Everything Costs Something To Someone

Earlier this year, the National Bureau of Economic Research found that the No Slacker Left Behind provision resulted in wage reductions of about $1,200 a year for workers with employer-based insurance coverage -- whether or not they had adult children on their plans. In effect, childless working people are subsidizing workers with adult children who would rather stay on their parents than get their own.
http://www.realclearpolitics.com/articles/2016/11/16/the_slacker_mandate_and_the_safety_pin_generation_132360.html

And, even the benefits are overestimated ...

The Obama White House will brag that the slacker mandate has resulted in increased coverage for an estimated 3 million people. As usual with Obamacare numbers, it's Common Core, book-cooked math. Health care analyst Avik Roy took a closer look and found that the inflated figure came from counting "(1) young adults on Medicaid and other government programs, for whom the under-26 mandate doesn't apply; and (2) people who gained coverage due to the quasi-recovery from the Great Recession."

The Grumpy Economist: Chris Demuth on Obamacare

This is an important point. The alternatives will advance "liberal" values, and give people of modest means better care at lower cost than Obamacare. They "go further and aim higher."  This is not the usual narrative of "people need" government help vs. stingy budget hawks. This is about a better way to achieve the same goals-- and more. 

What are we talking about? In a nutshell, 

Tax and regulatory reforms, and targeted public subsidies, would provide portable and renewable insurance, including for those who have developed costly health conditions; would legalize (rather than banish) low-cost insurance for essential medical services..and would encourage direct purchase of routine medical goods and services where insurance has nothing to offer but paperwork.

http://johnhcochrane.blogspot.com/2013/12/chris-demuth-on-obamacare.html

TANSLFL?

To begin, health care in Canada is anything but free. The average Canadian family of two parents with two children (similar to Walt’s family in the drama) pays approximately $11,320 in taxes for hospital and physician care through the country’s tax system, in addition to — for those who buy it — the cost of private insurance for things such as dental care and outpatient prescription drugs. While overall health care spending is lower in Canada than the United States in comparison to their overall economies, it is certainly higher than in almost any other developed country that offers universal health care.

Canadian Care?

Next comes the question of the scope and timeliness of medical services provided in exchange for this substantial expenditure. Surely such expenditure is justified if Canadians receive a stellar health care system in return for their tax dollars. Unfortunately, that simply isn’t the case. Canada actually has fewer medical resources (physicians, beds, and diagnostic imaging scanners, for example), and performs fewer medical interventions than its American and European counterparts.

In fact, Canada has one of the lowest physician-to-population ratios in the developed world. Add fixed hospital budgets and the monopolization of health insurance by the government, and you get a universal access health care system that also fails to provide access to services in a timely manner. The most recent annual survey of wait times in Canada revealed that patients have to wait approximately four and a half months on average to receive treatment for medically necessary elective procedures after referral from a general practitioner (whom many Canadians also have a hard time finding). While the wait is shorter for cancer patients (about a month), we also have to remember the long wait patients face for access to diagnostic imaging technologies like MRIs (over two months on average) and CT scanners (almost a month on average) which are vital for assisting in making the diagnosis in the first place. Such delays can have large impacts on cancer patients given the possibility that the size of a cancerous tumor doubles every four months.

http://www.american.com/archive/2013/october/hate-to-br-eak-it-to-you-walt-but-its-pretty-ba-d-in-canada-too

Well, I suppose you could say having health care paid for through taxes which insulates consumers from price and quality is the ideal, because it is universal, and "fair" and stuff like that.  But only the naive would think such a system wouldn't have consequences, some predictable and some unexpected.

The expected consequences are rationing, shortages, and wait times including filters between patients and doctors.  Other expected consequences would be quality decreases associated with a disconnect between patients and the service provider.  Unexpected consequences are that you could get better access to diagnostic equipment in Canada if you were a dog or cat, because animal care is not socialized and vets make money by buying good equipment (capital expenditure) to leverage for better patient care.

Who Chooses?

But this little scene -- lobbying for the right to medical treatment -- will play out so many more thousands of times in the future thanks to ObamaCare.

Ultimately, they'll start deciding who should live and who should die not merely on medical grounds, but on political ones -- not just expected life chances, but whether you're living a life they really want to save.

And for anyone who doesn't think that will happen, I have three words for you: I.R.S.
http://ace.mu.nu/archives/340604.php

Who get's to choose in these example of essentially nationalized health care?  The bureaucrats, of course.

Skillfully Killing the Straw Man

At that point, the freedom-crushing regulatory burdens of Obamacare may turn into a blessing. And this, of course, is the entire concept of insurance. Insurance is the spreading of risk. What distinguishes health insurance from insurance against, say, fire, is that insurers can make a much better guess which customer is likely to need medical care than which is likely to have their house burn down. Some people are bad actuarial health risks, and some people are good actuarial health risks.

That's the whole dysfunction of our horrendous health-insurance system. The individual health insurance market is a tragic mess: People who need insurance the most can't buy it, while the only people who can afford insurance don't need it. That's the reason for health-care reform.

The objections to health-care reform present themselves as if they've uncovered some kind of nightmarish bureaucratic inefficiency. What they've actually discovered, to the extent that they aren't simply misleading people, is that a functioning insurance system takes money away from people who are healthy. Likewise, fire insurance screws people whose houses will never burn down.
http://nymag.com/daily/intelligencer/2013/06/obamacare-a-war-on-bros.html

It sure is easy to kill a straw man.

In this case, the straw man is the concept of health insurance being an example of market failure.  In contrast, is was a market long "mal-nipulated" by the government.  At this point it is becoming illegal to buy a policy that insures one against catastrophic disease, and instead we are forced to buy pre-paid service plans.  We don't buy those for our cars because they are too expensive!

"A Useful Idiot"

This is worth a read, if you like bending your head around big numbers.  The takeaway - the people in this country are spending an absurd amount of money on "healthcare".  The questions:  What does "healthcare" mean in this context?  Where is the money coming from and why do we spend so much?  

My answer:  "Healthcare" means keeping sick people alive a long time by the use of drugs, without having any idea how to prevent or cure disease.  Nor are there any studies planned which would provide the answer for how to prevent/cure disease - even though nearly everyone agrees these diseases are "lifestyle related."  

The money comes from you, and we spend so much because we're stinking rich, and secondarily, because the government's interventions have created mal-incentives which have, in the words of Michael Porter, broken the value stream between the provision of health care and the consumers/purchasers of health care.

The author of the piece displays the normal confusion about what science is, and about how to understand what could make us healthy, and about the value of the opinions of experts (he loves to appeal to authority whenever convenient).  He shows a naive trust in government to come up with solutions - and completely ignores all the ways the government caused the problems that he points to.  He writes as if he believes he's smart and well enough informed on these topics to offer important insight.  "Not so much."  He is, literally, a useful idiot.

His analysis of economics is to real economics what most football predictions are to truth, and this one comment - "Dean Ornish, the San Francisco-based doctor who probably knows more about diet and heart disease than anyone" - proves he's utterly uninformed as regards health, diet and science.  Or, perhaps it proves he's writing to an audience that is not interested in genuine inquiry.  In short, he's an editorialist not a person to be taken seriously for analysis.

But aside from my temptation to hold him in "contempt of knowledge" for those and other sins of ignorance, he makes one very important point - we divert an immense amount of human effort into keeping sick Americans alive.  The dollar value on that effort is in the trillions.   Here are the stakes: 

For the first time in history, lifestyle diseases like diabetes, heart disease, some cancers and others kill more people than communicable ones.  Treating these diseases - and futile attempts to "cure" them - costs a fortune, more than one-seventh of our GDP.

Those are potent facts.  The author links to this article, for these numbers:

In 2008, the country spent $2.3 trillion on medical care, or 16.2 percent of gross domestic product and $7,681 per person.

His story is riddled with the ridiculous, like this appeal to an authority which is as responsible for the growth of lifestyle disease as any:

This isn't just me talking. In a recent issue of the magazine Circulation, the American Heart Association editorial board stated flatly that costs in the U.S. from cardiovascular disease - the leading cause of death here and in much of the rest of the world - will triple by 2030, to more than $800 billion annually. 

Well, it's not him just talking, it's a editorial board - of an organization with a track record of ignoring the holes in their advocacy of health solutions, and for making many dollars for endorsements of the food industry.  Heck, opinions from editorial boards, that's scary and convincing wouldn't you say?  Perhaps I'd be more convinced if the AHA had been funding a true test of what diet is best for prevention of the diseases of civilization. Instead the AHA put both feet into the "fat makes you sick" non-science.  The AHA is a joke, and gives every appearance of being an industry mouthpiece, existing primarily to raise funds through the licensing of their logo, with little evidence they are helping a single living soul.

The author employs results from epidemiological studies to represent things they can't possibly represent:

The INTERHEART study of 30,000 men and women in 52 countries showed that at least 90 percent of heart disease is lifestyle related; a European study of more than 23,000 Germans showed that people with healthier lifestyles had an 81 percent lower risk.

Those "studies" didn't show any such thing - they can't since the science has not even determined what "healthier lifestyles" are.  If science HAD made that determination, epidemiological studies still couldn't show what causes what.  That's not to say that I doubt the results, the larger point to me is this is an author who cites faux science and then says "let's just give this problem to the US government to solve."  Seems to me that since the US government is a top purveyor of faux science that solution could be problematic.

The crux of the article:

But the trillion-dollar question is, "How do we get people to eat that way?"

I don't have an easy answer; no one does. But it for sure will take an investment: it's a situation in which you must spend money to make or save money. (Yes, taxes will go up, but whose taxes?) Some number of billions of dollars - something in the rounding error area - should be spent on research to figure out exactly how to turn this ship around. (The NIH, which pegs obesity-related costs at about $150 billion, just announced a new billion-dollar investment. Good, but not enough.)

I'm amazed anyone lets anyone get away with saying "investment" as regards the government taking your money and spending to burnish the credentials of one politician or another.  It's black humor of the higher order.  Picture a highwayman holding you up saying "Look, this is an investment, I'm going to use this money to make me look good in the eyes of others, you can feel good about giving me your money!"   

As to the NIH (to their credit, the NIH did refuse to lie and say that there was proof of the "fat will kill you" conjecture) has proved to be incompetent in even determining what a healthy diet is; they spent a billion and came away with nothing in 30 years of trying.  Now they are supposed to skip that step and dive into figuring out how to get us to eat according to this author's strongly held belief about diet and health?  Before the NIH could viewed with credulity, how about they get their business into one sock and fund legitimate tests to determine what factors result in the diseases of civilization?

Again the author appeals to authority (count me skeptical about the "experts"):  Experts without vested interests in the status quo come to much the same conclusion: Only a massive public health effort can save both our health and our budget.

Perhaps these are the experts that have us eating 11 servings of grains per day, low fat milk, and advising the use of industrially produced polyunsaturated oils - none of which has been tested via intervention study to prove they are "healthy", or even tolerable.  But lets say for a moment they are what he portends them to be - if I have ten experts and you have 11 and they disagree about exactly how the government should take your money and "invest" it to save the world - what do you think will be done?  Correct.  Whatever the politicians think has the best chance of making them look good.  

Recap to this point:  the government which encouraged us to stop eating fat based on faux-science, and encouraged us to eat sugar and fructose, and who's agriculture wing makes it expensive and sometimes criminal to eat grass fed animals but pays union "inspectors" to watch while animals are mass slaughtered, is the only possible agent to fix the world wide problem of metabolic syndrome which leads to virtually all "lifestyle diseases."  These people live in Reversoworld.  The bad stuff that inevitably results from governments messing about in things that governments have no business messing in, creates all the justification needed for more messing about.  Perversely, after the government made us sick peddling agricultural products which have no proven "healthy" quality, they now spend our money - waste our money? - to pay for our "health care."  This is painting oneself into a spending corner on a scale only a government could accomplish.  

One last bone to pick - the author counts each "lifestyle disease" separately - cost of treating high blood pressure, cardiovascular disease, diabetes, gout, diverticulitis, many cancers, etc.  But even though he sees, and the experts he believes so faithfully in see, the nutrition-as-one-cause-of-lifestyle disease, they can't seem to put two and two together to think of these disease states as a spectrum of results caused by one problem.  They see them as discrete disease states caused by discrete lifestyle factors.  Hypertension - oh that's exercise, salt intake and obesity related.  Diabetes - results from obesity and eating too much fat.  Cardiovascular disease - too much saturated fat and inactivity.  Short version - people eat too much and move too little, resulting in obesity, which causes diabetes and other stuff.  They believe this wholeheartedly, seemingly unquestioningly, despite what should be a glaring fault - it is not proved.  And given that, it would seem that step one would be to fund the tests which would convincingly yield causality in this chain of conjecture.  

Here's what I think and this is what I see - when you treat people for glycemic control by restricting the type and quantity of carbohydrates - with specific attention to industrially produced polyunsaturated oils and all highly dense carbohydrates - all of the other outcomes are affected.  Obesity and abdominal circumference is affected.  Fasting lipids (best markers for CVD available) change for the better.  High blood pressure resolves for most.  Gout treatment is not required.  All of the short term markers for health can be manipulated with one intervention - carbohydrate restriction.  Intervention experiments out to one year support these observations, and these tests have been repeated and the results confirmed.  The author and his experts ignore this significant science.  It would be just fine with me if they keep their hands off of government efforts to make people "eat better."

Side note for econ geeks:

I don't know if he means to do it or not, but he also points out how meaningless it can be to say "private sector spending" versus "public sector spending."  

Of this $2.3 trillion, the federal government spent $817 billion, while state and local governments spent $290 billion. The tax exclusion for employer-provided health insurance amounted to about $250 billion in lost federal revenue — which is, effectively, a government subsidy for health care. Add up all of these sources, and you get about $1.35 trillion of health spending done by the public sector and slightly less than $1 trillion done by the private sector.

In other words, some health care spending results after government takes it away from taxpayers at gun point, and spends the money on someone.  Other health care spending results due to government incentives to avoid taxes by accepting very expensive "insurance" (pre-paid service plans which are call insurance) in lieu of taxable benefits.  The other half of health care spending comes out of the pocket of the customers who get the benefit of a doctor's care at the time of payment.  Where does all the money come from?  You and me, either via the government's coercive extraction via taxation, or via insurance we choose based on distortions in the "insurance" markets.  What would this system look like without the influence of a government which is influencing nearly every part of the US health care process?  It's hard to say but it wouldn't look anything like the one we have.  Given that government's influence is pervasive in this process, I'm at a loss why anyone would assume that more government is the cure.  But the author is in that camp of the naive few who seem to think the problem with US health care is that there's not enough government coercion being thrown around.  

Economics can show how wealth is created - when human energy is expended transforming copper into electrical power lines, or plastic and other raw materials into coffee makers, or bricks, or shingles, or automobiles, the result can be a product which has more value than the raw materials that were put into the end product.  Generally, a successful product is one which allows human being more free time to do as they choose, while spending less time on food, water and shelter.  Wealth is, in this model, the ability to spend time on something aside from satisfying your basic needs for continued life.  

What this means for "health care" is it creates value in a variety of ways; illness prevented, minimized and/or cured, allows a person to produce wealth.  Money poured into "health care" can produce more wealth by creating new technology (drugs, diagnostic machines, knowledge, application of knowledge via delivery process, training of medical staff), as well as by making sick folks well or preventing illness.  In other words, there is spending on outcomes and spending on capacity which eventually improves outcomes.  You can buy as much healthcare today for $100 as you could in 1970.  The difference now is that there is more health care you can buy, because the system has created a lot of "wealth".  Arguably, it's been the wrong kind of wealth.  The wealth we needed was to know how to avoid the diseases of civilization - determining why aboriginals exposed to civilization degenerate in health until they are as unwell as we are - and instead, we've been sorting out how to survive (but not how to avoid or thrive through these diseases).  Perversely, much evidence suggests the "knowledge" advocated by the government has compounded the diseases of civilization.  

In short, as the author suggests, most of the money spent on "health care" needn't have been spent, and need not be spent in the future.  The stakes are momentous - and that's understatement.  The military points out that the biggest national security threat the US faces is the insolvency of the government via medicaid.  The President has stated, more or less, that medicare is the sum total of our budgetary problems.  The math as of a few years ago was pretty telling - barring some massive increase in US economic growth, by 2042 the government will have enough to pay for medicare and the national debt payments only - no defense, no salaries for government employees, no nuttin' but health care for old folks and the payments on our debt.  Long before then, we enter the death spiral of scared investors needing higher interest rates to make giving us their money seem smart - how long do you think we could survive that.  

US government has, by intruding into healthcare and diet, created the possibility of it's own demise.  Our government has become a black hole of productivity.

For now, I'll restrain myself from addressing all the mal-incentives created by subsidizing and enabling patients to pay for meds that sustain their lives to some degree while allowing them to ignore the root cause of their disease.

Don't Want Help Screwing This Up

Last week, with the Fourth of July looming, I was able to get a quick CT scan to rule out appendicitis for one patient, and an ultrasound of the legs to quickly diagnose a blood clot for another. Tests like these - ordered solely on the basis of my medical intuition - may not be possible in a few years. Since in both cases the symptoms weren't "textbook," I would probably have had to appeal to some Kafkaesque committee, wasting precious time; in an extreme instance, this could even cost a patient his or her life.
http://www.nationalreview.com/articles/306578/obamacare-storm-coming-marc-siegel

The doctors have screwed up medical care pretty well via their "drug deals" with the insurance industry, government, the cartel on medical licensing, and the monopoly on medical training.  They clearly do not want more "help" from elitist government health care bureaucracy - and who could blame them ...

Negative Unintended Consequences

If not, the cost of government-mandated insurance could simply lead those businesses employing 57.9 percent of Oklahomans to drop employee coverage and take the tax hit as the cheaper option. Those workers would then be required to get coverage through either Medicaid or a health exchange. Oklahoma may not expand its Medicaid program, so scratch that idea. As we've noted, Medicaid expansion would likely divert money from schools and roads.


The federal government will provide worker subsidies, but only if you buy a policy through a state exchange, not one established by the federal government. But Oklahoma officials may not set up a state exchange. And if they do, Oklahomans will be paying federal taxes to pay themselves subsidies, which makes as much sense as anything else in Obamacare.

Read more: http://newsok.com/obamacare-a-minefield-for-workers-in-oklahoma/article/3691058#ixzz20KY3Iv8S
http://newsok.com/obamacare-a-minefield-for-workers-in-oklahoma/article/3691058

Nuff said.  This won't be pretty.

The Healthcare Myths

Myth #1:  Healthcare prices have soared in the recent past
Myth #2:  The pre-ObamaCare system was ‘insurance’
Myth #3: Stopping insurance companies from charging based on pre-existing conditions is the one good part of ObamaCare
Myth #4: Healthcare costs are very high in the United States compared to socialized countries


http://www.american.com/archive/2012/june/the-healthcare-myths-we-must-confront

Myth #5: if a bunch of smart people thought it over, they could figure out a way to get maximal health care to anyone who needs it and we'd all be better off; if only they could just get control of things and run it down to the last detail ...

Obamacare just doubles down on stupid; it stops none of the above, and just adds more governmentium, a toxic substance known to create unintended negative eventualities.

Health Care Metrics - Fascinating

A very interesting analysis with unpredicted findings - health outcomes vary widely and when examined, it is not clear why (except poverty itself is a consistent predictor of "poor" health).
http://www.economist.com/node/21552220/print

Taking Health Care's Temperature

When was the last time you saw prices posted in a doctor's office or hospital? Yet price is the key means through which information is transmitted, at least in functioning markets. There are many ways to make sure that the poor and seriously ill get medical care, including direct subsidies that don't undermine the price mechanism. But the complexity of accomplishing this goal in a hyperregulated health-care industry overwhelmed the system.
If the justices do send ObamaCare back to be rethought, politicians should address the problem with more humility. We'll know health care is on the road to recovery when basic information such as clear rules and transparent prices are again part of the system.
http://online.wsj.com/article/SB10001424052702303302504577327752347952344.html

Mirror Mirror, Who Is Ugliest Of All?

A college professor provides his expertise on what we should or shouldn't spend on defense, but happily ignores the other side of the ugly government contest - absurd expenditures for failing social programs. 

These are two equal and inevitable halves of the reality of government spending.  Both waste absurd amounts of money, and both are virtually unaccountable for any level of corruption, incompetence, and injury to the taxpayer.  One of the prime virtues of these aspects of government is that they so flawlessly demonstrate the folly of the 'fatal conceit.' 

I'm a little more sympathetic to the F-35 because there's a better chance that it will work - deter wars - than the social programs will.  I'm also slightly more sympathetic the F-35 because national defense is a legitimate, constitutionally authorized use of the coercive monopoly of the government.  If the government weren't stuck on being all things to all people, if it were still constrained by the intended constitutional constraints, it is remotely possible that politicians would get serious about a cohesive national defense strategy that could lead turn geopoltical change - nah, just kidding, that's absurd I know.  But seriously, Americans apparently expect people who are good at the art of politics - at being all things to all people whilst representing themselves to be selfless servants of the public good even though we the (gullible) people pretend not to know that the only folks who would chase political success are those with monstrous ego, ambition and desire for recognition - to also understand national defense AND health care public policy (such as it is) and other complex economic issues, nevermind the constitution? 

I heard today the US may eclipse a 14 trillion dollar nation deficit - and even that number must be qualified because there are many ways to count the deficit depending upon what your agenda is - and the author wants outrage over a trillion dollars in defense spending spread over the probably 25 year lifespan of the F-35, which is THE future plane for Air Force, Navy and Marines (replacing F-16s, F-15s, AV-8Bs and F-18s).  If he wants to convince me, he'd better come up with an alternative because it won't be much cheaper to just keep flying the remains of the existing force.  Those of us in the military have been looking for years at the projections for growth of entitlement programs and could see this clash coming, as they say, a mile away.  The irony of using a failed government system of entitlements as justification for cancelling the F-35 won't be lost on everyone.

Government procurement of anything is plenty ugly, at least there's a reason to make ugly defense purchases.

Bailey Notes Chait's Blinding Partisan Blinders

The following is posted in it's entirity for a glimpse of an interesting tale.  It's a great read for a numbers angles, but most significant to me is how wrong someone could get it in support of their partisan angle whilst sustaining credibility on the partisan stage.  I thought perhaps only Krugman could be so wrong for so long and still have an audience.
_______________________

I was amused yesterday to find out that Matthew Yglesias over at the left-leaning Center for American Progress has stumbled across my 2004 article "Mandatory Health Insurance Now!" and sent out this tweet to his fans:

"Excellent defense of the individual health care mandate from @Reason: http://ygl.as/iaydWc"

Excellent defense? Well, not really a "defense" but an alternative to really bad ideas like a single payer plan. But thanks, I guess.
Not suprisingly, The New Republic's chief left-wing ideologue Jonathan Chait picked up the ball tossed by Yglesias and ran with it. He quotes a bit of it and then writes:

The article proposes a plan centered around an individual mandate as a private insurance alternative to the "creeping socialism" proposed by John Kerry, who was then running for president. Now, of course, Reason considers an individual mandate a massive imposition upon freedom and even unconstitutional. (Indeed, Roger Vinson's ruling that the individual mandate was unconstitutional cites a segment on Reason TV.) Now, the plan as a whole is far from identical to the Affordable Care Act. But its defense of the individual mandate is virtually identical to the case liberals have been making, and which conservatives and libertarians have been angrily dismissing.

Far from identical to ObamaCare? Well, yes.
ObamaCare involves a massive expansion of Medicaid; does not promote health savings accounts as a way encourage consumers put price pressure on health care providers; continues to link health insurance to employers; punishes companies for not covering employees; enforces the mandate by means of levying tax penalties on citizens; and will eventually attempt to restrain spending by turning insurance companies into utilities by bureaucratically setting their rates.
BaileyCare would enable all Americans to purchase health insurance in a national competitive private market. It would completely eliminate Medicaid and S-CHIP (and possibly even Medicare) and use those funds to provide vouchers to poor Americans helping them to buy private insurance in a competitive market. It also would completely delink insurance from employment; it is a consumer-driven plan that combines high-deductible catastrophic insurance with health savings accounts with the aim of using market competition to rein in health care expenses. Vouchers also mean that there would be no need for tax penalties to force people to buy insurance.
So why did I offer BaileyCare as an alternative to what eventually evolved into the economically and medically absurd mishmash that is Obama's Affordable Care Act? As I wrote:

I want to stress that mandatory health insurance is a second-best proposal. A totally free market system would be preferable; it's just not likely politically. Mandatory health insurance is a way to stop creeping socialization and preserve private medicine.

In any case, the intellectually blinkered Chait goes on to declare:

In any event, watching the right decide a policy it once advocated is not only unwise but a threat to freedom itself is a fascinating episode of ideological hysteria.

Right? Advocate? Never mind that political and intellectual subtleties are lost on uber-partisan Chait. Clearly, what I did not attempt to do in my 2004 article was offer any sort of analysis of the constitutional or legal status of a national health insurance mandate. Fortunately, Chait links to just such analysis done by my colleagues at Reason.tv. For excellent analyses of the flaws in ObamaCare I heartily recommend the work of my colleague Peter Suderman. For further analyses of the legal and constitutional aspects of ObamaCare please see numerous articles by my Reason colleagues here.
In the meantime, as we wait to see how the federal courts rule on the constitutionality of a health insurance mandate, I hope that I can count on the Center for American Progress and The New Republic to advocate the repeal of ObamaCare and support the adoption of the BaileyCare private health insurance plan.

On A Mission From God

"McDonald's may get a waiver, but I like the Cato Institute's Michael Cannon's take on that: "Sorry, but I don't find it comforting that Obamacare gives HHS the power to waive these regulations on a case-by-case basis. Power corrupts. We've already seen HHS Secretary Kathleen Sebelius use other powers granted her by Obamacare to threaten insurers who contradict the party line."
In a letter to the trade group America's Health Insurance Plans, Sebelius wrote there would be "zero tolerance" for companies that attribute "unjustified rate increases" to Obamacare. "Simply stated," she wrote, "we will not stand idly by as insurers blame their premium hikes and increased profits on the requirement that they provide consumers with basic protections."
In other words: "We have repealed the basic laws of economics. Insurance companies must now give people more but not charge them for it. If you do charge more, you must not tell your customers why. Shut up, obey, and don't complain. We are your rulers.""
http://www.realclearpolitics.com/articles/2010/10/06/congress_cant_repeal_economics_107445.html

Hey John, don't you understand?  They are on a mission from God, they can repeal economics because they are doing GOOD!  You should just stand back and let them act on their good intentions, don't be so damned selfish about your liberty!

Disagree with Dr. B?

The following posted in response to this post:  Reports of the Earth’s Death are Greatly Exaggerated

I wondered if I would ever disagree w Dr. B. In this case, I do. Industrial agriculture achieves its incredible outputs at great ecological cost - I don't think even Dr. B could argue that point. Among other things, we have an industrial food chain that cost shifts both the environmental costs and the cost of production - that is to say, the low cost we pay at the point of sale hides the real costs of these foods due to the market distorting interventions of the USDA.

The ecological damage of the current USDA manipulated agricultural model is based on a crude oil made into fertilizer system which makes the land unusable for any other purpose, and delivers significant pollution to streams, rivers and the Gulf of Mexico (which, as commons, are not defended well as they would be if they were private property). The industrial model also requires the use of significant irrigation, the long term consequence of which is inarguable over-salinization and therefore sterilization of the land; it has been known since biblical times that 'salting' ruins the agricultural potential of land.
If the USDA/industrial model emerged as a result of markets, I would have some reason to believe it is the best available option, but since it is the direct result of USDA manipulations, and the agricultural cartels (which have undue influence over the more than 150,000 employees of the USDA), there's every reason to believe there are more sustainable methods of agricultural production which might well be both less expensive at the point of sale, but also would produce higher quality food, and have a less negative ecological impact (or positive impact). One excellent example of an alternative farm, which I request that Professor Boudreaux examine, is Joel Salatin's Polyface Farm. His innovative techniques provide outstanding yields with minimal processed feed and no use of ammonium nitrate. The Polyface model does not hide or shift costs, and would beat the industrial model easily in point of sale cost if not for the interventions of the USDA which subjects his model to absurd industrial agricultural policies - making his product slightly more expensive at the point of sale, if far better in quality, than that which the USDA/industrial food chain produces. A very accessible introductory read on the topic is the imperfect but good "Omnivore's Dilemna" by Michael Pollan.
It's far too large a topic to expound upon in this post, but a massive, negative, unintended consequence of the USDA/industrial food system is that low cost at point of sale, poor quality foods - high fructose corn syrup, processed cereal grains, over processed grain fed dairy products - are rapidly driving US health care costs through the roof (hyperinsulinemia and all related 'diseases of the West' - http://fireofthegodsfitness.blogspot.com/2010/08/jeff-volek-on-usda-food-guidelines.html); and the escalating HC costs have become the justification for even greater government intervention and distortions in health care markets. Isn't this always the way it goes ...
In closing - the mixed blessing of the industrial food chain as it operates now is that the very poor can buy very poor quality food at low 'point of sale' costs, but the cost of the system (in terms of total cost, ecological impact, and health impact) is both hidden and shifted. The system exists as it is due market distortions resulting from USDA interventions, including rules that violate your rights to buy food from whomever you would like to. The damage to the average American's health due to over consumption of artificially low priced, low quality food is just another cost of the USDA/industrial food system - paid in human suffering and increasing government intervention in the health care system. The USDA/industrial food production system is "stupidity gone to seed."

"Of Course I Don't Want Government To Run Health Care"

But those who have to live with the NHS and its “bottlenecks’’ don’t always find them so admirable. The British press has been reporting horror stories about the realities of government-run health care. Some recent headlines give a sense of the coverage:

“Overstretched maternity units mean mothers face a 100-mile journey to have baby.’’

“Hundreds of patients died needlessly at NHS hospital due to appalling care.’’

“Cash-strapped NHS trust introduces rationing for common children’s conditions.’’

“Standard of care in some wards ‘would shame a third world country.’ ’’

“Stafford Hospital caused ‘unimaginable suffering.’ ’’

No one can deny that America’s health care system is flawed in many ways. But when it comes to the standard that matters most — the quality of health care provided — our haphazard, expensive, insurance-based system towers above the NHS.

“In Britain 36 percent of patients have to wait more than four months for non-emergency surgery,’’ wrote journalist James Bartholomew in The Spectator. “In the US, a mere five percent do.’’

By one metric after another — cancer survival rates, performance of diagnostic tests, availability of CT and MRI scanners, consultation with specialists — US health care is superior. “British state-run health care,’’ Bartholomew concluded, “is so amazingly, achingly, miserably, and mortally incompetent.’’

http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2010/06/16/dangerous_to_our_health/

Obama Care Failing Already

"Already, businesses small and large are warning of the ill effects of the law's changes to the tax code. In order to generate the nearly $1 trillion necessary to pay for the law, its authors scoured the tax code looking to squeeze out more money whereever possible. And sure enough, within a few days of its passage, a handful of big companies took tax write downs in response to changes in the tax treatment of an existing drug subsidy. An estimate by Credit Suisse puts the total damage across the economy at around $4.5 billion—with $1 billion coming from AT&T alone.

The change involved the tax treatment of a subsidy that never should have existed, but it suggests the extent to which America's health care system is already reliant on government meddling, and how costly expanding the government's role in the system can be. And, perhaps more importantly, a planned investigation into the write-downs revealed that many big corporations are considering dropping their health care coverage and dumping employees onto the public dole."

http://reason.com/archives/2010/05/14/the-cure-is-worse-than-the-dis

One "Small" Step for a Government, One Giant Step for Health Care Reform

http://reason.com/archives/2010/01/20/a-promise-worth-breaking

"President Obama’s proposed tax on especially expensive medical benefits, which he last week agreed to modify in response to complaints from labor unions, breaks at least three of his promises. It still may be the best aspect of a health care plan that otherwise does little to control costs, ostensibly one of Obama’s main goals.

As approved by the Senate, the 40 percent excise tax applies to medical coverage costs above $8,500 a year for individuals and $23,000 for families. Although those cutoffs currently are far above average, they would rise more slowly than insurance premiums, and the Joint Committee on Taxation (JCT) estimates the tax would affect nearly a quarter of Americans with employer-provided coverage by 2019."

"Finally, during his campaign Obama vowed to “change the way business is done in Washington” by eschewing special-interest lobbyists. Yet the deal he struck last week with the unions was a blatant payoff to supporters whose interests diverge from those of the general public. In addition to raising the excise tax thresholds, the compromise allows government employees and union members to escape the tax for five years longer than everyone else.

Since those employees are especially likely to have the “gold-plated” medical benefits at which the tax is aimed, the exemption further undermines what was already a timid, needlessly complicated attempt to deal with one of the health care system’s central problems: the separation of consumption from payment. A better approach would be to make all medical benefits taxable while cutting tax rates or providing offsetting credits—something like what Obama’s Republican opponent suggested in 2008.

Obama condemned John McCain’s proposal, warning, “For the first time in American history, he wants to tax your health benefits.” But that was the same speech (the same paragraph, in fact) in which Obama made his “firm pledge” that “no family making less than $250,000 will see their taxes increase.” In the health care debate, Obama’s habit of reversing himself could turn out to be a blessing."

This was also addressed at length in one of my older posts: http://apolloswabbie.blogspot.com/2007/02/intelligent-policy-idea-from-unlikely.html

How Much Better Could It Get With Liberty Leading the Way?

http://reason.com/archives/2009/12/23/markets-not-mandates
"The typical American might purchase high-deductible insurance policies that cover expensive treatments for chronic diseases such as heart disease, cancer, AIDS, diabetes, and multiple sclerosis, as well as the catastrophic consequences of accidents. Coverage would also include expensive treatments such as heart surgery, organ transplants, dialysis, and radiation therapy. In addition, we'd be able to buy health status insurance that would guarantee that we could purchase insurance at reasonable prices in the future."
"Such policies are available already. The online clearinghouse eHealthInsurance pulls a quote of $131 per month from Anthem Blue Cross Blue Shield for a single 55-year-old male with a $3,000 annual deductible, no co-payment after the deductible, reasonable pharmaceutical benefits, and lifetime maximum benefits of $7 million, with an option for health savings accounts. (With such accounts, consumers make annual tax-deductible contributions, then take tax-free withdrawals to pay for uninsured medical costs.) That was the cheapest plan, but more than 80 other insurance policies were available. As deductibles went down, of course, the prices went up."

My Family, My Government

http://online.wsj.com/article/SB10001424052970204488304574430832455371844.html#printMode
He notes, for instance, that the national health insurance movement rose alongside a larger transfer of responsibility from the family to the state: "Every time the state assumes an additional function such as health insurance, child care or benefits for the aged, the need for close family ties becomes weaker."
But even the state must bond: "It may be that one of the most effective ways of increasing allegiance to the state is through national health insurance." This would have been Bismarck's purpose. "We live at a time when many of the traditional symbols and institutions that held a nation together have been weakened and fallen into disrepute. A more sophisticated public requires more sophisticated symbols, and national health insurance may fit that role particularly well." Updating the public symbols, Mr. Obama says health care is one of the two "pillars" of U.S. prosperity in the 21st century.