The End

"Remember, democracy never lasts long. It soon wastes, exhausts, and murders itself. There never was a democracy yet that did not commit suicide." - John Adams

This is the end of "Politics and Pigskins". I may start another blog in the future, but I am done discussing the subject of politics on a regular basis.

It seems to me the political battle I have been fighting was a losing battle from the start. John Adams was right.

Ironically, I think the battle was over even before I began it. The 17th Amendment of the Constitution (passed in 1913) sealed our fate, by turning the U.S. Senate into a directly elected legislative body. What seemed like an innocuous thing actually set in process the motion by which the United States will inevitably be destroyed. It changed the United States from a republic into a democracy.

The health care bill which was recently passed brought the subject home to me:

"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that justifies it." - Frederic Bastiat

Bastiat was right, and the health care bill is only the latest example of it. Where in the Constitution does it give the federal government the right to determine medical treatments? Where does the federal government get the right to determine how an insurance contract should be written?

Going back to previous examples of Medicare and Medicaid, where does the federal government get the right to determine how much a doctor can charge for his/her services?

The answer to these questions is simple: He who pays the piper calls the tune.

Once "We the People" decided money wasn't important, money was evil, that opened the floodgates to allowing the government to take what it wanted (as Bastiat said, "a moral code that justifies it"). After that, it was a short distance to creating a legal framework to plunder the people.

The next step? Enslaving the people. You think, how can that happen? I tell you, it has already begun. How much time did you spend on your income taxes this year? That is YOUR time, spent working for the government. For free.

With the passage of health care, whose ultimate result will be the death of the health insurance industry, that will leave the government with no choice but to assume the role of third party payer for all health care costs (God forbid we should take on this responsibility ourselves!). Then the government will decide what to pay for and how much to pay. That may sound innocent enough, but do you consider WHO gets paid? All the medical care providers in the country.

What if the government refuses to pay for what the medical provider deems the best treatment? Too bad.

What if the medical provider cannot make a living from what the government will pay? Too bad.

In a free market, if an employer wasn't willing to pay you enough to make a living from your labor, you have options. You can either go work for someone else, or take up another profession. That is not so easy when you have dedicated your life to the medical profession. That is not so easy when you have student loans to pay off for your medical education.

If you don't see it yet, we are in the process of enslaving the medical providers of this country. This is because the moral code of the Left does not recognize the rights of medical providers. It only recognizes the rights of the sick.

But I am not here to argue about the health care bill. That is just a symptom, not the disease. The disease is democracy.

Mind you, I am not recommending a dictatorship or an authoritarian state. No, a simple republic would suffice. Sadly, Ben Franklin was correctly reluctant about our ability to maintain the United States as a republic.

Why am I done blogging about politics? Simply put, political blogging is generally one of two things: I can either preach to the choir, or confront an opponent who will never be satisfied with anything less than my submission to their views. Only rarely does political blogging end in a reasonable discussion of the finer points of what public policy should be.

Preaching to the choir brings no pleasure. Arguing with an automaton who is well-versed in talking points but completely unacquainted with reason also brings no joy. So why bother?

My final message to you: Feel free to read through my past writings, and comment on them. I may even respond to your comments. But I am done with posting.

I leave you with the following thought:

"ALL ANIMALS ARE EQUAL
BUT SOME ANIMALS ARE MORE EQUAL THAN OTHERS." - George Orwell, Animal Farm

This is not something to be desired, but it is what we have.

Obama in Wonderland Part 2

I couldn't help but get a chuckle from the headline for Thomas Sowell's latest opinion piece: Alice in Health Care. I am glad to see I am not the only person who finds the current health care proposals to be on a level of absurdity approaching Lewis Carroll.

Naturally, Sowell nails the true reason why it all seems so surrealistic:

Most discussions of health care are like something out of Alice in Wonderland.

What is the biggest complaint about the current medical care situation? "It costs too much." Yet one looks in vain for anything in the pending legislation that will lower those costs.

Until someone in the government can provide a health care solution which lowers ALL costs, not just the patient's costs, AND provides the same quality of health care, there is nothing to discuss. Anything else is just a trip down a rabbit hole.

Obama in Wonderland

How did we get back on the topic of healthcare? HOW?!

We had already decided: The majority of American people do not want the bull that Obama is shovelling as a healthcare system (translation: government takeover of the healthcare system). Yet we continue with the silly process of watching that great artist Obama fiddling with healthcare, as America burns with debt and unemployment.

As I watch the Democrats in power today, I can't help feeling like Alice watching the incredible events in Wonderland. It has a surreal feeling, as if aliens or demons or some other kind of fictional characters had suddenly taken over the U.S. government.

But here we are, at the tea party, as our cheshire president promises not to tax the overwhelming majority of Americans, while promising them a benefit on top of our already overwhelming debt. Maybe he has a magic pill which will make the debt grow small? We have already seen his magic pill which made the debt grow big.

One thing I can say with certainty: Our government is mad as a hatter...

Money for Nothing

“I think the general broad principle is simply that people who are paying for their own expenses aren't subsidizing folks who simply choose not to until they need money and then suddenly they expect free money. That's -- that's basic concept of responsibility that I think most Americans abide by...penalties are appropriate for people who try to free ride the system and force others to pay for their expenses.” - Barack Obama

Actually, Barack Obama did NOT say that. I took a quote of his (quote link here)about penalties for not having health insurance, and made it about money in general.

This does beg the question: Why is it appropriate to have penalties for lack of health insurance, but NOT lack of money? It would seem to me, in the grand economic scheme of things, you need to have money before you can have insurance, n'est pas?

Mind you, we ARE talking about health insurance, NOT health care, so don't go off on a tangent about denying people health care. This is about money.

But here is a thought for Obama. If you want penalties for not having health insurance, why not try the ultimate penalty: Denial of health care.

The Real Solution to Health Care Reform

Economics reminds us of one simple rule regarding any good or service: If you offer people something they want at a cost of less than it is actually perceived to be worth, they will acquire more of it than they need. Under the rules of supply and demand, the cost is out of alignment, forcing the demand to exceed the supply, which will lead to insufficient supply to meet the demand. In a normal free market situation, the price would increase to pay for the needed increase in supply to meet the demand.

Unfortunately, when the price is set by the government, there is no mechanism to increase the supply without subsidization by the government.

On the issue of health care, there is a way to avoid the whole supply and demand problem which universal health care causes: Only provide those medical procedures and drugs which nobody wants. In other words, provide catastrophic health care only.

No one is going to use too much chemotherapy for their cancer treatments. No diabetic is going to use more insulin than they need (at least not intentionally). No one with a slipped disk in their back will be actively trying to acquire too many spinal surgeries to correct the condition. And people with heart conditions won't be begging for that extra triple bypass surgery.

On the other hand, do we need to pay for abortions? How about every case of the sniffles?

We need to draw a hard line, and let the health insurers take care of the little things, like preventive medicine.

Drop health care now!

Do you want to know why we have nearly 10% unemployment, with possibly more in the future, as our economy stumbles along like an auto accident survivor? Obama is pulling a Nero by fiddling with health care while our economic Rome is burning. While health care is a large portion of our economy, it is not and nor will it ever be all of it. By ignoring the rest of our economy for the sake of taking over this portion, Obama has brought the rest of our economy to a halt.

Consider what you would do if you owned a small or medium sized business (from which most of our economic growth comes). Would you hire anyone now, knowing the government might require you to provide health insurance to them? Would you expand your operations without knowing what new employees will actually cost you? Would you open a new business in this economy?

The longer Emperor Obama spends on his health care folly, the longer it will take the economy to recover.

Who's Disadvantaged?

Frequently in many domestic political issues, such as the debate over health care, we hear the poor used as an excuse for the institution of progressive political programs. Of course, when people argue against the progressive ideas, they are accused of being insensitive to the poor (that is one of the kinder accusations you are likely to hear from progressives), as if the benefit exists outside of any costs.

Even though progressives don't like to hear about costs, they still happen anyway. Whether you raise taxes, or charge fees, or come up with some clever scheme like cap-and-trade, someone has to pay for it.

One of the most politically popular ways is "soak the rich". Even when wealthy people like Warren Buffett support it, it ignores one economic reality: You are taking money away from economic investments. Economic investments create jobs. The more jobs there are, the lower the unemployment rate, and the greater leverage workers have in obtaining better salaries.

In addition, politicians tend to only soak the rich so much, because if they were to REALLY soak the rich, their campaign donations would drop. So they create oppressive tax rates on one hand, and then add in tons of deductions on the other, to effectively allow the wealthy to protect their money (as well as their future political donations).

Naturally, there is only so much the rich can be soaked. Eventually, they will move their money overseas to tax havens, or find ways around the oppressive taxation. Then the progressives have to move to the next most popular golden goose: Corporations. The only problem with this one is that the added costs to businesses have to come from somewhere. Here are the usual victims:

1. Customers. If a business can raise prices to cover their tax costs, they will. When taxes are levied on all businesses, that is usually what happens since even their competition faces the same increased costs.
2. Employees. The workers are the ones who usually face the axe for the added cost of minimum wage increases (Yes, that is a tax, since government gets it's cut of increased income) and other taxes. If a tax is oppressive enough, and the cost can't be passed along to customers, cutting the workforce is the lazy manager's solution. In addition, some companies will move operations overseas to where the labor costs are cheaper.
3. Inefficiency. Unfortunately, adding efficiency is the hardest thing for any business to do, and in many cases takes longer than the business has to accomplish it before the tax takes effect. Most businesses try to do this anyway just to increase profits, so this isn't usually a viable option.
4. Profits. This is the one progressives shoot for, but is rarely possible with ever-shrinking profit margins. In addition, this ends up hurting the shareholders of public companies, who include many pension funds and 401k funds, paid for by regular workers.
5. The business itself. In cases where none of the above are possible, sometimes the business cannot continue. That means loss of jobs, as well as job opportunities.

The next most politically popular way to acquire funds is simple, yet invisible: Print more money. This solution also has it's limits, in the form of inflation, which causes prices to go up. The voters, thanks to public education, are never smart enough to figure out that the higher prices they are paying are due to the actions of their politicians. The politicians can get away with it by blaming greedy corporations, and no one is any wiser.

Finally, the last solution is to raise taxes on ALL taxpayers. The problem with this solution is the burden it places on average Americans. How are you helping the poor by placing a greater burden on the middle class? How are you helping the poor by making more people poor?

All of these solutions have created one major unseen burden on the American people. Consider a married couple with a child or children. By taking money out of their pockets, whether directly or indirectly, the government makes it more difficult for them to support their family. Eventually, the couple faces a tough economic choice whereby BOTH parents must work, and the child/children must be relegated to daycare. With all the government regulations on daycare centers, plus the high liability insurance costs daycare centers face, daycare has become prohibitively expensive, adding yet another burden on working parents, which means even more time spent working and less time with their children.

At a time when too many parents already spend too little time with their children, we want to add to their economic burden with more government taxes? In the case of health care, we want to shift the high cost of health care from the private sector to the public sector? Economically speaking, the best case scenario is the government takes over health care and cuts costs by cutting the overall quality of health care for all Americans. That is NOT what anyone wants in the health care debate.

This leaves the alternative of shifting the "free buffet" of health care from the private sector, which limits the availability, to the public sector, which will give it away to everyone, who will proceed to take advantage of it, causing the demand to exceed the supply and raising the costs for the public sector, forcing politicians to utilize one of the means I described above in order to pay for the neverending rising health care costs.

Little Johnny can forget about seeing mommy and daddy for now. They will be busy providing health care to the poor.

Laffer's Warning

Economist Arthur Laffer, from the Wall Street Journal today:

In 1930-31, during the Hoover administration and in the midst of an economic collapse, there was a very slight increase in tax rates on personal income at both the lowest and highest brackets. The corporate tax rate was also slightly increased to 12% from 11%. But beginning in 1932 the lowest personal income tax rate was raised to 4% from less than one-half of 1% while the highest rate was raised to 63% from 25%. (That's not a misprint!) The corporate rate was raised to 13.75% from 12%. All sorts of Federal excise taxes too numerous to list were raised as well. The highest inheritance tax rate was also raised in 1932 to 45% from 20% and the gift tax was reinstituted with the highest rate set at 33.5%.

But the tax hikes didn't stop there. In 1934, during the Roosevelt administration, the highest estate tax rate was raised to 60% from 45% and raised again to 70% in 1935. The highest gift tax rate was raised to 45% in 1934 from 33.5% in 1933 and raised again to 52.5% in 1935. The highest corporate tax rate was raised to 15% in 1936 with a surtax on undistributed profits up to 27%. In 1936 the highest personal income tax rate was raised yet again to 79% from 63%—a stifling 216% increase in four years. Finally, in 1937 a 1% employer and a 1% employee tax was placed on all wages up to $3,000.

Because of the number of states and their diversity I'm going to aggregate all state and local taxes and express them as a percentage of GDP. This measure of state tax policy truly understates the state and local tax contribution to the tragedy we call the Great Depression, but I'm sure the reader will get the picture. In 1929, state and local taxes were 7.2% of GDP and then rose to 8.5%, 9.7% and 12.3% for the years 1930, '31 and '32 respectively.

The damage caused by high taxation during the Great Depression is the real lesson we should learn. A government simply cannot tax a country into prosperity. If there were one warning I'd give to all who will listen, it is that U.S. federal and state tax policies are on an economic crash trajectory today just as they were in the 1930s. Net legislated state-tax increases as a percentage of previous year tax receipts are at 3.1%, their highest level since 1991; the Bush tax cuts are set to expire in 2011; and additional taxes to pay for health-care and the proposed cap-and-trade scheme are on the horizon.

We CANNOT provide health care for 30 million people without raising taxes, either directly or indirectly. Our economy CANNOT afford a tax increase at this time, with nearly 10% unemployment (closer to 20% if you count the underemployed and those who have quit looking for work).

Providing health care for 30 million people doesn't do us any good if they cannot find jobs to pay for simple necessities of life like food.

If Obama is lying about not raising taxes to pay for his health care plan, and I have every reason to believe he is since he has before, then we need to stop this public option nonsense immediately. Frankly, I would even go so far as to end the business deduction for health insurance. But I will settle for simply ending the socialist stupidity from the Democrats.

Conscripting the doctors

Sheldon Richman may have the best health care post I have read yet, even if it is a bit tongue-in-cheek.

Richman gets to the heart of the matter: Changing the way we pay for health care really does nothing to improve on the current system. As Richman says:

Requiring insurance companies to pay for our medical care misses the point. Where do you think insurance companies get their money? From us! What kind of right to health care is it if we end up paying for it anyway? Obama means well, but his plan is a shell game.

Richman goes on to humorously suggest enslaving the doctors, which is really the inevitable end of the progressive ideal.

But it begs a question: How can progressives claim that health care is important enough to be a "right", and at the same time devalue the providers of that "right"?

A Deficit of Ideas

The following quotes are from President Obama's speech last night (transcript from Fox News):

Finally, our health care system is placing an unsustainable burden on taxpayers. When health care costs grow at the rate they have, it puts greater pressure on programs like Medicare and Medicaid.

If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined.

Put simply, our health care problem is our deficit problem. Nothing else even comes close.

No, our deficit problem is irresponsible politicians spending more than they get in tax revenue. Medicare and Medicaid are just two examples.

Medicaid is a welfare program, period. People who get Medicaid aren't paying for it. Even if they did pay taxes previously, that money was long gone by the time they actually received Medicaid benefits, since our politicians don't let money lie there unspent.

As for Medicare, if you think "I paid into it all my life", you are mistaken. You paid a tax, which the politicians spent on current Medicare expenses, and anything left over was spent on whatever else the politicians decided to spend. But you can be certain it was spent.There was no "Medicare lock box" which held your funds. Can you say "ponzi scheme"?

Even if you believe these programs are necessary, it is economically foolish to give away something for nothing. If grocery stores worked this way, would you be getting steak and lobster every night, or just the food you needed? So why would you expect people with no fiscal responsibility for their own health care to get just what they need when they can get far more? When this happens, the cost of health care rises, not only for taxpayers, but for everyone else who uses health care.

So when Obama proposes a plan which offers more free health care to more people, what do you think will happen to the costs?

For example:

[Insurance companies] will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime.

We will place a limit on how much you can be charged for out-of- pocket expenses, because in the United States of America, no one should go broke because they get sick.

And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies.

Because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse.

That makes sense. It saves money, and it saves lives.

A simple question: Does anyone NEED preventive care in order to live? If they don't have the condition, then the answer is no. Do most people have conditions such as breast cancer or colon cancer? Again, the answer is no. So why should we provide free testing for conditions which will not affect the majority of the American public?

Before you call me heartless, consider this: What happens when you get an incurable cancer? You die. What happens if you DON'T get an incurable cancer? You die. What are we preventing by screening people for cancer? In the end, nothing.

Mind you, I am not insensitive to the horrors of cancer. I saw my mother die from it. But shouldn't we find better ways of treating people AFTER they have cancer? Screening for cancer is NOT 100% effective. Tumors will get missed. Unless you plan to screen everyone everyday, you will miss some. It is inevitable.

The most cost effective approach to cancer is to find a cure for those who have it. THAT will save money and lives.

Speaking of cost effective:

Finally, let me discuss an issue that is a great concern to me, to members of this chamber, and to the public, and that's how we pay for this plan.

Now, Here's what you need to know. First, I will not sign a plan that adds one dime to our deficits, either now or in the future.

I will not sign it if it adds one dime to the deficit now or in the future -- period.

I will not sign it if it adds one dime to the deficit now or in the future. Period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promise don't materialize.

How can Obama say he won't sign the bill "if it adds one dime to the deficit" in the future, and in the next breath claim there's a provision that requires spending cuts if savings don't materialize? We know how our legislators treat such provisions: They just override them as needed.

Consider our government's debt ceiling, which Obama & Co. are calling for raising once again, this time above $12 trillion (see this link).

Can Obama guaranty that any costs which raise our deficit will result in spending cuts? As Bill Clinton might have said, it depends on how you define "raising the deficit". Which spending do you consider within our current budget, and within our current deficit? Technically speaking, unless the total cost of this program exceeds our ENTIRE budget, then our politicians can say that NONE of it is increasing our deficit. It's all those other things we are already paying for that are above the current costs.

Very clever Obama. But Joe Wilson was right: You're lying.

Mr. Rogers gets it right

This speaks for itself:


(special thanks to Jill T. for bringing this to my attention)

Death Care

From the Daily Telegraph:

In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.

But this approach can also mask the signs that their condition is improving, the experts warn.

As a result the scheme is causing a “national crisis” in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, and four others.

“Forecasting death is an inexact science,”they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong.

“As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients."

This is what happens when politics mixes with medicine. Even if Obama and the Obamacare cheerleaders have no intention of making a healthcare system like Britain's NHS, who is to say we won't see this in the U.S. when our government cannot afford to provide wonderful health care for everyone? What happens when our government has to ration health care because the costs have NOT gone down, and in fact have gone up because everyone starts using health care services like a free buffet?

President Obama can laugh off the "death panels" arguments because that is not his intent. But once government controls health care, and it becomes too expensive to provide everything to everyone, what then? By then, it will become another third rail of American politics, and the politicians will be faced with making hidden sacrifices or raising taxes, just as they have had to do in Britain. When faced with a choice of angering all voters, or killing off a few of the already dying voters, which choice is obvious?

Dead voters can't vote against you.

The Rationing of Health Care

I was reading "Confessions of a Health Care Rationer" by Dr. Eric Chevlen, and it occurred to me our entire health care debate is ignoring the inevitable question of health care rationing:

...I have always been opposed to healthcare rationing. But, then, I have always been opposed to aging, too. I have come to recognize the fundamental similarity between the two. They are simply unavoidable evils...The best we can do is to manage them with wisdom and compassion.

It’s a mistake to think of health care as a right. It is not a right; it is a good. Freedom of speech, by contrast, is a right, as is freedom of religious belief. They are privileges that inure to individuals as a consequence of the primordial right, free will. That is why we see them as inalienable. The exercise of these rights does not depend on any action of government, but rather on its inaction. Government may not legitimately interfere with their exercise, but nothing mandates that the government provide us with printing press or chapel.

Health care is different. It is more akin to the other goods which sustain life: food, clothing, and shelter. A well-ordered society exists to protect its members from the unlawful taking of life, and is structured to facilitate its members’ acquisition of these goods.

But health care differs from these other goods: First, health care is not absolutely essential for all people on a daily basis; second, there is an insufficient supply in this world to meet the demand of those who would have it. There is enough food in the world to feed everyone. Hunger and famine are the result of its inadequate distribution, not its absolute dearth. There are enough garments in the world to clothe everyone, and enough roofs to protect all from the rain. Health care, in contrast, is a far scarcer resource. Descartes once remarked that common sense is the most equitably distributed attribute in the world, because we never see anybody who feels he doesn’t have enough. Health care is not like common sense. We often see people who feel they don’t have enough, or at least can’t get enough at a price they’re willing or able to pay.

Until modern times, health care in the United States was distributed as most goods of life are distributed—according to personal wealth. The rich could afford it, and the poor couldn’t. Most economists would exclude this sort of market allocation as a form of rationing by definition. Nonetheless, market allocation is a form of distributing goods within a society, and when there are not enough of those goods to go around, the end-result in the short term is much the same.

Limiting health care’s availability by the criterion of personal wealth rightly offends our sense of the dignity of the individual. Are the lives of the poor not of the same intrinsic value of those of the wealthy? To be fair, it is rare in the United States that poverty alone prevents the uninsured poor from receiving lifesaving intervention in a healthcare crisis. A poor man having a heart attack is not turned away from the emergency room, nor is the poor woman in labor sent away to have her baby at home. (I am not arguing that such enormities never occur, but the fact that such occurrences remain scandalous and newsworthy is a testament to their rarity.) Yet it is equally undeniable that the poor get a lesser share of the preventive care that can maintain health or of the quotidian care for the less dramatic challenges to their health.

First, in answer to his question, "Are the lives of the poor not of the same intrinsic value of those of the wealthy?", my answer is no. Wealth is the mechanism our society uses to determine one's value. Wealth is acquired in accordance with perceived value: Those who offer the most productivity or useful ideas/items tend to have an easier time accumulating wealth than those with little or nothing to offer. We can sit here and point out how our society has some screwed up values when teachers make far less than NFL quarterbacks, but a teacher will only influence a few thousand lives during the course of his/her entire teaching career, whereas a good NFL quarterback may be watched by millions during just one day of his work. Like it or not, a good entertainer DOES have value; however, that is not the source of the problem: The economic reality is we have too many dollars chasing too little value, hence the ever increasing disparity between the wealthy and the poor. But thanks to the recent government bailouts, the politically-connected wealthy have managed to maintain this disparity, instead of facing the deflation which would have brought their wealth down to more reasonable levels. Look at it this way: With deflation, when you have little money like the poor do, the effect on you is actually positive (as prices drop), whereas the wealthy will take a huge hit under deflation as their investments sour and they make less than they did before (assuming their investments don't lose value completely).

Other than that one somewhat misguided assumption by Dr. Chevlen, his article is a must-read. Rationing is inevitable under any third party payer system, as we have seen under our current system as well as other countries where universal health care is present. As Dr. Chevlen goes on to explain:

Rationing must occur, but it need not be admitted. Denying the truth of rationing is more common in government-run health care schemes than private ones, because the government is reluctant to have the people know this ugly fact. Government-run programs, therefore, are more likely to disguise the rationing. This plausibly deniable form of limiting health care is called implicit healthcare rationing, and it assumes many forms. Rationing by termination occurs when patients are discharged from the hospital earlier than is medically optimal. Rationing by dilution occurs when second-best rather than first-best treatment is provided. Rationing by rejection or redirection involves healthcare providers turning away patients whose care will be inadequately reimbursed. This is commonly seen now in the Medicare and Medicaid programs, because those programs reimburse providers at a rate substantially lower than private insurance plans. Perhaps more common than those forms of rationing is rationing by delay, as exemplified by the outrageous amount of time patients in Canada must wait for hip replacement surgery or colonoscopy. The unifying theme in all these forms of implicit rationing is that, without admitting it, they force some patients to forego medical care that they want and are ostensibly entitled to receive.

Private insurance plans sometimes include an element of implicit rationing, but because they are, at heart, contractual agreements between the insurance company and the insured are more likely to ration health care explicitly. The many pages of the healthcare plan describe what is a covered service, which providers will be reimbursed for services, the duration of coverage, the dollar limit, and so on. The advantage of explicit over implicit rationing is obvious: It gives potential customers of the insurance plan information to use when deciding which insurance plan to buy, and gives them clear expectations of services to be delivered. Implicit rationing, by contrast, may have the sweetness of a promise, but is usually succeeded by the bitterness of a promise broken.

...Come, let us speak of unpleasant things. How is health care to be rationed? Who gets the short end of the stick?

While I consider that a classic line, I doubt we will ever have that discussion in any political arena.

Heal as I say, not as I heal

Simple solution for the whole health care debate: Whatever health care plan the politicians decide "We the People" need, they have to use too. No exceptions, no special treatment for politicians. Anything we aren't covered for, neither are they. The same goes for all government employees.

To President Obama: If you want single payer so bad, be ready to live with it too. You want a health care system that is "fair" for all Americans, why should you be excluded?

Defining Health Care's Problems

Let's step back from the health care debate for a moment, and define exactly what the problems are (in no particular order):

1. PATIENT COSTS: Even for the middle class, the costs are exorbitant. Between health insurance and deductibles, health care is becoming a burden on Americans of every class. CAUSES: The main cause is the tax deduction for health insurance, which has increased employees covered by health insurance by giving employers a reason to provide it. In turn, it has created a vast third party payer system whereby those covered under health insurance see little expense in utilizing our health care system. However, employees also see their own health insurance costs rising as employers cannot afford to cover their employees health insurance 100%.

2. DOCTOR COSTS: Doctors and hospitals have found their own costs going up. While they can pass along some of these costs to their patients, it is still a burden on our health care system any way you look at it. CAUSES: Medical malpractice has become a gold mine for the legal system (just ask John Edwards who got wealthy from it). Juries are more than delighted to decide for plaintiffs, since the only ones who they see being hurt are the doctors and the insurance companies. Unfortunately, this view is short-sighted, since insurance companies just pass along their costs to ALL doctors, who further pass it along to patients. There is some disagreement about how much of a burden this is on the health care system, but there is no doubt that these costs get passed along.

In addition, because of the hurdles both insurance companies and government programs put in the way of doctors and hospitals receiving payments, staff must be maintained just to deal with third party payers. These staffing costs also get passed along.

3. TREATMENT/DRUG COSTS: Recent years have seen vast improvements in both treatments and drugs, but also a corollary increase in the prices for these. CAUSES: Medical research doesn't grow on trees. For every advance, there are billions of dollars worth of failures. The only way to recoup these losses is to add their cost onto the successes. In addition, FDA requirements add onto the research costs, without necessarily guaranteeing safety. No matter how much research you do, some problems won't become apparent until a drug or treatment is in widespread use. Regardless, the health care consumer is the one who must bear the burden for these advances.

4. THE UNINSURED: This is a gray area. The number frequently quoted is 47 million uninsured, which is true. The problem is who is included in this figure: low income people, illegal immigrants, people between jobs, wealthy people who can afford their own medical costs, young people who could buy health insurance but don't think they need it, people with pre-existing conditions who cannot get health insurance, and poor people who don't realize they are eligible for Medicaid. The only ones here which should be a concern are the low income people, people between jobs, and people with pre-existing conditions who cannot get insurance. The rest either don't want it, shouldn't have it, or are just plain too stupid to live. CAUSES: The only reason this is a problem at all is because of the overall costs of health care. Would anyone worry about the uninsured if health care was available at Wal-mart prices? In addition, the main reason we have uninsured is because the first three items above are causing the health insurance rates to increase.

5. THIRD PARTY PAYER COSTS: Any costs incurred by third party payers, whether they are private insurance or government bureaucrats, will be passed along to the insureds in premium increases. In the case of government bureaucracies, some of these costs can be passed along to taxpayers. CAUSES: In the case of private insurance, their costs are varied, including everything from mail room staff to stock market losses. In the case of government, their costs are relatively fixed, but you still end up paying for government bureaucracies which have no incentive to perform efficiently. Regardless of whether you are covered by private insurance or Medicare, you are paying for an army of people who perform absolutely no function in health care, other than to pay your bill.

Feel free to add any health care problem which I have not covered above.

Overlooking the Doctors

Within the health care debate, the people most affected are also the people rarely discussed: doctors.

We talk about poor people who cannot afford health care, while ignoring that Medicaid doesn't fully cover the doctor's expenses of providing that health care.

We talk about "greedy" insurance companies, while ignoring the full staff which every doctor needs to get payment from those insurance companies, because patients don't want to have to deal with their own insurance company. That staff also has to fight government bureaucrats over Medicare claims.

We talk about universal medical records, without a thought as to who will actually be entering the data required to maintain this system.

We talk about providing world class health care to everyone, without considering who will actually be providing this treatment.

Any health care debate that doesn't mention the needs and expenses of the doctors is a pointless discussion.

Consider: How would you feel if the government decided to change the way you do your job, without ever consulting you? And by the way, the government will also be deciding how much money you will earn for what you do. Plus you'll be reporting on everything you do, and if a government bureaucrat doesn't approve of your action, you won't be paid for it. Does that sound like a good plan to you?

Whatever you may think of doctors, they are still the 800 pound gorilla in this debate. If they don't like your plan, they can walk, and there isn't a thing you can do about it. Without the doctors on board, there is not a single health care plan that will work.

This is where the whole "right to health care" argument falls apart. If you assume there is a right to health care, you are also indirectly assuming a right to the labor of another human being, specifically a doctor. Claiming a right to another human being's labor is slavery.

Are you willing to bring back slavery to assure your "right to health care"? Good luck selling the medical community on that one.

UPDATE: After writing this post, I came across a better version of it at Mises.org, written by Dr. Maria Martins. A teaser for your consideration:

Medical care is not a right. Medical care is a service provided by doctors and others to individuals who want to purchase it. A patient presents to the doctor with a request for care. The fact that the patient has a serious condition — even a life threatening one — does not entitle him, as his right, to the services of the doctor. To claim that he does means that doctors and others who provide these services have no rights, or that society can deliberately ignore these rights for the "greater good."

...What is a right? The concept of a right defines freedom to act within the boundaries of the rights of others. It is contradictory to claim that a person has a right to a good or service that requires, for its fulfillment, the violation of someone else's rights. If the exercise of a patient's so-called "right" to healthcare imposes obligations on taxpayers to pay for it and healthcare practitioners to provide it, then it is not a right, but an attempt to enslave one part of the population for the benefit of another part.

Please read the whole article (link here).

Social Insecurity

We knew this day was coming, but it is surprising how fast it got here. From Foxnews.com:

Millions of older people face shrinking Social Security checks next year, the first time in a generation that payments would not rise.

The trustees who oversee Social Security are projecting there won't be a cost of living adjustment (COLA) for the next two years. That hasn't happened since automatic increases were adopted in 1975.

By law, Social Security benefits cannot go down. Nevertheless, monthly payments would drop for millions of people in the Medicare prescription drug program because the premiums, which often are deducted from Social Security payments, are scheduled to go up slightly.

Let's get this straight: A government, which cannot live up to it's Social Security expenses, now wants to take over our health care?

A government, which created our current health care mess by providing tax deductions for health insurance, wants to take an even bigger role in health care?

A government, which cannot take care of our elderly, now wants to take on responsibility for all of our lives?

Aside from the inherent stupidity of even considering more government involvement in health care, why are we even having this discussion during an economic recession?

Your health care is in the mail

"People say, well, how can a private company compete against the government? If you think about it, UPS and FedEx are doing just fine. Right? No, they are. I mean, it's the post office that's always having problems." - President Barack Obama

Ironically, when President Obama made the above statement to defend how a public option for health care would not put private health insurance out of business, he actually made the argument against having a public option at all.

But let's take his comparison a step further. Think about the mailings for which you use the post office, versus the mailings for which you use UPS or Fedex. A simple greeting card? The post office is good enough, because if it doesn't get there, it doesn't matter (you can always tell grandma that you sent it). A business package which could cost you a deal? Fedex it.

Health care should work similarly: If you have important health problems, you will probably use the private option. If you are healthy, you will probably use the public option. Unfortunately, like in mailings, this will cause the price disparity to grow between the two options. As more unhealthy people choose the private health insurance, it will become prohibitively expensive, sending more people who cannot afford the private option into the public option. In turn, this will cause them to receive "post office"-quality health care, when they really need it "Fedex".

This begs the question of what the government response will be when the public option becomes more expensive than they expect? If it is anything like their handling of the post office, you can expect funding cutbacks. In health care, that means lower quality, or fewer available treatments.

In other words, the poor people who cannot afford the private option will STILL not be getting equal health care. But what if the government were to force the private insurers to charge the same thing as the public option?

Just consider what would happen to UPS and Fedex if the government forced them to charge what the post office does. Simply put, they would either go out of business, or provide approximately the same quality service you get at the post office.

Translate that possibility to health care, and the results are scary.

On the bright side, Obama's original quote above might be a nail in the coffin of this health care fiasco. At the very least, it should have the opposite effect of what he hoped to accomplish, and effectively kill the public option. If we don't need the post office to mail packages, why would we need a public option in health insurance?

Abortion Deck Chairs

From Fox News:

Health care legislation before Congress would allow a new government-sponsored insurance plan to cover abortions, a decision that would affect millions of women and recast federal policy on the divisive issue.

Federal funds for abortions are now restricted to cases involving rape, incest or danger to the health of the mother. Abortion opponents say those restrictions should carry over to any health insurance sold through a new marketplace envisioned under the legislation, an exchange where people would choose private coverage or the public plan.

Abortion rights supporters say that would have the effect of denying coverage for abortion to millions of women who now have it through workplace insurance and are expected to join the exchange.

Simple question: Regardless of your abortion views, will this issue determine your support of the health care bill?

To anyone who says yes, I say: You are arranging deck chairs on the Titanic.

That said, the hypocrisy on this issue is enormous. For the pro-abortion rights side, they fight for the individual's rights on one issue, abortion, and then throw them away on another issue, health care. When government makes your health care decisions for you, where is your right to decide?

For the anti-abortion side, don't come crying about your religious rights being violated as you violate women's rights to decide what to do with their own bodies.

For those who are simply against public funding of abortions, but not against abortion rights, I ask: If you are going to be fiscally responsible on this one issue, why would you support general health care funding at all? Even in the best of economic times, there are plenty of good reasons not to do this. But in the face of our current national deficit, and our current recession, and our government's reduced tax revenues, this is a fiscal nightmare.

The abortion funding issue is just another request to the band, as our ship of state sinks deeper into insolvency.

The Healthcare Issue

After reading my 50 millionth editorial on healthcare, I have come to one conclusion.

We already have government healthcare. It is in two programs called Medicare and Medicaid. And they do not work.

Both cost too much. In the case of Medicaid, many doctors will not even accept patients with it.

The only healthcare program which has shown the possibility of working: Medicare Part D. The only reason it works? It utilizes competition among private sector companies in order to achieve price efficiencies.

So President Obama wants to provide public healthcare (read: socialized medicine)? I will gladly go along with his proposal on one condition: He has to fix our current public healthcare programs utilizing whatever idea he has for all of our healthcare.

Is it too much to ask for proof that Obama's ideas will work?