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Thread: Joss on Romney

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    Well it's not free healthcare, it's just that everybody can access it because we pay together for the system, by example through taxes. Or in my country we pay all for our own insurance, and the state compensates the poor people.

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    Quote Originally Posted by Nina View Post
    Well it's not free healthcare, it's just that everybody can access it because we pay together for the system, by example through taxes. Or in my country we pay all for our own insurance, and the state compensates the poor people.
    I suppose free is a shorthand for free-at-the-point-of-access (at least it is in the UK). Just like pavements are free to use when you're walking on them (but you still pay for them in your taxes).


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    Quote Originally Posted by Wolfie Gilmore View Post
    I suppose free is a shorthand for free-at-the-point-of-access (at least it is in the UK). Just like pavements are free to use when you're walking on them (but you still pay for them in your taxes).
    I guess you can view it like that if the whole system is payed with tax money. On the other side, healthcare is so expensive (direct or indirect) that it sounds strange to speak about 'free', the taxes would be a lot lower if the state wouldn't provide a complete healthcare system for everybody. Nor is it the same in all countries with a good healthcare system for everybody, by example the one in my own country.

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    Quote Originally Posted by Nina View Post
    I guess you can view it like that if the whole system is payed with tax money. On the other side, healthcare is so expensive (direct or indirect) that it sounds strange to speak about 'free', the taxes would be a lot lower if the state wouldn't provide a complete healthcare system for everybody. Nor is it the same in all countries with a good healthcare system for everybody, by example the one in my own country.
    Yeah, it's free in the Pickwickian sense

    But, I suppose the significant way in which it can be "free" is if people don't have to pay each time they go to the doctor (or factor financial concerns in such as whether their insurance will cover it), they can go whenever they need rather than whenever they can afford it.

    Affordable/accessible are probably better words though!


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    The thing is... scarcity. It's an immutable fact, and it applies to healthcare just like it applies to anything else. The amount of quality healthcare (emphasis on quality, I'll come back to it) that can be provided with a given supply of providers to a given population is utterly finite. No law can change that. Making all healthcare "free" at the point of sale has a demonstrable effect of raising demand, dramatically. But it has no effect on supply.

    SuperBowl tickets are very expensive, because while probably millions wish they could go and would even pay face value of an NFL game ticket for it, it's only one game and there are only 70,000 of those seats -- so those seats are very expensive. What would be the effect on availability of SuperBowl seats if Congress passed a law that said all football tickets are free at the point of sale? Nothing -- it would just increase demand for them.

    So, quality -- there are only two ways to navigate extremely increased demand within the economic and natural laws of scarcity. You can either simply refuse to provide it, or defer providing care (and behold, a glance around the world of "free" healthcare and I see months long lines for pretty basic things like a CT) or, the quality of the care must suffer -- that's where we'll just see inflation hit the value of training in the medical field. Everyone will basically get promoted a couple ranks, where the PAs are the MDs, the RNs become the PAs, the LPNs become the RNs. Not without anybody having learned the skillset above them, mind you, just having the responsibility dumped on them. The day could be coming where all it takes to be a "nurse" is a high school diploma, and it's a $9/hour job -- because all the "real" nurses are needed to gap fill as on-the-job trained physicians.

    This is all moot in the short term, because Obamacare doesn't make so much as a tongue depressor free at the point of sale -- I actually anticipate a slight bit of schadenfreude when people discover that they didn't get the vaunted "free healthcare" and have to actually buy the (heretofore evil and sinister) health insurance. And that they'll have to buy a one-size-fits-all plan approved by the government. And, that way fewer businesses are going to be offering group insurance since, those that are small enough that they can avoid the mandates will do so by cutting jobs/hours, and those that are too big but discover the fine is cheaper than the plan, will pay the fine. I mean, that's all working as intended at the legislative level, because Obamacare is a means and not an end -- it's supposed to dramatically increase demand while breaking down the private insurance industries way of meeting demand, thereby collapsing the latter and leaving the government as insurer of last resort, i.e. single payer.

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    There are certainly problems you get when a system has to adjust to a new situation (like more patients), but a quick look over the borders and you can see how other western countries deal with it and fixed those kind of issues. 20 years ago we had waitinglists, those are all gone now. And the quality of the healthcare in most western countries is fine, no horrorstories about bad doctors and nurses who are uneducated.

    But even if Obamacare brings some problems with it, it's also a solution for a much bigger problem. The problem that so many people can't access healthcare in the USA, and that's why you can't compare it to tickets for a sportsgame. Missing out on a game is not a problem, missing out on healthcare is a huge problem. So perhaps the higher classes will notice some decrease of quality at first because new systems simply need some time, but the situation for lower classes will be so much better that it sounds to me like a very fair deal. Be innovative and smart, and fix the minor problems instead of refusing to change anything. If we have to go back to the superbowl, build a bigger stadium so all people fit in and not only the rich.
    Last edited by Nina; 14-11-12 at 02:26 PM.

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    Quote Originally Posted by Nina View Post
    There are certainly problems you get when a system has to adjust to a new situation (like more patients), but a quick look over the borders and you can see how other western countries deal with it and fixed those kind of issues. 20 years ago we had waitinglists, those are all gone now. And the quality of the healthcare in most western countries is fine, no horrorstories about bad doctors and nurses who are uneducated.

    But even if Obamacare brings some problems with it, it's also a solution for a much bigger problem. The problem that so many people can't access healthcare in the USA, and that's why you can't compare it to tickets for a sportsgame. Missing out on a game is not a problem, missing out on healthcare is a huge problem. So perhaps the higher classes will notice some decrease of quality at first because new systems simply need some time, but the situation for lower classes will be so much better that it sounds to me like a very fair deal. Be innovative and smart, and fix the minor problems instead of refusing to change anything. If we have to go back to the superbowl, build a bigger stadium so all people fit in and not only the rich.
    I could probably pull a dozen waiting list nightmare articles from the last couple years alone from Britain or Canada if I even remotely had the inclination. One of my favorites was a few years ago in Canada a woman needing to be helicoptered, in active labor, to the nearest maternity ward with a bed -- in another province. Yay!

    I'm glad you returned to the SuperBowl metaphor because it proves my point about scarcity/demand/quality. I mean, you could build a 400,000 seat stadium for it... but you'd still only have 70,000 seats worth watching it from. I mean, they could just draw lines on an open field in Iowa somewhere and not have an enclosed seating area at all, and then really, the entire world is at the SuperBowl together at the same time.

    That's what we're talking about -- there is manifestly, metaphysically, no way you can have the same or fewer doctors/nurses providing the same quality of healthcare to a greater number of people. Reality itself doesn't bend that way -- the availability of care goes down, or the quality of care goes down, or some combination of the two. That's why rationing boards come about at all; like buying a tank in gas in New Jersey after Sandy. Incidentally, this is also why price gouging laws create shortages, because demand has gone up dramatically, but since supply hasn't and price isn't allowed to rise to meet demand, the shelves clear out instantly instead of gradually.

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    Quote Originally Posted by KingofCretins View Post
    I could probably pull a dozen waiting list nightmare articles from the last couple years alone from Britain or Canada if I even remotely had the inclination. One of my favorites was a few years ago in Canada a woman needing to be helicoptered, in active labor, to the nearest maternity ward with a bed -- in another province. Yay!
    No system is perfect and yes some bad things happen, like that example. But is it not better to have to be taken to another province to give birth than to have your next door neighbour's kid dying of cancer because they can not afford to pay for the care? Healthcare is not the same as wanting to go to the superbowl. Wanting to live, being able to live, should be the most important thing for anyone. Someone wants to go to the superbowl. Someone else NEEDS healthcare to live.

    Waiting lists suck. Waiting in the ER sucks. But it is far better to me to have to wait than to not be able to go at all because I can't afford to. I know if I am in an accident I will be cared for, I won't have to worry about becoming bankrupt because of it. Australia has free healthcare and for the most part it works very well. Yes there are problems, there are with any system especially when it is new. But the alternative to free healthcare is many many preventable deaths and sickness. Sickness that spreads because those people can not afford proper care to get better. It is all well and good to say people don't deserve health care if you can afford it, but think of those who can't.

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    I do think of those that can't. Thinking of, caring about, those who can't afford it doesn't change the basic economic and material laws of the universe, like cost, like scarcity, like supply and demand. People need food and need shelter just as surely -- if not moreso -- than they need to see a doctor, but scarcity and cost and supply and demand operate in these industries and there seems to be little complaint. In fact, we've seen worldwide when attempts are made to remove food and shelter from the economic cycle and make them available and free to all, it a) takes a totalitarian mega-state to even attempt and b) still doesn't work. The Soviet Union collapsing was probably the only thing that cleared out the bread line, and those people had been waiting since the Revolution.

    The real answers are... individualism, self-reliance, and free enterprise. Let your community efforts be autonomous, municipal collaborations between like-minded interests, not anonymous mega-state bureaucracies (I always find it puzzling that people seem to intuitively understand how easily they get screwed by dealing with a mega-sized bank as opposed to their local bank or credit union where the President might know them by name, but don't seem to realize that the same applies, probably more, in the case of government) who can't and don't scrutinize the merit or necessity of grabbing money from one person to give to another. If you need your neighbor's help, ask your neighbor for it. And, if your neighbor hasn't had as much of his own wealth confiscated, he'll be more inclined to give it. Besides, you and your neighbor have to face each other. That's community, not an arbitrary, faceless Other that takes from one stranger to deliver to another.

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    Quote Originally Posted by Mara View Post
    I probably shouldn't but I have to ask because healthcare is something I feel strongly about. Why do you feel this way?
    Why in your opinion do people not have a right to health care?
    Because as far as I am concerned health care is (or should be in any case) a basic human right/a basic human need that should be made available and affordable to everyone. In my county the situation around health care is not optimal but we have a system where good basic health care is accessible to all and I feel that is normal. Now I am not talking about a right to free healthcare but I do feel everyone should have a right to health care being available
    Because I know what a right really is. It isn't a promise of things being done for you so much as things not being done to you. The U.S. was founded on principles of freedom and personal responsibility. Freedom is a two edged sword. You don't just have the freedom to succeed, you also have the freedom to fail. And because in order to provide this free healthcare the government has to assume powers it was never given in the U.S.

    We already know that people come from all over the world to this country in order to get medical treatment, many of them coming from countries with free healthcare. Whats happens when the quality of healthcare in the U.S. becomes the same as everywhere else? I would rather have high quality healthcare available to those who could afford it, of which btw I am not one, rather than medium quality care available to everyone. Not everyone can afford to live in a mansion, but that doesn't mean we force everyone to live in a townhouse.
    Last edited by PointMan; 14-11-12 at 10:47 PM.
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    I won't repeat what Beck just said because I agree with that post.


    Quote Originally Posted by KingofCretins View Post
    I could probably pull a dozen waiting list nightmare articles from the last couple years alone from Britain or Canada if I even remotely had the inclination. One of my favorites was a few years ago in Canada a woman needing to be helicoptered, in active labor, to the nearest maternity ward with a bed -- in another province. Yay!
    Strange huh that in all Western countries sometimes things go wrong because of logistics or one failing doctor or whatever. Yes you can make a huge list with this failures of the systems, but if you remember how many people need medical care everyday in the western world, it's really not that bad. Besides Canada is one of the worst examples in this case, if you look at Germany, Japan or Austria you'll see that their waitinglists are shorter than in the USA.

    I'm glad you returned to the SuperBowl metaphor because it proves my point about scarcity/demand/quality. I mean, you could build a 400,000 seat stadium for it... but you'd still only have 70,000 seats worth watching it from. I mean, they could just draw lines on an open field in Iowa somewhere and not have an enclosed seating area at all, and then really, the entire world is at the SuperBowl together at the same time.
    That's what we're talking about -- there is manifestly, metaphysically, no way you can have the same or fewer doctors/nurses providing the same quality of healthcare to a greater number of people. Reality itself doesn't bend that way -- the availability of care goes down, or the quality of care goes down, or some combination of the two. That's why rationing boards come about at all; like buying a tank in gas in New Jersey after Sandy. Incidentally, this is also why price gouging laws create shortages, because demand has gone up dramatically, but since supply hasn't and price isn't allowed to rise to meet demand, the shelves clear out instantly instead of gradually.
    So every country in the 'western world' can cover the medical care for all their people, often equally good as and quicker and cheaper than the USA, but the USA is unable to do the same? Sounds to me like the USA should take another look at their system and perhaps take a look in another country how they do it.


    edit:
    But it doesn't look like this is going somewhere... so I'll leave it with this.
    Last edited by Nina; 14-11-12 at 10:46 PM.

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    Speaking of Japan, http://www.economist.com/node/21528660

    I'm sure I could find articles like this on all those other countries you mentioned if I looked.
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    Quote Originally Posted by Nina View Post
    So every country in the 'western world' can cover the medical care for all their people, often equally good as and quicker and cheaper than the USA, but the USA is unable to do the same? Sounds to me like the USA should take another look at their system and perhaps take a look in another country how they do it.
    No, I just dispute your usage of "quick", "cheap", and "care" for that matter. If I print off $1 million and give it to everyone in the world, will they all be millionaires? Yes. Will it mean anything to be a millionaire anymore? No. Will the once $10,000 procedure they wanted still cost $10,000? No, it will cost a billion.

    Can I pass a law that guarantees everyone in the world a prime rib dinner? Yes. Can I deliver it without running out of cows and anyone having more than a bite? No.

    All the various examples that can be produced, sure, it's easy to condition oneself as describing them as outliers, but once you have enough outliers, you have a trend, a systemic fact. I don't think the people that are so long on a waiting list to diagnose their cancer that it progresses to an untreatable point, or who die on the waiting list to have it treated, really think of their "care" as having been "quick". It was cheap, though, since chemo is pretty affordable for the post-terminal demographic. For me, I'd much prefer knowing that, while one could have to sell every wordly possession, completely change my lifestyle, put myself in debt, beg everybody I've ever met for help... they could make the appointment and get the MRI in a week and start treatment in a matter of days after that. Because healthcare, like divorce, is expensive because it's worth it.

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    I think it is worth pointing out that the British National Health Service is not a state monopoly. On the contrary, private health insurancxe has been growing steadily over the years. It grows because the main drawback of the NHS is when you need an operation but it is not urgent in the strict medical sense.

    You can wait quite a time--it depends on how good your regional health authority is and what the position is in regard to particular medical problems.

    Private insurance for this type of problem, especially if you are young, is not too expensive. Even so, you will be well advised to seek a private room at an NHS hospital because they have the best specialists on hand.

    I notice that the rest of the developed world has not followed either the American or the British models. Some form of compulsory universal insurance is normal and the French system seems to have the best overall reputation.

    Even so it is politically difficult to change the NHS. They say it is the nearest thing the British have to a religion.

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    Quote Originally Posted by Michael View Post
    I think it is worth pointing out that the British National Health Service is not a state monopoly. On the contrary, private health insurancxe has been growing steadily over the years. It grows because the main drawback of the NHS is when you need an operation but it is not urgent in the strict medical sense.
    Yes - things like knee operations, you'll wait for unless you go private. It's very fast for acute things such as cancer.


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    Quote Originally Posted by Wolfie Gilmore View Post
    Yes - things like knee operations, you'll wait for unless you go private. It's very fast for acute things such as cancer.
    Fast quickly becomes relative. I pulled up a www.cancerresearchuk.org and a July 2011 Guardian article that both discuss the NHS 'targets' for waiting on things like a two-week wait to see a "cancer specialist" (and I'm suspicious of the fact that the word "oncologist" wasn't used, vis a vis quality of care) after a referral, which I don't find too unreasonable, although I'd have to ask my sister how long she waited for that in Maryland. But the eye-popping one is a target -- of 31 days thereafter to first treatment? 62 days from first GP referral (which presupposes the two week target is routinely missed, since it's effectively setting a sub-target of 31 days between referral and specialist)? I can't fathom that being 'fast'. And what's more, when I think of "targets" as a term of service quality, it's just that -- a goal, a threshold that it's hope a certain percentage of service satisfies. Like a call center expecting 80% of calls to be answered within 30 seconds, or a pizza shop expecting 70% of orders to leave the store in less than 15 minutes. So I'm wired to think that when they talk of an NHS target of these... very generous intervals, there are a lot of people expected to land on the wrong side of it.

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    Quote Originally Posted by PointMan View Post
    Because I know what a right really is. It isn't a promise of things being done for you so much as things not being done to you. The U.S. was founded on principles of freedom and personal responsibility. Freedom is a two edged sword. You don't just have the freedom to succeed, you also have the freedom to fail. And because in order to provide this free healthcare the government has to assume powers it was never given in the U.S.

    We already know that people come from all over the world to this country in order to get medical treatment, many of them coming from countries with free healthcare. Whats happens when the quality of healthcare in the U.S. becomes the same as everywhere else? I would rather have high quality healthcare available to those who could afford it, of which btw I am not one, rather than medium quality care available to everyone. Not everyone can afford to live in a mansion, but that doesn't mean we force everyone to live in a townhouse.
    OK first of all thanks for taking the time to answer me. I often have the feeling that I come off as rude when writing in these threads so I appreciate you taking the time to answer really.

    Now back to the issue. First thing I would like to ask is how do you know what a right really is? Because looking on how you phrase what a right is I would say that a promise of things not being done to you is indeed a form of right I believe we call it formal rights in my country and a promise of things being done for you are called social rights. Examples of social rights can be found in my countries Constitution so to me they are rights as well. A right to accessible health care being one of them. So then my question is I guess do you not consider social rights to be rights?and if so why? Because they somehow interfere on your freedom?

    My country, well ok I am Russian but we moved to The Netherlands a long while ago when I was a kid so when I say my country I do mean The Netherlands (Russia is another story which I am unsure I want to address)was founded on principles of freedom and self responsibility as well. But there was also a strong sense of community as well as the idea that people have certain natural rights and the government should provide the people with certain things as they have certain social rights to those things. I want to bring the issue of the social contract into this, because I am wondering what your thoughts are on that, or yours KingofCretins.

    On the subject of quality I don't think everything can be placed within an economic model. People make choices every day, often stupid ones,that do not fit or even contradict existing economic models. I think there is a big difference between super bowl tickets, and health care not only because the first is a choice while the second is a necessity to survive as has been pointed out already but also because the first is in the Private sector where it should be and ruled by economic models as it should be while the second should in my opinion be part of the common good sector for which the whole community pays for to make it available for everyone. the big difference between super bowl tickets and health care? Necessity.
    I can live without the first I can not live without the other. The availability of the first should depend on my income, as it is a want the availability of the second is not a want it's a need it's something without which I may die so it should be available to everyone in its basic form to prevent me and my fellow human beings from dying.

    Yes I can see the principle of scarcity and how it works but that's the whole point of having government provided basic common goods like for example railways or government funded public transport, not as comfortable as your own car but sure as hell better then walking on foot. If we let the principle of scarcity rule our whole society then we allow for people in our society to live in inhuman conditions, below the social minimum as it is called around here. Social rights fill the gap within a pure economic model of governing as they provide the basis without witch we would allow a part of our community other human beings to live under inhuman conditions how do you justify that?

    Another thing I'd like to comment on is your notion of freedom to fail. To have an equal freedom to fail one needs an equal start. For example if you are both healthy individuals and one of you chooses to work while another one chooses to do nothing then the other is free to fail and by all means let him but if you are healthy and your neighbour is not and he fails then no that is not freedom, not when you have to I don't know climb the stairs to get to work and your neighbour can not do it because he is wheelchair bound and he fails because of that.that's not his freedom to fail that's your inability, or your governments inability to provide him with a chance to try. The opportunities to succeed or to fail should be equal. social rights in my opinion do exactly that provide everyone with an equal start from then if you want to stick on that minimum be my guest and believe me living on the social minimum in my country is no party but if you want to climb into that penthouse by all means feel free. I guess what I am ineloquently trying to say is that freedom to me is accessibly of equal chances. no one should be forced to live in a townhouse when they can afford a mansion but everyone should have the starting point of a townhouse and a townhouse should be affordable to you when your mansion burns down or you can no longer afford one

    * goes to hide in a corner waiting for the first person to accuse her of being a communist/socialist wathever now..*

    And last point the quality of the basic care provided here in The Netherlands is not mediocre on the contrary I would say. Yes there are problems with the system but I don't believe more money would buy me a better doctor in this country not when I need basic healthcare at least. Sure a private clinic will probably buy me a more comfortable bed and a bit more service but those are extra;s for which sure you should ask more. But when I get sick good not mediocre but good quality health care will be available to me regardless of my income or the income of my neighbor and I think when you get sick money doesn't matter because the ultimate goal is to get better and getting better will occur more surely when there is good or even medicre medical care available to you then when there is none available at all

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    Quote Originally Posted by Mara View Post
    Now back to the issue. First thing I would like to ask is how do you know what a right really is? Because looking on how you phrase what a right is I would say that a promise of things not being done to you is indeed a form of right I believe we call it formal rights in my country and a promise of things being done for you are called social rights. Examples of social rights can be found in my countries Constitution so to me they are rights as well. A right to accessible health care being one of them. So then my question is I guess do you not consider social rights to be rights?and if so why? Because they somehow interfere on your freedom?
    Well, I believe, as our countries founders believed, that our rights from to us from our creator. It is because of this fact they are immutable. Something like the right to accessible healthcare comes from the government, which means the government is also free to take it away. To me that would be the big difference between what is an actual right and what is simply a perceived right.
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    An actual right is one that a court of law will enforce.Everything else is a matter of opinion.

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    What? KingofCretins's Avatar
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    Disagree, that's just another way to say rights come from government. They don't -- rights create government, rights are the basis for it to exist at all. That's what popular sovereignty ultimately means, IMO.

    I have yet to heard somebody dispute the argument laid forth long these 236 years ago --

    We hold these truths to be self-evident, that all men are created equal, that they are endowed... with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.--That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, --That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.
    Such a short statement that I think pretty much comprises the apotheosis of the Age of Enlightenment, and lays out in a half paragraph the reason that governments exist at all and the nature of the individual's relationship with it.

    Now, I omitted (to avoid spurious argument, to be honest) a key phrase, but I did so because when explaining the virtue of negative rights, it's important only to realize that all of this is premised on the fact that these rights are inherent in the human condition -- that they are just as much a function of Tom Hanks' character teaching himself to spearfish and befriending a volleyball to preserve and fulfill himself as they are people early voting and then heading off to work in their cubicle.

    But right there -- "that to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed" -- says all that is most important and entirely true in politics for me.

    I think this is a good read as well. I don't agree with Dr. Paul on everything, but I agree with him on more today than I did a couple weeks ago. Ron Paul (R-TX) gave what is presumptively his farewell address to the House of Representatives yesterday and it amounts to a treatise on the virtue of liberty and how, as a virtue, it has become diluted, qualified, and devalued. I tell you, I wouldn't have wanted him as President for a few reasons, but I dream of him being handed the job of Treasury Secretary, which will unfortunately never happen.

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