Jacob's blog

Forcing every American to buy health insurance is a key component of all five bills currently being considered in Congress. The logic behind the individual mandate is rather simple: to eliminate the problem of health insurance companies denying applicants based on pre-existing conditions, ban them from doing so. But to make sure that people do not wait until they are sick to purchase insurance, force everyone to do that now. 

Aside from the obvious problem many Americans may have with banning private companies from behaving in their own self-interest while forcing people to purchase a product they do not want, the individual mandate actually goes one step further. It tells a significant share of the population that they, and only they, do not even have to comply with this law at all.

The Senate Finance bill states that anyone who does not purchase health insurance that meets the minimum health benefits requirements must pay a fine of $750 to $1,500. The implication is clear: failure to purchase adequate coverage is a crime that is punishable by an annual fee. It is the act of forgoing health insurance that (apparently) constitutes a danger to fellow citizens and is consequently worthy of reprimand.

And that is all well and good, for failure to do a lot of things – like stopping at a stop sign – also endangers others and likewise is punishable by a fine. The problem is that the Finance Committee’s legislation only applies to people making over 100% of the federal poverty line ($10,830 for an individual), as if anyone making less than that arbitrary figure does not pose the same potential threat to her fellow Americans. Also exempt are those earning between 100-400% of the federal poverty line but who cannot find insurance for less than a given percentage of their income (between 3-12%). None of these people need to abide by the same laws that everyone else is forced to follow. The result is socio-economic discrimination, pure and simple.

However, there is an important distinction regarding how the legislation has been drafted and how it could avoid this problem. Currently, if the cost of health coverage forces people to spend more than a pre-determined percentage of their income, they are granted a hardship waiver and exempt from acquiring coverage. In principle, this is a very different policy than providing subsidies to poorer families and then forcing them to use that money to purchase coverage just like everyone else. The laws that would go into effect if the Senate Finance Committee’s bill were put in place today would be the equivalent of a law stating that anyone earning below, say, $10,830 does not need to pay traffic tickets and therefore will not be held accountable for their reckless driving habits.

Some may argue that driving is optional and therefore cannot be used as a fair comparison, but the analogy can be simplified further. An individual has committed an action, or in this case failed to complete an action, which the government feels is worthy of punishment by fine, but only for those earning above an arbitrary threshold. Surely when looked at in this light, the individual mandate appears highly questionable at best and unconstitutional at worst.

This is not to say that providing hundreds of billions of dollars in subsidies to lower-income Americans and then enacting an individual mandate would be the solution, either. Rather, the example should highlight the hypocrisy inherent in what lawmakers are trying to force on hard-working and higher-earning Americans. We should instead be working to free the health care market of government regulations that drive up the cost of health insurance, thereby allowing responsible citizens to purchase the highest quality health coverage available to them with the least government assistance possible.

An interesting observation from Byron York, the Washington Examiner's Chief Political Correspondant.

" So far this month, 38 American troops have been killed in Afghanistan. For all of 2009, the number is 220 -- more than any other single year and more than died in 2001, 2002, 2003, and 2004 combined.

 

With casualties mounting, the debate over U.S. policy in Afghanistan is sharp and heated. The number of arrivals at Dover is increasing. But the journalists who once clamored to show the true human cost of war are nowhere to be found. "

I hate to use the term "liberal media bias" because, like most political rhetoric, it is far too broad to really mean anything at all. But think back to all the print media and television outlets that would constantly show tear-jerking images of countless caskets draped in U.S. flags of fallen soldiers in the Middle East. Compare the frequency of those images between 2003-2008 to the frequency which with we see them today. Considering the statistics York mentions above, it's an interesting change in the media's style of journalism.

The main bills from the House and Senate -- HR 3200 and the Senate HELP bill, respectively -- both explicitly stated that illegal immigrants were not to benefit from the federal funds being put towards health care.  In fact, it's repeated a couple of times, for emphasis I suppose.  

But conservatives, one such example being Joe Wilson, were concerned with this issue not because they were illiterate and simply couldn't read those simple lines, but because they knew that without verification of legal status at the time of care, there was no way to know for sure whether or not illegal immigrants would receive the federal funds allocated for those who cannot afford care but have shown up in an emergency room requiring treatment nonetheless.

At the time of his outburst, Republicans and Democrats were appalled by the behavior of their colleague.  Democrats claimed it must have something to do with racism, because, in their (arrogant) minds, it could not possibly have dealt with a legitimate concern that he felt was not being properly addressed.  To Republicans, well, he shouted "You Lie!" at the president.  Enough said. 

But if the Democrats' assertion that this was a racially-charged, ideologically-empty accusation was correct, why did the Baucus bill that was released a week later expand so thoroughly on the exact issue that Rep. Wilson accused the president of lying on?  The Huffington Post, FactCheck, the AP, etc. all "debunked" the myth that illegals would receive funds from the new health care legislation time and time again, but if that was really the case, why was any change of language, let alone such a thorough expansion, even necessary at all?  Simply to appease Republicans?  Well, yes, and to make sure, once and for all, that illegal immigrants could not receive taxpayer money.  You won't be hearing any more shouts about lying from conservatives on this issue anymore (in relation to the Senate Finance version, at least) because the Baucus bill finally puts it to rest like all of its predecessors did not. 

I'll admit from the start that I tend to be more libertarian than conservative, but to be perfectly honest I see the libertarian wing as one of the more intellectually consistent and honest components of the conservative movements.  That being said, I also think the foundation of the conservative movement that began in the 60s borrowed heavily from libertarian ideology, specifically when it comes to the power of the private sector, lower taxes, less government spending, and free trade.

The conservative movement today is a far cry from the conservative movement of Barry Goldwater and Ronald Reagan that made its national debut in Reagan’s speech at the Republican National Convention in 1964.  That movement united socially conservative, small government types who steadfastly opposed the intrusion of government into all aspects of people's lives, or wallets I should say.  They were ideologically consistent between their claims and their policies (again, I'm speaking of the economic policies).  But rather than glorify the conservatives of yore, many of whose social policies I personally disagree with, I'll comment more on the GOP of today.  They claim to adhere to free-market and federalist principles, but they have also been responsible for a massive expansion of the federal government in the past decade.  I personally disagree with this.  So do many true and proper conservatives.  This phenomenon is what makes the GOP so difficult to defend these days.

However, If you can separate Republicans from conservatives, it becomes abundantly clear that it is unfair to claim that there remain no intellectual stalwarts among conservatives. (I'm not attacking all Republicans, but I am suggesting that many of them would prefer to pander to the extremists than partake in the intellectual debate.  I wouldn't necessarily include Joe Wilson in this camp, either.  To be fair to him, his concerns over illegal immigrants seemed vindicated when you examine the change and scope of language on illegal immigrants in the Baucus bill versus its predecessors.  Clearly, there was something missing in those previous versions.)  I hear the claim that, as it was mentioned a few posts ago, the intellectual conservative simply does not exist.  This is, of course, a false, arrogant, and not at all shocking piece of “misinformation,” so I thought I would offer a suggestion for the proponents of this claim and perhaps any skeptics who may be having a hard time identifying a counter-example. 

I see George Will as one of the most thoughtful and thought-provoking leaders in any intellectual arena.  Whether or not you agree with his assertions, I challenge any serious thinker to read some of his more intriguing articles and not admit that he is, indeed, an extremely intelligent, ideologically consistent political commentator.  Unlike some of his counterparts on the Left, like Paul Krugman – who in 2004 (note the party affiliation of the commander-in-chief that year) proclaimed that the federal deficit should be one of our biggest concerns and could eventually lead to an economic collapse, while in 2009 (likewise) assuaged his readers that the deficit really is not that big of a deal – Will is willing to either challenge or simply rise above and ignore many of the mainstream reactionaries on the Right who can turn any modest event into a nationwide cause for outrage (I have in mind those who claimed that Obama speaking to children, urging them to stay in school and avoid drugs, would somehow lead to a form of Socialist indoctrination). 

Set aside social issues, and I think the right and center – a group that is largely composed of fiscally conservative, socially liberal, partisan independents – would have a much easier time identifying conservatives whose arguments could be defended on an intellectual rather than rhetorical level.  The reason, in my opinion, that George Will has remained a respected political commentator for so many years is precisely because he chooses not to focus on social issues, knowing not only that they are more difficult to defend logically but also that they should, ideally, not have a place in politics in the first place.  As a constitutionalist (or at least I would imagine he would describe himself as such), he understands that a constitutional amendment to ban same-sex marriages would move well beyond the powers granted to the federal government.  As a result, he instead focuses on economic policy, foreign affairs, clear instances of encroachment on civil liberties, Supreme Court decisions, and the like. 

Perhaps my perspective of Mr. Will is distorted by my relatively limited time following him – I am, after all, barely 22 years old – but I have followed him for a number of years, read hundreds of articles and op-eds that he has authored, seen him countless times on Sunday morning shows, and every time reaffirm my faith that intelligent conservatives are in fact out there.  

Many people with a cursory knowledge of America’s health care system – limited mostly to forwarded emails and CNN – have an incorrigible habit of comparing our system to Canada’s and, after presenting a few “basic” facts, proclaim victory in the ideological war on socialized medicine. I would not say I am an expert myself, but I do know the basis for many of these facts and they certainly deserve some attention. For those of you who are unfortunate enough to have to constantly read the afore-mentioned articles (or perhaps worse, have listened to these arguments being made by friends and family), here are a few responses to the more common claims I’ve come across.

Life Expectancy. These figures are often different from one report to another, but the idea is that life expectancy is 2-4 years higher in Canada than America. Ergo, they have a better health care system, right? Maybe, but not necessarily. First let’s all confess that in the course of 80 or so years of life, one’s decision to smoke, abuse substances, avoid exercise, seek unhealthy food, get hit by a bus, get shot in a homicide, fall victim to a car accident, and, worst of all, inherent genes that lend oneself to a high probability of suffering from a chronic illness have more to do with how long one lives than does the payment method at one’s local hospital.

Two points reinforce this idea. First, after eliminating victims of accidental deaths and homicide from life expectancy measures, the U.S. ranks number one in life expectancy. Second, a simple comparison of life expectancy across states, let’s take Nevada (75.9) and Utah (78.7) for example, where health care systems are nearly identical, shows that a difference of nearly three years must be attributable to something other than the health care system.

Infant Mortality Rate. Another common statistic perpetuated by bemoaners of the American health care system is the comparatively low infant mortality rate north of the border. The U.S., like most other things, is the world leader in yet another dubious category that may partially explain this apparent oddity. Teen pregnancy rates in the U.S. are far and away the highest in the world and nearly triple those of Canada’s. Moreover, teen pregnancy has also been linked with low birth weight, a common cause of infant mortality that is beyond the control of any medical system, regardless of who pays the bill.

A recent article in the Journal for American Medicine discussed the successful narrowing of the gap in infant mortality rates between blacks and whites in a particular county in Wisconsin. Their findings indicate that only when the percentage of low-birth weight children could be lowered amongst blacks did the disparity between white and black infant mortality rates diminish. Again, culture and behavior may have more to do with infant mortality rates than the quality of health care delivery systems.

Administrative Fees. The story goes that government-run medicine is more efficient than the private insurance industry because the administrative fees for, say, Medicare are only 3% while for private insurance it can be upwards of 20-30%. Let’s ignore the laughable claim here that anything run by the government could possibly be run more efficiently than by the private sector. Instead, look at the numbers. Yes, while as a percentage of operating costs, Medicare dedicates a smaller percentage of its total spending to administrative duties, the reason is actually because the cost per beneficiary is so high that its huge administrative burden appears small. In other words, because Medicare spends so much more in sum than a comparable private insurance company, the administrative costs appear lower as a percentage of total costs.

And, of course, let’s not forget the incredibly unequal comparison between a government-run program which seniors are essentially forced into (under the threat of foregoing Social Security benefits) and a private insurance company which must dedicate a share of its expenditures to marketing, borrowing, and taxes (no small burden, in case you weren’t keeping up).

America has a free-market system; Canada has socialized medicine; yet look at all these great statistics I’ve found! Let’s be perfectly clear: the U.S. is a long way from having a free-market health care system. Not only are large sectors of the system dominated by nearly pure forms of socialized medicine (Medicare, Medicaid, TRICARE, etc.), but even the “private” sector is highly regulated, taxed, subsidized, and otherwise controlled more by Washington (or your local state capital) than by the consumer.  To be clear, the CBO studies that have been released in recent months have been on the unsustainability of Medicare and Medicaid, amassing an estimated $37 trillion in unfunded liabilities over the next 75 years.  Meddling in private markets has caused the most heavily regulated states, like Massachusetts, New York, and New Jersey, to likewise have the most expensive health insurance in the country.  The opposite can be said for the least regulated states.

No individual can purchase insurance across state lines. The price a doctor or hospital charges for even basic services is often virtually unknown. One out of every ten dollars spent on health related expenditures comes out of the consumer’s pocket. The government intends to limit how much someone pays out-of-pocket, and how much the insurance company must provide. These are hardly free-market principles.

Nationwide, there are over 2000 insurance mandates at the state level. These mandates dictate what benefits your insurance must cover, who must be covered, and in some states how much you must pay in relation to your (sickly, over-weight, obese, and aged) neighbor. In several states, I, a young, healthy, non-smoking 22-year-old would have to pay the same rate as that damned neighbor I just described. And only according to the Left would a country where individuals are required to purchase insurance against… alcohol and substance abuse even if you don’t drink (47 states), diabetic supplies even if you don’t have diabetes (47 states), maternity minimum stay even if you will not or cannot be a mother (50 states), breast reconstruction even if you have no intention of reconstructing your breasts (51 states), autism even if you’ve never met anyone with autism (23 states), and hair prosthesis even if you like being bald (10 states)… a “free-market” system.

These are but a few of the arguments made, but they are probably the most likely that one will come across. To be fair, none of these counterarguments are intended to be interpreted as “America has a superior health care system.” It’s just that these statistics are often superficial, inaccurate, oversimplified, and should be left out of the debate altogether.

Medical malpractice insurance has skyrocketed in the last 5-6 years, hitting certain specialties extremely hard. As a result, many health care providers feel they have been forced to raise prices to compensate for the increase in insurance premiums. This may well be the case, but a simple solution based on free-market principles has not received much attention and would alleviate much of the price inflation. Not only would doctors benefit, but the vast majority of patients – and insurance companies – would be left paying reduced prices and lowering the cost of care for those willing to participate.

Currently, only a small percentage of cases involving perceived malpractice are brought to court and plaintiffs awarded hefty sums for their suffering. But that small handful – who are largely responsible for raising liability insurance premiums over the past half-decade – are charged the same as the vast majority who avoid using the legal system as a means of redress.

One possible solution is the following: at the time of purchasing an insurance plan, individuals would determine their own cap for non-economic damages in the case of malpractice on the part of their provider. Poorer people might be willing to forego more expensive plans in exchange for a promise not to bring lawsuits against doctors and hospitals except in extreme cases of negligence. As a result, healthcare providers will know their personal level of liability ahead of time and price their services accordingly. Patients less inclined to seek damages in the case of something going wrong will likely be charged less, while those more inclined to do so could be charged more.

When punitive damages are either unlimited or capped at one global rate, many in need of care are still priced out of the market. On the other hand, if that limit is adjusted on the basis of one’s willingness to avoid litigation, price discrimination may just do a better job matching what the doctor is willing to charge with what the patient is willing to pay.

In turn, liability insurance will decrease as a result of insurance providers being able to more accurately predict what a policy will cost them based on the category of patients (those more willing to seek damages versus those who are not) a doctor is treating.

Ultimately, poorer patients benefit from reduced prices for the same services, doctors benefit from peace-of-mind as well as lower liability insurance, and insurance companies benefit from improved mechanisms of gathering information on what patients and doctors will cost if they choose to offer them a policy.

The resignation of "green jobs" czar Van Jones over the weekend drew little attention from mainstream media (even the New York Times admitted they were late on the piece) with the exception of those who were outraged that such an extraordinarily accomplished man -- author of a best-selling novel with a law degree from Yale to boot -- could be vilified so egregiously and forced to resign prematurely. Sure, he's made a few nasty comments about Republicans, admitted to converting to Communism (while in prison!) in the 1990s, and signed a petition to investigate the involvement of the Bush administration in the attacks on September 11. But come on, a Yale Law degree! And a best-selling novel! Aren't those ample qualifications to work at the White House?

I would suspect that Jones' very own mentor, Karl Marx, were he alive and writing today, would not have a difficult time being accepted to Yale on the grounds of "academic diversity" and would remain on the New York Times' Best-sellers list for years. After all, Columbia invited Iranian President Mahmoud Ahmadinejad to speak for those very reasons, and the Communist Manifesto isn't exactly the least popular item on reading lists across the country, I hear.

The amazing thing to me is that he is being defended by the Left despite these revelations. They often cite his apologetic tone for signing the petition or becoming a communist, and instead focus on his passionate pursuit of creating “green jobs” that will, admittedly, need to be created to compensate for the millions of jobs inevitably destroyed if current environmental legislation is passed in the Senate. He is, of course, a victim of a “smear campaign” being propagated by the Right, not to be confused with the smear campaigns of the Left brought against people like, as a random example, Joe the Plumber, who has absolutely no role in government but instead had the audacity to challenge future-president Barrack Obama. The result of his confrontation with the candidate was an investigation into his past personal and financial records to determine if he was in fact as indigent as he had initially claimed. If only the White House dug this deep when appointing czars, the whole situation with Mr. Jones may have been avoided entirely.

ht - James Taranto