of car (hybrid, elec­tric, what­ever). Which means you pay more (you are penal­ized) if you don’t buy those cars. The gov­ern­ment can, under cur­rent law, pun­ish you through tax­a­tion if you don’t buy the right car.
  • musclmed

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    May 01, 2011 5:12 PM GMT
    Someone may have the legitimate opinion . And support ACA , over the Ryan plan.

    But I would advise to abandon the argument that tax breaks are the same as mandates. You will find most do not agree with this.
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    May 01, 2011 7:33 PM GMT
    musclmed saidSomeone may have the legitimate opinion . And support ACA , over the Ryan plan.

    But I would advise to abandon the argument that tax breaks are the same as mandates. You will find most do not agree with this.


    Both are economic incentives designed to shape human and corporate behavior. In that sense they are the same.
  • musclmed

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    May 01, 2011 7:48 PM GMT
    A mandate is not an incentive. Its a order with a punishment that can be changed.

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    May 01, 2011 8:05 PM GMT
    musclmed saidA mandate is not an incentive. Its a order with a punishment that can be changed.



    As usual, I can't for the life of me figure out what you mean. What "can be change?" Do you think it will go from a tax penalty (as opposed to an incentive), which is all the much ballyhooed mandate is to being put in leg irons? icon_rolleyes.gif
  • musclmed

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    May 01, 2011 8:19 PM GMT
    Im sorry you do not understand the difference between a tax incentive and a mandate with a fine.

    Giving a tax incentive ( Ryan plan ) is completely different from the ACA ( mandate fine)

    The fine can be changed at the whim of congress or whatever health care administration comes forward.

    It maybe true that both pieces of legislation have the same effect on a average user now in numbers. But they are DIFFERENT.

    The logic from the NEJM blog would also state that the marriage tax incentive would be akin to having a fine to not be married.


    What is incredible is the author puts his credentials as a "JD" have us believe that a tax incentive is the same as mandate fine.
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    May 01, 2011 8:24 PM GMT
    Strangely I do agree with musclemed's point, but I think his argument is dreadful.

    It's absolutely clear from behavioral psychology that people do not make economic decisions entirely rationally. In consequence, the claim that a tax incentive is the same as a mandate, which is predicated on the idea that people spend rationally, requires supporting proof. [I suppose this is because most people are essentially innumerate and incapable of making sophisticated quantitative judgements objectively].

    Arguing which is better requires very careful scrutiny that considers the attitudes of all subgroups of a population—are some more likely [or able] to claim certain credits than others, for instance?

    In any case, musclemed's claim that one is preferable because the other may be changed in the future is entirely nonsense. The legislature may easily change EITHER scheme in ANY direction. Arguments to the future are completely fallacious.
  • musclmed

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    May 01, 2011 8:31 PM GMT
    TigerTim saidStrangely I do agree with musclemed's point, but I think his argument is dreadful.

    It's absolutely clear from behavioral psychology that people do not make economic decisions entirely rationally. In consequence, the claim that a tax incentive is the same as a mandate, which is predicated on the idea that people spend rationally, requires supporting proof. [I suppose this is because most people are essentially innumerate and incapable of making sophisticated quantitative judgements objectively].

    Arguing which is better requires very careful scrutiny that considers the attitudes of all subgroups of a population—are some more likely [or able] to claim certain credits than others, for instance?

    In any case, musclemed's claim that one is preferable because the other may be changed in the future is entirely nonsense. The legislature may easily change EITHER scheme in ANY direction. Arguments to the future are completely fallacious.



    Well you may make your argument base on "behavioral psychology" as you say it. What does it matter if people do things rationally or not?

    It really doesn't matter how people behave. What matter is what is legal and constitutional.

    Tax deductions are a legal way to support a policy.

    A mandate with a fine would have to be based on the fact the government had a legal right to enact the mandate. In ACA, it clearly does not have the right to make people buy anything.

    The author would have you think if each policies come to equal results, "Whats the difference?"

    Difference is you cannot fine based on a mandate if you had no right to make the mandate in the first place.


    Btw Tigertim, your analysis ( a rather unnecessarily complicated review of what would be better) assumes that government can just do everything it can without constraints. And we are just arguing whats better based on human behavior and psychology. Which is not really settled or predictable
    If you believe there are no limits on government power the conversation really cannot go forward can it.

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    May 01, 2011 8:46 PM GMT
    musclmed saidWell you may make your argument base on "behavioral psychology" as you say it. What does it matter if people do things rationally or not?

    It really doesn't matter how people behave. What matter is what is legal and constitutional.


    Are you kidding me? What kind of conservative are you exactly? As you know, one of the underpinnings of market theory is that people act rationally enough for the market to work. It's unbelievable that you would make such an insanely self-defeating point!
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    May 01, 2011 8:53 PM GMT
    musclmed said
    TigerTim saidStrangely I do agree with musclemed's point, but I think his argument is dreadful.

    It's absolutely clear from behavioral psychology that people do not make economic decisions entirely rationally. In consequence, the claim that a tax incentive is the same as a mandate, which is predicated on the idea that people spend rationally, requires supporting proof. [I suppose this is because most people are essentially innumerate and incapable of making sophisticated quantitative judgements objectively].

    Arguing which is better requires very careful scrutiny that considers the attitudes of all subgroups of a population—are some more likely [or able] to claim certain credits than others, for instance?

    In any case, musclemed's claim that one is preferable because the other may be changed in the future is entirely nonsense. The legislature may easily change EITHER scheme in ANY direction. Arguments to the future are completely fallacious.



    Well you may make your argument base on "behavioral psychology" as you say it. What does it matter if people do things rationally or not?

    It really doesn't matter how people behave. What matter is what is legal and constitutional.

    Tax deductions are a legal way to support a policy.

    A mandate with a fine would have to be based on the fact the government had a legal right to enact the mandate. In ACA, it clearly does not have the right to make people buy anything.

    The author would have you think if each policies come to equal results, "Whats the difference?"

    Difference is you cannot fine based on a mandate if you had no right to make the mandate in the first place.


    Btw Tigertim, your analysis ( a rather unnecessarily complicate review of what would be better) assumes that government can just do everything it can without constraints. And we are just arguing whats better based on human behavior and psychology. Which is not really settled or predictable
    If you believe there are no limits on government power the conversation really cannot go forward can it.


    The government's ability to tax citizens is well established in the Constitution. The government also mandates all sorts of laws in both the criminal, civil statutes and the tax code. This sad and increasingly silly argument that it cannot is really becoming desperate.

    Mind you the entire idea of a free market economy necessitates rationale actors who engage in said market, which is why Tim brought it up.

    Also, this argument that the government is taxing people or creating mandates willy-nilly is just pathetic. ACA was debated and legislated for more than a year by two parts of the federal government, going through numerous iterations before finally being passed. There was nothing even remotely close to the "government doing whatever it wants without constraints." The constraints are our elected representatives.

    Do you support Medicare reform as Ryan has outlined it? Because far more people object to it than ever did healthcare reform and yet the Republicans are just pushing it anyway. What you'll notice in that case is our government working because it's never going to become law.
  • musclmed

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    May 01, 2011 8:56 PM GMT
    TigerTim said
    musclmed saidWell you may make your argument base on "behavioral psychology" as you say it. What does it matter if people do things rationally or not?

    It really doesn't matter how people behave. What matter is what is legal and constitutional.


    Are you kidding me? What kind of conservative are you exactly? As you know, one of the underpinnings of market theory is that people act rationally enough for the market to work. It's unbelievable that you would make such an insanely self-defeating point!


    Who ever said I am a "Conservative". You are making alot of assumptions are you.

    Likely in your mind you believe anyone who would disagree with you is one monolith.
    What does market theory have to do with this?

    Simply at its core a tax incentive and a mandate fine are two completely different things.

    UNLESS , you believe that government is unlimited in that case it boils down to which way you think is the most efficient at getting the desired effect.

    btw I align pretty strongly with a libertarian point of view. What is self defeating about saying that a mandate with a fine is different than a tax incentive? They are completely two different things legally and historically.

    It is vitally important that Congress do things in a correct and constitutional manner
    Even if the practical effect of doing the same thing in a constitutional manner and an unconstitutional manner is exactly the same at this point in time.

    There are so many examples in history of why process is important.
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    May 01, 2011 8:59 PM GMT
    musclmed said
    TigerTim said
    musclmed saidWell you may make your argument base on "behavioral psychology" as you say it. What does it matter if people do things rationally or not?

    It really doesn't matter how people behave. What matter is what is legal and constitutional.


    Are you kidding me? What kind of conservative are you exactly? As you know, one of the underpinnings of market theory is that people act rationally enough for the market to work. It's unbelievable that you would make such an insanely self-defeating point!


    Who ever said I am a "Conservative". You are making alot of assumptions are you.

    Likely in your mind you believe anyone who would disagree with you is one monolith.
    What does market theory have to do with this?

    Simply at its core a tax incentive and a mandate fine are two completely different things.

    UNLESS , you believe that governement is unlimiteless in that case it boils down to which way you think is the most efficient at the desired effect.

    btw I align pretty strongly with a libertarian point of view. What is self defeating about saying that a mandate with a fine is different than a tax incentive? They are completely two different things legally and historically.

    Tell me how they are the same legally?


    I'm stunned by the bolded section. Fucking stunned.

    Dude - You just basically asked what physics has to do with space travel... icon_rolleyes.gif
  • musclmed

    Posts: 3284

    May 01, 2011 9:07 PM GMT
    Christian73 said
    musclmed said
    TigerTim said
    musclmed saidWell you may make your argument base on "behavioral psychology" as you say it. What does it matter if people do things rationally or not?

    It really doesn't matter how people behave. What matter is what is legal and constitutional.


    Are you kidding me? What kind of conservative are you exactly? As you know, one of the underpinnings of market theory is that people act rationally enough for the market to work. It's unbelievable that you would make such an insanely self-defeating point!


    Who ever said I am a "Conservative". You are making alot of assumptions are you.

    Likely in your mind you believe anyone who would disagree with you is one monolith.
    What does market theory have to do with this?

    Simply at its core a tax incentive and a mandate fine are two completely different things.

    UNLESS , you believe that governement is unlimiteless in that case it boils down to which way you think is the most efficient at the desired effect.

    btw I align pretty strongly with a libertarian point of view. What is self defeating about saying that a mandate with a fine is different than a tax incentive? They are completely two different things legally and historically.

    Tell me how they are the same legally?


    I'm stunned by the bolded section. Fucking stunned.

    Dude - You just basically asked what physics has to do with space travel... icon_rolleyes.gif


    Well i am not stunned you are suprised.

    It really doesnt matter what effect you are looking for.

    The blog stated there are NO difference between a mandate and a tax incentive. Our legal system treats these things differently.

    But I understand if you come from the premise that government can just do anything. These two ways of doing things are just dogma.

    And that's why I believe the conversation can go no further. Its ideology, the laws are just words for a means to an end.
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    May 01, 2011 9:10 PM GMT
    q1w2e3 saidIt's just boggles my mind how some people would fulminate and deride anything Obama-ish or Democratic, just for the principle of being against Obama, while they unapologetically accept a similar (if not worse) plan when presented by Republicans. Either they're
    a. Uninformed
    b. Inconsistent
    c. Malicious for the sake of being malicious, or
    d. just plain dumb.




    All of the above + they're hopelessly partisan knee-jerk critics of Obama and the Dems - and defenders of the Repub party - no matter what.

    Yes, we Dems savaged Bush too - that's true.
    But it was because we opposed what Bush DID.
    The lies to build support for a war in Iraq that should never have been started.
    The cold-hearted failure to help the victims of Katrina.
    The prescription drug bill that is 100% UNPAID FOR.
    The tax cuts that overwhelmingly went to the RICH.
    Turning yearly budget surpluses into yearly budget deficits.
    Failing to do anything to prevent or ease the housing crisis.
    Failing to do anything to avert the banking crisis until the last minute when it was too far gone.
    Causing yet another Bush recession.
    Doubling the National Debt.
    We had REAL and LEGITIMATE reasons to criticize Bush.

    The Repubs are just attacking Obama because he's a Democrat and becaue they put their love of the Republican party ahead of love of country - and ahead of what's right and fair.
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    May 01, 2011 9:21 PM GMT
    musclmed said
    Who ever said I am a "Conservative". You are making alot of assumptions are you.

    Likely in your mind you believe anyone who would disagree with you is one monolith.
    What does market theory have to do with this?

    Simply at its core a tax incentive and a mandate fine are two completely different things.

    UNLESS , you believe that government is unlimited in that case it boils down to which way you think is the most efficient at getting the desired effect.

    btw I align pretty strongly with a libertarian point of view. What is self defeating about saying that a mandate with a fine is different than a tax incentive? They are completely two different things legally and historically.

    It is vitally important that Congress do things in a correct and constitutional manner
    Even if the practical effect of doing the same thing in a constitutional manner and an unconstitutional manner is exactly the same at this point in time.

    There are so many examples in history of why process is important.


    Oh I completely agree with you—as I stated above—that an incentive and a punishment are different things.

    What I really don't understand is why on Earth you claim to be a libertarian and ask what market theory has to do with this. I mean, do you actually even understand what Libertarianism actually is?!?!?!!?!??!!??!
  • musclmed

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    May 01, 2011 9:32 PM GMT
    TigerTim said
    musclmed said
    Who ever said I am a "Conservative". You are making alot of assumptions are you.

    Likely in your mind you believe anyone who would disagree with you is one monolith.
    What does market theory have to do with this?

    Simply at its core a tax incentive and a mandate fine are two completely different things.

    UNLESS , you believe that government is unlimited in that case it boils down to which way you think is the most efficient at getting the desired effect.

    btw I align pretty strongly with a libertarian point of view. What is self defeating about saying that a mandate with a fine is different than a tax incentive? They are completely two different things legally and historically.

    It is vitally important that Congress do things in a correct and constitutional manner
    Even if the practical effect of doing the same thing in a constitutional manner and an unconstitutional manner is exactly the same at this point in time.

    There are so many examples in history of why process is important.


    Oh I completely agree with you—as I stated above—that an incentive and a punishment are different things.

    What I really don't understand is why on Earth you claim to be a libertarian and ask what market theory has to do with this. I mean, do you actually even understand what Libertarianism actually is?!?!?!!?!??!!??!



    You may understand it, but injecting other ideals into a simple point just drags it down.

    But it does allow me to make a bigger point on why people differ so much.

    Enlighten me, what about market theory makes something constitutional or not?

    Entertain for a movement you cannot look past the bias that government is limitless and this is just a "policy" choice of a regulated market or unconstrained market.

    If it were not a question of legality then of course we could discuss an open or regulated market.


    If left unchallenged every fad and fashion could be subject to a fine.
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    May 01, 2011 9:33 PM GMT
    TigerTim said
    musclmed said
    Who ever said I am a "Conservative". You are making alot of assumptions are you.

    Likely in your mind you believe anyone who would disagree with you is one monolith.
    What does market theory have to do with this?

    Simply at its core a tax incentive and a mandate fine are two completely different things.

    UNLESS , you believe that government is unlimited in that case it boils down to which way you think is the most efficient at getting the desired effect.

    btw I align pretty strongly with a libertarian point of view. What is self defeating about saying that a mandate with a fine is different than a tax incentive? They are completely two different things legally and historically.

    It is vitally important that Congress do things in a correct and constitutional manner
    Even if the practical effect of doing the same thing in a constitutional manner and an unconstitutional manner is exactly the same at this point in time.

    There are so many examples in history of why process is important.


    Oh I completely agree with you—as I stated above—that an incentive and a punishment are different things.

    What I really don't understand is why on Earth you claim to be a libertarian and ask what market theory has to do with this. I mean, do you actually even understand what Libertarianism actually is?!?!?!!?!??!!??!




    Nope.
    He just thinks that calling himself a libertarian will be more appealing than calling himself what he is.
    A partisan REPUBLICAN.
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    May 01, 2011 9:40 PM GMT
    musclmed said
    Well i am not stunned you are suprised.

    It really doesnt matter what effect you are looking for.

    The blog stated there are NO difference between a mandate and a tax incentive. Our legal system treats these things differently.

    But I understand if you come from the premise that government can just do anything. These two ways of doing things are just dogma.

    And that's why I believe the conversation can go no further. Its ideology, the laws are just words for a means to an end.


    Actually, the conversation can't go any further because you don't have the requisite knowledge to continue it, so you're rattling off the libertarian talking points of a 17-year old.
  • musclmed

    Posts: 3284

    May 01, 2011 9:44 PM GMT
    Christian73 said
    musclmed said
    Well i am not stunned you are suprised.

    It really doesnt matter what effect you are looking for.

    The blog stated there are NO difference between a mandate and a tax incentive. Our legal system treats these things differently.

    But I understand if you come from the premise that government can just do anything. These two ways of doing things are just dogma.

    And that's why I believe the conversation can go no further. Its ideology, the laws are just words for a means to an end.


    Actually, the conversation can't go any further because you don't have the requisite knowledge to continue it, so you're rattling off the libertarian talking points of a 17-year old.


    icon_lol.gif