Monthly Archives: March 2010
We’ve talked at length here at QandO about the dangers of the Nanny State to individual autonomy – liberty/freedom. If there is a zero sum game out there, it is the trade off between the power of the Nanny state and the degree of individual autonomy you are able to exercise.
I think why this health care bill bothers, no, outright scares libertarians is the degree of encroachment it represents in terms of individual autonomy. The premise I’m talking about is well stated here:
[I]individual autonomy is the core value of a democratic society; there is an inherent trade-off between individual autonomy and public health under health paternalism; and the abandonment of individual autonomy in health policy poses a threat to our other freedoms.
I’d change one word – individual autonomy is the core value of a free society. I’m not sure how it can be considered any other way. There is a trade-off between the state assumption of responsibilities and the amount of individual autonomy you retain. Call it a liberty index if you wish, but every time the state takes over more responsibility for the lives of the citizens, by whatever means, the liberty and freedom of that citizenry is commensurately reduced.
And, as the state takes more responsibility and attempts to enforce it, there is a less than subtle transition from a Nanny state to a Bully state.
The Institute for Public Affairs lays out that case quite well and uses health care to do it. the IPA focuses on a shift in thinking among our ruling elite who support the welfare state that is driving this transition from Nanny to Bully. The transition is based on the failure of their first assumptions. Their assumption was that if the state (Nanny) provided relevant and important health information to the public, the public would heed it and change its behavior to take advantage of that information to live healthier lives.
The provision of that information hasn’t yielded those results. Instead, people still smoke, drink and are fat. Obviously, at least in the opinion of some, that model isn’t working and something better is necessary – for their own good, of course. Nanny can’t get the results she wants simply by providing the information she thinks should motivate others into living the lifestyle she finds most healthy, so she must look elsewhere and at different methods.
To get the results desired, given the “failure” of the previous assumptions, different assumptions are necessary. See if you recognize any of these or can see them coming:
Most of the health care burden is driven by disease that results from lifestyle decisions.
Most of the health care burden is therefore, in theory, preventable.
The cost of most lifestyle-related disease is not recovered from the individuals with such diseases or from the industries whose products contribute to these diseases.
Individual autonomy cannot be the paramount value in health care.
Individual choice as a basis for health is ‘too simplistic’.
Individual freedoms may have to give way to the coercive power of the State.
Interventions, including coercive actions, to change behaviour may proceed in the absence of evidence of their effectiveness.
Individuals have a clear responsibility to refrain from lifestyle decisions that lead to disease and, consequently, treatment can be denied to those who refuse to change their behaviour.
For those of you who can manage to look at the health care bill objectively and have listened to descriptions of what it requires should have absolutely no problem understanding that the list of new assumptions are clearly evident in that bill. One only has to think “individual mandate” to know that the assumption “individual autonomy cannot be the paramount value in health care” is being acted upon. The hiring of 16,000 new IRS agents to enforce that mandate speaks to the assumption “individual freedoms may have to give way to the coercive power of the State”.
So it certainly isn’t at all a leap to also understand that at some point, to keep this from being another in a long line of centrally planned failures, the attempt to intervene and change behavior and to coercively enforce the “responsibility” to refrain from lifestyle decision which lead to disease and the consequent health care costs, will be acted upon. The Nanny state becomes the Bully state.
And for those of you who would wave this away with a “this can’t happen here”, I’ll simply remind you of what was signed into law yesterday and the fact that some of the assumptioins listed above, as I’ve pointed out, have already been acted upon.
All the unprecedented borrowing, spending and massive addition to the debt are building to a most unfortunate end:
In a fascinating dispatch Monday, Reuters reported that an interesting mix of corporate bonds have “yields” — rates of return — that have gone below that of Treasuries. (A bond’s yield corresponds to its risk: High-yield bonds are also known as “junk bonds,” while very safe bonds have very low yields.) The fact that Warren Buffett’s bonds are considered a safer bet than Tim Geithner’s should have been sobering news, especially on the morning after Democrats in Congress sent President Obama a mastodon of a new spending program with a $2 trillion price tag. As hangover headaches go, this is going to be brutal, and investors apparently have more faith in Johnson & Johnson’s ability to sell Tylenol than in Washington’s ability to pay for it. Mitchell Stapley, an analyst with Fifth Third Asset Management, told Reuters that the numbers coming out of the bond market are a “slap upside the head of the government.” The fearful question is: How much harder does Washington need to get slapped before government comes to its senses?
You have to wonder. After Tuesday’s signing of the budget busting Obamacare, it seems pretty clear “never” is the case. But it is obvious that the bond market isn’t fooled. Soon the only “junk bonds” out there are going to be government bonds if the borrowing and spending spree continues. Also at risk is the country’s bond rating. Moody, who is usually slow to move on these sorts of ratings, couldn’t be more clear in the warning it has issued to the US – yeah, that’s right, not Cuba, not Venezuela, but to the United States of America:
“Growth alone will not resolve an increasingly complicated debt equation. Preserving debt affordability at levels consistent with AAA ratings will invariably require fiscal adjustments of a magnitude that, in some cases, will test social cohesion.”
As you might imagine they’re not talking about “fiscal adjustments” which will add to the debt such as Obamacare (the statement was issued prior to its passage). The language is pretty clear, cut spending (and borrowing) drastically, dramatically, to the point that it will “test social cohesion”, and you have a chance of keeping your bond rating and surviving fiscally.
Given the 10 year Obama budget deficit forecasts averaging about a trillion dollars a year, we ought to be in AA bond rating territory fairly soon. You can figure out the fiscal stability part from there.
Don Surber reminded me yesterday in something he wrote that the thing that is being forgotten in all of this is the premise that health care reform is based upon is
cost containment. Or, as Surber puts it:
Government-run health care is about saving money, not lives.
Think back and think it through. What government is promising is insurance for all (more cost) and lower cost insurance plans (the repeated Obama promise was $2,500 per family on their premium – don’t forget Joe Biden’s promise that this bill “controls” the insurance companies). Those seem to conflict, but in reality, they can be accomplished even though you’re very likely not to like the result.
How? Severe rationing and imposed cost controls. Rationing would be accomplished by increased wait times, outright denials or limited care. Doctor visits would have to be shorter and shorter (reimbursement rates would encourage if not demand that). And of course limiting testing and the use of high-cost, high-tech diagnostic machinery is a given.
But won’t doctors and other health care providers have the choice of whether or not to take patients under such plans? Well, initially yes. However, it stands to reason that at some point, when large numbers of the newly insured can’t find a health care provider because of the constraints on care and reimbursement rates their insurance provides, that government will feel the necessity to step in – again.
If it can order individuals to buy insurance on pain of fine, what is to stop it from ordering doctors and other health care providers to take anyone with insurance, regardless of the reimbursement rates? It certainly doesn’t blink an eye at ordering insurance companies to take anyone with a pre-existing condition. So at the moment I can’t think of a thing that would stop that sort of a law (that’s not an argument for its constitutionality, it’s simply a recognition of reality). My guess is Congress certainly believes it has that sort of power right now. We can only hope the courts decide otherwise. The whole point, of course, is that having insurance doesn’t guarantee health care or access to a doctor. And low reimbursement rates will guarantee they won’t have access. The government is going to want to “fix” that.
If government-run health care is about saving money, not lives then one of the targets of any effort to “save money” is going to be high cost treatments. Many of the highest costs in health care come when? In the last months of life, of course. We’ve been told that 500 billion has to come out of the Medicare budget to help us save money on health care overall. And don’t forget, Medicare issues more denials of care than any other insurance provider. I don’t think it should take a particularly intelligent person to do a little dot connecting here.
That brings us back to the providers themselves. What will be their reaction to the primary push for cost control/containment?
Well, don’t forget, almost every practice out there is a small business. And if they make over $250,000 (and the vast majority do) they’re going to first and foremost be taxed at a higher rate. You know, because they’re “rich”. That will probably mean fewer staff, longer waits, less care. Or, by the simple means of taxing the practice, the government will manage to get between you and your doctor by changing how your care is delivered.
And, you have to wonder, how long will the better doctors put up with this before they decide to retire or find something else to do? I’m guessing this will be the first sector in the economy where Atlas will do some shrugging. I think in the next few years you’re going to see medical school enrollments drop, active government recruiting (subsidized education for x years of service) of students to go into the medical field as well as off-shore recruiting as well. Net result – the brightest and best will no longer be a characteristic of our medical community.
Those are a few of my thoughts on the future based on this law. Things may change, but like the CBO, I can only take a look at the static picture and make my assumptions based on that. I don’t see how this all accomplishes what the government has promised unless there are some pretty severe cuts in care and service and a lot of rationing through denial of service or claims. I don’t see how it all works as the government has promised unless all health care providers are forced to take anyone with insurance regardless of the reimbursement rates. That leads me to believe that government will try that in an attempt to accomplish it’s stated goal of bending the cost curve down. And at that point, my guess is health care providers rebel, many doctors quit and massive litigation begins.
For those of you hopping around celebrating this travesty today, is that what you expected or want?
Harry Reid sent a letter to Sen. Bernie Sanders saying he planned to introduce the public option in a month or so. Democrats in the House aren’t waiting that long. Again, assuming they know that their liberal agenda window is closing, “progressives” plan to get the most bang for their buck:
A leader of the House liberals’ caucus said Monday she’ll introduce new legislation to revive the public option.
Rep. Lynn Woolsey (D-Calif.), the co-chairwoman of the Congressional Progressive Caucus, said she plans to unveil legislation to add the government-run option to the national healthcare exchange established by legislation President Barack Obama is to sign tomorrow.
“We will introduce a robust public option bill on the very day the president signs the reconciliation bill into law,” Woolsey said Monday during an interview on MSNBC.
The public option, of course, is the precursor to single-payer and the progressive caucus has never been shy of telling anyone who will listen that’s what they want for real health care reform – a government run insurance program.
Meanwhile states are beginning to line up to file suit over the current bill which passed the House Sunday night – 11 or 12 states, including TX, FL and VA, plan on filing lawsuits upon the signing of the bill into law. FL, for instance, is claiming two elements of the bill are unconstitutional:
McCollum said the challenge is on two constitutional grounds: 1) its mandate that everyone must buy health care insurance, and 2) the new law challenges the sovereignty of states by forcing them to do things they cannot afford. He said the 10th Amendment protects states from that.
“It goes far beyond an unfunded mandate and would literally cost the state of Florida alone billions of dollars in additional costs to be able to implement,” McCollum said. “The whole bill is unconstitutional that it manipulates the state into doing things it cannot afford.”
If the individual mandate were to be ruled unconstitutional – and I think there’s a good chance there – it would cripple the law. One of the main funding provisions has to do with the mandates and fines for those who don’t comply. Of course if the court were to find for the states based on the 10th amendment argument (something I have no idea whether it has sound legal footing or not given the number of mandates the states presently have), the law would push all the cost back on the federal government and destroy any argument, however absurd, that it will reduce the deficit.
The point? The HCR debate is far from over. The left is going to continue to push for more and more add-ons to work toward their real goal – single payer, government run health care. The right is going to have to fight on two fronts – in the Congress where the 41st Senate vote will be very important and in the courts.
Like health care, no one is going to argue that immigration doesn’t need reforming. It’s the amount and type of reform that’s going to engender the argument.
That said, is immigration next on the Obama agenda? As I said on the podcast last night, I expect the Democrats to push for whatever they think they can get through the Congress by November. I think they recognize that their window for the radical side of the agenda will slam shut then. And I think they see some potential – in the form of electoral support, even if it ends up being future electoral support – in tackling the immigration issue. Let’s face it – after November, they’re going to need all the help they can get at the voting booth, illegal or otherwise.
Given all the focus on health care yesterday, you may have missed the news about an immigration rally in DC.
Mr. Obama addressed the crowd via a videotaped message displayed on huge screens, promising to keep working on the issue but avoiding a specific time frame.
“I have always pledged to be your partner as we work to fix our broken immigration system, and that’s a commitment that I reaffirm today,” Mr. Obama said.
He expressed his support for the outline of an immigration bill presented last week by Senator Lindsey Graham, Republican of South Carolina, and Senator Charles E. Schumer, Democrat of New York. While pledging to help build bipartisan support, Mr. Obama warned, “You know as well as I do that this won’t be easy, and it won’t happen overnight.”
What’s been clear is Obama has promised a lot of people a lot of things and has delivered on few of those promises. The speakers pretty much laid out the “benefit” a beleaguered Democratic party should focus on:
“Every day without reform is a day when 12 million hard-working immigrants must live in the shadow of fear,” said Representative Nydia M. Velázquez, a Democrat from New York who is the chairwoman of the Congressional Hispanic Caucus.
“Don’t forget that in the last presidential election 10 million Hispanics came out to vote,” she said. She told the crowd to tell lawmakers “that you will not forget which side of this debate they stood on.”
Wow – 22 million potential Democratic votes. Now there is incentive.
Don’t forget the bill Obama says he supports, the Graham/Schumer bill, requires a national ID. That is a new Social Security card (which, you were promised, would never be used for identification purposes) with your biometric info stored on it and on government data bases.
That’s a non-starter. Again, I am not the problem here. The 12 million here illegally are. I am not at all prepared to surrender even more of my privacy on the vague promises of politicians and bureaucrats.
Yes, immigration has to be fixed. So does border security – fix it first. Then, streamline the immigration process, make it easier to apply and emigrate. Figure out how to bring seasonal workers in efficiently and have them return home after the season is over. Offer a path to citizenship to illegals from the back of the line that requires fines, back taxes, an application process and a requirement to learn english. Address the anchor baby scam.
But, no national ID. Any bill that contains that is unacceptable.
I’m sure today we’ll see a certain amount of crowing from the left. Such is life. You ram an unpopular bill through by trickery, lies, bribes and BS and I’m sure for some it’s a reason for celebration. Principles, ethics and decorum never were big on that side of the spectrum. However, “by any means necessary” is. Unfortunately, like most major legislation, those who put us in this hole will likely not be around to shovel in the dirt when the fiscal lies bury us.
Today the right -and independents who don’t support this travesty- learn that elections do indeed have consequences. In November, one hopes, the Democrats learn bad legislation that opposes the will of the majority of Americans has consequences as well.
There’s more too it than that, though. I think Megan McArdle best sums up my thoughts on what has transpired in the last months and weeks, culminating in last night’s vote:
One cannot help but admire Nancy Pelosi’s skill as a legislator. But it’s also pretty worrying. Are we now in a world where there is absolutely no recourse to the tyranny of the majority? Republicans and other opponents of the bill did their job on this; they persuaded the country that they didn’t want this bill. And that mattered basically not at all. If you don’t find that terrifying, let me suggest that you are a Democrat who has not yet contemplated what Republicans might do under similar circumstances. Farewell, social security! Au revoir, Medicare! The reason entitlements are hard to repeal is that the Republicans care about getting re-elected. If they didn’t–if they were willing to undertake this sort of suicide mission–then the legislative lock-in you’re counting on wouldn’t exist.
Oh, wait–suddenly it doesn’t seem quite fair that Republicans could just ignore the will of their constituents that way, does it? Yet I guarantee you that there are a lot of GOP members out there tonight who think that they should get at least one free “Screw You” vote to balance out what the Democrats just did.
If the GOP takes the legislative innovations of the Democrats and decides to use them, please don’t complain that it’s not fair. Someone could get seriously hurt, laughing that hard.
But I hope they don’t. What I hope is that the Democrats take a beating at the ballot box and rethink their contempt for those mouth-breathing illiterates in the electorate. I hope Obama gets his wish to be a one-term president who passed health care. Not because I think I will like his opponent–I very much doubt that I will support much of anything Obama’s opponent says. But because politicians shouldn’t feel that the best route to electoral success is to lie to the voters, and then ignore them.
Please do everyone a favor, Democrats, and avoid talking about “polarization” and the “poisonous political atmosphere”. You created them (and if you didn’t you’ve taken them to a new and higher level) and any attempt on your part to shift the blame on others will be seen for exactly what it is – projection. Remember, it wasn’t the right calling those who earnestly turned out to oppose this monstrosity “fascists”, “brownshirts” and “astroturf”.
And please avoid whining about “bi-partisanship” and “transparency” as well. There was no attempt or desire to make this bi-partisan. The opposition was excluded from the beginning and then you acted surprised when they wouldn’t support this awful legislation. The process was about as opaque as one could make it. Backroom deals, political theater, bribes and legislation no one could read until it was up for a vote.
Yes, Democrats have set an new low for a standard in Congress – and that’s a pretty tough thing to do. Like McArdle, I hope they pay for it this November and November of ’12 and I intend to work toward that. My job? Keep reminding the electorate of what happened here. Keep the fire stoked and burning. Keep the anger bubbling. Keep reminding them that they were lied to and ignored. Keep pointing out that this bill wasn’t about how much the Democrats thought of the American people but instead how much they hold them in contempt. This was strictly about power, party and politics.
So celebrate on the left. Please. Do. I’d like to say you “earned” it, but I find unprincipled and deceitful grabs for power to be something less than that. It’s a gut feeling but I think you’ll pay heavily in November (I say you lose the House and retain a slim majority in the Senate sans Reid). At that point, you are barred from whining about minority rights, House or Senate rules, reconciliation and transparency. You’ve decided on a new set of rules and we’ll see how well you can live with them, won’t we?
And, since few will consider keeping their kids on their insurance until they’re 27 much of a benefit (and that’s about all that kicks in on this bill besides the taxes), my guess the fight for repeal will be popular, will most likely consume the next 2 years and will cost Obama his presidency in ’12.
Couldn’t happen to a nicer one term president. I’m sure his concession speech, barring a breakdown of TOTUS, will be a doozy.
In the meantime, let the law suits begin.
U.S. Congressman Bart Stupak (D-Menominee) announced three airports in northern Michigan have received grants totaling $726,409 for airport maintenance and improvements. The funding was provided by the U.S. Department of Transportation Federal Aviation Administration.
“This federal funding will help these airports better provide critical services to communities in northern Michigan,” Stupak said. “I am pleased the FAA has made this investment in our local airports and the individuals and businesses they serve.”
Do you seriously believe that Bart Stupak is so ill-informed that he believes an executive order will stand up in court against a law passed by Congress? Every single time the law passed by Congress will take precedence over an executive order. If the Senate bill allows for federal funding of abortions then the court is not going to set that aside for an executive order. Federal funding for abortions will be the law of the land.
So what is behind such an obvious cave by Stupak?
Unless Stupak is the dumbest Representative to walk the halls of Congress, he know his EO holds little but symbolic power. He has a nice autograph from the president that might bring a dollar or two on Ebay. And assuming he knows his EO is baloney, then you have to conclude that he just pitched principle (the supposed principle he found to be more important than health care reform) over the side. By doing so, he essentially announced that his former position wasn’t a position of principle, but one of convenience.
I can’t believe it was for airport funds although I do believe the FAA did “conveniently” decide now was a good time to award those grants (yes, friends – grants. That means your tax dollars given away to a few local airports in Stupak’s district). If it was he’s a cheap date. Or a cheap sell-out.
There has to be something more. Somewhere, hidden in all of this, we’re going to find 3o pieces of silver.
But hell, if that’s all it took, he’s not as cheap as Dennis “this bill stinks and I’ll be voting no” Kucinich. All it took for him was a 45 minute airplane ride.
Principles – something you can always depend on the left abandoning when the going gets tough.
Well, we all have our health care now. The House approved it, with the Dems racking up 219 votes. Now, Uncle Sugar will insure we all get to see a doctor. What a wonderful feeling to know that I now have a claim on your income–for the rest of your life–if I come down with the sniffles.
In this podcast, Bruce, Michael and Dale discuss the health care reform vote. The direct link to the podcast can be heard at BlogTalkRadio.
The intro and outro music is Vena Cava by 50 Foot Wave, and is available for free download here.
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What else? The health care reform vote, what it means, speculation on the future, and dire warnings about the consequences.
Or we might talk about puppies.