Max Borders

Healthcare: Bring on the Rational Freakin' Discourse

The ever-evolving healthcare narrative is getting stranger by the day. First it was “astroturfing.” That tack didn’t take, you know, because real people figured out they were neither plastic nor in anyone’s pay. (Strike one.)

Then, Obama’s media tried ridicule: Stephen Colbert, Rachel Maddow and The Daily Kossers would be unstoppable! ‘Let’s pick on people for having views different from ours. That’ll show ‘em.’ Turns out people don’t like having their core beliefs ridiculed. It didn’t work for the teaparties and it didn’t work for the town halls. (Strike two.)

‘Okay, then let’s find a few of the looniest, angriest rednecks, grandpas and protestors (or plants) we can find in all those town hall audiences and magnify them our way. Statistically, there will be at least one at every event. It'll look like they are the norm and not the exception.’

And hell, maybe the vulgar town-hall-er is the norm from their elitist perspective. But holding a mirror up in front of most of America and yelling “see” isn’t going to convince people they’re behaving badly, much less that they’re wrong for holding a certain view. Nor will it convince people that socializing medicine, partially or wholly, is somehow a good thing. Shall we appeal to the left’s elitism in order to explain why? We might follow Mencken in saying: “That Americans, in the mass, have anything properly describable as keen wits is surely far from self-evident. On the contrary, it seems likely that, if anything, they lie below the civilized norm.” But, just like you can’t admonish a five-year-old for acting like a child, you can’t pick on Americans for being Americans—left or right.

(Strike three.) You’re out.

Now, here in the eighth inning, things aren’t looking so good for Obamacare, at least as it was originally conceived.  Obama’s media are turning now to a plea for “rational discourse,” which is actually just a riff on the failed third strike, above. The narrative is now that the right has destroyed a rational debate with conspiracies, racism and radical activism (complete with swastikas, death panels and accusations of socialism!). Some in the liberaltarian salon are buying this appeal hook, line and Twitter. I don’t know whether it’s that these liberaltarians are longing for a return to those halcyon days when intellectual chess in the philosophy department breakroom actually had rules; or, if it’s that they don’t want their champagne-socialist friends to stop inviting them to Beltway bashes. For whatever reasons, some I can respect as a former student of philosophy, some of my fellow center-libertarians are trying to stand athwart the ugliness of bipartisan America yelling “Discourse!” Mind you, these are some of the same liberaltarians who didn’t like the Iraq War… But I will – as they conveniently did – pass over the oceans of pink-bedizened, effigy-toting, Bush-Hitler-costume-wearing “discussants” that routinely clogged the streets of D.C. and elsewhere during the height of the war. To these liberaltarians I say, it would have been nice if, in the interests of “rational discourse,” you had given us a little equal opportunity idiot-bashing back then to go with your sanctimony, now.

When it comes to “rational discourse,” I won’t, however, pass over the hordes of mindless Whole Foods shoppers that were bent on boycotting their favorite store because John Mackey didn’t share their statist opinions on healthcare ”reform.” For people so eager to engage in “rational discourse,” how many actually considered Mackey’s non-coercive proposals earnestly, much less thought about the portion of boycotted profits that would no longer be going to microfinance initiatives on the poorest parts of the earth, or the revenues that would no longer feed a massive network of organic growers and farmers whose “ethical” business practices Mackey helped take mainstream. The very idea that these Machiavellian misfits pulling the “rational discourse” card – as if they’d ever cracked open an Intro to Logic textbook – well, defies logic. I have carpel tunnel syndrome from the sheer number of times I’ve typed the phrase “g-e-n-e-t-i-c  f-a-l-l-a-c-y” every time I read a leftist dispute a counter-claim to global warming hysteria on the grounds that the author’s employer got a donation from an oil company. Rational discourse to a leftist is like Speed Stick is to a Frenchman.  So please, spare this educated redneck any sanctimonious claptrap about having a rational goddamn conversation.

And if any among y’all are truly interested in engaging any of us in such a conversation, try straightforwardly to answer the following questions without smearing, sneering, joking, changing the subject, setting up a straw man, stinking up the comments with red herrings, dropping non sequiturs, changing the context, whining about “the children”, questioning people’s motives, asking who’s paying us, or accusing us of lies, or making things up yourselves:

• Is the public option a step towards single payer (socialized medicine) or not? (Note: Socialism means the government owns the means of production, whether for a good or service. So the public option, like an ownership stake in GM or AIG, is socialist.)

• If the public option is not a step towards single-payer, then will it exist without any public subsidy whatsoever? (If yes, then will it be allowed to go out of business if other companies out-compete it? If no, why should we expect other companies to be able to compete, which would take us to single-payer by default?)

• If the public option is, indeed, a step toward single payer, then do you deny that the public option will lead to rationing, if the public option doesn’t itself ration? (If no, then do you understand the difference between my choosing to or even having to forego lobster, cookies or caviar at the grocery store is not the same kind of “rationing” as a bureaucratic forcing me to forego those items? // If you deny that the system will involve rationing, then how do you expect that you will a) control the costs of medical care, or b) suspend the laws of scarcity?

• If a single-payer system rations, i.e. forces people to get on long waiting lists for diagnostics or procedures that will save their life/ease their pain, how is forcing them to wait, or denying their care, humane? Isn’t it possible that people will die because they weren’t diagnosed in time or because their procedure didn’t come soon enough? 

• If the public option doesn’t pass, Congress is considering an individual mandate plus guaranteed issue, both of which are supported by the insurance industry, that gets to live, if not profit handsomely. Guaranteed issue has driven up insurance premiums in states like New York by 4 times that of other states, making it unaffordable for people, which makes them go uninsured. The individual mandate would force everyone, including “young invincibles” into the risk pool, which would theoretically drive down costs. But in Massachusettes, where this exact system is in place, premiums are now the highest in the nation. Are you seriously prepared to accept a compromise that looks like a cross between Hilarycare ‘08 and the Massachusettes failure? What if the nation suddenly looks like Massachusettes – what then?

The most egregious media narrative was framed perfectly by a Facebook friend and left-leaning journalist whose name I won’t mention, because he was probably an innocent casualty of “framing.” He asked his FB friends for memorable stories of people on “pro-reform” side who had gone to Townhall meetings (presumably for a retrospective he was writing). Of course, this framing, which I’ve seen done over and over again, presupposes that people on the right who oppose healthcare socialization are “anti-reform.” Nothing could be further from the truth. That’s why I will ask my leftish friends, so eager to engage in “rational discourse,” why they haven’t deigned to consider, discuss or otherwise entertain the great reform ideas that have been put forth by the center-right, which – though full of illiberal concessions – are far less an affront to liberty than Obamacare:

·         Allow people to buy health insurance in others states, as the commerce clause of the U.S. Constitution demands. (This would lower the costs of purchasing health insurance for millions.)

·         Expand the parameters of health savings accounts (HSAs) so that people have the ability to pay premiums from their HSAs. They would also have incentives to be cost-conscious, save for old age, and embrace preventive care. Providers would be more responsive to patients in both price and quality. This would be a massive step in mitigating the unfunded liabilities of Medicare and Medicaid. (This would also lower the costs of purchasing health insurance for millions.)

·         Offer refundable tax-credits (healthcare money) for poor and middle class people to purchase health insurance, health savings, or health care from the private market. (This would also lower the costs of purchasing health insurance for millions.)

·         Decouple health insurance from employment in order to get rid of that MASSIVE distortion while ensuring that people don’t lose their healthcare when they lose their jobs. (And I’m not talking about COBRA, either, which just has the distortions built into it, making it too expensive for the jobless.) The current system actually subsidizes wealthy and employed people via the tax code and leaves out the working poor! (This move would also lower the costs of purchasing health insurance for millions, because it would remove the anti-competitive distortions and lessen overconsumption.)

·         Stop adding all these crippling, cost-ineffective, special-interest-friendly coverage mandates that make healthcare unaffordable—especially for young people. Introduce federal “Mandate Lite” legislation that would force companies to offer certain items, but allow citizens the freedom not to buy them if they so chose. (This would lower the costs of purchasing health insurance for millions.)

·         Create a national high-risk pool for people with pre-existing conditions so that they can get affordable health insurance. This is far preferable to “guaranteed issue,” a mandate which raises premiums astronomically and makes insurance not insurance. (This would lower the cost of purchasing health insurance for millions.)

If in all of these ideas you can’t find a way to get the 45 million (or 35 million?) uninsured in America a policy, then you are a slave to the fetish of your own creation. That fetish is single-payer and all the political power and permanent special interests that comes with it. So come on, let’s have some rational freakin’ discourse. 

I Agree with Michael Moore?

The film should be called "Crony Capitalism: A Love Story." It's typical for leftists to blame capitalism when, the fact is, government is usually at the alpha and omega of any "crisis." But at least we may agree fundamentally with the premise that corporate welfare is evil. I have only seen this trailer, but I hope he gives as much shit to Congress as he does to Wall Street.

Climate Consequences & the Giggle Test

David Friedman has a different type of 'What if They're Right?' argument from mine here, which deals largely with political economy. His is more about the consequences of warming as more or less likely to be catastrophic. (Hell, I've always wondered why it wouldn't be beneficial to humanity and ecology, as in past non-anthropogenic warm periods.) Anyway, here's a good sliver:

But most of the argument is put in terms not of what might conceivably happen but of what we have good reason to expect to happen, and I think the outer bound of that is provided by the IPCC models. They suggest a temperature increase of about two degrees centigrade over the next hundred years, resulting in a sea level rise of about a foot and a half. What I find implausible is the claim that changes on that scale at that speed would be catastrophic—sufficiently so to justify very expensive measures now to prevent them.

Human beings, after all, currently live, work, grow food in a much wider range of climates than that. Glancing over a U.S. climate map, it looks as though all of the places I have lived are within an hour or two drive of other places with an average temperature at least two degrees centigrade higher. If people can currently live, work, grow crops over a temperature range of much more than two degrees, it is hard to imagine any reason why most of them couldn't continue to do so, about as easily, if average temperature shifted up by that amount—especially if they had a century to adjust to the change. That observation raises the question with which I titled this post: Does climate change catastrophe pass the giggle test? Is the claim that climate change of that scale would have catastrophic consequences one that any reasonable person could take seriously?

Find the whole post here. (HT: Michael Strong)

Remember that these 100 year, foot and a half sealevel rise predictions are the most extreme conditions made by a body who has strong incentives to bias their work in favor of warming. Indeed, empirical observations over the last ten years have seen no warming and no cooling. IPCC models predicted temperature increases, which simply haven't happened. Why should we trust their models on something even more difficult to predict -- i.e. future consequences of warming? I'd say ecologists like Dan Botkin are more qualified to talk about such consequences to the ecology. Indeed, I'm very sympathetic to Botkin's "non-steady state" view of the climate and ecosystem. 

Remembering Rose

I spent two hours with her that day. Open on her coffee table was an article on Hayek, the author lamenting the rampant Keynesianism of the year. We shook our heads about the mess. She didn't seem to realize that I was like a teenager sitting there, all pickled with admiration. Or if she did, she never let on. We sat and ate her favorite San Francisco corned beef. Bob told war stories and Jim Taylor fixed her coffee maker.

She talked a lot about how much she missed her best friend, Milton. I took from her an important lesson that day about the mutualism of marriage. Strange that Rose Friedman taught me how to love my wife more. I owe a tremendous debt to Bob Chitester for these precious hours. We all owe a tremendous debt to Rose Friedman for the freedom we have. RIP Rose.  

Cold Civil War - The Spirit of Free Speech is Dying

John Stuart Mill is known for his broader idea of free speech as radical toleration. He believed that an enlightened person should be willing to hear out views with which he doesn't agree -- both in order to test his own understanding and to strengthen it. This spirit of free speech is the essence of pluralism. But we are starting to see this spirit lost in America.

• Ordinary people go to town hall meetings to express concerns and displeasure with policy proposals and are called "mobs" and worse. 
• Nativist Tom Tancredo goes to UNC-Chapel Hill to express his views only to have bricks thrown at him and be shouted down. I think he's wrong. But I didn't get a chance to hear him, as he was silenced.
• John Mackey is boycotted because he dared challenge leftwing orthodoxy on heath care reform.

We have clearly gotten to the point where free speech has devolved. Toleration and open discourse is, well, no longer tolerated. We are slowly becoming a place of mere de jure free speech. And even that is being eroded by the day. I have to blame so-called "progressives" the most for this. They are people for whom the end justifies the means. So any lip-service they occasionally pay to civil liberties is but a tool of convenience to be employed on the way to getting things their way. A new cold civil war is emerging.

Ezra Klein's Mackey Post

Why did Ezra Klein take down his John Mackey post (at least I can't find it)? Probably because it seems to support McCain's health care proposal. Klein says we should subsidize health care like we do food stamps. Well, what are refundible tax credits if not the food stamps of health care? Wish I could find it again.

(Ah, here it is.)

Food is more like health care than it is like cable television. We worry if people don't have enough food to eat. We worry quite a lot, in fact. So we have a variety of programs meant to ensure that people have sufficient food. If you don't have much money, you rely on these programs. As of September 2008, about 11 percent of the population was on food stamps. It's probably somewhat higher now. Millions more rely on the Women, Infants, and Children nutrition program, and reduced-price school lunches.

The insight that people need food has not led us to simply deregulate the agricultural sector (though that might be a good idea for other reasons) or change the tax treatment of food purchases or make it easier for rich people to donate to food banks, which is what Mackey recommends for health care. It's led us to solve, or try and solve, the problem directly by giving people money to buy food. And that works. (My emphasis.)

Great. So Ezra Klein has just endorsed refundable tax credits a la the Galen Institute and John McCain, which was essentially Grace Marie Turner's plan. Welcome to the dark side, Ezra. 

Compromise Hides Nefarious Aspects

It appears the Obama Administration may be ready to drop the public option. But that's not nearly all that is nefarious about this multi-headed hydra of healthcare legislation. We have to be wary of anything done under the rubric of "healthcare cooperatives," as well. While there is nothing fundamentally wrong with special non-profit insurers (many insurers are already non-profit), we simply cannot allow legislation that involves any of the following elements:

1. A federal guaranteed issue mandate - If we have guaranteed issue (that's where all insurance companies have to let people buy insurance after they become sick or injured), premiums will simply go through the roof. No one will understand why. The ruling party will then be able to claim healthcare costs must be checked by single payer. This has been the strategy all along, as I argue here.

2. A federal community rating mandate - Same deal, except this bit would mean young, fat people pay the same premium as old, sick people. That's just downright stupid and designed to drive the death spiral so liberals can blame the "free market".

3. Special interests - Whatever the Democrats create - and whatever they call it - the opposition should watch out for anything that creates a massive new bureaucracy with massive new dependent constituencies. And if there is a system whereby the government picks "providers" or other such winners and losers in the name of cost savings, this will simply be a means of attracting special interest resources for reelection coffers.

I can't see anything that could come out of Congress that will be anything but stinking rotten. Unless the reform looks like this, don't allow it to pass.

Boudreaux on the Whole Foods Boycott

Quoting in entirety...

Dear Olivia Jane:

You and many readers of Daily Kos are furious that Whole Foods CEO John Mackey expressed - in the pages of the Wall Street Journal - his opposition to greater government involvement in health care.

Exercising your rights and abilities as consumers, you are therefore boycotting Whole Foods.  You're using your freedom to avoid paying for products offered by someone whose attitude toward government you disapprove of.

Isn't freedom wonderful?!

But I must ask: do you endorse my freedom to boycott paying for products offered by those whose attitude toward government I disapprove of?  Like you, I have very strong opinions about the proper role of government, and also like you, a famous chief executive is now endorsing government policies that I find reprehensible.

Will you champion my freedom to stop supporting, with my money, Barack Obama's services?  Will you come to my defense if I stop paying taxes to support those policies of Mr. Obama with which I disagree - policies such as the economic 'stimulus,' more vigorous antitrust regulation, and cap and trade?  Indeed, will you defend me if I choose not to pay taxes to support Obamacare?

If you will support me in my boycott, then I applaud your principle and, although I disagree with you about Mr. Mackey's political views, fully support your freedom to boycott Whole Foods.  But if you will not support me in my boycott, then can you tell me on what principle you would stand if someone (say, Mr. Mackey) managed to secure legislation that obliges you to shop at Whole Foods?

I await your reply.

Unwilling to Trade Principles for Profit

John Mackey was very well aware of the risks to his business when he wrote this excellent WSJ article on right and proper healthcare reform. I can't imagine the libertarian backing down, either, despite the statists who would boycott his stores. You can bet those who refuse to shop at Whole Foods today won't ever have made a shopping trip there to support Mackey's commitment to microfinance or to the transformative affect of voluntary association. I plan to make a Whole Foods shopping stop today, even though they're expensive as hell. I like his moral courage. 

I think this affair shows just how divided we are as a country. And I'm no longer so sure I'm interested in the rift healing. Our vocabularies are becoming "incommensurable," as Richard Rorty would say. The fundamental difference between us is a principle of coercion versus a principle of choice. How am I supposed to coexist with coercion? 

Anyway, as Mackey continues to fight for both principle and pragmatism, he may end up losing millions. But his legacy will be measured in the liberty he bought with those millions -- and we'll have him to thank.

Healthcare: Mandates Mean Everyone Buys SUV Plans

Imagine if the government reguired everyone to buy SUVs in order to improve safety. You couldn't buy a compact car because the government wanted to protect you in the event of a car accident. What would happen? Well, many would go carless--especially young people, because many people can't afford an SUV. 

This is exactly what government regulations of doing to health insurance. Even if you're young and healthy, government forces you to buy all sorts of coverage items that you may not want or need. Depending on what state you live in, the coverage mandates can add anywhere from 10-25 percent to the cost of a premium (I've seen higher estimates). 

Part of any healthcare reform would be to override state-level insurance mandates, which would allow people more choices - a la carte insurance - and allow them to save money. In North Carolina, the government shouldn't force me to buy alcohol/drug abuse treatment, pastoral counseling and mental health coverage, for example. I am the sovereign of my own life and I am a big boy. Let me choose my level of risk just as I do when I buy a Scion XB over an SUV.