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.
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...
...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.
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.
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.
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.
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.
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?
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?
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.
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?
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.
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:
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!
(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.)
(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.)
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.
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.
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.
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...
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!
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!
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.)
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.
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.
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...
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".
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.
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.
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.
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.
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.
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.
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
