patrick.net

ZippyDDoodah says

I’m sure there would be “some”, but at what financial cost? Some savings in ER versus massively increased costs in regular treatments?

lol--you are trying to dispute someone else's claim with nothing but your opinion. "massively increased costs"? really?

ZippyDDoodah says

Regarding your claim of hundreds of thousands of dollars being saved by providing regular medical treatment, since that particular claim is purely economic, I’ll reply in economic terms - those who don’t receive regular medical care likely die well before those who receive regular medical treatment, saving money in overall lifetime medical costs. For example, it’s well established that our social security and medicare system would be even deeper in debt if not for smokers. Smokers tend to die on average, shortly after retirement, saving the govt a TON of money in both SS payments not made and medicare services not provided. So from an economic perspective, I believe you’re mistaken

Again--really? How much do we spend trying to keep these smokers alive? On cancer treatment? How much productivity is lost to smokers being in the hospital and dead? I don't have the numbers handy, but I can almost guarantee that smokers are a net cost to the economy, and probably a very significant one.

don’t have the numbers handy, but I can almost guarantee that smokers are a net cost to the economy, and probably a very significant one.

http://www.usatoday.com/news/opinion/columnists/freeman/ncjf49.htm

From the article:

Harvard economist Kip Viscusi ran the numbers on smoking, even before the big payday for the government known as the tobacco settlement. Said Viscusi in a 1997 interview for the PBS program TechnoPolitics, "Because it's risky, [smoking] has adverse health effects that increase medical care costs of people when they are younger. But, in addition, smoking kills people," says Viscusi. "And smokers tend to die after they have contributed to Social Security and Medicare, but before they've collected all of their Social Security pension and Medicare benefits. As a result, there is a cost savings at the end of smokers' lives, and a cost increase earlier. But, on balance, the cost savings offsets the cost increase, so that smokers offer a net financial gain to the government…society saves almost $30 billion a year in Social Security benefits and Medicare benefits that would otherwise have had to be paid out, had smokers lived."

tatupu70 says

I don’t have the numbers handy, but I can almost guarantee that smokers are a net cost to the economy, and probably a very significant one.

Actually, smokers are a net win in purely financial terms compared to non-smokers, for exactly the reason Zippy said. Yes a lot is spent on treatments. But everybody needs treatment for something eventually unless they're lucky enough to just have a sudden fatal heart attack out of the blue, or die in an accident. See this for example

Conclusions: If people stopped smoking, there would be a savings in health care costs, but only in the short term. Eventually, smoking cessation would lead to increased health care costs.

That's not even counting pension expenses. Fewer lost days of productive work might make up for part of that, but I doubt it's even close.

I have a friend that went to grad school for public policy. The joke there was that the government should be giving away free cigarettes, not taxing them. But of course it's a joke since public policy for the security and welfare of citizens.

So if we were to completely socialize medicine and at the same time remove seat-belts, remove taxes on cigarettes (put them back in GI rations) and alcohol, ban sunscreen, sell more twinkies, etc... we would have more to show for it in the end? gotta love the bean-counters!

Smoke 'em if you got 'em
Need a light?

All joking aside, this OP spreadsheet is merely to educate and balance the propaganda from those who say "This is what CHANGE looks like." I say THIS IS what "change" looks like. LOOK at it. I doubt many of you will like what you see, or at least will be very dissappointed with many of the "changes" let alone the consequences of the "change".

We need change, the right kind of change. Unfortunately this bill isn't it.

Prediction: there are going to be an awful lot of layoffs by small businesses that have employees numbered slightly above 50. Also, 43% of Drs. recently polled claim they are considering leaving the medical profession as a direct result of the passage of Obamacare. Obama is being proactive regarding all this bad news. He's INCREASING the IRS by 16,500 in order to help offset these losses of jobs.

AdHominem says

We need change, the right kind of change. Unfortunately this bill isn’t it.

Now, there's a statement of substance.

I hope the bill is a step in the right direction. I haven't made it all the way through - and do believe that it could have been much simpler.

I go nuts dealing with insurance auths, rules & regs. I explain these things to patients and they can't wrap their heads around it - it doesn't make sense to them. Hell, it barely makes sense to me. Try explaining to someone who needs a piece of specialty equipment that their insurance doesn't pay for it - and, if they want it, they'll have to pay for it out of their pocket. Co-payments for specialty equipment can climb quickly, resale value is nil...

Take a power wheelchair, for instance. A patient who is unable to propel a wheelchair qualifies for a power chair at a cost of around $6,000. There's a $1,000 co-payment (and equipment companies accept monthly payments for the customer's share). However, the resale value on the equipment is about $700 or so. Most people can't afford to pay $700 at once, so the Medicare system pays for a new chair for the next person when a used chair would easily fit their needs. What a load of crap.

There is no rhyme or reason to the system as it is now. True healthcare reform will take years to work out. But at least it's hope. Those people who haven't been able to afford medications in the donut hole see light at the end of the tunnel - all they have to do is hang on for a few years...

elliemae says

I go nuts dealing with insurance auths, rules & regs. I explain these things to patients and they can’t wrap their heads around it - it doesn’t make sense to them. Hell, it barely makes sense to me.

I agree ellie and your complaints about the system are valid and need to be addressed. Every administration in the past 100 years has worked to get more people insured (to please their campaign contributors in the insurance, pharma and medical industries). They have us all convinced that WE NEED HEALTH INSURANCE! And more than likely just to prove their point they will drive up costs even more. They have even passed laws giving tax breaks to employers who buy insurance for their employees and yet strangely they do not offer the same tax breaks to individuals.

But the question is who/what is the cause of this problem? The way I see it insurance companies get away with it because they are essentially entirely unaccountable for their behavior. Employers (or the government through taxpayers) foot the insurance bill for the vast majority of those insured. Therefore the "consumer" has little or no say in the negotiation of the contract so the negotiation naturally is skewed in favor of the insurer (or most powerful special interest lobby) and against the patient. Then on the other end since people are insulated from the true cost of medication, services, etc... there is little or no incentive for the individual to keep expenses down because their copay is $25 (or zero for Medicaid) either way.

elliemae says

Take a power wheelchair, for instance.

I agree it is ridiculous the choices these plans make. That is a classic example of the outcome of Federal programs. Fraud, waste and abuse.

elliemae says

There is no rhyme or reason to the system as it is now.

Here I disagree. There is a rhyme and a reason. Or put it another way there is a pattern here. With each passing year, and each piece of legislation there are winners and losers. Corporations rarely lose, big pharma grows bigger, medical costs keep rising, and insurance companies continue to grow in power and profits too. Oh, and government grows as well, adding more burdens for the taxpayer. Oh, and we have given entitlements to health care for many different groups of people, and now it seems we are entitling health insurance to everyone as well. So many thousands more people will get "health insurance" who didn't have it. The powers that be have to justify their power grabs by throwing us a carrot. There is definitely a rhyme and reason, the government and the larger corporations get more powerful. That is big business in America empowered by the Federal Reserve and powerful banksters and corporatists. Democrats and Republicans both serve these same special interests. Every cry for more government intervention plays right into their hands. The only way to reign them in is to take back the control of our currency.

"If the American people ever allow private banks to control the issue of their currency, first by inflation, then by deflation, the banks and corporations that will grow up around them will deprive the people of all property until their children wake up homeless on the continent their Fathers conquered...I believe that banking institutions are more dangerous to our liberties than standing armies... The issuing power should be taken from the banks and restored to the people, to whom it properly belongs." Thomas Jefferson

Zlxr says

I meant Drs. couldn’t bill for phony visits because they need the patient to validate that they visited.

Ya know when you sign in at the desk? That verifies that you've been there. MD's are required to keep that to prove that you were there. Ya know when they photocopy your ID? ditto. The problem isn't that docs bill for phony visits, although some docs add extra diagnoses to make an end run around the insurance company rules as to how often you can visit for the same problem. The patient usually has these diagnoses, but the doc is forced to use it as the reason for the visit.

There are still equipment companies that call and then mail stuff to patients, charging Medicare for the item. This happens often. Also, I see hospices sign people onto service even though they're not declining and don't need any care. Altho legal, it's not super ethical. The hard-sell marketing practice of hospices should be looked at carefully, but I guess that CMS has more to do with its time. So they're paying millions to hospices whose goal is to make money, not help people. That irks me, because I see it every day.

I've enjoyed some of the comments on this thread; the Freakonomics emergency room data is something I'll look into more. But I digress, I have uncovered the REAL reason for ObamaCare. He is trying to make himself more attractive to women (I challenge the Tea Partiers to top that one!). Women with the strongest masculinity preferences tended to hail from the countries with higher disease and mortality rates and some of the poorest scores on the health-care index... Women with the weakest masculinity preferences of all lived in Belgium, a country considered to have one of the best publicly funded health-care systems in Europe (alongside Denmark and the Netherlands in the health-care index).
And where does the U.S. stand in the masculinity ranking? The answer is fifth out of the 30 countries in the study, one of the highest. This is, after all, the home of James Dean and Clint Eastwood. And where does America stand in the health index ranking? Twentieth of 30 countries, one of the least healthy.

EBGuy says

I’ve enjoyed some of the comments on this thread; the Freakonomics emergency room data is something I’ll look into more. But I digress, I have uncovered the REAL reason for ObamaCare. He is trying to make himself more attractive to women (I challenge the Tea Partiers to top that one!). Women with the strongest masculinity preferences tended to hail from the countries with higher disease and mortality rates and some of the poorest scores on the health-care index… Women with the weakest masculinity preferences of all lived in Belgium, a country considered to have one of the best publicly funded health-care systems in Europe (alongside Denmark and the Netherlands in the health-care index).
And where does the U.S. stand in the masculinity ranking? The answer is fifth out of the 30 countries in the study, one of the highest. This is, after all, the home of James Dean and Clint Eastwood. And where does America stand in the health index ranking? Twentieth of 30 countries, one of the least healthy.

Um, yeah, really? What does this have to do with anything discussed in this thread? Are "masculine" men somehow more superior to men who are viewed as "less masculine?" You do understand that the gender adjective "masculine" is a culturally-based and culturally defined term, don't you? In ancient Egypt "masculine" men wore long hair, shaved all body hair, wore make up, and wore skirts. "Masculine" men in some tribes in Africa stretch their earlobes down to their shoulders and wear large discs in the holes.

So, under whose definition of "masculine" are we operating? And what does this cultural phenomenon have to do with the health care debate?

With subsidized housing, food stamps and now free health care, millions more dependents will be heading toward America..."Home of the Free" - get it, Free? Hahaha - we're dumb. We voted this upon ourselves.

Let's get this straight, 32 million more dependents and the same number of Doctors. That would result in: (1) better quality health care, (2) the same quality health care, (3) worse quality health care?

In case you can't handle the truth I'll help you - it will equally lower the quality of health care for all - comrade. Well, except for those few in the Political class - since the health care program is for the peons, not the Political class - after all they are better than us, right?

"Some animals are more equal than others" has already become true.

Honest Abe says

Let’s get this straight, 32 million more dependents and the same number of Doctors. That would result in: (1) better quality health care, (2) the same quality health care, (3) worse quality health care?

I'm not sure why this is so complicated to figure out for people like yourself. Many of the additional covered do not need immediate care, they just need a yearly checkup maybe so small problems don't become big ones. I expect a company with an increased number of customers and money, would hire more doctors. Probably they'll have to do some simple requests by PHONE which is more efficient, instead of trying to get everyone to come into the office because that means more billable hours. I've been angry with my previous HMO a couple of times when I want to ask the doctor something simple over the phone and they tell us no you need to come in. In the short-term there'll probably be increased involvement of nurse and other "non-MD" professionals. The system will cope.

You're joking, right? "The system will cope" - haha, the system will be flooded - and why not, its FREE. Every scratch, every cut, everything that most people would take care of themselves will now get "proper" medical attention, after all, its free !! Comrade, common sense says that a dramatic increase in the load will simply overload the system and as a result the system will provide an equally lower quality of care for all.

Vicente says

In the short-term there’ll probably be increased involvement of nurse and other “non-MD” professionals.

This is a great idea. Unfortunately there would be huge liability for having a simple checkup conducted by anything less than a fully trained doctor. Also, the AMA would cry foul. They want to keep their monopoly on health care, and can't do that if we have nurses and med students doling out low cost, basic care.

Vicente says

Many of the additional covered do not need immediate care, they just need a yearly checkup maybe so small problems don’t become big ones.

This might lower costs, but it has yet to be empirically proven. Besides, this only works if people actually want to see a doctor regularly, and put in effort to take care of themselves. Many of the "additional covered" do not want to go to a yearly checkup. They prefer the simplicity and efficiency of having free access (well, free to them anyways) to the ER any time they need to see a doctor. Here is a casestudy detailing a complete lack of interest in a free clinic program in alabama, which was an attempt to keep low income citizens from overcrowding the much more expensive ER.

"To effect a genuine reduction in ER crowding, HealthPlus had to attract 3000 patients. After two years, it succeeded in attracting only 500 individuals to sign up for the program, and of these, far fewer kept their follow-up appointments at participating clinics."

http://mises.org/daily/1133

Also, many people in general will not take doctor's orders to change their lifestyle either, which is a far bigger determinant of lifelong health than regular checkups. Our populations' low health scores, as compared to the rest of the western world, are partially a natural result of leading the world in obesity, for instance.

And if you are mistaken about this? Are you going to be back here apologizing and saying "ZOMG MY HMO DIDN'T COLLAPSE!" or will you just switch to some new tack? You seem convinced that it's a zero sum game and there's only so many units of health care to go around like a mineral, and are terrorized that someone is about to hornswoggle you out of your rightful share.

Vicente says

And if you are mistaken about this? Are you going to be back here apologizing and saying “ZOMG MY HMO DIDN’T COLLAPSE!” or will you just switch to some new tack? You seem convinced that it’s a zero sum game and there’s only so many units of health care to go around like a mineral, and are terrorized that someone is about to hornswoggle you out of your rightful share.

We will be forced to ration care somehow. That process is not one that I have heard addressed by either side, besides some moronic pundits throwing around "death panel" and "grandma killer" type phrases. Seriously though, how will rationing be decided? This is kind of important.

I would love to have an I-told-you-so follow up on this bill in two years time. How do we decide who wins? More importantly, what are we betting? Honor? Bragging rights?

Maybe HMO will do to doctors what most in America live with now. "Work more for less!" Whattya gonna do about it, we'll just SWAT the AMA really hard and modify visa rules so we can bring in cheaper doctors from somewhere else in the world! We have rationing right now. I remember like 5 years ago when my brother had a hernia and struggled mightily to get it treated in a timely fashion. Was there a hue & cry about rationing then? It's always existed! Even as a child watching MASH and other medical shows I learned the word "triage" which is a French word popularized after WWI for the prioritization of those needing medical treatment.

Soon enough, we'll find out!

Here is an interesting article about the AMA, regarding your comment.

http://www.forbes.com/2009/08/25/american-medical-association-opinions-columnists-shikha-dalmia.html

"One way to relieve the shortage of providers that the medical industry has created would be for the AMA to abandon its aggressive game of turf-protection and allow nurses, midwives, physician assistants and practitioners of alternative therapies such as chiropractors, to offer standard treatments for routine illnesses without physician supervision. For instance, midwifery, once a robust industry in this country, has been virtually destroyed, thanks to the intense lobbying against it by the medical industry. In 1995, 36 states restricted or outright banned midwifery, even though studies have found that it delivers equally safe care at far lower prices than standard hospital births. "

In the short-term there’ll probably be increased involvement of nurse and other “non-MD” professionals. The system will cope.
I agree Vicente; my doctor's group (which I have access to under a HMO plan -- which is more about being a gatekeeper) employs an NP (nurse practitioner). Hell, at times I prefer the NP and can get seen right away if the need is urgent. With more NPs, doctors get relegated to a managerial role.
Honest Abe said: its FREE
Cadillac health care plans (you know, the ones where you don't even think about the cost of seeing the doctor because its FREE) will be heavily taxed under ObamaCare.

Vicente, If I'm wrong I'll be happy to apologize. What I think will happen with an overloaded system, unfortunately, will be rationed care.

Honest Abe says

You’re joking, right? “The system will cope” - haha, the system will be flooded - and why not, its FREE. Every scratch, every cut, everything that most people would take care of themselves will now get “proper” medical attention, after all, its free !! Comrade, common sense says that a dramatic increase in the load will simply overload the system and as a result the system will provide an equally lower quality of care for all.

Because that's exactly how it is in other countries, right?

Oh, sorry, I forgot you've never been to one.

Kevin, why would you assume I've never been to another country? My point was that you cannot overload any system and expect the same level of service. Schools try to limit the number of students per classroom to provide a higher level of instruction. High quality cruise lines have a smaller number of passengers to staff ratio in order to provide a higher level of service. The worlds best cars are produced in lower numbers to insure a higher quality end product. Shall I continue?

And by the way, you're right - I haven't been to one foreign country, I've been to 11 (actually 12, but why count Canada?).

Honest Abe says

Kevin, why would you assume I’ve never been to another country? My point was that you cannot overload any system and expect the same level of service. Schools try to limit the number of students per classroom to provide a higher level of instruction. High quality cruise lines have a smaller number of passengers to staff ratio in order to provide a higher level of service. The worlds best cars are produced in lower numbers to insure a higher quality end product. Shall I continue?

So, your idea is to not let some people have access to health care? Is that how we handle schooling? We just tell the kids--sorry, this school is full. Too bad.

tatupu70 says

So, your idea is to not let some people have access to health care? Is that how we handle schooling? We just tell the kids–sorry, this school is full. Too bad.

Not sure how the government will handle rationing of care. If we eliminate the ability to pay as the rationing method, what do we have left?

CBOEtrader says

Not sure how the government will handle rationing of care. If we eliminate the ability to pay as the rationing method, what do we have left?

Well, I think public school is a good analogy. How do we make sure that everyone is able to go to elementary school?

tatupu70 says

Well, I think public school is a good analogy. How do we make sure that everyone is able to go to elementary school?

Our public school system is in shambles. We crowd them in like sardines, and don't seem to care about the quality of the education. Our politically-correct brainwashing keeps us from acknowledging there is a difference in educational aptitude, and we thus fail to teach the non-college types any employable skills. Then we proclaim "no child left behind" and let all of them pass with "diplomas" anyways. There is an obvious class-based tier system, where rich kids get pretty good educations and poor kids get far, far less.

Perhaps this is a good analogy of the health care system.

I figured out how Lord Barry is going to pull this off ... all of the illegals are going to be sent to medical school to become State Doctors .... problem solved.

CBOEtrader says

tatupu70 says

So, your idea is to not let some people have access to health care? Is that how we handle schooling? We just tell the kids–sorry, this school is full. Too bad.

Not sure how the government will handle rationing of care. If we eliminate the ability to pay as the rationing method, what do we have left?

We have Queen Palin's Death Panels. I mean, don't you believe her? That's what this legislation has set up. Don't worry, you'll get your rationing if Queen Palin has anything to say about it.

CBOEtrader says

Here is an interesting article about the AMA, regarding your comment.
http://www.forbes.com/2009/08/25/american-medical-association-opinions-columnists-shikha-dalmia.html
“One way to relieve the shortage of providers that the medical industry has created would be for the AMA to abandon its aggressive game of turf-protection and allow nurses, midwives, physician assistants and practitioners of alternative therapies such as chiropractors, to offer standard treatments for routine illnesses without physician supervision. For instance, midwifery, once a robust industry in this country, has been virtually destroyed, thanks to the intense lobbying against it by the medical industry. In 1995, 36 states restricted or outright banned midwifery, even though studies have found that it delivers equally safe care at far lower prices than standard hospital births. “

I'm not defending the ama but the forbes article is pure crapburger. From the article "No new medical schools have been allowed to open since the 1980s." simply garbage. Almost 2 dozen new medical schools have opened in the last 10 years (a few are in the final stages of accredidation). That isn't too hard to check even of the semi literates that seem to be the majority of the staff writers at Forbes. Forbes is very close to being all opinion all the time on the best of days but this article couldn't be called journalism by even the most liberal definition of the word. It's always amazing to me that Forbes manages to say in business.

Nurse midwifes are legal, common, and used extensively in all states. What you are referring to is lay midwifes who are not certified or formally trained (although they can be). There are only 9 states that outright ban lay midwifes, 21 states allow them, 5 require licensing but don't have a mechanism in place for it, and the other 15 states lay midwifes practice in the absence of any state law on the issue. So 36 states allow lay midwifes, not ban them. All states allow and encourage nurse midwifes. Did you get this (mis)information from Forbes also?

bob2356 says

I’m not defending the ama but the forbes article is pure crapburger.

MMMMMMmmmm....crapburger. Interesting. After you pointed this out, it does appear that your description of the medical school issue, and midwifery is more accurate than the author's. Though she is not technically wrong, it is very misleading. I definitely read it in a way that was not reality. Her statement about medical schools is wrong, as you stated.

I have been bamboozled by slick misinformation. This is my embarrassed face.

As much information as we process in this media bombardment era, it is impossible to check every fact that you hear. It is impossible to rationally think through all of your decisions, affiliations, or beliefs despite how much anyone would like to think that they do. To do so would be too cumbersome for anyone to get anything done. I am reminded of Burridan's ass...

Anyways, this woman is now on my shitlist. Her name is Shikha Dalmia. She is a frequent (bi weekly?) contributer to Forbes. I would suggest that you write an editorial letter to forbes. If it written well enough it might get published (wishful thinking?). She frequently writes about Obamacare as of late, so you should find plenty of material.

http://search.forbes.com/search/colArchiveSearch?author=shikha+and+dalmia&aname=Shikha+Dalmia

Nomograph says

Take a look at all the other first-world industrialized nations and see how they handle it.

It is undeniable that Canada and the UK ration care. The rationing in these purely socialized healthcare systems is a scary prospect.

http://www.npr.org/templates/story/story.php?storyId=92916560

http://online.wsj.com/article/SB124451570546396929.html

In France and Germany, they have been able to kick the rationing can down the road by keeping costs lower than we do here. However it is becoming a topic of debate. From what I can tell, rationing will happen in Germany and France but no one seems to agree on how.

http://www.dw-world.de/dw/article/0,,5139759,00.html

http://online.wsj.com/article/SB124958049241511735.html

Given that we spend 16% of our GDP on healthcare, with France coming in a distant 2nd place with 11%, we will have an immediate need to ration care.

Nomograph says

Not sure how the government will handle rationing of care. If we eliminate the ability to pay as the rationing method, what do we have left?

Are you implying that insurance companies don't already "ration" care? They routinely deny to pay for treatments as it is.

tatupu70 says

Are you implying that insurance companies don’t already “ration” care?

No.

tatupu70 says

They routinely deny to pay for treatments as it is.

The hodgepodge of government mandates, regulatory burdens, and local insurance monopoly pricing has resulted in many issues. The above is one way that the insurance companies attempt to control costs.

Given that the government is mandating coverage by insurance companies to those with pre-existing conditions, our society will have a decision to make. Do we allow health care expenditures to go significantly higher, or do we ration care in some other way? I suspect in reality, it will be a combination.

Not only does no one seem to be able to answer the rationing question, but most supporters of this bill deny the necessity of discussing the issue.

CBOEtrader says

Not only does no one seem to be able to answer the rationing question, but most supporters of this bill deny the necessity of discussing the issue.

I'm not sure what you mean. Given that we already ration care in that sense--if it continues, nothing will have changed. What sorts of questions do you have?

Rationing based on ability to pay? Who is arguing against that? And if you are against rationing based on ability to pay, then what other things do you also think we need government to provide for people?

Is it governments job to educate us?

Is it governments job to clothe us?

Is it governments job to house us?

Is it governments job to feed us?

Is it governments job to entertain us?

Is it governments job to find us a job?

Is it governments job to make sure we make/have enough money?

Is it governments job to give us meaning in life?

What is our job, to provide for the government?

Just asking questions.

AdHominem:

Is it governments job to provide police protection?

Is it governments job to ensure waterways are not polluted?

Is it governments job to provide for proper sewer systems and waste disposal?

Is it governments job to provide inspection for building standards and food safety?

Is it governments job to provide a system of roadways?

Is it governments job to provide a national defense?

Is it governments job to provide regulation for smog emissions from tailpipes?

Is it governments job to provide regulation for banks so they don't claim "profits" and run off with your money?

Is it governments job to provide regulation for life/fire/health insurance companies so they don't claim "profits" and run off with your money?

I'm assuming your answer to all these is *NO*. Though I'd love to hear why you'd answer yes to any.

Mark,

Is it governments job to take from those who have and give to those who do not? I would assume your answer is a whole hearted YES! Since I asked the questions first perhaps you could also answer first? What is governments job? Education, Clothing, Housing, Nutrition, Entertainment, Employment, Finance, Meaning?

What is our job?

And if you are against rationing based on ability to pay, then what other things do you also think we need government to provide for people?

we need a government to guarantee access to everything that is needed to become, and remain, a productive member of society, without regard to ability to pay.

Your minarchist world would be no utopia, even if you could find an economy on the planet run like one. No taxes just means sky-high rents and land values, a Monopoly®-game economy of a few big winners and many people shut out of the wealth game.

AdHominem says

Mark,
Is it governments job to take from those who have and give to those who do not? I would assume your answer is a whole hearted YES! Since I asked the questions first perhaps you could also answer first? What is governments job? Education, Clothing, Housing, Nutrition, Entertainment, Employment, Finance, Meaning?
What is our job?

In answer to your questions, mostly NO. Basic survival, yes it does. That's the whole point of police protection or national defense. It would be a little absurd to provide police protection to someone you're willing to let starve to death. So yes, government is responsible for feeding people, at least at a basic level. And I'd add it's responsible for providing many other basics too, as I implied in my questions, along with some education.

Troy says

a productive member of society

That is an interesting and ambiguous concept. Especially in a country founded on the pursuit of happiness principle. If my pursuit of happiness does not meet your definition of "productive member of society" then what? Do you round me up and put me in the ghetto, prison or the work camp? It is dangerous to think in your vague idealistic terms. Furthermore the most important criticism of your line of thinking is that it places the collective and society above the individual. As if a woman or man has to bow to the will of the society, or sacrifice himself for the collective. That is not liberty. That is not what Patrick Henry stood for, and I dare say it is not what the blood of the Revolution was spilled for.

If it truly is governments job to provide all these things, it becomes just another tool of the corporations to make money in the "service" of providing these things. Never mind the fact that EVERYTHING the government has it must TAKE from someone else.