More Doctors Going Galt

The New England Journal of Medicine (hardly a right-wing rag) reports a recent poll showing:

46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.

24% of physicians think they will try to retire early if a public option is implemented.

21% of physicians would try to leave medicine if a public option is implemented, even if not near retirement age at the time.

(Via @BradMD.)

Maybe our politicians need to read Brian Schwartz's talking points on why ObamaCare is wrong and won't work.

Update: Thank you, HotAir, for the link!

Update 2: The NEJM has updated the text of the page to reflect that the poll data comes from The Medicus Firm.

They note:

The opinions expressed in the article linked to above represent those of The Medicus Firm only. That article does not represent the opinions of the New England Journal of Medicine or the Massachusetts Medical Society.

Two Doctors Speak Against ObamaCare

Two doctors speak out against ObamaCare in these videos from Docs4PatientCare.org.

Dr. Fred Shessel tells his patients: "You know, under ObamaCare I may not be able to take care of you to the best of my ability, or I am may not be able to see you at all."



Dr. Scott Barbour warns us: "There's gonna be only one choice for the government and that's gonna be to severely ration your care."



Let your Congressman know what you think, especially if he or she is one of these critical swing votes.

(Links via Bradley Hennenfent, MD.)

Hsieh in GCC: "What America Needs to Know What’s at Stake with Obama Care"

The Gold Coast Chronicle, a Florida-based publication, recently solicited opinion pieces from physicians opposed to ObamaCare. I'm glad to report that on March 15, 2010, they published my piece, "What America Needs to Know What’s at Stake with Obama Care". (Title theirs.)

Here's the opening:

President Obama is now determined to ram his health care bill through Congress by any means necessary, despite the fact that it will drive the government hundreds of billions of dollars further into debt and despite the fact the polls consistently show a majority of Americans opposed to his plan.

Why is this?

In a speech to Congress, he piously declared that health care was "a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country."

President Obama is right, but not in the way that he means. Thousands of Americans at Tea Parties across the country have rallied precisely to oppose the fundamental principles behind the President's plan.

These protests were not just about health care, but about the proper scope of the government -- and ultimately, the future of America...

(Read the full text of "What America Needs to Know What’s at Stake with Obama Care".)

This is an updated version of my October 1, 2009 Denver Post piece, "The Real Stakes", republished with the consent of both papers.

Quick Links: Protests, HSAs

On March 16, 2010, Tea Party activists from across the country will converge on Washington, DC to rally against ObamaCare.

Dr. Evan Madianos explains, "How to Protest ObamaCare Nationwide in Front of Your Local Hospital".

Jared Rhoads of the Lucidicus Project urges all Americans concerned about their future health care to, "Hold A Sign and Speak Out".

Ron Bachman of the NCPA warns that the proposed ObamaCare legislation could severely limit (or effectively kill) Health Savings Accounts. Read more in his March 5, 2010 paper, "Congress Declares War on HSAs".

Interviews With Dr. Milton Wolf

Dr. Milton Wolf has been giving interviews explaining his opposition to ObamaCare.

Here is Part 1 of his March 11, 2010 interview with PJTV:



Here is Part 2, which contains the more substantial policy discussions, including some excellent free-market reforms:



Here is his March 12, 2010 appearance on "Fox & Friends":



Dr. Wolf also blogs at The Wolf Files.

Here's the March 11, 2010 Washington Times OpEd that vaulted him into national prominence: "WOLF: Obama family health care fracas".

Thank you, Dr. Wolf, for speaking out for American patients and doctors, as well as for American principles of freedom and individual rights!

Health Care Endgame

This upcoming week will be the critical week in the health care fight. Speaker Pelosi is expected to start the process for the House to hold its final vote to approve the Senate bill. The vote will probably take place at the end of this upcoming week.

Right now, they are probably still a few votes shy of the majority they need:

"Dem House vote-counter lacks health care votes now"
Associated Press, 3/14/2010

"Can Nancy Pelosi Get the Votes?"
Michael Barone, Wall Street Journal, 3/11/2010

This is an extremely risky move by the Democrats. Normally, a Speaker wouldn't plan on voting on such major legislation unless he or she was sure of having enough votes.

But the Democrats are also (correctly) concluding that time is not on their side. They have made the calculation that if they push for it now, then maybe then can squeeze out the last few votes via a combination of political carrots and sticks. For example, they have "sweetened" the deal for the wavering moderates by promising billions of dollars of new student loan subsidies.

On the other hand they recognize that if they wait much longer, then when these wavering Congressmen go back home for the Easter recess, they will get an earful from their constituents who are strongly opposed to the bill, and they'll lose even more support.

Hence, from the Left's perspective, it's now or never.

If you (like me) support free-market health reforms, this means three things:

1) We are winning. We have a chance to defeat this terrible bill.

In particular, do not uncritically accept the inevitable news stories about how the Democrats are "close to getting the votes" or how Pelosi is "confident she'll have the votes". She has to exude an aura of public confidence, otherwise her coalition will quickly unravel.

Polls repeatedly show Americans opposed to ObamaCare:

"Why Obama Can't Move the Health-Care Numbers"
Rasmussen and Schoen, Wall Street Journal, 3/9/2010

Similarly, head counts of House Democrats also show that they don't quite have enough votes yet:

"Scrambling for votes, Democrats face uphill climb to pass healthcare reform"
The Hill, 3/13/2010

"The Hill's 'Whip Count' on ObamaCare –- as of 3/13/2010"

If they had the votes, they'd have already passed it by now.

2) We must keep up the pressure.

The Democrats are pulling out all stops to find some way to get this through now, before the critical Easter recess.

At this point in time, the single most important thing you can do is contact your Congressman and tell him or her what you think:

http://www.usa.gov/Contact/Elected.shtml

This is especially important if your Congressman is one of the undecided or swing votes on these "Code Red" lists:

http://www.nrcc.org/CodeRed/targets/
Tea Party Patriots Code Red Alert

Even if your Congressman is a firm "Yes" and you disagree, it's still important to let them know where you stand. If even the liberal Democrats from "safe" seats consistently hear that their constituents are against it, it will give the wavering moderates more political cover to vote "No". They can then tell Pelosi, "Even your constituents hate this thing -- there's no way I can support it".

*** Our counter-pressure is our best weapon against the pressure that the statists will exert on these wavering Congressmen. ***

Your letter doesn't have to be long or eloquent. It just has to convey certainty, passion, and moral conviction. One short letter that I've seen against ObamaCare runs something like this:

"Please vote NO on this terrible health care plan! If you vote yes, you will destroy the ability of me and my family to receive good health care in the future. This is personal! If you vote yes, we will never forgive you for hurting our lives and trampling on our basic freedoms."

(Of course, you should express your opinion in a fashion that reflects your own style and values.)

Feel free to use all contact methods -- phone, fax, and e-mail. And please feel free to contact them multiple times over the upcoming week. In this context, repetition is a virtue!

And of course if you agree with your Congressman's position, then thank him or her. They also need our moral support.

3) If you have friends or family in other parts of the country, tell them to contact their Congressmen.

If you need intellectual ammunition for them, one of my personal favorites is from the AFCM website:

"Fifty Fallacies About Health Care" by Richard Ralston

Jared Rhoads' Lucidicus Project also has a good set of OpEds.

And of course, FIRM has its archive of articles and OpEds.

I personally think that the most important thing we can do in the next few days will be to directly contact our Congressmen and have friends/family do the same. LTEs and OpEds will still be important, but not as much as before. (That said, I'm still going to continue writing and/or disseminating some of my earlier writings to people I know around the country.)

This is the endgame, folks. Most political observers regard the health care bill as a 50-50 "toss-up" or "too close to call". It really could go either way. What happens this week will determine the course of this great country (for good or for ill) for decades to come.

Your voice could be the critical difference in swaying the right one or two minds. If you value your lives and your freedom, the time to speak up is now!

(Anyone is welcome to forward or repost this to any appropriate recipients or venues.)

Hennenfent on Death Panels

Dr. Bradley Hennenfent has been blogging up a storm lately.

In this recent post, he warns "'Death Panels' are Real and Exist Now":

Please stop ObamaCare. I have seen the "death panels." They are Medicaid, Medicare, and the Veterans Administration. They share one thing in common, they are run by the government. The "death panels" are government bureaucrats who come between you and your physician and, after being fiscally incompetent, ration, delay and deny care.

He also correctly warns against private insurers who have illegitimately achieved their dominant position in our marketplace via "crony capitalism" engaging in similar practices against patients and physicians.

In a related post, Dr. Hennefent quotes James Schott:

...[J]ust because the bill does not say specifically 'in our socialized medicine system there will be death panels' doesn't preclude a mechanism evolving that will make life and death decisions based on budget considerations, nor does it mean that the system won't become one where private health insurance cannot survive against the government's monopolistic tendencies, and in a few years we will have socialized medicine.

Both Dr. Hennenfent and Mr. Schott are completely correct on this important issue -- and we have been duly warned.

If you want to stop ObamaCare, call your Congressman.

The upcoming vote will be extremely close. If your Representative is one of these crucial swing votes, then your voice could make the difference.

Even if your representative is a firm "yes" or a firm "no", it's still important to let them know where you stand. Word gets around the Congressional grapevine, so if wavering Congressmen learn that Americans everywhere are consistently opposed to this bill (as polls consistently show), it will make a difference.

Contact your Congressman!

Will and Gratzer on the 12% Problem

In the March 11, 2010 Washington Post, George Will discusses some of the ideological underpinnings of Obama's political approach in "As a progressive, Obama hews to the Wilsonian tradition".

With respect to health care, Will also links to a nice piece by Dr. David Gratzer from 2/26/2010, "The Health Care Number You Didn't Hear".

Gratzer calls this "the 12% problem":

American health care is an accidental system. Private coverage -- the type most Americans have -- has its origins in the wage controls of the Second World War as employers offered rich health-insurance benefits in pre-tax dollars. Public coverage like Medicaid and Medicare, on the other hand, takes its inspiration from the Beveridge report in Britain, drafted in the early 1940s; Lord William Beveridge believed in zero-dollar health care -- that people ought to pay nothing at the point of use. Today's American health care fuses these two systems, but with a common economic flaw: people are overinsured, paying pennies directly on every dollar of health service they receive.

The end result: for every dollar spent on health care in the United States, just 12 cents comes out of the individuals' pockets. Imagine what food costs might be if your employer paid 88% of your grocery bill or what a trip to Saks might be like if your company covered the vast majority of the costs of the shopping spree.

Far from addressing the 12 cent problem, Obamacare would exacerbate it. With its rich subsidies, expansion of government programs, insistence that all insurance cover specific services (and some with no copayments at all), Obamacare would pour fuel on the fire of health inflation. It's one reason that even the chief actuary of the Centers for Medicare and Medicaid Services -- a federal employee -- predicts cost rises under the President's plan.

(Read the full text of "The Health Care Number You Didn't Hear".)

Gratzer is completely correct. Bad government policy creates perverse economic incentives, which give rise for yet more bad government controls to "fix" the problem.

This is why we need to take a step back and think about free-market reforms that repeal those prior bad laws. That's the only way we will get costs under control.

(Links via LT.)

Beware Both Parties

In the March 11, 2010 Investor's Business Daily, Larry Elder reminds us that "Collectivists Come With Both D's And R's".

Here's an excerpt:

The most disturbing part of the Obama-Care debate is not about where Republicans and Democrats disagree, but where they agree.

Take this issue of those with pre-existing illnesses. Many Republicans actually support government action to prevent insurance companies from refusing to insure them. Ignoring the benefits of cost-lowering free market competition and the role of charity, many Republicans believe it acceptable to force an insurance company — in business to insure against unknown risks -- to "insure" someone currently experiencing a known risk.

Sen. Tom Coburn, R-Okla., supports legislation to "eliminate pre-existing conditions" as a reason for a carrier to deny coverage. Sen. John Barrasso, R-Wyo., says government needs "to take care of things like pre-existing conditions so that that doesn't stop (people) from getting insurance."

Sen. Chuck Grassley, R-Iowa, supports prohibiting "insurers from denying coverage to people with pre-existing medical conditions or charging higher premiums to people who are sick."

But this should not surprise anyone who observes the allegedly "fiscally conservative," "pro-free market," "limited government" party in action. From the acceptance of the New Deal to government bailouts of private industry, Republicans — sooner or later -- go along.

Republican President George W. Bush, for a time, worked with a Republican House and Senate. Bush promised and delivered a prescription benefits bill for seniors. It expanded Medicare, the popular underfunded entitlement program passed — with Republican support, by the way -- in 1965. We like seniors. Seniors vote. So if they struggle with their drug bills, why, by all means make someone else help pay them.

On the 10th anniversary of the Americans with Disabilities Act, signed into law by his father, Bush bragged about the law's importance and effectiveness. That such an assault on private employers engenders praise says much about the GOP's acceptance of federal government's command and control.

Elder also reminds us that government policies such as medical licensing requirements and insurance controls drive up costs and are supported by members of both parties.

(For the record, I oppose medical licensing requirements as a violation of the rights of patients and providers to voluntarily contract to their mutual benefit. I agree with Alex Epstein's reasons.)

So as the health care debate rages, let us remember that "Collectivists Come With Both D's And R's".

Vote Count Update

Are there enough Democratic votes in the House to pass ObamaCare?

Speaker Pelosi says they're almost there.

They think they can do it, even without the anti-abortion Democrats.

Some analysts think that Pelosi is forging ahead, even though she may not have the votes from a combination of hope and fear -- hope that she'll pick up the final few votes once the process gets started, and fear that if she waits until after Easter recess, she'll lose even more votes.

The Hill reports, "House Democrats' 'no' votes are piling up on healthcare reform".

In the Wall Street Journal, Michael Barone thinks probably not.

I don't think anyone really knows yet...

President Obama's Cousin Opposes ObamaCare

Dr. Milton Wolf is a radiologist practicing in Kansas. He's also President Obama's second cousin once removed, and he's written a powerful opinion piece in the March 11, 2010 Washington Times explaining why he's opposed to the President's health care plan.

Here's an excerpt from "WOLF: Obama family health care fracas":

The justification for Obamacare has been to control costs, but the problem is there is little in Obamacare that will do that. Instead, there are provisions that will ration care and artificially set price. This is a confusion of costs and price.

As one example, consider the implications of Obamacare's financial penalty aimed at your doctor if he seeks the expert care he has determined you need. If your doctor is in the top 10 percent of primary care physicians who refer patients to specialists most frequently - no matter how valid the reasons -- he will face a 5 percent penalty on all their Medicare reimbursements for the entire year. This scheme is specifically designed to deny you the chance to see a specialist. Each year, the insidious nature of that arbitrary 10 percent rule will make things even worse as 100 percent of doctors try to stay off that list. Many doctors will try to avoid the sickest patients, and others will simply refuse to accept Medicare. Already, 42 percent of doctors have chosen that route, and it will get worse. Your mother's shiny government-issued Medicare health card is meaningless without doctors who will accept it.

Obamacare will further diminish access to health care by lowering reimbursements for medical care without regard to the costs of that care. Price controls have failed spectacularly wherever they've been tried. They have turned neighborhoods into slums and have caused supply chains to dry up when producers can no longer profit from providing their goods. Remember the Carter-era gas lines? Medical care is not immune from this economic reality. We cannot hope that our best and brightest will pursue a career in medicine, setting aside years of their lives - for me, 13 years of school and training - to enter a field that might not even pay for the student loans it took to get there.

More broadly, Dr. Wolf notes:

The problems in the American health care system are not caused by a shortage of government intrusion. They will not be solved by more government intrusion. In fact, our current problems were precisely, though unintentionally, created by government.

World War II-era wage-control measures -- a form of price controls - ushered in a perverted system in which we turn to our employers for insurance and the government penalizes us if we choose to purchase insurance for ourselves. You are not given the opportunity to be a wise consumer of health care and compare prices as well as quality in any meaningful way. Worse still, your insurance company is not answerable to you because you are not its customer. It is answerable to your employer, whose interests differ from your own.

Insurance companies have been vilified for following the perverse rules that government has created for them. But it gets worse. The government, always knowing best, deploys insurance commissioners across the land to dictate what the insurance companies must provide, whether you want it or not, and each time, your premiums increase. Obamacare will make all of this worse, not better.

Dr. Wolf also proposes a variety of genuine free-market reforms that would actually address correct the underlying problems (rather than ObamaCare's proposed new government controls which would only make things worse.:

One of America's founding principles is our trust in the people and their economic freedom to rule their own lives. We should decouple health insurance from employers and empower patients to be consumers once again. Allow them to determine the insurance plan that best meets their families' needs and which company will provide it. This will unleash a wave of competition that will drive costs down in a way that price controls never have. Eliminate the artificial state boundary rules that protect insurance companies from true competition and watch as voters demand that their state insurance commissioners get the heck out of the way. Innovative companies will drive down costs similar to how Geico and Progressive have worked for automobile insurance. And it won't cost taxpayers a trillion dollars in the process.

This free-market approach has worked for everything from high-definition TVs to breakfast cereals, but will it work for medicine? It already is. Take Lasik eye surgery, for example. Because patients are allowed to be informed consumers and can shop anywhere, doctors work hard for their business. Services, availability and expertise have all increased, and costs have decreased. Should consumers demand it, insurance companies -- now answerable to you rather than your employer - would cover it.

Read the full text of "WOLF: Obama family health care fracas".

Dr. Wolf is offering both an excellent diagnosis and an excellent prescription for our health care policy problems. Let's hope his cousin, the President, listens to him.

Hillman: "More health care 'help' we can't afford"

Former CO state senator Mark Hillman discusses more unintended consequences of health insurance mandates.

Here is an excerpt from his post, "More health care 'help' we can't afford":

Two years ago, my wife and I had our first child. We are both self-employed and buy policies through the individual market. We specifically chose not to buy pregnancy coverage, although coverage for "complications of pregnancy" were standard with our Assurant Health policy.

The reason we didn't want to buy coverage for a normal pregnancy is the same reason everyone should have that choice -- a normal pregnancy is not an "insurable event." An insurable event is defined as something that occurs without warning, is unlikely to occur, and is unwanted.

Consumers understand this concept well in every situation except health insurance. We buy home insurance to pay for losses due to fire, hail storms, tornadoes or theft -- not to pay for repainting the family room or updating the kitchen. We buy auto insurance to pay for accidents, storm damage or vandalism -- not to pay for a new set of tires or an oil change.

Over the years, health insurance has moved away from the concept of insurance and become a complicated financing scheme for everything related to health. That's why it's so expensive.

Hillman makes many additional excellent points in his piece. I strongly recommend reading the full text of "More health care 'help' we can't afford".

Quick Links: Williams, Boudreaux, America

The March 3, 2010 Investors's Business Daily carried Walter Williams' column, "Health Care A Right? More Like A Wish".

GMU economics professor Donald Boudreaux tells NPR why ObamaCare would merely mean more of the economic problems of Medicare, but on a vastly larger scale.

March 8, 2010 polling data from Rasmussen shows a majority of Americans still opposed to ObamaCare.

Mankiw on Deficit Neutrality

Harvard Professor Greg Mankiw notes the following fallacy about "deficit neutrality" when discussed by supporters of ObamaCare:

Imagine you have a friend who has a budget problem. Every month he spends more than he earns. His credit card bills are piling up. He is clearly on an unsustainable path. Then one day he comes to you with an idea.

Friend: I am going to take off a few days from work and fly down to Bermuda for a quick vacation.

You: But isn't that expensive? Won't that just add to your growing debts?

Friend: Yes, it is expensive. But my plan is deficit-neutral. I have decided to give up that half-caf, extra shot caramel macchiato I order at Starbucks twice every day. I really don't need that expensive drink. And if I give it up for the next three years, it will pay for my Bermuda trip.

You: Well, then, how are you going to solve the problem of your growing debts?

Friend: I am going to figure that out as soon as I return from Bermuda.

You: But in light of your budget problem, maybe you should give up Starbucks and skip the Bermuda vacation. Giving up Starbucks could be the easiest way to start balancing your budget.

Friend: You really aren't any fun, are you?

This conversation is meant to illustrate why claims of deficit-neutrality in the healthcare reform bill should not give much comfort to those worried about the U.S. fiscal situation...

ObamaCare Update and Odds

Some analysts think that the "reconciliation" strategy is just a ruse; instead, if the House passes the Senate version of the bill, then Obama will just sign it into law (despite promises to Congressional Democrats to the contrary), declare "victory", and move onto other issues:

Wall Street Journal, "Tinker, Tailor, Soldier, ObamaCare"

Susan Anne Hiller, "The House Vote on the Senate Healthcare Bill Is the Final Vote; Obama Will Sign It Into Law"

Phil Kerpen, "Forget Reconciliation -- Why the Real Fight Is In the House"

Such a move by the President would leave the Democratic Congressmen on the hook for having voted for all the provisions of the Senate Bill, including the Cornhusker Kickback, as well as the broader bad plans for mandatory insurance and draconian controls on private insurance, despite their personal misgivings.

If you wish to tell your Congressman what you think, you can contact him or her at:
http://www.house.gov/

Other analysts are essentially saying that the odds of ObamaCare passing are 50-50. In other words, neither victory nor defeat are a slam dunk.

For details of the various procedural and political convolutions and machinations, see:

Keith Hennessey, "Health Care Reform CPR".

Nate Silver, "Is Obamacare a Favorite to Pass?"

Brian Schwartz also covers the Intrade betting market on ObamaCare.

Buckle your seat belts! It's going to get real interesting now...

Mark Steyn: Obamacare worth the price to Democrats

In the March 5, 2010 Orange County Register, Mark Steyn warns that some Democrats are quite willing to incur voters' wrath by passing ObamaCare (including a temporary loss of control of Congress), because they know it will give the government a permanent stranglehold on the American people for the foreseeable future.

Here's an excerpt from his piece, "Obamacare worth the price to Democrats":

I've been saying in this space for two years that the governmentalization of health care is the fastest way to a permanent left-of-center political culture. It redefines the relationship between the citizen and the state in fundamental ways that make limited government all but impossible. In most of the rest of the Western world, there are still nominally "conservative" parties, and they even win elections occasionally, but not to any great effect (Let's not forget that Jacques Chirac was, in French terms, a "conservative").

The result is a kind of two-party one-party state: Right-of-center parties will once in a while be in office, but never in power, merely presiding over vast left-wing bureaucracies that cruise on regardless.

...Look at it from the Dems' point of view. You pass Obamacare. You lose the 2010 election, which gives the GOP co-ownership of an awkward couple of years. And you come back in 2012 to find your health care apparatus is still in place, a fetid behemoth of toxic pustules oozing all over the basement, and, simply through the natural processes of government, already bigger and more expensive and more bureaucratic than it was when you passed it two years earlier. That's a huge prize, and well worth a midterm timeout.

...Because government health care is not about health care, it's about government. Once you look at it that way, what the Dems are doing makes perfect sense. For them.

(Read the full text of "Obamacare worth the price to Democrats".)

The big question is how many House Democrats will buy into that logic. I don't think anyone knows yet. But we'll find out soon.

Steyn is right that once government programs are put into place, they almost never get repealed even by allegedly "conservative" politicians. (The American experiment with alcohol Prohibition is one of the few examples I can think of a successful political repeal.)

On the other hand, we must not commit the fallacy of treating laws of Congress as if they were laws of nature. Even if ObamaCare passes, Americans can and should demand that their politicians repeal it. It may be difficult but it's not metaphysically impossible. And whether it happens will depend on whether Americans have the courage, stamina, and determination to stand up for their individual rights.

Quick Links: Colorado and Indiana

Linda Gorman of the Independence Institute has two new commentaries on Colorado health legislation:

"Bill Summary: HB10-1330, the All-Payer Database: A Transparency Trojan Horse"

Gorman warns that this bill would, "give the Executive Director of Health Care Policy and Financing the power to create a database to collect and store unlimited information on everyone who provides or receives health care in Colorado whether or not the state pays for that health care and whether or not the transaction is a private one."

"Colorado House Bill 1008: Women Pay, But Not Because of Unfair Discrimination"

Gorman notes, "Some people in the Colorado legislature think that everyone should pay the same price for individual health insurance regardless of age, personal habits, or gender. They believe this even though women as a group use more health care than men. They cling tight to the belief that charging someone a lower price for health insurance simply because he uses less health care is, in the language of the bill, 'unfairly discriminatory and shall not be allowed.'"

Ironically she observes, "The Colorado legislature actually helps ensure that women's health insurance premiums cost more."

On a positive note, Indiana governor Mitch Daniels praises health savings accounts in his March 1, 2010 Wall Street Journal essay, "Hoosiers and Health Savings Accounts".

Daniels writes:

Are HSA participants denying themselves needed care in order to save money? The answer, as far as the state of Indiana and Mercer Consulting can find, is no. There is no evidence HSA members are more likely to defer needed care or common-sense preventive measures such as routine physicals or mammograms.

It turns out that, when someone is spending his own money alone for routine expenses, he is far more likely to ask the questions he would ask if purchasing any other good or service: "Is there a generic version of that drug?" "Didn't I take that same test just recently?" "Where can I get the colonoscopy at the best price?"

To the extent that the free market is allowed to operate, patient receive quality care for lower prices. Surprise, surprise!

(Links via PatientPower and JG.)

Hsieh OpEd at PJM: Can the Moral 'Narrative' of ObamaCare Be Defeated?"

PajamasMedia has just published my latest OpEd, "Can the Moral 'Narrative' of ObamaCare Be Defeated?"

My theme is that we have to oppose ObamaCare on moral grounds, not just economic or procedural grounds. I'm especially glad to be able to cite Dr. Peikoff's essay, "Health Care is Not A Right" in my piece.

Here is the opening:

President Obama has finally demanded an "up or down vote" on his health care plan. Republicans have already raised numerous economic and procedural objections, arguing that his plan relies on economic "smoke and mirrors" and that the president is now endorsing the same controversial "reconciliation" process that he denounced in 2005 as a senator as "the wrong place for policy changes." Yet the president and his supporters remain committed to their goal of government-run "universal health care." Why is that?

The key is Obama's declaration, "I don't know how this plays politically, but I know it’s right." Ultimately, Obama and his liberal base believe that government-guaranteed health care is a "moral imperative" -- i.e., "it's right." And that will also be the key to defeating it.

As Leonard Peikoff once wrote, "So long as people believe that socialized medicine is a noble plan, there is no way to fight it. You cannot stop a noble plan -- not if it really is noble. The only way you can defeat it is to unmask it -- to show that it is the very opposite of noble. Then at least you have a fighting chance."

Hence, one must challenge ObamaCare not merely on the economic or procedural levels but on the moral level.

(Read the full text of "Can the Moral 'Narrative' of ObamaCare Be Defeated?")

Mythbusting From Megan McArdle

Megan McArdle asks the provocative question, "Everyone knows that people without health insurance are more likely to die. But are they?"

Here's an excerpt from the article in the March 2010 Atlantic, "Myth Diagnosis":

...If we lost our insurance, would this gargantuan new entitlement [of government-guaranteed health insurance] really be the only thing standing between us and an early grave?

Perhaps few people were asking, because the question sounds so stupid. Health insurance buys you health care. Health care is supposed to save your life. So if you don’t have someone buying you health care well, you can complete the syllogism.

Last year's national debate on health-care legislation tended to dwell on either heart-wrenching anecdotes about costly, unattainable medical treatments, or arcane battles over how many people in the United States lacked insurance. Republicans rarely plumbed the connection between insurance and mortality, presumably because they would look foolish and heartless if they expressed any doubt about health insurance’s benefits. It was politically safer to harp on the potential problems of government interventions -- or, in extremis, to point out that more than half the uninsured were either affluent, lacking citizenship, or already eligible for government programs in which they hadn't bothered to enroll.

Even Democratic politicians made curiously little of the plight of the uninsured. Instead, they focused on cost control, so much so that you might have thought that covering the uninsured was a happy side effect of really throttling back the rate of growth in Medicare spending. When progressive politicians or journalists did address the disadvantages of being uninsured, they often fell back on the same data Klein had used: a 2008 report from the Urban Institute that estimated that about 20,000 people were dying every year for lack of health insurance.

But when you probe that claim, its accuracy is open to question...

McArdle raises a similar point in her February 10, 2010 essay, "How Many People Die From Lack of Health Insurance?":

...Probably the best one looked at patients who had been taken to the ER, which still showed higher mortality for the uninsured. But it's not clear that this indicates that lacking insurance is dangerous; it may be telling us that people who lack insurance have a lot of factors that lead to poorer health outcomes.

To my mind probably the single most solid piece of evidence is this: turning 65 -- i.e., going on Medicare -- doesn't reduce your risk of dying. If lack of insurance leads to death, then that should show up as a discontinuity in the mortality rate around the age of 65. It doesn't. There are some caveats -- if the effects are sufficiently long term, then it's hard to measure, because of course as elderly people age, their mortality rate starts rising dramatically. But still, there should be some kink in the curve, and in the best data we have, it just isn't there.

McArdle highlights the greatly under-appreciated concept that "coverage" is not care.

Insurance is a particular method of financing medical care, but is distinct from actual medical care, just like automobile insurance is distinct from the actual services rendered by a mechanic in an auto repair shop.

Too many politicians conflate insurance "coverage" with care. And by imposing government policies that attempt to guarantee theoretical "coverage" (as in Massachusetts), they hinder people's ability to receive actual medical care.

Reconciliation: Then And Now

Now that President Obama has endorsed the use of the controversial "reconciliation" tactic to ram his health care plan through Congress, some have noted the gross hypocrisy between his current view and his prior statements as a US Senator.

On December 20, 2005, then-Senator Obama stated:

Under the rules, the reconciliation process does not permit that debate. Reconciliation is therefore the wrong place for policy changes... In short, the reconciliation process appears to have lost its proper meaning. A vehicle designed for deficit reduction and fiscal responsibility has been hijacked...

(Link via LT.)

Similarly, Rossputin and other bloggers have been circulating this astounding video of various Democratic Senators' pious statements from 2005 (when they were in the minority) defending the filibuster as a vital protection against the "tyranny of the majority":



As then-Senator Biden declared (time-stamp 3:48): "I pray God when the Democrats take back control we don't make the kind of naked power grab you are doing". (Link via @AriArmstrong.)

Unfortunately, arguments about political hypocrisy or arguments about procedural details can only be secondary arguments in opposing ObamaCare.

Economic arguments such as those offered by Congressman Paul Ryan are far more important:



(Ryan transcript here.)

But ultimately, the most important arguments to make are core fundamental moral and philosophical arguments about freedom, individual liberty, and the proper role of government, such as those offered by Dr. Leonard Peikoff in his essay, "Health Care Is Not A Right".

Unless we make the proper fundamental philosophical arguments, then secondary arguments about economics or political procedure will at most only delay (but not stop) the passage of some form of socialized medicine.

Amerling: The Threat to Physician Autonomy

Dr. Richard Amerling highlights an often under-appreciated aspect of ObamaCare -- namely that it will severely limit physician autonomy in the name of "practice guidelines", thus compromising the doctor-patient relationship.

Here's an excerpt from his article, "The Threat to Physician Autonomy":

Whatever its final form, ObamaCare... will include enhanced measures to control medical care. These will be implemented under the guise of quality assurance and cost containment. Slipped into the so called stimulus bill passed last February is a new federal health care panel that will decide which procedures and drugs are "medically necessary" and "cost effective." Based on the writings of Ezekiel Emmanuel, brother of Rahm and close Obama health advisor, we can assume rationing of care to the elderly (over 65!) and very young (under 2). Also included is a mandate for adoption of electronic health records (EHR). The clear goal here is to have access to every medical interaction; the only rationale for gathering such detailed information is to exercise control over medical decision-making.

The mechanisms are already in place. For the past couple of decades medical specialty societies, aided and abetted by the government, the American Medical Association, and Big Pharma, have been crafting clinical practice guidelines. These mostly opinion based recommendations will be transformed into mandates, first as "clinical performance measures," then as "payment for performance." Treatment algorithms will be built into the EHR to guide decision making at the point of service. Such a "one size fits all" approach will be an unmitigated disaster for patients.

(Read the full text of "The Threat to Physician Autonomy".)

In other words, doctors can treat the patient anyway they want -- as long as it's according to government-approved guidelines, and under the watchful eye of the government. If your needs fall outside of those guidelines, then tough.

Do Americans really want that kind of medical care?

Mazer: The Business of Health Care

The Spring 2010 issue of The Undercurrent has published an article by 4th-year medical student Laura Mazer entitled, "The Business of Healthcare".

What I especially liked about her piece was that she cut to the heart of the health care policy debate:

Medicine often focuses only on the physical act of living -- breathing in and out, keeping the heart beating. But human life is more than the functioning of the moving parts. Although healthcare may be the only requirement for a brain-dead accident victim on life support, it is not the only requirement for the rest of us. To live, we need food, we need shelter, we need companionship and work, and hundreds of other material and spiritual requirements. Healthcare is a necessity -- and after a car accident, or during a flu infection, it may be the most important necessity. But it is not the only requirement for life.

When people talk about a 'right' to healthcare, they mean an entitlement to healthcare. They mean that unlike other goods and services that must be earned through individual work or trade, healthcare should be provided for free.

Medicine is not the only industry that fulfills a necessity for life, so what entitles us to the products of this particular industry, and not others? Why not food or clothes? And why not those products that provide a good life -- feather beds or paintings or tickets to the movies? Or are we entitled to those as well?

The issue goes far beyond healthcare. It is a question of what the government's role should be in providing for its citizens. Should the government collect taxes to provide citizens with whatever goods and services they deem 'necessary?' Or is it the responsibility of individual citizens to work for whichever products and services they can independently earn -- with the government existing to secure their freedom to pursue these ends?

(Read the full text of "The Business of Healthcare".)

I'm glad to see that one of America's future physicians is asking exactly the right questions!

Legislative Update

Keith Hennessey has a good update on the arcane mechanics of the threatened "reconciliation" process to pass ObamaCare.

David Catron argues that it's all bluster and bluff by the Democrats.

Fox News reports that President Obama will announce a scaled back version of his health plan on Wednesday. This may indicate a recognition by the Democrats that the full-fledged version of ObamaCare lacks sufficient support to pass with "reconciliation".

Given that it is described as "smaller in scope" than either the current House and Senate versions, it will presumably have to go through Congress again.

In that case, we'll see if the Republicans fall for the trap of "limited reforms" or not.

Napolitano: 4 Health Care Questions and Answers

Judge Andrew Napolitano posts, "4 Health Care Questions and Answers". The questions include:

1. Can the federal government compel a person to have health insurance?
2. Why can't I buy health insurance from whatever carrier is willing to sell it to me?
3. Is tort reform constitutional?
4. Is there anything in the Constitution that empowers Congress to regulate health care or get between patients and their physicians or empower bureaucrats to tell physicians how to practice medicine?

(Read the full text of "4 Health Care Questions and Answers" for the answers.)

What's especially noteworthy is the how the problems we are experiencing are caused by bad government laws. Hence, the solution is not to impose yet more bad laws (which will only make things worse) but instead to repeal the existing bad laws.

Hsieh Cited in Re:new Magazine

The February 2010 issue of the British magazine Re:new has published a story on the American health care debate and how it relates to ongoing problems with the British National Health Service. They quoted me as a representative of the free-market side.

The story is entitled, "A Bitter Bill".

Although the article is generally supportive of the concept of "universal health care", the author quoted me fairly and she gave me and FIRM a lot of space on the first page. In contrast, the representative for the pro-"single payer" US group, Physicians for a National Health Program, was not named and received less column space.

The online version of the story is not available yet, but you can see the print version here:

http://issuu.com/renewmagazine/docs/renewmagazine1

(Use the navigation controls to go to pages 6-7.)

Here is the relevant excerpt from the article:

Despite living in the only Western country without universal healthcare, millions of Americans are keen to keep things as they are. The current system may not be perfect, but the alternative, or so they believe, is unthinkable.

To them, the idea of paying for others is a socialist one, going against their definitions of rights and freedom. Collective responsibility is an alien concept that means spending your hard-earned money on someone else. To these Americans, Obama's "socialism" is only a short step away from communism, the great fear of the 1950s.

Lobbying groups, such as Freedom and Individual Rights in Medicine (FIRM), argue that universal health care infringes on individual rights. "There is no such thing as a right to healthcare any more than there is to a car or a house," argues FIRM's Dr. Paul Hirsch [sic]. "President Obama's health care plan -- or any other form of universal health care -- is wrong, because attempting to guarantee an alleged right to health care must necessarily violate the actual rights of those forced to provide such care and those forced to pay for it".

The British National Health Service has often been dragged into the American debate, and Dr. Hirsh believes that government provision of healthcare like that in Britain results in unnecessary bureaucracy. "Whenever the government attempts to guarantee health care, it must necessarily also control it," he says. "Hence crucial medical decisions are inevitably made by government bureaucrats, rather than physicians and patients. Healthcare becomes just another privilege to be dispensed at the discretion of bureaucrats."

(The author apologized for misspelling my name and she told me that it would be corrected on their website.)

Overall, I thought she represented my views fairly, and I'm honored to have FIRM's ideas circulated to readers in the UK!

Quick Links: Madianos, Pelosi, Coburn

Dr. Evan Madianos alerted me to a notice that some doctors will be posting in their offices come Monday, following the Medicare cuts.

(The first half of the page is the original posting, ending with "I won't do either!"; the second half is Dr. Madianos' commentary. As long as the Medicare program exists, it will remain a permanent "political football" for patients, doctors, and other interest groups -- yet another reason that Medicare should be phased out and eventually eliminated.)

The February 27, 2010 New York Times notes that, "Pelosi Struggles to Corral Votes for Health Care Bill".

Republican US Senator Tom Coburn (himself a practicing physician), comments on the recent "summit":



(Note: I generally agree with Senator Coburn's critique of the Democrats' proposals. However, the Coburn-Burr-Ryan-Nunes bill appears to be a very mixed bag, with some better elements and some bad statist elements. Hence, this should not be construed as an endorsement of that particular bill.)

PJTV Health Summit Summary

The February 26, 2010 edition of PJTV includes a good discussion of the health care "summit" by Yaron Brook and Terry Jones:



If you missed the full 7-hours of mind-numbing speechifying, Brook and Jones summarize the economic, philosophical and political highlights!

Ryan At The Summit

Yesterday's health care "summit" was of course the big story. Anyone interested in a complete transcript of the proceedings can find a full compilation here by the Washington Post.

For now, I just wanted to highlight this segment by Republican Congressman Paul Ryan, as well as an observation from HotAir.com, which illustrates both the strengths and weaknesses of the Republican approach to the debate.

First, Ryan's segment on costs (transcript and video):



I want to give Ryan credit for an excellent dissection of the financial problems with ObamaCare. The facts he presented should definitely be part of the debate.

And to his credit Ryan also stated, "We don't think the government should be in control of all of this. We want people to be in control. And that, at the end of the day, is the big difference."

But consider this excerpt from the HotAir discussion of Ryan's rebuttal of ObamaCare:

This has always been a core problem of Obama's health-care pitch: He [Obama] knows that the moral argument for the bill -- sure, it'll cost us dearly but it's worth it to insure the uninsured -- is a political loser so he resorts to preposterous assertions about how our giant new federal entitlement will actually save us money in the long run.

And this indirectly highlights the key weakness of the Republican approach.

The GOP needs to more explicitly challenge the moral argument for ObamaCare, rather than concentrating on secondary issues such as costs.

They need to make the argument that government-run "universal health care" is morally wrong and that free-market health care is morally right.

Americans are very moral people and they passionately want to "do the right thing". So if they accept the premise that it's supposedly right for the government to (somehow) make sure that everyone has guaranteed health care, but gosh this particular way just happens to be too expensive, then the statists will eventually win by proposing some plan that doesn't look too costly.

Whatever statist plan is eventually adopted will inevitably either cost more than originally promised or lead to rationing (or likely both). But sooner or later, Americans will buy into such a plan -- if they think that it is "the right thing to do".

But if Americans can be persuaded that government-guaranteed health is fundamentally wrong on moral grounds, then they'll reject all proposed variants regardless of the specific financial details.

With respect to moral and/or philosophical arguments, Republican sometimes say things that sound promising, such as Ryan's "We don't think the government should be in control of all of this. We want people to be in control."

But they never consistently defend the underlying principle of individual rights, the concept that individual rights are essential to human life in a social context, or the morality of a limited government which leaves honest men free to peacefully pursue their lives and their self-interest.

Hence, the Republicans leave themselves constantly vulnerable to statists claiming that there is a "moral imperative" to implement some new entitlement program, whether it be guaranteed health care, a jobs program, or a Medicare drug benefit. The most they can do is object to the costs of a particular program (or to some other specific implementation details) -- but not to the worthiness of the underlying goal.

In other words, the Republicans often argue that socialized medicine is impractical (or the closely related "it's too expensive"), but they rarely if ever argue that it's immoral.

As Leonard Peikoff noted in "Health Care Is Not A Right":

Most people who oppose socialized medicine do so on the grounds that it is moral and well-intentioned, but impractical; i.e., it is a noble idea -- which just somehow does not work. I do not agree that socialized medicine is moral and well-intentioned, but impractical.

Of course, it is impractical -- it does not work -- but I hold that it is impractical because it is immoral.

This is not a case of noble in theory but a failure in practice; it is a case of vicious in theory and therefore a disaster in practice. I want to focus on the moral issue at stake. So long as people believe that socialized medicine is a noble plan, there is no way to fight it.

You cannot stop a noble plan -- not if it really is noble. The only way you can defeat it is to unmask it -- to show that it is the very opposite of noble. Then at least you have a fighting chance.

Without this sort of moral clarity, economic arguments of the type Ryan is offering (as important as they are) will only delay the implementation of government-run medicine, not stop it.

To stop it, one needs to (1) not automatically concede the moral high ground to the statists (i.e., not grant the premise that guaranteed health care is a noble end), and (2) offer the proper moral defense of free market health reforms.

The debate is slowly shifting in this direction. But we still have a long ways to go.

To the extent that the Republicans are able to delay the implementation of ObamaCare, they will at least buy us more precious time to bring these core moral issues to the forefront.

We can't necessarily control how much time we are given, but we can control how we use it. Hence, we must be careful to use it wisely, rather than squander it.

Hsieh OpEd at PJM: "Republicans: Beware the Trap of 'Limited' Reforms"

PajamasMedia has just published my latest health care OpEd, "Republicans: Beware the Trap of 'Limited' Reforms".

My theme is the seemingly innocuous compromise "reform" of requiring insurers to cover all pre-existing conditions would gradually lead to a full government takeover of health care.

I was very glad to be able to cite John Lewis' excellent TOS article observing that the Democrats' last secret weapon against the American people was the Republicans' willingness to compromise (in the final paragraph).

Here is the opening:

President Obama attempted to revive his faltering health care initiative by releasing a revised version of his plan on Monday. But as Grace-Marie Turner of the Galen Institute noted, the president's basic approach remains to "Tax, Spend, Regulate, Mandate" -- i.e., to impose massive new government controls over health care that Americans have already rejected in tea party protests across the country and in the polling booths of Massachusetts.

GOP leaders have been appropriately skeptical of the president's demand that his plan be the basis for their "summit" negotiations, calling it a "nonstarter." But while they've avoided that obvious trap, the Republicans are still in danger of falling for the subtler trap of agreeing to seemingly benign limited compromise "reforms" that would merely result in a slower government takeover of American health care.

One of the Democrats' favorite limited proposals has been to require insurance companies to accept all customers regardless of pre-existing medical conditions -- an idea supported by many Republicans...

(Read the full text of "Republicans: Beware the Trap of 'Limited' Reforms".)

Dissident Doctors Challenging the AMA

Matt Latimer profiles a group of dissident doctors in his article, "What MSM Won't Tell You: Doctors Are Challenging Government Health Care-and the AMA".

I don't know much about the group Docs4PatientCare.org. But they seem to raising the right issues and asking the right questions. Many of their proposed reforms move us at least partially in the proper direction of a free market.

(I do have questions about their idea of "high risk pools" for patients with pre-existing conditions. If some patients are truly uninsurable, they may need to rely on private charity. The last thing we should do is create yet another government entitlement program. The D4PC statement is vague on whether private parties or the government would ultimately pay for these patients' insurance and/or care. I fully support the former, but would be opposed to the latter.)

One point they raise which bears repeating:

The AMA does NOT represent the majority of 'practicing" US physicians. Only 17% of US physicians belong to the AMA and most of these members are administrators, practice in academic medicine, retired or residents and students. Therefore, the AMA's endorsement of this legislation is meaningless and irrelevant.

Hence, to the extent that D4PC provides doctors who disagree with the AMA endorsement of ObamaCare with a vehicle to express their views and promote free-market reforms, I applaud their work!

More Alternatives To ObamaCare

Dr. Bradley Hennenfent has compiled a nice list of proposed alternatives to ObamaCare.

I haven't looked at each one in detail yet. But from my first pass, they contain many excellent free-market reforms that deserve to be on the table.

(I'm sure I would probably disagree with some specific points of some of these proposals as well.)

But the President and Congress should be including these ideas in the debate, rather than merely trying to split the difference between the current bad House and Senate versions of ObamaCare.

Thank you, Dr. Hennefent, for compiling this information!

Reconciliation Roundup

A few quick updates on the proposed "reconciliation" tactic for ramming ObamaCare through the Congress:

Politico reports that "Senate Dems warm to reconciliation".

RedState reports that according to Micheal E. Hammond, former General Counsel of the U.S. Senate Steering Committee (in consultation with Senate parliamentarian Alan Frumin), the reconciliation process is not a legally valid way to pass ObamaCare 2.0 in the Senate. (Via David Catron.)

Keith Hennessey think that is more political theater rather than a real threat -- at least for now.

My own opinion -- I don't know. So much of this depends on details of backroom arm-twisting and deal-making that we in the general public (by definition) won't be privy to.

But we'll all find out soon.

Hsieh OpEd at PJM: "Government Grab of Retirement Accounts"

As a slightly off-topic post, PajamasMedia has just published my latest OpEd, "Government Grab of Retirement Accounts a Matter of 'Social Justice'".

Although it's not directly related to health care, it covers many of the same themes of freedom and individual rights vs statism and the entitlement mentality.

In this piece, I criticize the latest Obama Administration proposal to convert some of our private 401(k) retirement money into government annuities in order to help prop up the failing Social Security system. I also attempt to make the moral argument for the phasing out and eventual elimination of Social Security.

Here is the opening of "Government Grab of Retirement Accounts a Matter of 'Social Justice'":

Uncle Sam wants your retirement money.

The Obama administration has just solicited public comment on their proposal to take money from Americans' private 401(k) retirement accounts and convert it into government-backed annuities. In other words, they want to take your money now to purchase U.S. Treasury bonds, then pay you a monthly sum later after you’ve retired.

Although this proposal is being initially portrayed as a voluntary choice, Americans already have the ability to purchase Treasury Bonds with their retirement money. Moreover, the Obama administration is considering making these annuities the default option. And as analyst Karl Denninger noted, "'choices' have a funny way of turning into mandates." Nor is his concern unjustified.

In 2008, Professor Teresa Ghilarducci of the New School of Social Research testified before Congress proposing a similar scheme to convert private 401(k) accounts into government-run "Guaranteed Retirement Accounts" that would pay a 3% return. And in 2008, the Argentinian government attempted to nationalize private retirement funds to help cover its runaway deficit.

As the U.S. Social Security system moves ever closer to bankruptcy, the billions of dollars Americans have saved in their private retirement accounts will become an increasingly tempting target for our politicians...

(Read the full text.)

Presidential Plan Panned

President Obama has just announced his new health care plan based on new price controls on the insurance industry, and it has apparently landed with a "thud".

AP News reports, "Outlook no brighter for Obama's new health plan".

Grace-Marie Turner notes that is just more, "Tax. Spend. Regulate. Mandate."

In other words, he is attempting to address the problems created by prior government controls on insurance with yet more government controls. That's as likely to work as the proverbial "putting out fire with gasoline".

Let's hope the rest of the country sees through this folly.

Permanent Political Football

While reading a seemingly-unrelated story in the New York Times about the Texas State Board of Education, I was struck by the parallels between special-interest lobbying that occurs with a mandatory school curriculum and special-interest lobbying that occurs with mandatory health insurance.

The February 14, 2010 New York Times Magazine published a lengthy article entitled "How Christian Were the Founders?" This article described in detail the ferocious political lobbying in Texas resulting from the fact that Texas has established a statewide curriculum guideline for all its schools. Hence special interest groups have a powerful incentive to have their point of view promulgated in this mandatory curriculum.

The NYT article focused primarily on the Religious Right, and their often-successful attempts to promote the theme that "America is a Christian nation" -- by which they mean that "the United States was founded by devout Christians and according to biblical precepts". This in turn has powerful implications for what they believe children should be taught about American history, the proper relationship between government and religion, and what they considered the dangerously flawed notion of "separation of church and state". And they have been successful in using the power of government to include their views within the textbooks in use throughout the state of Texas.

Regardless of whether one agrees or disagrees with the various Religious Right theories of American history, the kind of lobbying they engage in is a completely predictable consequence of a government-mandated educational curriculum. In other jurisdictions, we might see hardcore environmentalists attempt to require school textbooks adopt a radical "green" perspective or leftists require teaching an anti-West, anti-capitalist curriculum.

Basically, the presence of a mandatory curriculum serves as a giant magnet for special interest groups seeking to have their particular viewpoint represented in the curriculum. It turns the educational curriculum into a permanent political football to fought over by the various interest groups.

Hence, there is a parallel with the lobbying that occurs under a system of mandatory health insurance. If everyone is required to purchase health insurance (as they are in Massachusetts), the government must necessarily determine what constitutes an "acceptable" package. This creates a giant magnet for special interests to have their particular pet benefit included in the mandatory package. In Massachusetts, residents must therefore purchase numerous benefits that they may neither need nor want, including in vitro fertilization, chiropractor services, alcoholism therapy, and hair prostheses -- raising costs for everyone to benefit the few with sufficient political clout.

Nor does the lobbying ever stop. As Michael Cannon noted in the August 27, 2009 Detroit News:

In the three years since Massachusetts enacted its individual mandate, providers successfully lobbied to require 16 specific types of coverage under the mandate: prescription drugs, preventive care, diabetes self-management, drug-abuse treatment, early intervention for autism, hospice care, hormone replacement therapy, non-in-vitro fertility services, orthotics, prosthetics, telemedicine, testicular cancer, lay midwives, nurses, nurse practitioners and pediatric specialists.

The Massachusetts Legislature is considering more than 70 additional requirements.

As with mandatory educational curricula, mandatory health insurance thus becomes a permanent political football for special interests to fight over.

Of course, the solution in both arenas is to eliminate the government mandate. Just as parents should be allowed to decide what kind of education their children should receive, consumers should be allowed to decide what sorts of health insurance they wish to purchase. The government should respect and protect these individuals' rights to make these decisions for themselves, rather than making that decision for them.

However, according to the February 18, 2010 New York Times story, "Obama to Offer Health Bill to Ease Impasse as Bipartisan Meeting Approaches", President Obama is still insisting on his plan of mandatory insurance as the basis for his upcoming health care "summit" with the Republicans.

His plan would thus turn health insurance into an unfair game of permanent political football, where the politically strong perpetually pummel ordinary Americans who lack sufficient lobbying pull. Unless Americans want to become the permanent tackling dummies for the special interest groups, they should remain firm in their current opposition to the President's plan and not let down their guard yet.

Quick Links: Health Care Summit - Trap or Opportunity?

Allahpundit at HotAir thinks it's a trap for the GOP.

In the February 16, 2010 Wall Street Journal, Betsy McCaughey says the GOP should "Just Say No to the Health-Care Summit" until mandatory insurance is taken off the table.

And most Americans want the Congress to start over on health care, rather than taking the Democratic plan as the starting point of the summit.

But some Republicans think they can turn the "summit" into an opportunity.

Unfortunately, I think the Republicans who think it's an opportunity are badly mistaken. Unless they explicitly challenge and repudiate the basic premise of universal health care (i.e., that the government needs to somehow find a way to guarantee health care for all Americans), they'll merely play into the statists' hands.

Duke University professor John Lewis once observed that the Democrats' last secret weapon against the American people was the Republicans' willingness to compromise.

We'll find out soon if the GOP has learned any lessons from the past, or they'll be suckered into offering political life support for the nearly-dead ObamaCare proposal.

Ralston LTE in NY Times

The February 17, 2010 New York Times has published an LTE by Richard Ralston on health care reform (5th one down):

Although you do not think small ideas will do much, you provide a good list of small ideas that would improve the cost and availability of health care. Some of them would be more helpful than you indicate. (Health savings accounts help middle-income Americans and do not primarily help the wealthy, for whom the few hundred dollars in tax savings are not worth the paperwork.)

Americans have rightly become suspicious of big, bad, expensive ideas that are adopted only because they pay off a laundry list of special political interests. They would not object to small ideas that actually work and that don't need bribes to get votes in Congress.

Richard E. Ralston
Executive Director
Americans for Free Choice in Medicine
Newport Beach, Calif., Feb. 15, 2010

(He was responding to their 2/14/2010 editorial, "Small Ideas Won't Fix It".)

The ObamaCare Nuclear Option

I don't know how reliable this sort of procedural analysis is. But I wanted to pass this on to those who might be interested.

According to Brian Darling at RedState, the Congressional Democrats have one last "nuclear option" they could use to pass ObamaCare.

His conclusion:

Conservatives need to be wary that the liberals are not done trying to pass ObamaCare. This may be a desperate last ditch effort to pass President Obama's signature item of his first two year, so be ready for this scenario to play out after the summit, if the summit does not bear any fruit. For those of you that thought ObamaCare had been laid to rest, remember that it is not over.

Again, I can't vouch for the reliability of the analysis, since much of this depends on backroom deals that by their very nature will not be accessible to most of the general public.

Scott Brown: A Mere Speed Bump on the Conservatives' Road to Serfdom

The January 20, 2010 Capitalism Magazine has a terrific essay by Richard Salsman entitled, "Scott Brown: A Mere Speed Bump on the Conservatives' Road to Serfdom".

Here is the opening:

Yesterday's allegedly "surprising" election of Republican populist Scott Brown to the Massachusetts Senate seat occupied by the late Ted Kennedy since 1962 -- a win which removes the 60-seat, filibuster-proof "super-majority" for Democrats in the U.S. Senate -- seems to worry the illiberal-regressive Democrats who've control Washington since 2006, while it heartens the religious-conservative Republicans who are now itching to regain control. Yet neither reaction is justified. America still treads a road to serfdom, with Democrats and Republicans alike paving the way. Brown is a mere speed-bump on this road, which will only slightly decelerate the speed of the journey.

Like Brown, today's religious-conservative Republicans don't in the least oppose socialized medicine -- only the speed, manner and cost by which it's ultimately adopted -- because they share with the illiberal-regressive Democrats a whole-hearted (and irrational) belief in altruism, the notion that it's moral and noble to sacrifice oneself and to serve. Emotional commitment to this virtue' of service necessarily leads -- however long it takes -- to serfdom in politics.

(Read the full text of "Scott Brown: A Mere Speed Bump on the Conservatives' Road to Serfdom")

Salsman is correct. Brown's election has bought supporters of free-market health reforms some valuable time to continue to make our case. But until conservatives embrace the concept that pursuit of rational self-interest is moral (and thus should be legally protected as a right), they will eventually cede the moral high ground to those who would impose serfdom on this country, and eventually lose the political battle.

The good news is that these core issues are being discussed and debated right now.

The question will be whether the right ideas will take hold in our culture.

Schwartz Rebuts Carroll

Brian Schwartz does a nice job rebutting Colorado state senator Morgan Carroll's claim that allowing people to purchase insurance across state lines would create a "race to the bottom".

Virginia Legislature Outlaws Mandatory Insurance

From the February 12, 2010 New York Times:

Virginia Legislature Passes Ban on Insurance Mandate

The Virginia House of Delegates on Friday passed legislation intended to shield citizens from any federal requirement that they purchase health insurance. The bill goes to the governor for signing.

Assuming the governor signs this bill, it means that any attempt by the federal government to impose mandatory insurance could create a constitutional issue that might ultimately need to be resolved by the U.S. Supreme Court.

Ten Small-Scale Reforms for Pre-Existing Conditions

John Goodman and the National Center for Policy Analysis have proposed "Ten Small-Scale Reforms for Pre-Existing Conditions". All of these would move us in the right direction of free-market health reforms, without creating a huge new government welfare entitlement.

The ideas include:

* Encourage portable insurance.
* Allow special health savings accounts for the chronically ill.
* Allow special needs health insurance.
* Allow health status insurance.
* Allow self-insurance for changes in health status.
* Give people on their own the same tax break employees get.
* Allow providers to repackage and reprice their services under Medicare and Medicaid.
* Allow access to mandate-free insurance.
* Create a national market for health insurance.
* Encourage post-retirement health insurance.

According to Goodman, "These 10 reforms would encourage insurers to compete to cover patients with chronic illnesses, rather than trying to avoid them. They would give doctors and other health care providers incentives to innovate, and to use technology in order to improve quality and reduce costs".

For further details of each proposal, see the full text of "Ten Small-Scale Reforms for Pre-Existing Conditions". There's also a PDF version.

Update: Trey Givens raised a good point in the comments about point 7 ("Allow providers to repackage and reprice their services under Medicare/Medicaid").

My $0.02: Eventually, the government should get out of all providing health insurance since that's outside of its basic function of protecting individual rights. But point 7 could be a transitional step towards eventual complete privatization of such programs. As Lin Zinser and I discussed in our TOS article on "Universal Health Care", those programs can't be eliminated overnight.

I personally believe that #7 could be an appropriate part of the process of phasing them out. (I'm not necessarily speaking for my co-author Lin on this matter.) Thanks, Trey, for pointing this out!

Taxing MDs in Michigan

Michigan Governor Jennifer Granholm has revived the idea of taxing physicians to help make up the state budget deficit.

It would be like trying to solve the hunger problem by taxing the farmers who grow food.

Between the predicted 21% Medicare cuts and these additional taxes, I expect many Michigan physicians will either stop accepting indigent patients or just leave the state.

With the apparent stalemate at the national level on ObamaCare, we'll see more state-level action such as this. Will states attempt more government controls (as Michigan), or will they adopt genuine free-market reforms?

Ralston OpEd: "Health care fight: What's next?"

The February 10, 2010 Orange County Register has published the latest OpEd by Richard Ralston entitled, "Health care fight: What's next?"

Here's the opening:

The pause seems to be ending in the inept debate in Congress on health care. After a year of struggle, some comfort might be taken from the fact that neither of the monstrosities passed by the House or the Senate has become law.

However, truer than ever is the adage that "no man's life, liberty or property are safe while the legislature is in session." The change of one Senate seat is not a solid foundation to protect us from the threat of massive government intrusion in American medicine. And President Barack Obama's State of the Union address indicated that all the worst features of last year's House and Senate bills are likely to come roaring back.

If the best defense is a good offense, real reforms should be put forward now that permit better and more affordable health care and that expand, rather than restrict, personal choice and freedom.

(Read the full text of "Health care fight: What's next?" for more details on genuine free-market reforms.)

Ralston also offers the following excellent guidelines for our politicians:

The best way to evaluate reform proposals is, first, to determine the direction in which they would take us. More government spending or less? More or fewer taxes? More or fewer government agencies? More freedom and choices, or more obedience to rules, regulations and mandates? More decisions by physicians to best meet the unique condition of each patient, or more government enforcement of "protocols" that physicians must apply to all patients? Privacy for the doctor-patient relationship, or the turning over of all personal medical records to the government so it can monitor and supervise doctors' decisions?

President Obama has asked Americans to give him their own ideas on how to reform health care. Ralston has stepped up nicely. Let's hope the President and Congress decide to listen.

(Ralston is the Executive Director of Americans for Free Choice in Medicine.)

Reconciliation Trick Back On The Table

This report from the Washington Examiner suggests it is.

Opposite Trends in Health Spending

The Wall Street Journal notes that "government programs next year will account for more than half of all U.S. health-care spending".

Meanwhile, Greg Scandlen cites a report that "medical costs for individuals in account-based consumer-driven health plans (CDHPs) went down 26% over four years".

To the extent that free markets are allowed to operate in the CDHPs, the costs go down without loss of quality.

Meanwhile, government health spending is following a clearly unsustainable upward trend. As we all know, "if something can't go on forever it won't". The only question is how it will end -- in a controlled rational fashion, or a fiery crash.

Filibuster For Me But Not For Thee

I've already gotten used to seeing various pro-"universal health care" pundits arguing that we should get rid of the Senate filibuster because it causes "paralysis" and makes America "ungovernable".

Here's one typical example from New York Times columnist Paul Krugman, "America Is Not Yet Lost" (2/7/2010).

However, there's also a new argument being advanced by Ben Eidelsen at Slate, "Why the filibuster is OK for Democrats but not for Republicans" (2/8/2010).

Basically, Eidelsen argues that when Democrats use the filibuster it's for the benefit of the majority of Americans, whereas when Republicans do so it's to thwart the majority.

Leaving aside the issue of whether it would be tenable to allow only one political party to use certain parliamentary tactics but not the other, I want to point out that thwarting the majority (in a controlled fashion) is precisely the idea.

In other words, it's a feature, not a bug.

Our founders did not intend America to be a majority-rule pure democracy. Instead, it was intended to be a constitutionally-limited republic, based on the principle of individual rights.

(I fully acknowledge that this principle has not always been consistently respected and/or adhered to during our history. Government-sanctioned violations of individual rights such as slavery represent some of America's most shameful actions.)

The filibuster helps insure that major legislation doesn't pass without some semblance of a broad consensus. Of course, a "consensus" on any issue does not guarantee that it will be correct. But in a rational (or at least semi-rational) political culture, this constraint will help weed out some of the worst ideas.

Hence to the extent that checks-and-balances like the filibuster slow down ill-considered legislation and help protect our individual rights, then I'm glad for this so-called "paralysis".