TAG | health care reform
Having initially cast aside their usual view that “from those to whom much is given, much shall be taken away” in battling the tax on Cadillac health insurance plans, government and private sector unions have now won a five-year exemption from that tax for their members in an extraordinary show of political clout. I have been wondering recently why there hasn’t been a grass-roots revolt against the favoritism shown public sector unions in the various pseudo-stimulus initiatives. If the unions can get away with this patent injustice towards non-unionized workers, the conundrum only deepens. (The print version of the New York Times’ article on the deal, by Robert Pear and labor reporter Steven Greenhouse, amusingly delays any mention of the union carve-out for four windy paragraphs while extolling the marvels of health “reform,” and then initially only mentions it in the vaguest of terms: “The changes would lessen and delay the impact of the tax on workers.” Um, not all workers. The web version of the article does not bury the lede quite as flagrantly.)
In 2000, commercial jets carried 1.09 billion people on 18 million flights, according to a no-longer-linkable Boeing document. Assuming that the number of flyers has not increased since then, that makes for one would-be underwear bomber out of about 10 billion travelers over the last decade. Does that record represent success or failure? Are we jacking up physical security measures on planes and in airports because we think that the risk of another underwear bomber has risen since Dec. 25, or because we think that our record of prevention over the last decade was inadequate? The notion that we should be able to protect against every terrorist incident is understandable, and announcing that we are not going to try to stop every such incident is unthinkable, though former DHS Secretary Chertoff did make tentative noises in that direction regarding cargo screening. But it’s still intriguing to me why dying in a terrorist-induced airplane crash has a greater hold on the public imagination than driving on the highway, where there are about 40,000 fatalities in the U.S. a year, much higher on a per-mile basis than the number of deaths from non-terror-induced airline crashes, of which there are many more than terror incidents. We do not have a federal agency checking everyone who gets on a highway for driving safety. Terror attacks are intentional, not accidental, so the public policy imperative of sending a tough-on-terror message is arguably far greater than for highway crashes. But that fact doesn’t affect the individual perception of risk, which seems to be influenced by issues of agency, control, possibly even altitude.
Maybe the proper denominator in assessing risk is rather the number of would-be underwear bombers. If the number of would-be underwear bombers is small–let’s say, one–then our security system deserves a huge black eye, but our perception of a huge phalanx of ready recruits would need readjusting. Admittedly, the size of the recruit pool is probably affected by the perception of our security system, so security overkill may be responsible in part for its own disproportionality.
(Contra my impatience with what appears to me to be security excess at airports, one could argue that we approach all activities with similar levels of risk intolerance. The difference is that security measures designed to eliminate even very small risks are constantly being engineered into the design of products–such as cars and planes–making them invisible. That may be. But then people drive while texting and talking on the cell phone [see below], introducing massively higher levels of risk into their own and others’ lives.) (more…)
Following Derb’s vent, I have to get this one off my chest, however elementary the sentiment: If I hear one more Democrat (and occasional Republican) in the House or Senate condescend to business, I am going to throw up. Today it’s insurance and drug companies, tomorrow it’s oil producers, toy companies, banks, chemical manufacturers, or any number of other enterprises that offer necessary or simply life-enhancing products and services. The preening self-righteousness towards for-profit economic activity is not specific to any particular legislative initiative such as “health care reform,” it is part of the psychological make-up of many politicians and huge swathes of educated professionals, including virtually the entire academic world and non-profit sector, the media, and many high-paid lawyers. It is simply unbearable to hear these sheltered senators and congressmen look down upon people who have had the guts to try to create something that other people want to buy; who have had to figure out intricate supply chains and methods of financing; who have had to organize and motivate their employees; and who take financial risks with no guarantee of reward. For the anti-business mindset, the fact that businessmen need to make a profit in order to continue operating renders them prima facie suspect, if it doesn’t outright undercut any claim that they might have to contribute to the public good.
Vermont Senator Bernie Sanders recently encapsulated one fallacy regarding for-profit activity prevalent among intellectual elites: “The point of insurance companies is not to provide health care but to make a profit,” he said, as if these were mutually exclusive goals. Sanders complained that for-profit insurance companies are too bureaucratic and, in a flight of fancy that would have seemed like a fringe conceit just a year ago, asserted that they require government to provide efficiency-inducing competition. The hilarious idea that government is less bureaucratic and more efficient than private sector companies will endure even if the seemingly nine-lived public option finally stays dead. (more…)
The just-negotiated Senate health care bill contains a big new pot of money to make it easier for pregnant teens to raise a child:
The federal government would provide $25 million a year for a “pregnancy assistance fund.” The money could be used for “maternity and baby clothing, baby food, baby furniture and similar items.”
The fund is supposed to encourage more teens to bring their children to term, rather than have an abortion. I am not convinced that increasing the number of children raised by teen mothers represents a win for society. But if pro-lifers want to make sure that every pregnant teen gives birth to a child–a moral position that I understand if not share–they would be far better off trying to revalorize adoption as a solution to pregnancies for which the mother is wholly unprepared. (Of course this “pregnancy assistance fund” may be purely a Democratic ploy to expand both government and dependency, with no support among the Lifers. But the goal of persuading teens to give birth is unquestionably a Lifer one.) Public policy should not be enabling teen motherhood, it should be doing everything it can to discourage it, starting with turning off the money spigot that subsidizes it. Teen motherhood should be made more, not less, onerous, since the evidence is indisputable that being raised by a single mother (regardless of her age) is a high-risk proposition both for the child and for society. As Barack Obama himself noted in 2008, “children who grow up without a father are five times more likely to live in poverty and commit crime; nine times more likely to drop out of schools and twenty times more likely to end up in prison.”
Obviously, this “pregnancy assistance fund” is hardly the first taxpayer subsidy to single-parenthood; garden-variety welfare, despite the 1996 welfare reform bill, still pumps massive sums into single-parenthood, treating it as a sort of unforeseeable act of nature deserving of social safety-net protection.
Teen mothers don’t need more taxpayer-funded “maternity clothing and baby furniture.” They need to learn that having a child at their age is an irresponsible act for which they are emotionally unfit, however much saying so flies in the face of feminist “strong women” propaganda. Adoption has virtually disappeared in the inner city as a response to teen pregnancy, gone into the same black hole as stigma. Pro-lifers would do the country a service by bringing it back.
The furor over the recent mammogram recommendation illustrates how distorted our assumptions about health care and health insurance have become, distortions which the Senate and House bills only exacerbate.
In a saner world, where medical consumers paid for routine services, women would use the new information about breast cancer screening to decide for themselves how the costs of possibly superfluous screening measure up against their own tolerance for risk. If they wanted the extra security, they would pay for it. Instead, thanks to our assumption that every medical procedure should be paid for by someone else as a virtual entitlement, any new treatment consensus becomes a matter of national concern—and, in the case of Republicans, a certain amount of opportunistic grandstanding as well.
It’s no more logical to have so-called “insurance” for foreseeable, routine medical needs than it would be to have employer-subsidized grocery insurance. Food costs would shoot up as grocery stores hired reams of clerks to manage the reimbursement paperwork. Hungry customers would wait in little antechambers filling out forms in triplicate before they could collect their “free” gallon of milk.
Rather than giving health consumers more choice, however, the Senate and House bills define a minimum level of benefits that all insurers must offer and fail to allow consumers to buy insurance across state lines. As a result of this regulatory paternalism, any promise of savings is chimerical.
I’m inclined to support a mandate to buy insurance, since I’m not charitable enough to happily bail out someone who decided to take a risk on catastrophic health costs and can’t pay his hospital bills. I suppose, however, that in a world where the bad bets of the uninsured get passed along to the insured or to the taxpayers, one very quickly reproduces the over-regulated insurance mess that we find ourselves in.
Bill O’Reilly was elaborating on the “ineffective Obama” meme last night:
This guy’s been paralyzed on Afghanistan for two months,
he sneered. Apparently, if you were to possess the insight of Mr. O’Reilly, deciding whether to escalate or deescalate a war in a tribal, backwards country, each of which options comes with considerable, if not massive, geopolitical repercussions, would be a straightforward decision, kind of like that other no-brainer of invading Iraq. I mean, what could you possibly learn in two months about as transparent a spot as Afghanistan that you couldn’t have brushed up on in a week? Two months, after all, is several lifetimes on the “no-spin zone.”
Then there’s the stretching-on of the health care debate:
How long has health care been going on?
O’Reilly asked.
He’s not even going to make Christmas.
Now the simplest way not to have a months-long negotiation over health care reform is not to engage in such reform at all, or at least, not to seek a total transformation of the system in one stroke. Some would argue, with justification, that such inaction is precisely the proper course. But if you do set yourself such an ambitious goal, leaving aside whether it is a wise one, spending months debating and working out the details hardly seems excessive.
The Right launched the “ineffective Obama” meme a few weeks ago, and even the MSM has picked it up. It happens to conflict with the “Obama is rapidly turning us into a socialist country” meme, but what the heck. (more…)
We need to induce doctors to practice preventive, not just reactive, care! is a favored nostrum in the current health care debate. I’ve yet to hear an example of what this means. Prevention lies overwhelmingly within the realm of individual behavior, but our modern reflex of transferring agency from favored victim groups—in this case, millions of artery-clogged, waddling Americans—onto less-favored entities guarantees that we see the problems of Fat America as the failure of doctors to practice the right kind of medicine. Perhaps more doctors could counsel their patients to exercise and avoid over-eating, but my guess is that if they stay silent on these topics, it is from hard-won experience regarding the futility of such suggestions. As for other types of “preventive medicine,” it has been said repeatedly that doctors run too many diagnostic tests out of pecuniary motives (or, alternatively, as lawsuit protection), but such tests presumably have some preventive uses. Where medicine truly has preventive power, as in inoculations against polio and other once epidemic diseases, it has been marvelously effective.
I keep waiting for the doughty advocates of “increasing health insurance competition by more government regulation” (that may or may not include a public option) to explain why insurance should not be available across state lines. Not only is this reform missing from Democrat proposals, the reason why it is missing remains completely off-stage. I’d like to hear some rationale for so limiting the insurance market, even if it’s a specious one.
Church leaders in Los Angeles are calling for illegal aliens to be included in the government health insurance plan, a position echoed by the U.S. Conference of Catholic Bishops. A free dialysis clinic in Atlanta whose clients are overwhelmingly illegal aliens provides a glimpse of the potential costs, which the New York Times does not fully clarify. The clinic has been trying unsuccessfully to close for years, unable to sustain its $2 million annual losses. Atlanta has scores of commercial dialysis centers, but its illegal patients cannot afford them and they say that they could not get comparable care in their home countries. Perhaps rather than asking American taxpayers to foot the bill for what would be a flood of new illegals coming to take advantage of their new entitlement, the Catholic Church could help defray the costs itself (though its resources are admittedly already rather strained).
