health insurance

1. If I do not want health insurance at all, and am willing to accept the risks involved, would you permit me to forego it?

2. If all the health insurance I want is catastrophic care, and I am willing to pay out of pocket for everything else, would you permit me to do this?

3. If I have objections to modern medicine in general, either based on religion or efficacy, would you permit me not to subscribe to a health insurance system that is entirely based on Western medicine?

The rhetoric about "stimulus" gets more head-spinning every day. As I note in my Galen Institute post today, folks like Heritage's Robert Book have picked up on the insanity of spending more (taxpayer) money where we're supposed to be reducing costs in health care.

Interestingly, we're not the only nation trying to spend our way out of an economic downturn in this area. China has announced it will provide universal health care for all 1.3 billion of its people.

A Chinese study showed "that in government-sponsored health insurance areas, people are spending more" -- and they see this as a good thing!

So, more government financing should strengthen the economy... and raise health care costs, too?

Those who are commenting on the stimulus should call attention to this disconnect in logic.

While you're at it, spread word far and wide about this scary language from the House on comparative effectiveness -- two long words that mean government could decide which drugs and treatments are acceptable. Here you go:

"By knowing what works best and presenting this information more broadly to patients and health care professionals, those items, procedures, and interventions that are most effective to prevent, control, and treat health conditions will be utilized, while those that are found to be less effective and, in some cases, more expensive, will no longer be prescribed."

This is part of the "stimulus."

Read more.

First, I think we should all agree that single-payer health insurance is probably the most un-conservative idea that one could possibly imagine and that this is one issue that Republicans should go to the mat and beyond fighting against.

But what I most object to is the philosophy behind single-payer health insurance.  It is a philosophy of dependency on government.  It is the philosophy of entitlement - that we are all entitled to certain things without having to work for them.  It is the philosophy that government should provide citizens with needs, even if they are able to pay for them themselves.  It truly is the old-school hard-core central-planning-style socialism.

De Tocqueville was an amazing man.  In his book Democracy in America, he wrote (among many other things) about ways that a democratic nation like America might succumb to despotism.  It would of course be different than the despotism of a king, emperor or tyrant since a democratic nation has none of these.  Instead, he wrote (yes it's long but read the whole thing anyway):

"I think, then, that the species of oppression by which democratic nations are menaced is unlike anything that ever before existed in the world; our contemporaries will find no prototype of it in their memories. I seek in vain for an expression that will accurately convey the whole of the idea I have formed of it; the old words despotism and tyranny are inappropriate: the thing itself is new, and since I cannot name, I must attempt to define it.

"I seek to trace the novel features under which despotism may appear in the world. The first thing that strikes the observation is an innumerable multitude of men, all equal and alike, incessantly endeavoring to procure the petty and paltry pleasures with which they glut their lives. Each of them, living apart, is as a stranger to the fate of all the rest; his children and his private friends constitute to him the whole of mankind. As for the rest of his fellow citizens, he is close to them, but he does not see them; he touches them, but he does not feel them; he exists only in himself and for himself alone; and if his kindred still remain to him, he may be said at any rate to have lost his country.

 "Above this race of men stands an immense and tutelary power, which takes upon itself alone to secure their gratifications and to watch over their fate. That power is absolute, minute, regular, provident, and mild. It would be like the authority of a parent if, like that authority, its object was to prepare men for manhood; but it seeks, on the contrary, to keep them in perpetual childhood: it is well content that the people should rejoice, provided they think of nothing but rejoicing. For their happiness such a government willingly labors, but it chooses to be the sole agent and the only arbiter of that happiness; it provides for their security, foresees and supplies their necessities, facilitates their pleasures, manages their principal concerns, directs their industry, regulates the descent of property, and subdivides their inheritances: what remains, but to spare them all the care of thinking and all the trouble of living?

 "Thus it every day renders the exercise of the free agency of man less useful and less frequent; it circumscribes the will within a narrower range and gradually robs a man of all the uses of himself. The principle of equality has prepared men for these things;it has predisposed men to endure them and often to look on them as benefits.

 "After having thus successively taken each member of the community in its powerful grasp and fashioned him at will, the supreme power then extends its arm over the whole community. It covers the surface of society with a network of small complicated rules, minute and uniform, through which the most original minds and the most energetic characters cannot penetrate, to rise above the crowd. The will of man is not shattered, but softened, bent, and guided; men are seldom forced by it to act, but they are constantly restrained from acting. Such a power does not destroy, but it prevents existence; it does not tyrannize, but it compresses, enervates, extinguishes, and stupefies a people, till each nation is reduced to nothing better than a flock of timid and industrious animals, of which the government is the shepherd."

The reason why De Tocqueville couldn't come up with a name for this despotism was because it hadn't yet been invented in the early 19th century.  He was writing of the despotism of the welfare state.  It doesn't crush a person's spirit like a jailhouse tormentor might, but it simply attempts to divert a person's life into a prescribed direction, like a shepherd does for his flock.  I don't want government as my sheperd.  And that is why I oppose single-payer, and that is why I am a conservative.

P.S. For those of you seeking conservative ideas about health care, see this website and associated book from the Cato Institute.

Forty-seven million uninsured. An HMO withholding approval to save a dying young woman. One in six dollars spent in America going to health care (1) (notes below), which is 4.3 times more what America spends on national defense (1). Despite that, one in four Americans saying health care is a serious national problem in 2008 (2). Not less than 81% of Americans "dissatisfied" with health care in America (3). The specter of socialism looming as 64% of Americans recently polled say it is the federal government's responsibility to make sure all Americans have health care coverage (3).

Let's not exaggerate the problem. The number of uninsured grew from 12 millon in 1989 to where it stands today mostly because of legal and illegal immigration (4), making the uninsured a one-time problem. We all know how Michael Moore gets hysterical. His last movie made much of the fact that Cuba's health care system has a lower infant mortality rate than America's, but undeniably America still leads the world in health care, with the finest hospitals, doctors, professionals, and innovations in the practice of medicine.

Yet it is clear that something must be done. If the trend keeps up, the middle class will have to make extraordinarily difficult kitchen table decisions: cut back on health insurance or food or education. Some large American companies increasingly feel at a disadvantage. They feel they have to pay for their employees' health care, when their foreign competitors do not. Obama supports "single-payer," which is a soft way of talking about socialized medicine (5). An Obama presidency coupled with a Democratic congress would likely mean the end of free market health care in America.

In these shaky times, the political tide in 2008 is dredging up a leftist economic policy. The tide is strongest in health care. Our goal must be to ride this wave to the extent we must, while steering the country into the safe cove of market economics. The free market will not stay free without a fight.

Socialism does not work. I speak as an ex-socialist. It took me years to shake off the blinders and see the light. Socialism could only work if human beings were infinitely flexible, so that if you could imagine it theoretically, it could work in real life. That's where socialism's problem starts. Human nature is not something we can change, as I eventually came to realize. People like to buy and sell what they want. People want to take risks. They want to own a tiny little bit of the world and have it as their own. People want to control their own destiny, and not be told what to do in every aspect of their lives. People want wealth, even just a little wealth, but socialism does not deliver the goods. Socialism has been tried. It has failed. Most dramatically, East Berliners voted with their feet, turning the monicker of "democratic socialism" into a bad joke. With the sole exception of the starvation state of North Korea, every former socialist country in the world now looks to China as their model. The China model, love it or hate it, has nothing to do with state ownership of private property. It has at its core the private ownership of property, and the freedom to buy and sell as you please. Socialism's inevitable failures are costly. Over 100 million lie dead from communist rule. There is no faster way to stifle innovation and destroy the quality of people's lives than to rip people's freedom away from them. The government must let people live their own lives. Socialism slices away human freedom, and so is unacceptable.

The experience of Britain's National Health System, with a country of rotting teeth, antiquated care, and long lines, and of Canada's national system, with the long waits for basic care and Canadians hopping the border for simple medical procedures, tells us more than we need to know.

Socialized medicine, or "single payer," would wreak an untold disaster upon the health and quality of life of Americans. Our country has led the way forward against disease, disability, and injury. Smallpox and polio are all but wiped out. The art of medicine has advanced to an unbelievable degree, with much thanks to Americans. Great institutions of American health care are renowned throughout the world: names like Sloan-Kettering, Mayo, and Johns Hopkins. Socialized medicine will take decisions out of doctors' hands, and prevent them from innovating and providing the best care. Socialism would take the art out of medicine and turn clinics and hospitals into factories. The quality of health care in America depends on patients, doctors, and nurses all being free to be at their best. Expanding government will increase taxes, hurt the economy, and take the freedom out of health care.

Take a look at the list of the Nobel Laureates in Medicine and you will see that there is one country that has dominated that famous prize, especially since World War II, and that country has a free market medical system. Of course, it is the United States of America (6). If we allow socialism to take root in America, there is no telling what damage will eventually be done to medicine and the American way of life. Even if we cast out socialized medicine after only a few years, those years will be lost, and whatever is lost will have to be rebuilt. Our institutions are so valuable and vulnerable, we can't risk throwing it all away for the pipe dream of socialism.

Our health care problem today is a case of market failure. Disease and injury being what they are, people will always need health care, and they won't be in a position to bargain much over the price. The markets for health insurance and health care have broken down. Health care costs have spiraled out of control, and are heading north. The price of health care has grown disproportionately to the quality of care. We must find a way forward to uphold our free market system, resolve this market failure, and keep America great.

This blog will focus exclusively on health care policy. It will argue for a market-oriented approach to health care reform. Free market basics will be stressed like being able to choose whatever doctor you would like no matter what your insurance is, and being able to get health insurance for your family at a decent price. Common sense also matters. Health insurance companies are private companies. They need to have the incentive to minimize costs while maximizing the health and well-being of their insurance customers.

The pressure to adopt socialized medicine is already large, and will grow larger. Obama has hinged his campaign on a promise he can't keep: he says will make our health care system perfect. Americans just might be desperate enough to believe he has a miracle under his sleeve. The trouble is, people don't understand why he is wrong. The voters don't understand the most basic principles of economics: scarcity, and the law of supply and demand. 

McCain must have a savvy response to the health care crisis. The first part of the response is that Republicans care about health care, deeply want all Americans to have access to good health care, and will work hard to achieve that. This is emotional, and comes out of human compassion. The second part of the response is a smart, market-oriented policy to get us there. That's where this blog comes in.

Thank you to TheNextRight.com for the opportunity to start this blog. I am taking the name of Xenophon here to honor that figure who is associated with a long and successful struggle to survive against great odds.

(1) http://www.nchc.org/facts/coverage.shtml

(2) http://www.health08.org/polls.cfm

(3) http://www.gallup.com/poll/4708/Healthcare-System.aspx

(4) http://www.cis.org/articles/2005/back1405.html

(5) http://blogs.wsj.com/washwire/2008/08/19/obama-touts-single-payer-system/

(6) http://en.wikipedia.org/wiki/Nobel_Prize_in_Physiology_or_Medicine