Why We Are Angry

Why are conservatives so upset about the Obama health-care bill? Don’t they want medical care for the uninsured? Don’t they want to control the escalating costs of health insurance? Don’t they want people to be able to count on their insurance to be there when it is needed? Well, I am a conservative, by some definitions at least, and I want all those things. And it is pretty close to home for me. I have just undergone a very expensive medical procedure which is supposed to keep me alive. That is a pretty big deal and I didn’t have the money in my checking account to pay for this procedure. I will be paying a small fraction of the cost because I have a good health insurance plan. But I was and am bitterly opposed to the newly passed legislation. Am I a hypocrite? I don’t think so. Let me explain my opposition.

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.

Health-care in 3,200 Words or Less

The Democrats still have the upper hand. If they don’t support a bill it can’t pass, but their total control over the legislative process has been broken by the election of a Republican senator from Massachusetts. So those we elect to represent us now have a choice. What we have had for the last year was World Wide Wrestling. Now it is time for chess. My question is, are the Democrats and Republicans going to play politics or statesmanship?

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.

Democracy As Mob Rule

For all of its virtues, democracy can be a dangerous thing, which can easily deteriorate into mob rule. That is the genius behind the constitution. The founding fathers were concerned about a majority abusing their power at the expense of the minority. That is why we have two houses of congress which are elected in different ways. It is why we have three distinct branches of government, which are chosen differently. It is the reason behind the, often misunderstood, Electoral College, and it is the reason some states refused to ratify the constitution until the Bill of Rights was added. As brilliant as the constitution is, it is not bullet proof. It can still be abused and used to allow a majority to assert their superior numbers and impose injustices upon the rest.

This isn’t as hard to understand as we may like to think. Most of us try to live according to our belief system. That belief system may be skewed by self-interest, but skewed or not it is what we believe. Thus there was a time when many white men and women believed black men & women to be lesser humans, and as such, it was as acceptable to use them as slaves as it was to keep beasts of burden. We may look upon that now and decry that belief system to be barbaric, but people believed it and acted on that belief. The fact that it was believed primarily by people that profited from that belief, only serves to warn us to examine our motives for accepting what we may claim to be obvious truths.

The same holds true of those who believe that it is the government’s role to take care of us. If your belief system is that people can’t be trusted to make responsible decisions, you may logically believe that it is the responsibility of government to make those decisions for them. The obvious pitfall that government decisions are made by people and people who can insulate themselves from the more negative consequences of their decisions is overlooked.

So, here we are with Democrats running both the legislative and executive branches of the government ramming through a health-care bill without regard for the rights, beliefs or protests of constituents at home or Republicans in congress. The arguments originally were that we had to curtail the escalating cost of health-care and provide benefits for the nation’s uninsured. In the headlong race to get something past, we seem to have forgotten the goals.

Republicans wanted to make insurance more affordable, and therefore more available utilizing several methods to achieve that goal. And this without undermining what is arguably working right with the present system.

Much of the cost of medical care today can be attributed to litigation. Between the cost of malpractice insurance, and the need for doctors and hospitals to practice defensive medicine resulting in unnecessary tests and procedures, we are all paying for the jackpot jury awards of the few that call 1-800- SUE-SOMEONE. So it has been proposed that laws be enacted to control outsized medical lawsuits. The Democrats refused to include any such provision in their health-care bill.

Because of an anomaly of wage controls imposed during WWII, medical insurance in our country today is considered largely an employer benefit. This has been codified by the fact that an employer gets to deduct the cost of providing medical insurance as a taxable business expense, without the employee having to declare it as income. Smaller employers often find it difficult to afford to provide health insurance. Even those that can afford it, find that the options available to smaller employers are less attractive than those available to a large employer. So it has been proposed that all health insurance premiums be tax deductible, whether paid for by an employer or an individual or family. The Democrats refused to include any such provision in their health-care bill.

Different states require different provisions in health insurance plans sold in their jurisdictions. The tighter the provisions the more insurance companies have to charge to cover the cost of those benefits. Also, because insurance companies have to apply to each individual state for the right to sell insurance in that state some insurers may decide to market their products in some states and not others. So it has been proposed that we be allowed to buy any insurance policy offered by any insurance company anywhere in the country. This would cause the money to flow to those policies and companies that offered better costs and services, increasing competition and lowering costs. The Democrats refused to include any such provision in their health-care bill.

Democrats have been claiming that they want a bi-partisan bill, but what they apparently mean by that is that they want Republicans to support their bill without using any of their ideas. Their solution is to mandate changes from Washington D.C. Studies have concluded that instead of lowering the cost of health-care, their provisions will increase insurance costs. The Democrats want to provide coverage for all Americans, but they are raiding Medicare, which is already going broke and underpaying for benefits. The Democrats have been vilifying insurance companies, who we can replace with another company if unhappy. Can we expect better from the government which we can’t change and who has the force of law to impose their decisions? The Democrats claim that their bill will not increase the deficit. However, they are using tricks of timing and hiding expenses in other bills to cover their deception.

The majority in congress and the White House are about to take away from us our right to control our health-care. They, aparently, do not think any idea put forth by the minority party worthy of considering. Power does indeed tend to corrupt. Not even the constitution can protect us from all abuses of power if the majority we elect are hell-bent on imposing their rule on the rest of us.

Presidential Speech on Health Care

He may not be succinct, but The President does deliver a good speech. As was true for his campaign for office, he articulated many positions most Americans can agree with. Who wants to see a woman denied coverage in the middle of her cancer treatments? Who doesn't agree that everybody should be able to obtain affordable health care? Who would object to a government run health plan that was completely self-funding, did not compete unfairly with the private sector, and only covered the poorest 5% among us? Who would not want all of those things and have it not cost any money? Who doesn't want there to be a Santa Clause?

The goals the President laid out Wednesday night are accepted by Democrats, Republicans and independents. The debate has always been about how to get there from here. He threw in something of an olive branch on torte reform, though it was either so vague, or I was so stupid that I'm not sure what exactly was being offered.

To continue to demand a government option in the face of the public opposition to it is either dogmatism, arrogance, or political expediency. Expediency being the least objectionable of the three. After all, if he can't get enough votes in his own party to support a bill without a public option, he can't get the bill. He did leave a crack in the door but it is a narrow one. Some think he insisted on the public option then threw it out. That is not the way it sounded to me, but we will see.

Libertarians will have a difficult time with the idea of compelling people to buy insurance. I am among them, but I am a libertarian with a small "L". I am practical too. There are likely three purposes for the mandatory insurance.

First of all, in practical terms everybody is insured now, since it is illegal to deny medical care to those in need. So those who are uninsured can show up in an emergency room and get taken care of without paying for it. So even these people are receiving a minimal level of care now and paying no premiums. Although they may see the doctor less often, when they do see one, it is under the most expensive circumstances.


The second purpose is likely the fact that in order to prohibit insurance companies from denying or canceling coverage, you have to deal with something called adverse selection. That is the tendency of healthy people to postpone buying insurance until they need it. That gaming of the system destroys the concept of insurance as a risk pool, where we all contribute now because we don't know who will need the pooled money (premiums) we have all contributed or when that money may be needed. If we allow people to do that I don't know how we are going to be able to keep premiums at an affordable level.

The third reason is related. That is the additional healthy insureds are a carrot to get the insurance companies to support the program. Thus, this provision may actually be a means to keep the government option out of the final bill because insuring everbody means lower premiums for everybody, thus keeping down health care costs. So I am conflicted about this provision of the plan. There are practical reasons to support it, but their are philosophical reasons to oppose it.



For the sake of brevity, I will only deal with these items for now, but there will be more to come.

We Aren't Enemies

I was debating politics with my step-father several years ago, when part of his argument rolled around to the fact that Barry Goldwater had opposed Medicare. This was meant to be an indictment to prove that Senator Goldwater was opposed to providing medical care for the elderly. The fact of the matter was that the senator from Arizona was in favor of another bill that he believed did the job in a better way.

Recently another relative asked me how families were supposed to afford health insurance if not by the passing of the healthcare bill now before congress. So I gave her a list of things that could be done without gutting and undermining our current system.

In an effort to win votes and support for their side, politicians and interest groups often paint their solution as the only solution to a problem. The corollary is that if you oppose their solution you are opposed to solving the problem. Don't let this hocus pocus fool you. Many, if not most, politicians and Americans want to address inequities in our society. They want to protect us from terrorists, and preserve our civil rights. They want to encourage prosperity for all and provide for a social safety net. The arguments, for the most part, revolve around the methods of resolving problems and ranking priorities. The demagoguery comes into play once a proposal is made by one side or the other and then both sides begin a game of deceit and gamesmanship in order to preserve power and prestige for their party or ideology.

We forget that we are all on the same side. Remember the mood of the country on September 12, 2001? You can argue about some of the decisions that came out of that mood, but we recognized that more important than whether we were Republicans or Democrats, labor or management. we were Americans & there were real enemies out there whose quarrel with us wasn't the methods of achieving our goals, but the goals themselves.

When somebody holds up a banner that says "Healthcare for All", we can all agree with that goal. Just don't get confused and begin to think that if we oppose the present legislation we don't want anything done. That is just a ploy to scare you into supporting something that you may not understand, or with which you may not agree. It is an effort to make you believe that those who oppose this bill are against quality healthcare for all Americans. Be assured, that isn't the case.