PPACA And The Death Of Medical Care (And Choice)
The Market Ticker ® - Commentary on The Capital Markets
Posted 2012-07-01 15:04
by Karl Denninger
in Health Reform
Ignore this thread
PPACA And The Death Of Medical Care (And Choice)
 

Go watch this segment again:

http://www.youtube.com/watch?v=qgdIzdNnhD8

Now consider this -- the PPACA sets forth a "fine" (tax) of $2,000 per employee for a business that has 50 or more and does not provide "at least" the minimum "insurance" to all.

There is no health care plan I'm aware of that a business can buy today that costs less than $2,000 per employee per year, and which also meets the requirements in the law.  None.  That was almost impossible to meet back in 1995 for a healthy, 18 year old insured single male.  It's flatly impossible now and it's doubly-so if your workforce has other than 18-year old single, healthy males in it.  I know this to be factual because I was responsible for buying it for our employees as a CEO of a company.

Therefore the incentive is for all businesses to drop health care. 

Period.

Second, your choice is to either (1) buy and have said plan (whether through employment or individually) or pay a "fine" (tax) of 1% of income (increasing to 2.5% of AGI in 2016.)  The minimum "fine" is $95 starting in 2013, rising to $695 in 2016.  The average family income is about $50,000/year, which means that the fine (tax) will be $1,250 in 2016.  It's less now.

You cannot buy health insurance at their "minimum level" for anything approaching $1,250 a year no matter how healthy you are at any age. 

The law prohibits insurance companies from charging you more if you're sick, or refusing to cover you at all.  They must accept everyone on equal terms.

Therefore:

  • Businesses will drop coverage; it's cheaper (by far) for them to pay the fine and, for those under 133% of the federal poverty level, those employees can go onto Medicaid.  This is a "family of four" income of $31,900 (as of today; it will go up of course.)  That's roughly the second quintile.

  • Individuals will drop coverage and pay the fine, since it's far cheaper than to buy the "insurance."

Both will buy the "insurance" only when they get sick, since they cannot be upcharged.

The cost of "insurance" will thus skyrocket to 10x or more what it costs now, just as it would if you bought auto insurance only after you wrecked or homeowners insurance only after you had a fire.

At the higher price nobody will be able to afford to buy the insurance at all, since that will be indistinguishable from just paying for whatever is wrong with you, plus the insurance company markup.

In very short order the entire medical system and health insurance scheme will collapse, leaving only two choices -- either a return to free market principles (including all I've argued for since this debate began) or a single-payer, fully-socialized system ala Canada.

You can bet the government will continue to try to change the terms of the deal -- including ramping up the tax/fine and other games, to prevent this outcome, but they will fail.

Now the question becomes this:

Which Presidential political candidates have told you the above, and what are their answers to this dilemma?

Let's go down the list.

  • We know what Obama's is -- he passed it.  You will lose your private health care under Obama.  Period.  We are headed for a fully-socialized medical system and a collapse of the current medical paradigm under Obama.

  • We know what Gary Johnson's position is -- he wants to "block grant" all Medicare and Medicaid to the states, cut the amount of money in the budget (all line items) 43% and repeal Obamacare (including the mandate.)  But he refuses to demand an end to the cost-shifting where Juanita the illegal Mexican immigrant who is 7-1/2 months pregnant while drug and alcohol dependent shows up in the hospital, in labor, and foists off a $2.5 million NICU and birth expense bill on you!  He also refuses to stop the drug companies from effectively forcing Americans to bear the cost of all drug and device development and he has refused to put a stop to differential billing.  The latter two only exist because of explicit federal laws that make lawful in the health industry market behaviors that are illegal in virtually every other line of work (see The Sherman Act, The Clayton Act, and Robinson-Patman for starters.)  All of these facts are why the costs are ramping in the first place, which means his plan will simply force the States into bankruptcy and continue screwing you at the same time.

  • We don't know what Romney's plan is in detail.  He's been oddly silent in that regard.  He says "Obamacare is not the answer" but he passed it as Governor on a state basis!  He too advocates nothing to put a stop to the cost-shifting and anti-competitive acts of drug and device makers nor hospitals and other medical providers.  He too wants to block grant Medicaid but that does nothing to address the problem and will simply bankrupt the state budgets (as noted for Johnson.)   Conspicuously absent from Romney's plan (as is true for Johnson) is (1) a repeal of EMTALA, (2) a demand for level, consistent pricing irrespective of how one pays for a service (3) and a demand to remove anti-competitive laws protecting differential billing across state and national boundaries (e.g. Viagra for $2 in Canada .vs. $20 here) so that Americans are not forced to subsdize everyone else in the world and you pay the same price as the guy next to you in the hospital for the same product or service, instead of 2x, 3x, 5x, or even 100x as much.

So we have three Presidential candidates, none of which will do a damn thing to fix what's wrong with health care.  All three are promoting a path that will bankrupt the States, bankrupt the Federal Government, bankrupt you or all three.

All three are promoting mathematical impossibilities.  All three are protecting monopolistic behavior and refusing to address specific laws that were passed to protect that behavior and special government-granted privilege; without those protections that monopolistic behavior would immediately collapse. 

And worse, none of them has proposed a damn thing to deal with what the Supreme Court just did, which is grant a permanent ability to the Federal Government to compel any behavior by linking it to a tax.  Some examples of where this can (and might in the near future!) go include:

  • You make cars.  You're told to sell a car to anyone who makes under $25,000 a year for $5,000.  This is of course under your cost of production.  If you refuse, every car you make is subject to a $5,000 tax.  This is now Constitutional, as of this last week.

  • You would like to have three kids.  The government decides that you may have only two.  If you have get pregnant with a third and refuse to have an abortion you must pay $10,000 a year in additional tax forever.  This is now Constitutional, as of last week.

  • You may have all the abortions you want, but each costs $10,000 in tax.  This is Constitutional, as of last week.

  • You must eat Broccoli and submit receipts with your 1040 proving you bought 1lb of Broccoli per person in your household per week.  If you do not, you must pay $5,000 in additional tax.  This is Constitutional, as of last week.

  • If you are more than 10lbs overweight you must pay $2,000 of additional tax for every 10lbs overweight you are, with no cap.  This is Constitutional, as of last week.

You probably think I'm kidding on this.  I'm not.  This is what the Roberts Court held.  There is literally nothing that Congress cannot mandate that you do, or not do, under penalty of paying a tax.  All that was unconstitutional before the ruling now is explicitly constitutional if the only "compulsion" to do (or not do) a given thing is that you will be taxed if you refuse.  The court promised to review "reasonableness" of any such taxes in the future, but note that at the same time the court ignored two other problems with the Health Care law, making a lie of their claim of "future reasonableness" tests right up front:

  • Direct taxes are unconstitutional without being apportioned.  This is clearly a direct tax and it is not apportioned.  It is therefore unconstitutional, but the USSC simply ignored this. (The 16th Amendment was required to make income taxes constitutional for this reason.)

  • The Anti-Injunction Act prohibits suing the government over a tax until you have actually paid it.  This means that if the PPACA "penalty" is a tax then the entire lawsuit that went to the USSC is moot as it's not yet "ripe" (since nobody has yet paid the tax.)  If they were going to find that this was a tax they were thus bound to dismiss the entire complaint as unripe.  They ignored that too.

In short the USSC has become no more legitimate than the North Korean government and is unworthy of your respect.

Unfortunately, as things stand right now on Health Care, none of the Presidential Candidates is worthy of your vote as none of them have put forward any of the above facts, or solutions to these problems, in their campaign positions.

I'm waiting for one -- just one -- to put forward a platform plank with regard to health care that I can actually support.

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User Info PPACA And The Death Of Medical Care (And Choice) in forum [Market-Ticker]
Mo
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Quote:
Both will buy the "insurance" only when they get sick, since they cannot be upcharged.

The cost of "insurance" will thus skyrocket to 10x or more what it costs now, just as it would if you bought auto insurance only after you wrecked or homeowners insurance only after you had a fire.


The vast majority of people who are uninsured don't have two nickels to rub together. When they get sick or injured, are they all the sudden likely to be able to buy insurance and pay a fine? Of course not.

The assumption is - those who still can afford insurance will pay for 3 or 4 FSAers. And if you have SOMETHING, like a house or savings, and don't buy insurance, the IRS will take every stinkin' thing you have.

It's like a loan from the mafia.

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Blairkiel
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This is a very interesting take


Update from the last post on the Supreme Court decision

There is in fact a huge difference between a tax on people without health insurance and a mandate enforced with a penalty.

A mandate is a mandate, a law that everyone must have health insurance. If the minor penalty envisioned in the ACA isn't sufficient (it's not) to get people to buy health insurance, it was entirely within HHS power to find more effective means of enforcement.  They could literally have sent inspectors around and drag you off to jail for not having health insurance.

A tax is only a tax.  If you pay the tax, there is nothing else they can do to you. And taxes have to be approved by Congress, not just HHS. And there is no way Congress is going to vote in a $10,000 head tax for not having health insurance. 

Since the penalty under the mandate is so much less than the cost of health insurance, it was already pretty clear that they were going to have to start using strong-arm tactics to enforce the mandate.

They could have started by requiring proof of health insurance for getting a passport, student loan or grant, unemployment check, or any other interaction with the Federal Government.  That was, according to the fawning New Yorker article on Obamacare, already contemplated.  Next, go to the point of sale: they could have required that delivery of any health service must include a check of health-insurance status and report to authorities. They could have used medicare funds to force states to make proof of health insurance a requirement to get a driver's license. In the end, yes, they could have sent inspectors around to check health insurance status and haul people off to jail.  You think I'm kidding? They already send inspectors around to check immigration status and haul people off to jail. 

Now, none of this can happen. By construing the penalty as a "tax," and holding it unconstitutional as a "mandate," Roberts has clearly said that the penalty is the only recourse the Federal government can use to enforce its mandate. It is only a tax on individuals who don't have health insurance. It is not a law that people must have health insurance, enforceable by the usual array of legal administrative and regulatory sanction.  

The minute HHS tries anything beyond the penalty to coerce people to buy health insurance (which it will--it must), HHS will be sued (which it will).  The suit will say: "A mandate is unconstitutional. It's only a tax. We paid the tax. Go away." The suit will go to the Supreme Court. In the current court, it will win in a heartbeat.

That pretty much undermines the whole mandate business just as effectively as striking it down would have done. 


http://johnhcochrane.blogspot.com/2012/0.... -cents-on-obamacare-decision.html

Blairkiel
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Isn't the best option for most...

Pay the fine and purchase a low cost catastrophic policy?


That would be significantly cheaper than the govt approved plan.


I believe this is how it played out in Mass.


I could be wrong.
Pdxr13
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Outstanding low-spin summary of the sticky-muck we are in.

As an individual, can't a person resist on religious grounds that gambling is forbidden to believers, or do I have to look harder at "religious Medi-Share"? How is insurance/gambling working out with devout (and pre-jihadi) Mohammedians and other fellow-travelers of the Lightworker?

Cheers.
Inline

Noodleman
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Under the new law what's the criterion for 'ability to pay'? Income or net worth? Let's say someone loses their job and has no income, has little savings but owns a home with $80,000 equity. Could the government slap a lien on the home or force a sale to collect the 'tax' due for failure to purchase health care insurance? Or would the new jobless and incomeless citizen get a 'poverty' classification and be eligible for 'medicaid' enrollment at taxpayer expense? If (when) we encounter another economic crisis that would significantly ramp up the medicaid enrollment.

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Seektruth
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I can't believe people are talking about 'choosing' to pay the 'fine', as if they're actually planning to pay it. How 'bout nobody pays the damned 'fine'?

Oh, that's right. The IRS has never ending reach to take your assets. I guess it's time to have no assets, time to just party up and stop worrying about saving.
Jstanley01
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Firms will still have the countervailing incentive to offer it to attract workers and talent, but how well will that incentive hold up in an employer's market with insurance costs going parabolic?

I don't see any incentive for households to buy it.

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Sean
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Quote:
In very short order the entire medical system and health insurance scheme will collapse, leaving only a single-payer, fully-socialized system ala Canada.



IMO, this is the point all along.

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Quote:
You can bet the government Empire will continue to try to change the terms of the deal ...





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Waiting for the link to this Ticker by Ann Barnhardt!

- Sean

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* I think Ann Barnhardt is more and more right. God help us!
* Progressives / Marxists / Communists are many things, STUPID and IMPATIENT are not two of them.
* A hot civil war is coming.
* And people wonder why I prep!

Ignorantsavage
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The one disagreement I have is with the premise that, merely on the say-so of five people in black dresses, a plainly illegal government activity becomes legal and/or Constitutional.

Dred Scott claimed, in essense, that black-skinned people weren't human. That was plainly unConstitutional then and it is plainly illegal now.

Wickard v Filburn included the tortured explaination that abstaining from interstate commerce was participating in interstate commerce. It is and was plainly illegal from a Constitutional standpoint to stand on the Court's ruling.

Now, the PPACA ruling stands, and government will enforce it, that is agreed. They will enforce it with guns, just like muggers enforce their demands. My question is, what is the difference between an individual acting outside the law and a government acting outside the law?
Azzi
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I would say it is a good outcome. If nobody can afford having an insurance then we will go back to paying cash for treatment and will return to fair prices. Big employers will still offer the benefits though and will benefit from this law over small ones. They will have a larger pool of job candidates if they offer benefits.

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Bertdilbert
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So the business fine of 2k per is removed if we have 49 employees... I see a birth of new businesses. One to handle shipping, one to handle receiving, one to handle clerical... Or do we just go to a part time society like BoA did with all the bank tellers years ago?

Math. Business fine $2,000. Individual fine $1,250. Total $3,250 per year or $270.83 per month...

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Mac
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Now I'm reading that Roberts buckled under pressure and changed his vote. This supposedly royally ticked off the remaining conservative justices AND Justice Kennedy. Wonderful, just wonderful. Now all three branches are worthless at best and outright enemies of the productive at worst.

If I was in the U.S., I'd be flying the flag on Wednesday but I'd be flying it upside down. America is in deep, deep trouble.
Tz
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Jim Puplava noted the IRS has limited authority to force you to pay the 'tax'

Now all we need is a one-click 'buy health insurance now from the pool' app for iOS and android you pre-fill and click before dialing 911.

It might even be in the localities interest (as in getting paid) to sign you up on the gurney.

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Mo
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Quote:
Math. Business fine $2,000. Individual fine $1,250. Total $3,250 per year or $270.83 per month...


Think about this, though. The fine goes to the federal government. Health insurance premiums (which people paying the fines can't afford) go to health insurance companies.


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Mpilar
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Now all three branches are worthless at best and outright enemies of the productive at worst.

Now? Really?? They were worthless a VERY long time ago...today, they are enemies of the Republic.

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Every normal man must be tempted at times to spit on his hands, hoist the black flag, and begin to slit throats. H. L. Mencken
Marcustullius
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Mo wrote..
BertDilbert wrote..
Math. Business fine $2,000. Individual fine $1,250. Total $3,250 per year or $270.83 per month...

Think about this, though. The fine goes to the federal government. Health insurance premiums (which people paying the fines can't afford) go to health insurance companies.

Should we construe this as FedGov muscling in for a piece of the action, since there's so much health-care money flying around? I suppose that they might share with insurers, but that's not like them: whatever money they get is never enough, and they're always looking to ratchet up current payments and to create new sources of income.

What other motivations do they have? Enforcing a law? Give me a <CENSORED> break! How many unenforced laws already are on the books? It's a question of money. Follow the money!

In the same vein, I assume that this "single-payer" deal is viewed by the gummint weasels as a veritable fire-hose of taxpayer revenue, good for empire-building all over the place. If they can also pull down the incomes of physicians and such to the point where they're making less than the weasels, that's a tasty lagniappe.

Tully

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"It does not require a majority to prevail, but rather an irate, tireless minority keen to set brush fires in people's minds." (Samuel Adams)
Sean
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Quote:
Now I'm reading that Roberts buckled under pressure and changed his vote.


Mac, Links please. If true this is true then he should be kicked of the court and the case re-tried!

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* I think Ann Barnhardt is more and more right. God help us!
* Progressives / Marxists / Communists are many things, STUPID and IMPATIENT are not two of them.
* A hot civil war is coming.
* And people wonder why I prep!
Campbeln
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I see this all as good news; It can't succeed therefore it won't and change will be forced upon all by the collapse. Excellent.

"The Americans will always do the right thing... after they've exhausted all the alternatives." -- Winston Churchill.

Winston was right. Now will there be collateral damage? Yes. Will this damage be tragic and avoidable? Yes. Will things change WITHOUT this damage occurring? In my view, no. America as a country seemingly needs to have the Fit hit the Shan before we bother to do anything about the problem. So I say anything that gets the **** airborne is a "good" thing.

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My friends call me "**** yourself, liberal trash" http://market-ticker.org/akcs-www?single....

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Gamma
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My gripes about all of this is that the assertion that this grandiose plan is supposed to "do something" yet "cost no more" and "work better for all" including many who are not now covered...is such a obvious flaming impossible lie; and those who express happiness at being lied to so blatantly are little more than drug addicts or perhaps spoiled children, applauding being told such a lie. It's one thing to decry that some folks do not nor can not comprehend exponential functions, but this is just addition and subtraction. It is this willingness, no, this eagerness, to be lied to that baffles me. Any analysis of the dynamics of this leads to impossible conclusions; for one example, how is it that your so-called "right" to health care means that you are somehow entitled to the work and attention of others. Doctors, in other words, folks who had to go to school for a dozen years and today probably get out of school with a quarter million in debt. These folks, who are supposed to be in nice clean facilities, with the latest gear and medicines, these folks are supposed to earn $15 an hour fixing your problem and paying off their debt? How the hell is that supposed to happen?

ALL of the things that the "right wing whackos" who spoke out about 0bamacare would occur are indeed coming true. Ins rates are skying. The mathematics of these so-called exchanges (WTF are those?) and the obvious money appeal of simply paying the fine in lieu of functional insurance or waiting until you are sick to begin compliance with the law are rewrites of known, functioning methodologies by which this stuff all works. Just rewriting all the word definition doesn't have the ability to affect the realities that are going to come down from this thing.

And as Karl eloquently lays out, the Pandora's box of governmental overreach under the guise of this newly minted taxing authority is just frightening. But I'll leave that out of it because as ominous and bizarre as it is, nobody conceived the plan that way. It is the plan that such a goofy, impossible Rube Goldberg hodgepodge of new bureacucracies and agencies and panels and committees, all of whom are going to have essentially life or death power over Amerrican citizens if they can dispense healthcare according to some mysterious mandate. Hell, if you are a registered Republican, maybe you have to wait 5 months to get your broken leg fixed instead of only 2 months if you are a registered Democrat. I believe, as Mark Levin said, that the Constitution was severely damaged the day of this decision, and that is plenty upsetting enough.

When the **** did this country turn into this situation where so much effort on the part of citizens had to be expended to prevent Congress from inflicting so much torment upon the citizenry? Levin is big on the word "torment". I think it's perfectly appropriate.

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This stuff we're going through, this is nothing compared to the Middle Ages.
They told me if I voted for John McCain, an idiot would be a heartbeat away from the presidency. Sure enough...
Mortgageguymn
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"The vast majority of people who are uninsured don't have two nickels to rub together. When they get sick or injured, are they all the sudden likely to be able to buy insurance and pay a fine? Of course not."

On a related note, I've heard that emergency room utilization did not go down in Massachusetts after Romneycare. http://byrondennis.typepad.com/masshealt....

I haven't studied that thoroughly, but if true, it gives the lie to a primary argument of Obamacare's proponents. Of course, their response would be "but these go to 11". http://www.youtube.com/watch?v=EbVKWCpNF....
Morla
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Karl has made the point clear that mathematics will eventually put a stop to this. When the music finally stops, the statists will have no chair to sit on. A lot of damage is going to be done until then.. It may seem that the worst has come to pass, like this PPACA ruling, but I'm afraid it will get much, much worse. I'm concerned when I see someone lose their temper (not talking about anyone specifically), especially so soon. Madness begets madness, and these sad tribulations are just beginning.

I may be agnostic, but I consider Jesus a great philosopher and speaker of truth. IMO one of his most profound statements was "Render unto Caesar that which is Caesar's, render unto God that which is God's". We should protect our lives and the lives of our families, not lose perspective over material things and the doings of Caesar or Pharaoh. Kleptocratic bandits may take the shirt off your back but as long as you and yours are safe and healthy there is hope and there is light. If Caesar were a common thief rather than a mighty emperor I doubt Jesus's position would be any different.

Another quote I think is important is "Forgive them, for they know not what they do". Most statists have no idea they'll bring ruin upon us.. They've been tricked by the ivory tower and sophist criminals. Deep down in their hearts most of them believe their statist ideology will help others. There is no place here for hating your fellow man, no place at all. You wouldn't despise a child playing with matches or running with scissors, nor should you despise an adult fool who knows not what he does. Now of course some of the higher-up statists know damn well what they're doing.. They should be stopped or hindered but it won't profit you to hate even evil men.
Siddhartha Buddha wrote..
"Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned."

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Fear of govt IS the government.. Statism is a pack of unbacked threats; If govt gets out of control, ignore it and go about life as you see fit. Where's your crown, King Nothing?
Irishsamurai
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Morla wrote..


They should be stopped or hindered but it won't profit you to hate even evil men.



You're right, of course, but not for the reasons you may believe ...



"Every normal man must be tempted at times to spit upon his hands, hoist the black flag, and begin slitting throats". - H. L. Mencken



We've just about passed that awkward stage where voting will do no good ...

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“Why is it the ship beats the waves when the waves are so many and the ship is one? The reason is that the ship has a purpose.” - Churchill
Morla
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Irish, the important distinction, and what I take from Jesus, is that wealth and property are one thing, your life and your family are another. They are not the same and only one is worth killing or dying for. To kill over wealth, beyond that needed for survival, is a wicked act, every time it is done. EVERY time. Every man may be tempted to slit throats over this and that which is to come, but those men should not do so.

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Fear of govt IS the government.. Statism is a pack of unbacked threats; If govt gets out of control, ignore it and go about life as you see fit. Where's your crown, King Nothing?
Mpilar
Posts: 5613
Incept: 2009-01-05
Gold
Nashville, TN
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Quote:
We've just about passed that awkward stage where voting will do no good ...

smiley

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Every normal man must be tempted at times to spit on his hands, hoist the black flag, and begin to slit throats. H. L. Mencken
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