Tons and tons at Ideas Matter.
In the Washington Examiner:
- One on longevity and the coming fountain of youth.
- One on anemic concepts of human nature.
- One on the implications for a partial Obamacare strikedown.
In the Daily Caller:
Tons and tons at Ideas Matter.
In the Washington Examiner:
In the Daily Caller:
Daily Caller ran my personal story of wrestling with stereotypes.
Still plugging away at building up Ideas Matter. I hope you'll sign up for the newsletter, Dear Reader.
Had a piece over at the Examiner on my HSA experience and fallout from Obamacare. For the record, I didn't put the apostrophe in the title.
Been busy defending liberty on a number of fronts:
Thanks for checking in.
Posted at the Opinion Zone. A sliver:
These guys [out-of-pocket docs] are lowering prices, increasing quality and refusing the bureaucratic, ballooning, cost-shifting third-party system the government has created here in the US. I pay $40 for a visit and I shift $0 to you. PPO/HMO folks pay a $30 copay and shift $100 or more to the risk pool (and wonder why premiums go up). Perverse.
The base insight is that providers -- doctors and hospitals, mainly -- have most of the leverage in the battle with insurers. If there's one hospital in town, then either your insurer cuts a deal with them, or you get another insurer. What you don't do is get another hospital.Candid, but only part of the picture. Klein ends up concluding all this makes the "original public option" essential, as if such a beast would have some magical, para-market properties. His desire to "tighten networks and review care" is, of course, doublespeak for state price controls and rationing a la mammogate. But I'm still happy to see acknowledgement of a) the cost symptom and b) this bill's inability to treat it.
The problem [of doctor and hospital "leverage"] is exacerbated by the fact that the insurer doesn't really care to negotiate lower prices. They tried that in the late ’90s, and everyone hated them for it. It turns out that workers don't feel the cost of their health care because they think employers pay it, and employers don't care that much about cost increases because they take it out of wages. Neither group likes premium increases, but they don't really care. But everyone screams if you tighten networks and review care. As such, providers have pretty free rein. That's part of why we pay so much more than any other country per unit of care.
Additionally, health-care reform is going to great lengths to avoid touching providers. Hospitals and doctors are simply too powerful to seriously anger. Insurers aren't.
The cost problem is the big healthcare reform problem. And if Obamacare 2.0 isn't going to solve this problem, what does it amount to? Little more than a special interest bonanza loaded with mandates (public option or no). Klein, closing his eyes to the possibility that a freer market may be the only cure for current healthcare distortions, fails to diagnose these real problems. He focuses instead on an expensive government band-aid -- the public option -- and a rather septic one. Cost spirals are always a symptom of a government meddling. But in the timeless logic of the left, more government (i.e. more of the disease) will do the trick.
Take Klein's first point above about hospital and doctor "leverage". He points to an urban institute paper, which figures out the symptom of provider leverage, but fails to diagnose the diseases: Certificates of Need. These state policies give hospitals considerable anti-competitive power--because it's pure, government-created protectionism. And, of course, doctors are a licensed, protectionist guild. Instead of abolishing bad regs that give undue power to providers, Klein and the Urban Institute want a government panacea.
Atypically, they underplay insurer "leverage". But why? Health insurers do enjoy undue power due to government-created in-state monopolies. That doesn't make them evil, just protected. And yes, it's also easier for a monopoly to jack up a premium than negotiate a lower rate with a provider. But the reason we have dominant health insurers is still due to a lack of interstate competition and a crazy-quilt of state insurance regs (i.e.: government pathologies). Insurance monopolists use state mandates to create barriers to entry for market entrants in that area. Premiums go up.
The price of goods and services also gets distorted because of our preoccupation with third-party payment versus out of pocket. As David Goldhill points out so eloquently here, people who pay copays aren't bargain shoppers, they're cost-shifters. But if they were buying more plans on the individual market, they might not want Cadillac Cost-shifting Plans. (They'd be much more likely to choose HSAs and HDHPs, which control costs better than any other form because they're patient-driven plans.)
Providers and insurers - though they "negotiate" rates - are sort of like industrial colluders dividing the spoils of the economic distortion. These spoils come from the system of government design. And when consumers don't feel the full impact of their purchasing decisions, they don't shop. Prices go up. Premiums go up. We might gripe about premiums. But we'll go on shifting costs of Viagra and Nexium onto the risk pool, or paying for a $2000 CT scan that should probably only cost $400 if we had the incentive to shop. These system, and it's distortions, are government induced.
The distorting tax treatment of health insurance that encourages people to take employer health plans, makes things even worse, not only because it subsidizes wealthy employed people on the backs of the marginally employed, but it reduces competition and means people lose their insurance when they lose their jobs. From our WWII job-based, third-party-payer system, to the fact that I can't legally buy a cheaper policy in Idaho... government is the problem.
This healthcare debate shows that posturing against "corporate interests" is so often a convenient moralism to pepper on a weak argument. In fact, almost every major element of Obamacare works in the service of Big Pharma, Big Doctor, or Big Insurance. A 2000-plus page bill can only be filled with more distortions and more rent-seeking opportunities. It cannot control costs. It's refreshing, at least, to see the left is starting to admit this much, at least.
Ever heard the term useful idiots? Thousands of them gathered in the streets of D.C. at the height of the Iraq War. Pink-bedizened. Face paint. Bush/Hitler signs… strutting and fretting their 15 minutes on the stage. They were incapable of engaging in rational discussion. Arguments began with an effigy and ended with a ‘No Blood for Oil’ sign. America eventually turned against the War. Perhaps the idiots were useful. But when it came to “rational discourse,” there was no outcry from the establishment left.
These days, useful idiots comprise a small percentage of the town hall meetings and tea-parties of the center-right. This subset is loud, angry and not particularly conversant on the subject of health care. But they may be useful. Early on, the MSM tried to magnify this minority as a means of discrediting all opposition to healthcare nationalization. Turns out, they were more useful to the right for whipping up the base and expanding opposition to healthcare nationalization despite the MSM. For better or worse, people did a double-take.
Now that these idiots are being somewhat effective, the left (and even some libertarians) are whining about “rational discourse.” Part of me longs for an intelligent conversation. But as one who has witnessed way too much useful idiocy on the left – from Code Pink to the Hope and Change sheeple – I am no longer terribly eager to explain the nuances of end-of-life consultation now that the tables have turned. Democracy is warty. And tit was made for tat.
When it comes down to it, the right has been offering good ideas for healthcare reform for years—one of which was completely sandbagged in 2006. Saner rightwing voices are being marginalized by the MSM. The MSM's favorite narrative is that the right is being “obstructionist,” offering no reform ideas of their own. Nothing could be further from the truth. Now that a merry band of useful idiots is helping shut down the left’s aspirations for a “public option,” I’m okay with some of these folks being right for the wrong reasons. Until the left and the MSM are willing to a) acknowledge our reform ideas exist, b) discuss them intelligently before the public, and c) stop framing genuine opposition as nothing but a bunch of birthers, racists and troglodytes, I for one will sit back and smile whenever I hear a useful idiot say something like “death panel.”
(Note: none of this is meant as my weighing on on the World Net Daily controversy. Some forms of idiocy are probably not useful.)
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:
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.
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.
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.
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.