Saturday, June 24, 2017

The current health care / insurance juncture and the larger question of why we have government

You'll recall yesterday's post inviting you to compare and contrast Avik Roy's favorable take on the Senate health-care bill and the thumbs-down it got from the editors at NRO.

Roy, whether he's fully aware of it or not, is making a point Charles Krauthammer has been making some time, a point echoed by Jazz Shaw today at Hot Air (which I'll link to and excerpt from momentarily). I say "whether he's fully aware of it or not" because I don't detect any tone of resignation in his summation of why he's big on the Senate bill:

Full repeal was never going to be possible in a Senate where Republicans did not control 60 votes. And furthermore, we have learned that moderate Republicans in both the House and the Senate have no appetite to fully deregulate Obamacare at the federal level.

Jazz Shaw at Hot Air puts it this way:

So is the fight to repeal Obamacare pretty much over? Let me take a saw to the limb I’m currently sitting on and say… yes. But really, the fight was over shortly after the original Affordable Care Act was passed. There’s an old maxim in American politics which tells us that any entitlement program or other initiative which gives away goodies to the public, once in place, is pretty much there forever. There have been a few rare exceptions, but for the most part this is a tradition which is written in stone.
We’ve got Senators from the more conservative side saying that this new bill isn’t going to do anything to reduce costs and premiums. Of course it won’t, because the government is entirely incapable of doing that through mandates and executive orders. Even if we ignore the fact that our bloated bureaucracy composed of career politicians was never exactly suited to manage something the size and complexity of the nation’s health insurance system, any effort to institute top-down socialization of something as inherently capitalist in nature as the health insurance industry was doomed to blow up in your face.
But that’s not even the core fault in our stars here. You see, even if the GOP manages to remove Obamacare, all they’ll be able to do is take out the parts which most conservatives hate (such as the mandates). Taking out the goodies is not only harder, but likely impossible. Obamacare was structured brilliantly in that the things everyone was going to like (mandatory coverage for preexisting conditions, parents keeping their kids on their plans longer) kicked in fast. It took years for the really ugly features to fully come on line (higher penalties for not having insurance, additional mandates driving up premiums). That means that people were already used to the candy being handed out before the flaws in the system ensured that it would begin to implode.
So who wants to be the one to take away those goodies now? Nobody. And this leaves the GOP in the position of trying to make it look like they can still play Santa and hand out all the sugar without the slug of bitter medicine to follow. In order to “fix” this system and make it solvent we would have to deliver bad news which is the political equivalent of blowing out the pilot light in your oven and sticking your head in.
But wait,” I can hear some of you saying. “If this doesn’t work, can’t we just go back to plan B and let Obamacare implode on it’s own?” Not really. Whoever is in charge will take the blame no matter whether they supported it originally or not. We now basically have a new entitlement theory in which more than 60% of American voters think that affordable health insurance (not Health Care, which is a critical distinction the media generally tries to ignore) is a human right and it’s the government’s job to make sure they get it. But the cost of health insurance isn’t dictated by the government… not for long, anyway. It’s dictated by the cost of actual health care and Washington still hasn’t the beginning of a clue as to how to bring that down.
So what’s the only solution left to keep delivering bread and circuses to the masses? Probably a completely top-down, socialist single payer program, which will rapidly bankrupt the entire system. (California is already finding that out the hard way.) You can expect to eventually see some Republicans going along with that line of thinking too, believe it or not. It’s that or the aforementioned head-in-the-oven scenario.
Now, there's some resignation for you. As I say, Krauthammer has been asserting this for some time.  He, like Shaw, says that the "A"CA, even though it polls dismally, has been in place long enough that the mindset positing that health care and / or health insurance is some kind of right has permeated society and is not going to go away.

I hate resignation.

I will not stand for it when the truth is obscured thereby - and especially when that obscuration leads to bankruptcy. If I wanted to live in Venezuela-like conditions, that's where I'd move.

So I was glad to see David French at NRO take on the leftist smears on the Senate bill with this reasoning:

Here’s the Washington Post’s Eugene Robinson with an odd attack on Republican health care plans:

The “health-care bill” that Republicans are trying to pass in the Senate, like the one approved by the GOP majority in the House, isn’t really about health care at all. It’s the first step in a massive redistribution of wealth from struggling wage-earners to the rich — a theft of historic proportions.

Not to be too pedantic about this, but the government isn’t “redistributing” wealth when it lets a citizen keep more of his money, and it isn’t “stealing” from the poor when it cuts benefits they didn’t actually own. Welfare programs like Medicaid represent a forcible transfer wealth. Welfare is the redistribution. And if there’s any actual argument for “theft,” it’s the theft of money from the private citizen by the government.

But that would be hyperbole. In civilized societies, people understand that a certain degree of taxation is necessary for a nation to function. Safety nets are compassionate and prudent. But it is dangerous and wrong to get confused about who owns what. I own the money I earn. America’s less fortunate citizens don’t own Medicaid. It’s a privilege, not a right — a privilege that is subject to the same budgetary and fiscal concerns inherent in any other government program, including national defense. 

Entitlement culture plagues this nation, and it plagues America’s poorest communities. So let’s speak accurately about ownership and redistribution. Medicaid is a program, not property, and it’s not theft to attempt to moderate its enormous financial cost. 

Or let me put it in my own words. There is no right to health care. It is impossible by definition. How did people in the year 1300 exercise their "right" to a triple bypass? My point being that caring for health is a human activity borne of human volition. The only reason it exists is because someone wants to do it. One cannot have a right to the activity of one's fellow human beings. Down that slippery slope lies the s-word. 

At the very least, the likes of Roy and Krauthammer could preface their observation that, hey, the populace has bought into this and it's just where we're inevitably headed with the assertion that we'll be plunging headlong into policy based on utter falsehood.

Damn it, when does somebody besides four Senators say what is plain? We can't even begin to counteract the it's-a-right notion if everybody is worried about votes, viewership and readership.

And I really bristle when the notion is put forth that getting government the hell out of health care, and the insurance coverage thereof, is somehow a mere conservative wish list, something conservatives may get part of but will probably have to live with the compromise attendant to the art of the possible.


We are talking about an individual's freedom to keep what is his or hers.

It's the current battle line in the twilight struggle over the proper scope and function of government.

Government should not be in the business of providing services. James Madison made that quite clear.

Refuse to be resigned to a service-providing government as a done deal. Refuse to acquiesce to that notion prevailing. There is nothing radical about the pre-Progressive-era understanding of what government was for.

And someone, somewhere, invite Roy and Krauthammer to a picnic, a car race, a jam session - anything, anywhere outside the damn Beltway.


  1. The top down in the health care industry is the place to start. Providing health care to the sincerely infirmed should be something here we are proud of. Providing general health care to the uninsured is a much more complex topic. "If catastrophic care is unselectively provided" the costs in the health care industry are higher. And no one addresses the real lack of actuary planning. Nor the moral implications.

  2. The only health insurance anybody really should need is catastrophic care coverage. Other than that, let producer and consumer transact directly.

  3. This comment has been removed by the author.

  4. We cannot ignore precedent in our legal system. Our legal system is primarily based upon it. Social insurance in America evolved within our legal system over the entire time we have been a republic. Today the elected representatives of by and for the people are engaged in an effort to change a law enacted by elected represents of by and for the people. For whomever is covered by the extant laws in this Republic, insurance is a right. Simple as that. Bloggie's ilk wants to take away that right. If they are successful, people will no longer have that right. I am not sure what they'll have or be if a loss occurs without that "contractual" right, but one thing is that they'll not have coverage. Simple as that. And the band played on......

  5. So what we are debating is really who we elect to represent us in this republic.

  6. Breaking News!!! We interrupt this thread to bring you breaking news completely off topic. This is epochal!

    BEIJING (Reuters) - China and the United States agreed that efforts to denuclearize the Korean Peninsula should be "complete, verifiable and irreversible", Chinese state media said on Saturday, reporting the results of high level talks in Washington this week.

    "Both sides reaffirm that they will strive for the complete, verifiable and irreversible denuclearization of the Korean Peninsula," a consensus document released by the official Xinhua news agency said.

    Now onto more concerning America's civil war.....

  7. Legal precedent isn't helpful unless it gets us to a free-market model for health care.

    Insurance can't be a right by definition. Insurance only exists because someone of his or her own volition provides it. There is no such thing as a right to something that requires one's fellow human being to do something.

  8. It's immaterial whether legal precedent is helpful, it's the tao of US.

  9. I'm interested in what will maximize ordered liberty in America. All else is obstacles.

  10. The word ordered leaves a lot of room for interpretation.

  11. Well, quite obviously, the human being cannot be considered so free as to be able to kill his fellow human being (outside of a self-defense situation), or steal from him.

  12. Breaking Commentary from the Lib Press on the subject of this post!

    "The bill is, in many ways, a Medicaid-repeal bill masquerading as an Obamacare-repeal bill. And Medicaid is not a program the public is complaining about."

    Conservatives often take a narrow view of the value of health insurance: they focus on catastrophic events such as emergencies and sudden, high-cost illnesses. But the path of life isn’t one of steady health punctuated by brief crises. Most of us accumulate costly, often chronic health issues as we age. These issues can often be delayed, managed, and controlled if we have good health care—and can’t be if we don’t.

    Conservatives also dismiss Medicaid by arguing that it provides inadequate or unsatisfactory coverage. The opposite is true, according to the evidence. Compared with private coverage, Medicaid produces at least as much improvement in access to care, measures of health, and mortality reduction. And polls indicate that recipients like Medicaid more than private coverage, even with the difficulties finding doctors who take Medicaid, because the program provides them with better financial protection.

    Despite these facts, the Senate reform bill, like the bill that House Republicans passed earlier this year, would hollow out or terminate coverage for tens of millions of Americans who rely on Medicaid or the private-insurance exchanges set up by the A.C.A. These bills are, in many ways, Medicaid-repeal bills masquerading as Obamacare-repeal bills. And Medicaid, remember, is not a program that the public is complaining about. It is immensely popular and works well. It provides coverage for sixty per cent of disabled children, and maternity coverage for half of pregnant women. Two-thirds of nursing-home residents end up relying on Medicaid coverage after their savings are spent. Among adult Medicaid recipients, sixty per cent work, and eighty per cent are part of working families.



    As one of the experts interviewed in this piece from the Minneapolis Star-Tribune notes, it is not surprising that this is happening — it is only surprising that it's being said out loud by the Mayo Clinic's CEO:

    Mayo Clinic's chief executive made a startling announcement in a recent speech to employees: The Rochester-based health system will give preference to patients with private insurance over those with lower-paying Medicaid or Medicare coverage, if they seek care at the same time and have comparable conditions.

    Mayo will continue to take Medicaid patients. But for this world-renowned facility to survive and serve those patients, it needs to treat more people who can pay. And the government, despite the massive, unsustainable expense of the Medicaid and Medicare programs, just doesn't pay enough, and in some cases delays payment long enough that it's a serious problem for someone trying to keep a practice or facility afloat.

  15. So Medicare too is going to get 2nd tier huh? This sounds like a plea for crony capitalism to pick up some speed. What constitutes a plan that John H. Noseworthy, M.D. (3.8 million compensation annually) considers a trump card? And who has it and where do they work or get their coverage. I presume you will reply that those who will get favorable treatment planned out their lives properly.

  16. And the Mayo Clinic technically is a not-for-profit organization.

  17. So is Medicaid a program that the public is complaining about?

  18. The number of people enrolled in Medicaid in 1990 was 29 million. Today it's 73 million. That's a 252 percent increase over a period when the population only increased by 30 percent.

    That's not sustainable.

    Nor should it be.

    And believe me, I'm as disgusted with Congressional Pubs as anyone. They clearly lack the balls to knock it off with the wonky charts and tables and just put forth a cleanly free market approach: disengage health insurance from employment, make it available for purchase across state lines, get government out of the business of telling companies what they have to cover in the policies they offer, and allow for citizens to form collective-bargaining groups to get the best deals from insurance companies.

  19. Employers have largely abdicated the bennies game. 40% of American workers are 1099, and many W2s are part time. This is a societal issue that will likely have to be resolved by single payer. The free market failed us in health care a long time ago.