George Sarant

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Posts Tagged ‘health care

REFLECTIONS ON HEALTH CARE

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What is the proper role of government with regard to the health care of its citizens? How should costs be allocated?  These are questions that are still up in the air in the USA, but how these questions are addressed still applies everywhere.  The Republicans appear to have painted themselves into a corner on this subject, while the Democrat-imposed Obamacare is collapsing from its own defects. This legislation was deeply flawed and fundamentally unjust insofar as it expanded coverage for some uninsured people, largely by expanding Medicaid, while otherwise imposing steep additional costs on other individuals in a haphazard fashion. But the Republicans are the governing party now and are stuck with having to come up with solutions they have not adequately provided. They should know by now that it is virtually impossible to get rid of a benefit once it has been established, and the plan passed by the House is going nowhere in the Senate and fails to provide the fundamental overhaul they promised. 

There is a desperate need to rationalize the American health care system by going back to the drawing board and starting from scratch. Republicans first need to concede that everyone ought to have adequate health care, giving that to the Democrats, who might then be brought on board. But this does not necessarily mean that health care should be provided by the government. Nor should it be provided because it is a “right;” it is rather a benefit. Why then should the state in some fashion underwrite such a benefit? 

The short answer is that a developed society can afford to, and we must increasingly come to grips with the consequences of technological change, which is far more salient than “globalization” in causing economic disruption. Given that inequality is an inevitable consequence of a truly free society, those who lack higher skills and who are left behind by the consequences of automation, AI, and other developments- something that can happen to  anyone, need to provide a basic level of support. If growth and economic dislocation eventually benefit everyone, then those who have disproportionately suffered the consequences ought to be provided with some level of adjustment. This is a different population than the poor, who already get everything for free. It is a population we want to prevent from falling into the ranks of the poor. As society develops and grows richer overall, it is reasonable to provide basics for everyone through some mechanism that does not overly burden everyone else. 

The way to do this is to resolve to get the government completely out of the health care business and let market forces do what they do best- rationalize the distribution of goods and services. The state would instead provide a graduated insurance stipend to those who cannot afford it, who would then be able to purchase whatever health care they want or need. For this to work the government would no longer provide any other services directly or indirectly; no more mandates, no more policies, just a cash benefit and there would no longer are any pre-existing conditions. Since everyone is obligated to pay taxes, insurance and medical costs would be deductible, and medical savings exempt from taxation, but anyone who fails to purchase coverage would be charged with the cost of providing a policy for them, which would at least cover catastrophic circumstances, which otherwise would be passed on to everyone else. This does sound like the Obamacare tax but you cannot have universal health care without universal participation and no one is here being compelled to do anything. 

This is not socialism, which is unworkable. Socialism would be government control of all health care, and hence ownership of the system. This is the opposite of that. Government is completely removed from any operational role and only would  only maintain the principle that everyone be covered, by providing direct cash transfers where needed. This would dismantle the administrative state, save billions, and allow a rational system of costs and services to develop, leading to a reduction in overall expenses. There are many details to be worked out and this is preferred only as a roadmap. There are only two fundamental principles that must be adhered to: that everyone be covered and that the government gets out of the health care business. 

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HELPING THE FEW BY PUNISHING THE MANY

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The Obama administration forced through a radical overhaul of the health care system despite public opposition, and the results have been disastrous. Not only does the system not work, but it is actually causing real harm to people, particularly individuals who purchased their own health insurance. Under this dysfunctional system they are being dropped from their existing policies since their existing coverage does not conform to Obamacare, thus losing their coverage while facing steeply increased premiums. But it gets worse. Since the website does not work they cannot even get a new policy at the Obamacare “exchanges,” leaving them with no coverage at all. All of this is happening while the president promised that people could keep their existing plans under Obamacare, but he knew, it now develops, as far back as 2010, that this was not true.

This is a sad example of the consequences of the warped thinking of the left, which demanded that the entire system of coverage for 80-85% of the population be upended because a minority did not have health insurance. Never mind that the overwhelming majority of people were satisfied with what they had, and the number of people lacking coverage was fluid; it didn’t matter, because the left-wingers cannot abide any distinctions. In other words, they insist on disrupting society if a minority (pick any one you want) is somehow allegedly not included in what prevails among the majority of the population. So we must endure continued social, cultural, and political disturbance for some misconceived sense of justice. The state must ameliorate any discrepancies, no matter what the cost. In addition, the true cost has been buried, for in order to pay for the minority in this instance, the costs for the majority must inevitably go up, bearing what effectively amounts to an additional tax.

It is also part of the liberal delusion that they know what is good for you better than you do yourself. For the left, government is an instrument through which they can impose their policies, values, and beliefs on other people. If the government manages more of our lives and the world around us, they think it is good. For them any flaw in society can only be changed for the better by the state, usually with some costly, vast new program. This faith in government planning and supervision remains unshaken by the facts.

To achieve such ends it is apparently okay to misinform, mislead, and even to lie to reach a desired goal. In the case of health care, the administration was, at the very least disingenuous in its claims. Given the foreknowledge of what was going to happen to individual coverage, suspicion can only be aroused that the intention all along was to force everyone into government health care program. I cannot subscribe to the notion that Obamacare was somehow designed to fail to achieve this end, because I think the people responsible thought they were doing good. It is rather a glaring case of ineptitude, overreach, and an example of what happens when ambitions far exceed the abilities that are applied to them. No, what is insufferable here is the conceit that they still know best and the continued smugness of the administration in the face of cascading failures.

They continue in damage control mode, while the rational answer would be to pull the plug on this monstrosity and cut their losses, or at least postpone implementation until they are presumably able to do so competently. The latter is unlikely to ever occur given the ill-conceived nature of this whole fiasco. The Democratic party will likely pay heavily for this, having forced it through when they controlled the congress, at least in the next election. The media also have a lot to answer for as well. They have been carrying water for the administration since its inception. Only now are they beginning to report on the magnitude of the problems, although they still have not come to grips with the fundamental flaws of the whole endeavor. What we need now is some public humility, if not contrition, across the board.

Written by georgesarant

October 29, 2013 at 8:48 PM

THE WRONG FIGHT AT THE WRONG TIME

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There is an excellent chance that the 2014 elections could result in a Republican landslide, given the present unpopularity of the administration and programs like Obamacare in particular, as its phase-in disrupts the entire health care system and the coverage of millions. This is a classic case of unintended consequences, as businesses reduce full-time jobs and replace them with part-time work to avoid various mandates, along with many other negative effects. The question is what is to be done about this? 

There are many who think it is time to defund Obamacare. While this may pass the House, it is dead in the Senate, as well as in the White House, given the presidential veto. Thus there is no possibility that such legislation can succeed, at least in the present congress. The focus should instead be on winning the upcoming elections. The problem is that this action could backfire and and seize defeat from the jaws of victory. First, as stated, it is a waste of time and energy given the current political configuration, second, if there is a government shutdown resulting from an impasse it is congressional Republicans who will be blamed, not the administration. The media has already seen to this by framing the story in terms of a “threatened shutdown” of the government. Third, as more of this health plan goes into effect, more and more people are being alienated, and left to itself, an increasingly angry public will justifiably blame the administration and vote accordingly. 

It is unsurprising that that the “Affordable Care Act” is a disaster for the existing health care of millions as well as for the economy. It is a result of the typical liberal impulse to upend and entire system because a minority is not being accommodated. Over 80% of the population were satisfied with their existing health care, but because a minority was uncovered for various reasons, rather than address that question directly, they decided to redesign the entire system, to benefit this minority. In addition there is no way around the fact that the cost of care for the minority is going to be born by the 80% in higher fees, taxes, benefits, etc. 

The media are laying all of this on Republicans, and it makes no sense to fulfill their narrative. The line is that the Republicans are “divided” between “moderates” and “conservatives” on whether or not to defund the government. This is a losing proposition, even though it is a lie. Both those labeled as “moderate” in this instance as well as “conservative” oppose Obamacare. The differences are purely tactical. Is this really the right time and the right legislative process to deal with this issue?  I think not, for the reasons I cited above.  There is simply no way that the realities of the current congress can be changed, and therefore the focus should be on winning the next congress. The best strategy is to sit on the status quo for the next year, and then reap the windfall when an alienated public takes it out on the governing party. 

 

Written by georgesarant

September 20, 2013 at 4:01 PM

THE REAL COST OF LIVING

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While the administration and congress have forced through a radical health overhaul certain basic questions have not been directly addressed. Are we responsible for keeping everyone who is living today alive? Does this mean everyone in the United States or does it also mean the developing world as well, as some would have it? These are difficult moral questions, but there is nothing in the constitution to suggest that the state has any responsibilities along these lines. One could stretch the meaning of “life, liberty, and the pursuit of happiness” in the Declaration of Independence to encompass this, though it is unclear to what extent the state could guarantee life any more than it can guarantee happiness.

Are we responsible for taking care of those who will not bear the cost of taking care of themselves? Those who cannot already have support systems, no matter how imperfect. Clearly before any attempt to overhaul the health care system is attempted these basic questions ought to be thoughtfully addressed given that there is no consensus on them.

The left would establish a “right” to health care for everyone, thus assigning the state the responsibility for life itself. On the other hand many on the right emphasize the sanctity of life and oppose abortion and euthanasia and would involve the state in these matters. Thus there is an odd convergence of opinion that the state ought to be involved in some sense with the matter of life, although understandings as to what this means differ widely. For any overhaul to be acceptable there has to be some agreement on fundamentals. Any new right ought to have the broad base of a constitutional amendment, if not an amendment itself.

Health care literally constitutes the fundamental “cost of living.” For countless centuries basic human needs have consisted of food, shelter, and clothing. Over the past hundred years as life spans have increased due to medical innovation, health has become another need, in that people can live into old age to the extent they are healthy. In prior centuries little could be done to extend lifespans and the average person died at a considerably younger age. What was “old” in the past is now relatively young. This is what accounts for much of the increase in health care costs over the years. This is the real “cost of living,” and the administration’s health care program would effectively make this a responsibility of the state, thus transforming a need into a right. Even if such a right was established it does not follow that government should manage it, anymore than it manages our choices in food, shelter, or clothing. But they go even further, not only creating a right but a requirement.

However most of the innovation has come from society’s institutions, not the state, whether it be new drugs, medical devices and procedures, or cures for disease. Can the state effectively “control” this innovation? Or will it stifle further improvement? Part of the reason American health care costs are so high is that we are effectively subsidizing the rest of the world in terms of innovation, as reflected i.e. in domestic drug prices. As long as innovation continues unfettered there may well be an increase in the cost of living, unless or until yet other innovation leads to cost savings. This is clearly possible, as in the case of procedures that once required extended hospitalization and that can now be done on an outpatient basis. Thus innovation cuts both ways, but once the government takes control this engine will be stifled. The fallacy of the Democratic health care plan is that conditions that exist today are going to prevail in the future. Thus apart from cost factors, the Democratic plan represents a closed system based upon present day assumptions. But no one can accurately predict the future more than a few years out. Rather than expanding care it would effectively freeze it.

In addition to costs, the long term consequences of state control have not been seriously thought out. Suppose a procedure to extend lifespans was developed. There would certainly be a cost involved with this, which would effectively add to the cost of living. Would it then be then the responsibility of the government to guarantee an extended lifespan to everyone, regardless of their living habits? Prudence would indicate that we ought to think through exactly what responsibilities the state would assume. Unless and until there is a broader consensus change should be incremental at most and this monstrous legislation must be undone.

Written by georgesarant

April 1, 2010 at 12:19 AM

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SHREDDING THE CONSTITUTION

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As I am preparing to leave on a twice-postponed trip to Cozumel I won’t be here for the vote on the Democratic Health care bill(s). I cannot recall a time when the constitution has been so blatantly ignored, in order to achieve, what the proponents of this travesty perceive to be the “greater good.” This is a terrible precedent in trashing the Rule of Law, which I’ve written on previously. The Democratic leadership of the House cannot even muster up enough votes to pass the Senate version of the Health Care bill. Instead they are resorting to an unprecedented maneuver, in which they vote on changes to that bill but “deem” it passed without ever voting on it and then the Senate votes on the changes.

It was a stretch to use the reconciliation process in the Senate in order to pass with only 51 votes for a major piece of legislation. But this is sheer lawlessness. The constitution clearly states “Votes of both Houses shall be determined by yeas and Nays, and the Names of the Persons voting for and against the Bill shall be entered on the Journal of each House respectively.” But with these maneuvers no single bill with all features will ever have been voted on in the House.

This is an unprecedented travesty, the consequences of which cannot be foretold. Once the spirit of the law is violated can it be put back together again? We now have the prospect of a major piece of social legislation becoming “law” despite the massive opposition of the people and the unrepresentative methods that have been used to achieve it. These are desperate people who put an ideological commitment ahead of the rule of law and democracy itself. Opposition must not cease, but instead be further intensified. The perpetrators must be voted out, the legislation repealed (although that will face a presidential veto), and further no funds be appropriated for it. It will also be subject to court challenges on numerous grounds and could also be overturned by the Supreme Court anyway. One way or another it must ultimately be undone. Truly this will not stand.

Written by georgesarant

March 19, 2010 at 4:14 PM

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THE FRAUDULENT HEALTH CARE PROGRAM

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The President and the Democratic congress are trying to ram through their health care “reform” package despite serious flaws and public opposition. The only thing good about this Kamikazi attack is assured self-destruction of this radical regime. Should this monstrosity pass the opposition must run a focused campaign on repealing it. The analysis provided by Representative Paul Ryan is clearly devastating.

He points out that this plan is based upon the subterfuge of applying ten years of revenue to six years of expenditures to support the claim of budget neutrality. It provides ten years of tax increases and Medicare cuts, not a continuation of existing programs. The plan does not control costs. It does not reduce deficits despite claims to the contrary. “What this bill essentially does is treat Medicare like a piggy bank. It raids half a trillion dollars out of Medicare, not to shore up Medicare solvency, but to spend on this new government program.” There are also double accounting gimmicks but in the end the ten year cost of the bill has a $460 billion deficit, with the next ten years running a $1.4 trillion deficit. It is a total fraud and people can see through this when presented with the facts. The administration has no credibility on this issue.

It is nothing short of revolutionary to nationalize one sixth of the economy with a dubious scheme, rather than an incremental approach that would work first towards reducing costs. This disastrous course must be stopped or we all are going to pay a heavy price.

Written by georgesarant

March 7, 2010 at 8:55 PM

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HEALTH CARE, THE MEDIA, AND THE MAJORITY

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I had an indication of what health care may become like the other day when I had to stand in line for an hour and a half to get a flu shot at a pharmacy, since none of my doctors had it on hand. Whatever the outcome of this legislative process it is going to result in something infinitely worse than what we currently have. The original purpose for health care “reform” was the forty something million who are uninsured. Never mind that this consists mostly of illegal aliens and young people who don’t want to pay for insurance. Nevertheless if the government was really interested in a safety net for those without coverage, it would provide for that, not upend and revolutionize the coverage everyone else has.

Over 70% of the population is satisfied with the coverage they have, so the liberals, in typical fashion want to destroy something the majority has because they cannot abide a minority without. In the liberal mindset any minority that is at variance with the majority average must be accommodated, almost always at the expense of the majority. Think about “affirmative action, “ etc. and you get the picture.

But in the process they are pursuing two mutually exclusive objectives- expanding coverage and reducing costs. This is a no-brainer that most people can figure out; it just isn’t possible without taking something away from someone else. As a result there is skepticism and opposition from many quarters, even as pernicious organizations like the AARP betray their members interests. In desperation the administration has proactively attacked perceived enemies, such as Fox News and the Chamber of Commerce, going beyond anything Nixon ever did.

I’m particularly nervous about News Corporation, the parent of Fox. I own stock in the company, although as an investment it is a turkey. I had mixed feelings about the purchase of the Wall Street Journal, for as people like John Stossel move over to Fox you have virtually the entire right located in one company. This is a recipe for disaster should anything go wrong. Although the head-on attack on Fox backfired as even the “official” media balked at excluding them from briefings, the company is particularly vulnerable to back door pressure, via administration appointments to the FCC, which will certainly be gunning for them. Meanwhile Fox ratings are increasing while the administration’s popularity is decreasing, and continued public support and vigilance is the best safeguard for what in truth is press freedom. Jefferson said given a choice between a government without newspapers and newspapers without a government he would choose the latter, and his word echo to the modern media of today.

Overall I believe that the administration and congress have seriously overreached and there will be a reaction in 2010, which should help undo whatever damage they have done by then.

Written by georgesarant

October 26, 2009 at 4:55 PM

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