In what I can only hope was an opinion article in the LA Times, Michael Hiltzik asks the question, “What’s so great about private insurance?“  In support of his answer which seems to boil down to “approximately nothing,” he encourages us to “remind ourselves what th[e] American way [of health care] entails.”  Without question, “the American way” is a huge issue in the debate over health care.  It is an issue which extends well beyond doctors and nurses, insurance companies, and bureaucrats.  It is not only “the American way” of health care which is in question, but the American way of life itself.

“So it’s proper to remind ourselves what that American way entails.”  For most of our nation’s history, Americans have prided themselves on being a free and independent people.  The American tradition, in fact, is founded on freedom, and our Declaration of Independence continues to resonate as one of the guiding lights in what it means to cast off the reigns of an overbearing and distant government.  Our people have fought two wars against our own countrymen (the American Revolution, as then-Englishmen against England, and the American Civil War, as Americans against America) against the real and perceived excesses of government authority.  We have fought, with pen and blood, against Nazis, Fascists, Communists, Despots, Dictators, and Totalitarians to “secure the Blessings of Liberty” not only “to ourselves and our Posterity,”(US Constitution, Preamble) but to anyone else brave enough to fight for the right of self-rule.

It is notable that of all of the government intrusions upon the individual Americans have fought in the past, not a single one has been so personal or intimate as government intrusion into the doctor’s office.  In fact, that singular alcove has been the focus of one of the deepest divides in modern American politics.  Some of the most prominent advocates of government healthcare today are the very same people who harp incessantly on the fundamental liberty of choice and the right to no-government-here privacy when medical discussions turn from unwanted illnesses to unwanted fetuses.  So sharp is the conviction against government involvement in the abortion doctor’s office that every year a march is made in front of the Supreme Court on the anniversary of Roe v. Wade.  The moral certainty that the government should not direct the fate of people’s lives by interfering with those who help us in white robes is not wrong.  Yet, interfere is precisely what government healthcare by definition would do.

As plenty of other commentators have pointed out by now, government healthcare is a deep threat to American liberty.  Unlike the police and military force which so animated Washington, Jefferson, and Madison, the force of government on our lives through healthcare would be vague and ill-defined.  But once the government has entered our bodies, it becomes far more powerful than a uniformed officer ever could.  Every decision could be rewarded or punished through the evolution of some sort of tax “to help pay for healthcare,” or by lengthening or shortening the line to the doctor’s office.  The government, literally, would have the last word over who lives and who dies.

When Patrick Henry spoke to the Virginia Convention in St. John’s Church, he most assuredly did not have a heart attack, stroke, or cancer on his mind.  Yet, the words “Liberty or Death” resonate through time in the best of the American tradition, and they apply no less to us now in health than they did to the founders in war.  In the American tradition, it is better to die free than live as a slave.

So, what’s so great about the private system?  To be sure, it isn’t perfect.  No system is.  But the private system is able to innovate, able to change, and able to seek out ways to improve.  It is not interested in controlling lives.  The private system allows Americans to live as Americans: Strong, independent, and free.

Tags: freedom, healthcare

In today’s Washington Post, Dan Eggen and Rob Stein tell us about how abortion has played into the health care debate.  The article focuses on regulation, particularly, whether or not government or private insurance may be required to fund abortions under some or all of the new health care proposals currently winding their way through Congress.  As the article reads (and as I’m inclined to believe), the effort for compromise would allow private insurance to fund abortion, but not federal dollars.  While the compromise is common and has worked well in the past, it is also no compromise at all if the “public option” is made to exist.

As I have argued previously, the “public option” is long-term irreconcilable with private insurance.  Nothing has changed my mind on that point.  Eventually, the government will be responsible for paying all of our medical bills.  Once that happens, the government will no longer be able to avoid paying for abortion.  There will be no room for compromise.  The reason federal abortion funding will happen is subtle, and has very little to do with politicians.

Under the abortion regime handed to the country in Roe and updated in Casey, the government is constitutionally prohibited from imposing an “undue burden” on the ability of women to receive abortions.  While there is plenty of room to debate whether or not such a standard is proper, what is clear is that it denying payment for abortion would be tantamount to denying abortion itself.  Under the Court’s precedents (which make the legality of prohibiting a single procedure, while other procedures (and, thus, abortion in general) remain available, a close question), it takes very few mental gymnastics to conclude that the government’s failure to fund abortion when there is no other funding source would be an “undue burden.”

Whether the pro-abortion members of Congress are sincere or not, any compromise on leaving abortion out of the “public option” would be a hollow and temporary one at best.  Having been enshrined into the Constitution, abortion on demand is not a practice which will go away quickly or quietly.  For legislators concerned about federal dollars going to abortion, the only viable option is to vote against the “public option.”

Tags: abortion, healthcare

According to the Associated Press, Senate Finance Committee Chairman Max Baucus has managed to find a way to make even less sense than Obama on the subject of healthcare.  Assuming that the AP article is an accurate reflection of what Senator Baucus actually said, he has just added another huge contradiction to the healthcare debate.

From the article:

A key Senate chairman says he hopes to convince President Barack Obama that taxing some employer-provided health benefits will help control escalating health care costs  … Baucus says the tax-free benefit packages Americans now enjoy are a big factor in the high costs of the country’s health care system, because they provide workers free or low-cost access to too many health care services.

So, according to Senator Baucus, a “big factor” which makes healthcare more expensive are “tax-free benefit packages … [that] provide workers with free or low cost access to … health care services.”  Put another way, healthcare costs so much because people don’t  have to spend a lot of money to get it.  Yet a third way, healthcare is expensive because it’s not.

Senator Baucus’s solution, which I guess is pretty obvious if you can swallow the contradiction above, is to tax private healthcare benefits.  The line of reasoning is certainly sound: Make healthcare more affordable by increasing the price.  Of course, with President Obama wrangling with care providers to knock costs lower, the only way to jack up the price is to do so artificially, with a tax.

Of course, it is possible that I misrepresented the Senator, and honesty demands that I address his “too many” straw man.  While some people certainly do behave this way, I know of very few people who seek out medical services that they do not actually need.  Indeed, part of the reason America’s emergency rooms are so full is the fact that most people don’t seek out medical services until they’ve long past needed them.  Even if you assume that people are overconsuming healthcare, are they doing so to the tune of offsetting nearly 46 million people who are not insured at all, and for whom President Obama wants to guarantee “free or low-cost” coverage?  And even if the answer is somehow, astonishingly, yes, exactly how is the government going to determine when a person has used “too many … services”?  And why wouldn’t private insurers do the same thing if they could?

The string of illogic given to us by Senator Baucus is only reconcilable with the proposition that he wants to end private insurance without saying so.  If President Obama goes back on his campaign rhetoric mocking McCain for supposedly having similar ambitions, it will be proof even stronger that his goals are the same.

Perhaps we should have given honest debate a health insurance plan ages ago.

Tags: economics, healthcare, logic, taxes

Last night, I got into an interesting discussion with one of my more liberal leaning friends.  The subject of the discussion was about public policy as it relates to vaccination, particularly, the vaccination of school aged children.  In his view, this is clearly an area where existing mandates for vaccination have become too diluted with exemptions, particularly the “personal belief” exemptions which allow parents to opt out of otherwise mandatory vaccinations because they hold strong personal beliefs against administering them.  He seemed to hope that I would come to agree with his position that the solution is to reduce the availability of exemptions.  On principles of liberty, I stubbornly refused.

Society has a clear interest in preserving herd immunity, as the alternative is significant exposure to serious illnesses like small pox and polio which have not afflicted society for many years.  As my friend rightly argues, if enough people individually make the decision to not vaccinate, the collective risk is nothing short of a possible epidemic.  Clearly a bad thing.  Yet, as my friend observes, a rising interest in natural / holistic medicine and fears about the safety of vaccines (perhaps most notably the thoroughly debunked vaccine-autism link) has moved society closer to a dangerous precipice.  And, as he points out, the most efficient way to prevent a bad outcome is to prevent people from making the decision to not vaccinate.

While my friend’s method may be efficient, it is also a direct assault on liberty.

Whenever people in society are free to make decisions, it is inevitable that some of the decisions people make will be sub-optimal, or flat out wrong.  Sometimes disastrously so.  Knowing the danger, it is tempting to want to step in to reduce the chance of a bad outcome.  It is tempting to step in and say that some decisions are too risky to leave in the hands of the people.

Liberty demands more.  It is impossible to talk seriously about liberty when the only available freedoms are with respect to low risk issues.  Liberty itself is dangerous business and, as history has shown, the freedom to talk about freedom is always one of the first that governments try to strip away.  The reason, of course is obvious: A free person might decide to do something other than what whoever has power wants them to do.

A commitment to liberty demands accepting the fact that some things will not go your way.  To be sure, it is proper to try to persuade people to your side, and much of the discussion I had with my friend focused on how to persuade parents to vaccinate their children even if they may be skittish about the idea.  At the end of the day, however, a freedom itself requires that parents themselves make the decision.

There is only meaning in liberty if the people are at liberty to decide something meaningful.

Tags: freedom, healthcare

In the New York Times, Reed Abelson published an article talking about President Obama’s plan for a government operated healthcare system. The article is a good one which I found to be fair both in its description of President Obama’s proposed system (at least, to the extent that it has a description) and of some of the criticisms which surround it. The bulk of the article is spent discussing how a government healthcare system could coexist with private healthcare with a particular emphasis placed on how the government could be a fair competitor in the marketplace. Although the article raises several good points, I believe it misses certain fundamental flaws in the notion that the government could compete fairly.

As both I and Mr. Abelson understand President Obama’s proposed healthcare plan, the President’s idea is essentially that the government would become a health insurance company. It is distinguished from other healthcare plans proposed by Democrats by the fact that it is not, on its face, a single-payer system. Instead, the government would enter the insurance market as a large nonprofit insurance organization in competition with private insurance. The apparent theory is that the government would be able to use its size to negotiate price reductions with healthcare providers and drug makers while simultaneously having lower overhead than private insurers because the government plan would not be a profit seeking venture. Cost savings would then be passed on to consumers in the form of lower insurance premiums.

From this point, Mr. Abelson spends most of his article presenting one major reason that the government would not be a fair competitor. The government, the argument goes, would have such a size advantage that it would be able to push prices well below anything a private insurer could accomplish. In so doing, the government would effectively out compete private insurance. To the extent that this argument is true, it is ultimately uninteresting. If the government’s competitive advantage is volume leverage, then so be it.

The real threat to fair competition comes not from the first part of the theory, but from the second. Not only would the government not need to seek profit, it would not even need to break even. This immediately gives the government an advantage that even private nonprofits do not have. The government could easily charge below cost and still remain viable by subsidizing the shortfall out of tax revenue. Indeed, a government insurance plan would almost be forced to do this if it is truly going to guarantee some form of coverage to every American, even those with $0 available to spend on premiums.

The only way to have truly fair competition is for the government to restrict its healthcare funding to premiums paid by actual participants in the plan. Of course, there is no chance of that happening, because doing so would entirely defeat the purpose. Private insurers will, therefore, be forced to compete in a market dominated by a competitor which, in the private sector, would almost certainly be found guilty of anti-competitive predatory pricing.

With no meaningful hope that the government would act in the market as a fair competitor, it strikes me as highly unlikely that private insurance would be able to compete. Perhaps private insurance would take on a role similar to what we see now with Medicare gap insurance, with private insurers picking up the slack where government insurance cuts off. For the bulk of coverage, however, the real question will not be if private insurers will be able to compete, but how long they will try before closing their doors.

Tags: free markets, healthcare