Monday, January 21, 2019
Tuesday, November 13, 2018
Saturday, March 27, 2010
Why We Are Angry
The United States is, more than anything else, an idea. Men sat down and talked about how a nation ought to be run. As they hashed out their ideas, they realized that this nonsense of governments ruling people was a false concept perpetuated by those in power. People are born with an inherent right to live their own lives. There are legitimate reasons to band together and form governments, but the power of that government comes from the people. The corollary is that people can’t legitimately give government power they do not have themselves. That idea created the most powerful and wealthiest nation in history. It also created a nation that evolved to eliminate slavery, insist on civil rights for all people, regardless of race, religion or sex and has been the most magnanimous toward conquered foes of any the world has ever seen. That idea has enabled power, wealth and compassion to spring up from the raw material of a new land and the hearts of a free people in a short period of time, in historical terms.
An integral part of that formula that has worked so well is a free market economy. Men and women have been able to utilize their resources to invent and create. It is a free wheeling process that produces some winners, some losers, and some incredible jackpots of success. There are medical treatments available today because people have been able to invest money in an idea, the idea has worked and made them fabulously wealthy while saving and improving the lives of countless others. That kind of thing can’t work without the possibility of profit to match the risk. Philanthropists can’t do it alone. When you invest money in a mutual fund that invests in a biomedical firm you are part of that process. The risks are high. More drugs fail the screening process than succeed, and each failure is incredibly costly. You invest your $100, or $1,000, or $10,000 because there is a possibility of a medical breakthrough that will cure cancer, or diabetes, or enable the paralyzed to walk again. And if it works, your investment will be returned to you several times over. You are contributing a small fraction of the cost, but your small fraction is pooled with thousands of others and that enables medical breakthroughs to happen. It is expensive, but the payoff is incredible. In the new health-care bill, this is going to be harder to do. The government is going to levy taxes on medical device makers that will make those devices more expensive and less available and therefore less profitable. They are going to have more control on what insurance can cover and how much it will pay. That will negatively impact the cash flow that allows medical breakthroughs. That is one problem.
Insurance companies have been demonized during this process because the Democrats needed an adversary to rally the troops. But the villain is not the insurance companies. It is power. Outsized power is always the problem. The ironic thing is that it has been a powerful government that has been persuading people to give them more power in order to remedy an inequity. That doesn’t work, because power is the problem. Power concentrated anywhere is a problem. But power concentrated in government is, perhaps, the worst kind, because it is so hard to take power away from government once it has it, and government already has the power of law and vast resources of institutions to enforce that power, and to do so violently. What the government should have done was not to take more power upon itself, but to give more power to the people to overrule the insurance companies.
One of the biggest problems with the current system is that it removes the patient from the cost equation. So employers, insurance companies, and drug companies are the only players with a significant financial stake in medical decisions, but the patients are the ones that are utilizing the benefits. There is a disconnect here. The government could have given the power back to the people, by allowing anybody who pays a health insurance premium to deduct it from their taxes, and encourage the use of high deductible medical insurance plans in conjunction with health savings accounts. Remove barriers to cross state purchase of insurance (a version of this is in the bill) and implement tort reform to minimize the incentive for doctors to perform defensive medicine.
The bill requires everybody to buy medical insurance. As I have written before, that is an understandable requirement if you are going to mandate that insurance companies take all applicants regardless of health. But this is the government in charge approach, not the freedom of choice approach. What if we incentivized people to buy high deductable medical plans with health savings accounts? What if instead of fining people who do not, or can’t afford to, comply, we provided a tax incentive to those who do comply by buying an inexpensive form of insurance that makes them more aware of the cost of their care? Why does the government opt for compulsion and control instead of freedom and incentive?
Then there is the cost. Any government entitlement has an inherently unknowable cost. The bill, as passed, utilizes some tricks to control the costs as scored by the Congressional Budget Office. One such trick is that the bill includes a takeover of student loans from the private sector. This has nothing at all to do with health-care, but because it is part of the bill, the profit from student loans is included in the accounting. The bill does not address the “doctor fix”, which is an annual dance congress goes through because Medicare & Medicaid underpay severely for medical care. In the case of primary care the underpayments are so drastic that physicians often lose money on Medicare patients. As a result congress regularly makes an adjustment to the built-in reimbursement cuts to primary care physicians. It is still not profitable for them to treat elderly patients, but the “doctor fix” keeps the losses at a more modest level. Because this routine practice is not addressed in the bill, it is using inaccurate revenue savings to come up with its numbers. These are two of several sleights of hand the bill uses to give the impression it can be fiscally responsible. We have a national unemployment rate of 10%, we are clawing our way out of a long and painful recession, and the Democrats have added to our economic burden.
Conservatives aren’t and have never been opposed to health-care reform. We have been opposed to government taking more control of our lives. Several individual bills that addressed the shortcomings in the existing system could have made a significant difference without undermining a system that has worked well for most Americans and damaging an already damaged economy.
Thursday, February 11, 2010
Criminals & Terrorists
Osama bin Laden has declared war on the United States. It is a bit absurd that a religious fanatic in the wastelands of Afghanistan and Pakistan (apparently depending on the day) can declare war on the world’s only superpower and be taken seriously. He doesn’t represent a government, so on whose behalf is he declaring war? It helps to understand that you and I think in terms of national identity. I am American. My grandparents came to this country from Italy, so it appears that Italy considers me to be Italian (it’s complicated). That is how I think of myself, as an American who is proud of his Italian heritage. My religion, family and political beliefs describe some of my characteristics; but I identify myself as an American.
Not all cultures think in those same terms, and we are ill served by insisting that they do. For Muslims in the Middle East, that identity is reversed. Their primary identification is with their religion or tribe first and their country is the modifier. So for us to say that radical Muslims can’t legitimately declare war on us is to insist that they see themselves as we see ourselves. But national boundaries in the Middle East are largely arbitrary, it is tribe &/or religion that is primary. As long as radical Islam has leaders who are willing to wage war on us, and followers and resources enough to carry out that threat, we are at war. At a time when the only entities capable of waging war were nations, it made sense to brush aside such a self-important claim. But when the world changes, if you don’t change with it, you get run over.
What about the rule of law and the justifiable U.S. pride in protecting civil liberties? Both President Obama and Eric Holder have made comments that sounded an awful lot like the conviction and execution of terrorists was a certainty. Those comments themselves go a long way toward harming the image we want to present to the world. Governments that know the outcome of trials before they take place are generally described as totalitarian. Apart from the P.R. harm that kind of rhetoric causes, it is inaccurate. Our system of justice is based on the theory expressed in the 1760s by William Blackstone, that, “it is better that ten guilty persons escape than that one innocent suffer”. Hence our judicial mandate that a defendant is innocent until proven guilty (does that negate my earlier inclusion of Bill Ayers as a terrorist?). That principle frustrates justice and us at times, but there is a reason so much effort is made in our judicial system to protect the rights of the innocent, even if that means some guilty are protected as well. Government, by nature, will tend to be abusive. It was such abuse that motivated 13 colonies to reluctantly declare their independence from Great Britain. Most of us know of examples of people who have committed crimes but were never convicted. Our law enforcement officials are even required to warn people upon their arrest not to say anything that would incriminate themselves. In matters of criminal behavior, those safeguards are important. Criminals typically harm individuals or finite groups of people. War is focused on the submission of the enemy. As such the international community recognizes that different rules apply to war.
In war the need is not to get a conviction in a court of law, but to gather intelligence about the enemy’s plans and strategies. Miranda rights don’t apply here. In war the point is to keep enemy combatants out of the fray so they can’t continue to fight you. Bail, and potential acquittal, don’t apply here. The rules are different. We are not dealing with citizens that may or may not be guilty. We are dealing with an enemy caught in the act of waging war.
There are, admittedly problems with treating the war on terror as a true war. Because of the nature of the enemy, this war can go on for decades. That is a long time to maintain a state of war. Particularly when enemy attacks are intermittent and often comparatively small in scope. We need to figure out a way to be the best of what America is and still protect ourselves from organized attack by religious zealots. We need to be vigilant that we only apply warlike standards to those who are actually waging war on us. But we need to make sure that we take them seriously enough to put an end to their grandiose visions of toppling us. If we don’t, as ridiculous as it may seem, they may succeed.
Saturday, January 23, 2010
Health-care in 3,200 Words or Less
Both parties acknowledge we need health-care reform. There is a legitimate issue as to whether now is the time to pursue it. We have an unprecedented budget deficit, severe unemployment and a shaky economic recovery to deal with. All three of which are arguably more urgent than health-care reform, unless you don’t have health insurance and are or become sick. On the other hand, health-care is on everybody’s mind now. This may be the time to pass a reasonable plan to improve the health-care environment. But are the members of either party willing to set aside extreme positions and pass something reasonable, at the risk of giving the other party a partial victory? I have a few suggestions.
First of all, there needs to be some kind of tort reform. Between malpractice insurance premiums and the need, whether perceived or real, to practice defensive medicine, the cost of litigation drives up the cost of health-care. Actual damages certainly need to be covered, but there ought to be a limit on punitive damages.
Drop the barriers to cross-state purchasing of medical insurance. Let the money flow to where the best coverage, services and prices are. The market will reward those who do well and punish those who don’t.
Make all health insurance premiums tax deductible to the payer of those premiums.
Make it illegal for an insurance company to drop somebody for other than non-payment of premiums, or to deny coverage.
People need help in paying for medical care, but if they are responsible for the cost of care, they will make better health-care decisions. Therefore, make it easier for anybody to buy a high deductible health insurance policy in conjunction with a Health Savings Account (HSA). For those below a certain income level have the government make an annual deposit into their Health Savings Account equal to the premiums plus a portion of the annual deductible. As their income increases above a certain threshold phase out the government paid deposit into their HSA at the rate of $1 lost for every $4 earned over the threshold. Mandate that health-care providers accept payments at low or no interest from patients below some specified income level. These provisions will address the adverse selection problem posed by the mandate to take all comers, as well as eliminate the need to force people to buy insurance that is in the current bill.
Allow insurance companies a reasonable and generous profit, but require that they pay out a certain percentage of revenue in benefits in order to participate in the cross-state sale of their products.
Get rid of the absurd taxes that have been proposed on health-care devices and insurance plans. If you want to hold the cost of something down, you need to lower the cost, not increase it.
There you go. In less than 3,200 words I have just written a comprehensive health-care plan that addresses cost and availability. It does not put the government in the health-care business and it does not gut a system that has produced many of the greatest advances in health-care anywhere in the world. I don’t know what the cost of this would be. It is possible that it could not be implemented until we get the economy rolling better, but it is a whole lot better than what has been proposed to date.
Monday, January 18, 2010
Politically Correct Racism
How careful do we have to be? Are we not allowed to notice what we all see and know? How does that help anybody? Why does it offend anybody? I am overweight and I stutter. I neither pretend nor assume that people don’t notice those things about me. If they are pertinent to a conversation about me, I expect them to be brought up.
Friday, January 8, 2010
Muslim Protesters
A group of Muslims gathered outside the federal courthouse in
Every news outlet in the country needs to make note of these brave Americans. They know, maybe better than most, the risk they take to speak out against the desecration of their religion by jihadists. The silence from Muslims has been a concern to me and a source of condemnation of the entire religion among many. If they haven’t been silent, if it has been the lack of news coverage that has made us unaware of their protestations, then the news media is largely to blame for much of the anti-Muslim sentiment in the country. Nobody thinks that white supremacists represent Christianity. We all know enough about the teachings of Christianity, and we know enough Christians (if we aren’t Christian ourselves) to know that the ideals of white supremacy are anathema to Christians. But that same distinction isn’t as clear for Muslims. It is people like these demonstrators that will isolate radical Islam from Islam as much as white supremacists are isolated from Christianity.
These brave people should be heralded and encouraged. Their being there to proclaim to the world their opposition to the use of their faith to promote hatred and murder will give others the courage to stand up and be counted. I thank them for letting me know they are out there.