But see, they're spinning climate change as being a positive thing (and, by omission, as not being man-made)
I don't see how that is spinning it as "not being man-made".
I also don't see how that is spinning it as a "positive thing"; rather, it is saying that we can adapt to climate change.
so we can still ignore scientists when they say we have to stop polluting so much.
Scientists can tell us what the consequences of our actions are, but they have no business making policy choices for the nation. That's something politicians and the people do as a whole.
More or less the entire scientific community of the planet has been in a consensus about this for most of the last decade or two and our government still does not give a fuck.
AGW is real, in that humans have caused the climate to warm, but that doesn't mean we can or should do anything about it.
The only way we'll ever start making progress on climate change is if somebody finds a way to outspend big oil, the car manufacturers, and every other petro-lobby.
Yes, that's the only way, and fortunately that's not going to happen. When all is said and done, if you could give people a choice between driving their cars and economic growth now, and a few degrees warmer temperatures and a few feet of sea level rise, they are going to prefer driving and growth.
Of course, the idea that we even have that choice is an illusion. Global warming is inevitable and we better just learn to live with it.
But, again in partial defense, even his good-faith efforts were blindly opposed by the GOP
I don't think he has made a "good faith effort". I think he has tried to do what he believes is the right thing on every issue and has been unwilling to give his opponents the benefit of doubt. In fact, his rhetoric alone is clear and uncompromising.
Unlikely, since he probably would have lost Congress in 2010 regardless of what else happened. Either the right wing was going to accuse him of being a radical socialist, or they (and everyone else) were going to blame him for not doing more to improve the economy.
By "a little longer", I mean a couple of presidencies. There was no reason for Obama to take this on; he had more than enough other things to do.
It's a nice fantasy, except both Romney and the Republicans have moved so far to the right that anything they passed was likely to be even more favorable to the insurance companies and even less effective at bringing insurance to the people who don't have it.
I can hardly imagine a bigger giveaway to insurance companies than Obamacare, with people being forced to buy coverage and services they don't want, and a nearly complete lack of cost control measures.
My family wouldn't have chosen expensive end of life care and we have had high deductibles, but you bet that with Obamacare, we are going to get every test and treatment we can talk and force doctors into giving. Why not? Someone else is paying for it.
Frankly, it doesn't matter what "liberals" want. What matters is what the vast majority of the country wants, and until the vast majority of the country has settled on anything, the status quo should remain. Even if Obama had a thin majority for Obamacare, that wouldn't have given him a mandate to impose it on the country.
He "rammed it through" after it was obvious to anyone paying attention that republicans wouldn't allow healthcare reform until it was a republican president doing it.
Yes, and that might well have been the best choice, also so that the economy would have had time to recover. Obama should have done what he ran on and got elected for: rein in the NSA, restore the rule of law, and restore Constitutional protections of civil liberties.
I voted for Obama in 2008, and I think he has ended up a worse president even than Bush, and that is saying something.
He probably shouldn't have antagonized the Republicans from the start. He might have done more horse trading and made more sacrifices elsewhere: the budget, gay rights, financial regulation, whatever.
Where he could have become active is scale back the abuses of the Bush era, the NSA, and all the other things he promised to do but has failed to. Health care reform could have waited a little longer.
I agree that the new bill is a huge mess
Or he could have simply not passed health care reform. Maybe the economy needed to recover first. Probably a Republican president would have been better for passing this; in fact, if Romney had become president, we probably would have gotten reasonable health care reform, because he could have passed something better and more consistent with bipartisan support.
Also, whacking Defense tends to knock pts off the GDP so that will cause the deficit to reappear.
The taxes used to pay for Defense knock off more points of the GDP.
Whacking science similarly except the effect gets greater the farther into the future one looks.
I generally favor federal funding for basic scientific research because I suspect has one of the best ROIs for all federal spending. But even that is merely a guess. Nobody knows whether it actually does.
"Not having money" wasn't even the problem here. A shutdown means that they're not authorized to operate at all. Except for the NSA, because they provide an essential service.
And make no mistake: that reflects the administration's preferences, not any kind of legal necessity.
I have enough savings to last me a couple of years; you should to. I go through my expenses every month, cancel things I don't need, and make a note of where I can save. I pay off all my credit cards every month. If I can't afford paying cash for it, I don't buy it. The only thing I ever have taken out a loan for was my condo. And, most importantly, I have a budget surplus every month.
The government could easily operate the same way. Instead, it reflects and imposes a culture of financial irresponsibility among my fellow citizens on me, and I object to that.
The short answer is because the demands were unreasonable, and ending health care reform to appease a small minority of the country's demands doesn't make sense.
Portraying this as the "demands of a small minority" is b.s. The debate is about a disagreement about the future of the country. People opposing Obamacare believe it's a very bad idea, and the country as a whole at least is sitting on the fence about it.
Furthermore, Obama is responsible for this: he chose to ram through his health care reform without bipartisan support, and then he chose to take a "no compromise" stance on budget negotiations. The obvious consequence is that Republicans are going to hate him and torpedo everything he does. Obama is evidently unable to negotiate, administrate, or make compromises; he made his career as a "community organizer", i.e., getting people angry and sowing dissent.
I think the Republicans picked the wrong fight and handled this badly. Obamacare wasn't worth picking a big fight over; it will simply collapse by itself anyway. But make no mistake about it, both Bush and Obama have been dismal failures as presidents and their failures will haunt this country for decades to come. Both will be the laughingstock of historians to come.
You can bet that if there had been a strong lobby or interest group invested in the results of this paper, there would be strong counter-claims and attacks on people trying to debunk it. That's the case in many papers in economics, for example: their data is shaky, their models arbitrary, and their conclusions absurd, but one or the other political party uses it to justify its economic policy, it acquires a lobby, and becomes unassailable.
But even in papers where merely a lot of scientific careers and reputations are at stake, you can't overturn established dogma until the proponents of that dogma have retired or died.
Debunking pointless papers like this, papers that don't do any harm, actually is itself harmful, because it gives the erroneous impression that "the system works" and errors get corrected. The only errors that get corrected in science are those that don't have a lobby.
I'ts not an easy solution, but given what we regard as "freedom", we have to accept that people make bad choices. And then decide what to do with them when they are sick.
Then we also have to accept that they need to live with the consequences of their choices, which may include bankruptcy, suffering, or death. Otherwise, the freedom to choose will disappear anyway because society can't afford the downstream costs anymore and tries to start regulating behavior, just like we have tried with alcohol, drugs, guns, sex, banking, and other areas, often without much success.
For medicine, this isn't even as horrible as it may sound. First of all, medicine (in particular of the costly kind) is much less useful than people think; if someone manages to get diabetes, heart disease, or kidney failure due to obesity, there's little that can be done for them anyway. Furthermore, society would likely still offer charity (and so would I). But I object to the idea that someone has a right to take my money for expensive and ineffective medical care that attempts to fix problems that are a consequence of their own choices. If I support someone who made bad choices, it should be my choice to do so.
I'll point out that you suggested problems with all modern health systems and i don't know of any that don't suffer from these problems, so I encourage you to suggest alternatives.:-)
That's not surprising, because it's really a general problem of societies: everybody tries to shift their risks and costs onto society as a whole. The obese getting subsidized care is really no different from big banks or mortgage holders getting a bailout. Historically, societies collapse under their own weight of "bread and circuses" and start over. We may not have that option this time.
It takes an extremist to abbreviate "my minority interpretation of the law" to "the law".
In many cases in our system of government, a "minority interpretation of law" ends up being decisive: minorities in the House and Senate can block laws and government action, as can courts and the executive branch.
That's the way it should be: the default for our government is inaction and the status quo. That just riles up progressives so much because they have a knee-jerk response to every problem, namely to make new laws and regulations, institute new taxes, or create some kind of new branch of the executive.
Loud extremist uttering nonsense which has seduced a small but influential minority of idiots, dragging everyone e;se in the wrong direction and making things a lot worse.
You're welcome to believe that if you like, but it really doesn't matter. The Tea Party seems to be big and popular enough to have real influence on government and throw some monkey wrenches in the progressive party machinery and Obama's plans. As far as I'm concerned, that's a good thing.
Both the Tea Party and the "Open Source Tea Party" are against totalitarian tendencies in government and the bloat they produce.
So, his analogy works. And he's on the wrong side of the debate too. Fortunately, unlike the federal government, with Ubuntu, people can vote with their feet and switch to a different distro.
You can enhance any part of the spectrum you want, but enhancing caucasian skin tones would negatively affect other parts of the spectrum.
For color, it's not a question of "enhancing" or "negatively affecting"; it's simply a question of how the spectrum is mapped into color and what kind of palette people prefer for skin. Nor is there a big difference between Caucasian and other skin tones: it's the same two pigments that matter in all cases, melanin and hemoglobin. But I don't think this is about color anyway.
It's more likely that cinematographers simply found dark skin tones difficult to light: you either lose details in the dark areas or you blow out the light ones. Losing detail in dark areas looks more natural than blowing out light areas, because that's what human eyes do. Furthermore, even in person, it's harder to read facial expressions of dark skin tones under bad lighting, so this isn't really a "bias" of film but more a reflection of reality.
Incidentally, brochures for both Kodak Portra and Fujicolor Pro (both "portrait films") show Africans and Latinos.
Eat lots of vegetables and fruits. Eat fat and animal protein in moderation. Cut out sugars and starches (including soft drinks, sweet coffee drinks, cereals, potatoes, pasta, and breads). Cook at home, know your ingredients, and avoid fast food, processed foods, and most restaurants. Check your weight, blood pressure regularly; if they are OK, your diet is probably fine. Have a full physical once a year. Walk a lot and pick some sport you enjoy. That will put you ahead of the majority of Americans. It isn't rocket science.
Your example illustrates the insanity of the current system and the perverse incentives it creates.
Most people with diabetes should never have gotten it in the first place because it's so easy to prevent in most people: they get it because of obesity, poor diet, and lack of exercise. But they don't make the necessary lifestyle choices because they don't understand the serious consequences. Doctors have no incentive to push patients to make changes, and few are even qualified to give people advice on weight loss and diet. And people get little financial feedback either, since their premiums are not affected very much, if at all.
Then, mild cases of diabetes are often treatable with diet and other lifestyle changes, changes that have lots of other health benefits and cost nothing. But doctors have no incentive to push such no-cost solutions; it requires lots of time and supervision of patients and results in no profit for them. It's more profitable and simpler for them just to start putting people on drugs and insulin because, hey, it's covered anyway.
And if people have diabetes that requires insulin injection can be provided with insulin and (if needed) antibiotics for next to nothing. Almost everybody could pay that out of pocket, it's so cheap. If people carefully control their diabetes, there is no reason for them to get seriously ill. But, of course, if you are an obese patient who doesn't exercise and has acquired a lifetime of bad habits and lack of concern for your health, you aren't suddenly going to be able to monitor your health and control your diabetes.
And that's the point where it gets expensive: hospital care and expensive interventions due to poorly controlled diabetes.
Your example of diabetes illustrates nicely what's wrong with the current system and Obamacare-like coverage: it encourages everybody to do the wrong thing by making it cheap and easy to do the wrong thing for people's health. Instead of cheap and effective solutions, it encourages expensive and ineffective solutions. The end result is not just enormous medical costs, but also enormous human suffering.
Too simple and ignores the fact that diseases themselves are much stronger incentive. Do you REALLY think that many people are just like "Well if I smoke and get lung cancer, insurance will pay so its ok"?
No. What people actually think is: "I won't get lung cancer", and since it's 20-40 years off, they don't care. The beauty of insurance is that it translates this long term risk that people ignore into short term costs that they understand: "Smoke, and your insurance rates go up 70% right away." Of course, for smoking, Obamacare tries to give insurance companies the option, which is a good thing, but it prohibits it for other kinds of things.
For example, you might be able to get cut-rate insurance rates with weekly weigh-ins and monthly health screenings, with a variable insurance rate based on your results; e.g., if your blood pressure goes up 5% and/or your BMI goes up 0.2 points and you pay $100 more per month. That is something people do notice. You might get a special discount if you shop in the right places and your shopping patterns indicate healthy nutrition. I'd certainly go for that if it substantially reduced my health insurance premiums.
Now, if you don't like some fraction of people dying on the sidewalk, the question is simply to decide how to pay for the service.
Keeping people from dying on the sidewalk is easy: you provide terminal hospice care for them, which is comparatively cheap and the humane thing to do.
Expensive medical care has little to do with preventing death or keeping people healthy; there are dozens of nations that pay a fraction what the US pays with comparable or better health outcomes. Money in the US medical system goes largely to expensive and useless procedures that only prolong suffering. Universal coverage or single payer just feeds even more money into a broken medical system and bad individual choices; it won't make people healthier or live longer.
Generally, the more mentally fit and alert she starts out, the longer she'll stay healthy and functional. Exercise and a good diet may also help. Of course, those are generally good things to do, but for some people they have much less importance than for others. If she knows she is predisposed for Alzheimer's, she knows that these choices are likely to be much more important for her than for average people.
Alternatively, she can also simply decide not to bother and instead to live life faster and more intensively; maximizing lifespan isn't everything, in particular since years after 60 are arguably less valuable than years before 60, but you need to make sacrifices in your earlier years to prepare for the later years.
First of all, it's not clear that this is a problem that needs addressing. In a free market, parents would buy child health insurance prior to getting a child that would cover such risks. In fact, in some countries that's how it works: your kids are automatically on the parents' policy, and they have the option of continuing coverage. All you really need for that to work is to legally prevent insurance companies from weaseling out of their obligations once they get more information than when they had when they wrote the original insurance contract.
But if this really were a problem, it still shouldn't be addressed by making insurance blind to all pre-existing conditions. Once you know that a person is likely to develop a disease, "covering" them by insurance at average rates isn't insurance anymore, it's welfare; you simply change the pool of people you tax in order to pay for it. The problem with paying for this kind of welfare out of risk-blind insurance payments is that you end up making insurance blind to preventable pre-existing conditions as well, removing a strong incentive for people to stay healthy.
A much bigger problem is the way government contracts are awarded. In many cases our government costs so much because we have too few government employees, and have to pay exorbitant prices to private sector contractors to do the work of employees.
Yes, having government programs carried out by private contractors is clearly the worst choice, allowing private companies to enrich themselves at taxpayer expense while delivering inferior results; government programs should be carried out by government employees.
The way to reduce the federal workforce is to reduce the number and complexity of federal programs, getting rid of some and transferring others to states.
Then why don't you specify exactly what government functions need to go?
Many federal jobs are related to federal programs that themselves shouldn't exist; get rid of the program, you also save the jobs. For example, agricultural subsidies should be eliminated. Entitlement programs, veterans affairs, and taxes should be greatly simplified and administered together in a much simpler program. Some departments should be eliminated outright at the federal level, like HUD and ED.
Really, you are not asking the right question. The right question is: which of the current federal programs (1) by their nature must be federal and cannot reasonably be carried out at the state level, (2) can't reasonably be privatized, and (3) does the federal government have authority to carry out. Any program or department that doesn't clearly meet these criteria should be cut.
. For instance, the FDA was considered non-essential because the country could still function for a while without food inspection (or so they thought, a few thousand people who recently got salmonella might disagree if they could get away from the toilet long enough to post). Systems might need to be upgraded -- anyone working on improvements to existing infrastructure would be considered non-essential
Of course, for most government programs, there is not a shred of evidence that they are actually effective at accomplishing what they are supposed to accomplish, and that the cost of having them is lower than the benefits we supposedly derive from them. And functions like food inspection should not be federal in the first place.
Complain all you want about government employees, but at the end of the day most of them bust their ass for people like yourself who demand that they all be fired.
That still doesn't mean that it is desirable to have them around. In fact, even if they were accomplishing everything they are supposed to exactly the way they are supposed to, many of them still may be a net minus to society and humanity.
I'm not against all government, but I think it's pretty clear that the Federal government has grown much larger than it needs to be.
Slashdot Mirror
I don't see how that is spinning it as "not being man-made".
I also don't see how that is spinning it as a "positive thing"; rather, it is saying that we can adapt to climate change.
Scientists can tell us what the consequences of our actions are, but they have no business making policy choices for the nation. That's something politicians and the people do as a whole.
AGW is real, in that humans have caused the climate to warm, but that doesn't mean we can or should do anything about it.
Yes, that's the only way, and fortunately that's not going to happen. When all is said and done, if you could give people a choice between driving their cars and economic growth now, and a few degrees warmer temperatures and a few feet of sea level rise, they are going to prefer driving and growth.
Of course, the idea that we even have that choice is an illusion. Global warming is inevitable and we better just learn to live with it.
I don't think he has made a "good faith effort". I think he has tried to do what he believes is the right thing on every issue and has been unwilling to give his opponents the benefit of doubt. In fact, his rhetoric alone is clear and uncompromising.
By "a little longer", I mean a couple of presidencies. There was no reason for Obama to take this on; he had more than enough other things to do.
I can hardly imagine a bigger giveaway to insurance companies than Obamacare, with people being forced to buy coverage and services they don't want, and a nearly complete lack of cost control measures.
My family wouldn't have chosen expensive end of life care and we have had high deductibles, but you bet that with Obamacare, we are going to get every test and treatment we can talk and force doctors into giving. Why not? Someone else is paying for it.
Frankly, it doesn't matter what "liberals" want. What matters is what the vast majority of the country wants, and until the vast majority of the country has settled on anything, the status quo should remain. Even if Obama had a thin majority for Obamacare, that wouldn't have given him a mandate to impose it on the country.
Yes, and that might well have been the best choice, also so that the economy would have had time to recover. Obama should have done what he ran on and got elected for: rein in the NSA, restore the rule of law, and restore Constitutional protections of civil liberties.
I voted for Obama in 2008, and I think he has ended up a worse president even than Bush, and that is saying something.
He probably shouldn't have antagonized the Republicans from the start. He might have done more horse trading and made more sacrifices elsewhere: the budget, gay rights, financial regulation, whatever.
Where he could have become active is scale back the abuses of the Bush era, the NSA, and all the other things he promised to do but has failed to. Health care reform could have waited a little longer.
Or he could have simply not passed health care reform. Maybe the economy needed to recover first. Probably a Republican president would have been better for passing this; in fact, if Romney had become president, we probably would have gotten reasonable health care reform, because he could have passed something better and more consistent with bipartisan support.
The taxes used to pay for Defense knock off more points of the GDP.
I generally favor federal funding for basic scientific research because I suspect has one of the best ROIs for all federal spending. But even that is merely a guess. Nobody knows whether it actually does.
And make no mistake: that reflects the administration's preferences, not any kind of legal necessity.
I have enough savings to last me a couple of years; you should to. I go through my expenses every month, cancel things I don't need, and make a note of where I can save. I pay off all my credit cards every month. If I can't afford paying cash for it, I don't buy it. The only thing I ever have taken out a loan for was my condo. And, most importantly, I have a budget surplus every month.
The government could easily operate the same way. Instead, it reflects and imposes a culture of financial irresponsibility among my fellow citizens on me, and I object to that.
Portraying this as the "demands of a small minority" is b.s. The debate is about a disagreement about the future of the country. People opposing Obamacare believe it's a very bad idea, and the country as a whole at least is sitting on the fence about it.
Furthermore, Obama is responsible for this: he chose to ram through his health care reform without bipartisan support, and then he chose to take a "no compromise" stance on budget negotiations. The obvious consequence is that Republicans are going to hate him and torpedo everything he does. Obama is evidently unable to negotiate, administrate, or make compromises; he made his career as a "community organizer", i.e., getting people angry and sowing dissent.
I think the Republicans picked the wrong fight and handled this badly. Obamacare wasn't worth picking a big fight over; it will simply collapse by itself anyway. But make no mistake about it, both Bush and Obama have been dismal failures as presidents and their failures will haunt this country for decades to come. Both will be the laughingstock of historians to come.
You can bet that if there had been a strong lobby or interest group invested in the results of this paper, there would be strong counter-claims and attacks on people trying to debunk it. That's the case in many papers in economics, for example: their data is shaky, their models arbitrary, and their conclusions absurd, but one or the other political party uses it to justify its economic policy, it acquires a lobby, and becomes unassailable.
But even in papers where merely a lot of scientific careers and reputations are at stake, you can't overturn established dogma until the proponents of that dogma have retired or died.
Debunking pointless papers like this, papers that don't do any harm, actually is itself harmful, because it gives the erroneous impression that "the system works" and errors get corrected. The only errors that get corrected in science are those that don't have a lobby.
Then we also have to accept that they need to live with the consequences of their choices, which may include bankruptcy, suffering, or death. Otherwise, the freedom to choose will disappear anyway because society can't afford the downstream costs anymore and tries to start regulating behavior, just like we have tried with alcohol, drugs, guns, sex, banking, and other areas, often without much success.
For medicine, this isn't even as horrible as it may sound. First of all, medicine (in particular of the costly kind) is much less useful than people think; if someone manages to get diabetes, heart disease, or kidney failure due to obesity, there's little that can be done for them anyway. Furthermore, society would likely still offer charity (and so would I). But I object to the idea that someone has a right to take my money for expensive and ineffective medical care that attempts to fix problems that are a consequence of their own choices. If I support someone who made bad choices, it should be my choice to do so.
That's not surprising, because it's really a general problem of societies: everybody tries to shift their risks and costs onto society as a whole. The obese getting subsidized care is really no different from big banks or mortgage holders getting a bailout. Historically, societies collapse under their own weight of "bread and circuses" and start over. We may not have that option this time.
I don't see anything that could go wrong. What do you believe could go wrong with this?
In many cases in our system of government, a "minority interpretation of law" ends up being decisive: minorities in the House and Senate can block laws and government action, as can courts and the executive branch.
That's the way it should be: the default for our government is inaction and the status quo. That just riles up progressives so much because they have a knee-jerk response to every problem, namely to make new laws and regulations, institute new taxes, or create some kind of new branch of the executive.
You're welcome to believe that if you like, but it really doesn't matter. The Tea Party seems to be big and popular enough to have real influence on government and throw some monkey wrenches in the progressive party machinery and Obama's plans. As far as I'm concerned, that's a good thing.
Both the Tea Party and the "Open Source Tea Party" are against totalitarian tendencies in government and the bloat they produce.
So, his analogy works. And he's on the wrong side of the debate too. Fortunately, unlike the federal government, with Ubuntu, people can vote with their feet and switch to a different distro.
For color, it's not a question of "enhancing" or "negatively affecting"; it's simply a question of how the spectrum is mapped into color and what kind of palette people prefer for skin. Nor is there a big difference between Caucasian and other skin tones: it's the same two pigments that matter in all cases, melanin and hemoglobin. But I don't think this is about color anyway.
It's more likely that cinematographers simply found dark skin tones difficult to light: you either lose details in the dark areas or you blow out the light ones. Losing detail in dark areas looks more natural than blowing out light areas, because that's what human eyes do. Furthermore, even in person, it's harder to read facial expressions of dark skin tones under bad lighting, so this isn't really a "bias" of film but more a reflection of reality.
Incidentally, brochures for both Kodak Portra and Fujicolor Pro (both "portrait films") show Africans and Latinos.
Eat lots of vegetables and fruits. Eat fat and animal protein in moderation. Cut out sugars and starches (including soft drinks, sweet coffee drinks, cereals, potatoes, pasta, and breads). Cook at home, know your ingredients, and avoid fast food, processed foods, and most restaurants. Check your weight, blood pressure regularly; if they are OK, your diet is probably fine. Have a full physical once a year. Walk a lot and pick some sport you enjoy. That will put you ahead of the majority of Americans. It isn't rocket science.
Your example illustrates the insanity of the current system and the perverse incentives it creates.
Most people with diabetes should never have gotten it in the first place because it's so easy to prevent in most people: they get it because of obesity, poor diet, and lack of exercise. But they don't make the necessary lifestyle choices because they don't understand the serious consequences. Doctors have no incentive to push patients to make changes, and few are even qualified to give people advice on weight loss and diet. And people get little financial feedback either, since their premiums are not affected very much, if at all.
http://wholehealthsource.blogspot.com/2012/07/what-causes-type-2-diabetes-and-how-can.html
Then, mild cases of diabetes are often treatable with diet and other lifestyle changes, changes that have lots of other health benefits and cost nothing. But doctors have no incentive to push such no-cost solutions; it requires lots of time and supervision of patients and results in no profit for them. It's more profitable and simpler for them just to start putting people on drugs and insulin because, hey, it's covered anyway.
And if people have diabetes that requires insulin injection can be provided with insulin and (if needed) antibiotics for next to nothing. Almost everybody could pay that out of pocket, it's so cheap. If people carefully control their diabetes, there is no reason for them to get seriously ill. But, of course, if you are an obese patient who doesn't exercise and has acquired a lifetime of bad habits and lack of concern for your health, you aren't suddenly going to be able to monitor your health and control your diabetes.
And that's the point where it gets expensive: hospital care and expensive interventions due to poorly controlled diabetes.
Your example of diabetes illustrates nicely what's wrong with the current system and Obamacare-like coverage: it encourages everybody to do the wrong thing by making it cheap and easy to do the wrong thing for people's health. Instead of cheap and effective solutions, it encourages expensive and ineffective solutions. The end result is not just enormous medical costs, but also enormous human suffering.
Or: "Buy this and you won't be able to afford a new iPhone. Which one is more important to you?"
No. What people actually think is: "I won't get lung cancer", and since it's 20-40 years off, they don't care. The beauty of insurance is that it translates this long term risk that people ignore into short term costs that they understand: "Smoke, and your insurance rates go up 70% right away." Of course, for smoking, Obamacare tries to give insurance companies the option, which is a good thing, but it prohibits it for other kinds of things.
For example, you might be able to get cut-rate insurance rates with weekly weigh-ins and monthly health screenings, with a variable insurance rate based on your results; e.g., if your blood pressure goes up 5% and/or your BMI goes up 0.2 points and you pay $100 more per month. That is something people do notice. You might get a special discount if you shop in the right places and your shopping patterns indicate healthy nutrition. I'd certainly go for that if it substantially reduced my health insurance premiums.
Keeping people from dying on the sidewalk is easy: you provide terminal hospice care for them, which is comparatively cheap and the humane thing to do.
Expensive medical care has little to do with preventing death or keeping people healthy; there are dozens of nations that pay a fraction what the US pays with comparable or better health outcomes. Money in the US medical system goes largely to expensive and useless procedures that only prolong suffering. Universal coverage or single payer just feeds even more money into a broken medical system and bad individual choices; it won't make people healthier or live longer.
Generally, the more mentally fit and alert she starts out, the longer she'll stay healthy and functional. Exercise and a good diet may also help. Of course, those are generally good things to do, but for some people they have much less importance than for others. If she knows she is predisposed for Alzheimer's, she knows that these choices are likely to be much more important for her than for average people.
Alternatively, she can also simply decide not to bother and instead to live life faster and more intensively; maximizing lifespan isn't everything, in particular since years after 60 are arguably less valuable than years before 60, but you need to make sacrifices in your earlier years to prepare for the later years.
First of all, it's not clear that this is a problem that needs addressing. In a free market, parents would buy child health insurance prior to getting a child that would cover such risks. In fact, in some countries that's how it works: your kids are automatically on the parents' policy, and they have the option of continuing coverage. All you really need for that to work is to legally prevent insurance companies from weaseling out of their obligations once they get more information than when they had when they wrote the original insurance contract.
But if this really were a problem, it still shouldn't be addressed by making insurance blind to all pre-existing conditions. Once you know that a person is likely to develop a disease, "covering" them by insurance at average rates isn't insurance anymore, it's welfare; you simply change the pool of people you tax in order to pay for it. The problem with paying for this kind of welfare out of risk-blind insurance payments is that you end up making insurance blind to preventable pre-existing conditions as well, removing a strong incentive for people to stay healthy.
Yes, having government programs carried out by private contractors is clearly the worst choice, allowing private companies to enrich themselves at taxpayer expense while delivering inferior results; government programs should be carried out by government employees.
The way to reduce the federal workforce is to reduce the number and complexity of federal programs, getting rid of some and transferring others to states.
Many federal jobs are related to federal programs that themselves shouldn't exist; get rid of the program, you also save the jobs. For example, agricultural subsidies should be eliminated. Entitlement programs, veterans affairs, and taxes should be greatly simplified and administered together in a much simpler program. Some departments should be eliminated outright at the federal level, like HUD and ED.
Really, you are not asking the right question. The right question is: which of the current federal programs (1) by their nature must be federal and cannot reasonably be carried out at the state level, (2) can't reasonably be privatized, and (3) does the federal government have authority to carry out. Any program or department that doesn't clearly meet these criteria should be cut.
Of course, for most government programs, there is not a shred of evidence that they are actually effective at accomplishing what they are supposed to accomplish, and that the cost of having them is lower than the benefits we supposedly derive from them. And functions like food inspection should not be federal in the first place.
That still doesn't mean that it is desirable to have them around. In fact, even if they were accomplishing everything they are supposed to exactly the way they are supposed to, many of them still may be a net minus to society and humanity.
I'm not against all government, but I think it's pretty clear that the Federal government has grown much larger than it needs to be.