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Creating Your New Master

Why Medicare for All Would Damage our Republic by Jay Cost at National Review

This is a very diverse array of policies, but they all exhibit a similar flaw. When the government wishes to accomplish some public purpose that it does not have the means to do itself, it contracts with private parties to accomplish the end. In exchange, the state promises, in effect, to guarantee the private parties a profit from the arrangement. The interest groups gladly accept and then use their public bounties to build a political power base, ensuring that their ends are secured, even if they are not in the public interest.

What Sanders and the left wing of the Democratic party aim to do is to top all these previous endeavors — committing to pour trillions of dollars into the medical-services industry for the sake of public health. They assure us that the government will be able, under such an arrangement, to negotiate a better deal for the taxpayer. But this assurance only demonstrates that they do not understand how our government functions in practice. History has shown that precisely the opposite has happened, again and again. Factions that are blessed by the government come to dominate it, to the detriment of the general welfare.

“Medicare for all” would be like creating a fearsome new Pretorian Guard. These elite soldiers were tasked with protecting the life of the Roman emperor, but their rarefied position gave them extraordinary influence over the affairs of state, to the extent that they sometimes assassinated emperors they opposed and set up new ones more to their liking. If the federal government commits to giving trillions to the medical-services industry to protect the lives of the American people, expect that industry to wield dangerously inflated influence. And it would be dreadful for the republican quality of our system.

HKO

The American Government is more prone to this government creation of special interest conflict because of the institutionalization of influence by way of lobbying.  Make a private interest dependent on the government and then make the government dependent on the interest they enabled; what could go wrong.

I recommend you read the entire piece. It explains a concern missing from the debate.

Pragmatic Liabilities

by Henry Oliner

The reason ideology is relevant in the health care debate is that at the core of the difficulty is the separation of pragmatic solutions from sound ideological support.

Our health care problem is an accumulation of short sighted policies considered in isolation from health care policy. Like adding bricks on a pickup truck we can keep adding beyond the load capacity, until we load just one brick too many, and then the suspension collapses and the truck cannot move. We will blame the last few bricks, the straw that broke the camel’s back, because they are the most visible; we have long forgot the ones on the bottom, but they are also to blame. “Every snowflake pleads innocent, but it is still an avalanche.”

When we seek government solutions were are subject to another adverse reality.  Political actors tend to promise benefits in exchange for votes, without paying for them.  In theory benefits are debated and funded from the Treasury, but with dramatically increased regulatory influence the government has exploited other options.

Our government has constructed a Rube Goldberg system of regulations, mandates, perverse incentives, cross subsidies, and wishful thinking to hide the costs from everyone, including themselves. Each component is crafted in isolation with no vision of the final product, another victim of pragmatism. Yet the failures are blamed on the market mechanism.  The problem is not that health care does not adequately respond to market conditions, as single payer supporters contend, but that it does.

These twin liabilities of political pragmatism are mere hosts to the thinking that has plagued our health care markets.

The Failure of Pragmatic Health Care

by Henry Oliner

The search for pragmatic health care solutions seems to only create bigger problems.  This is because pragmatism has gone amok; and totally rejected sound economic and political principles. Pragmatic approaches are one thing to address short term problems; but pragmatism without sound supporting principles is doomed.

Pragmatism in health care is failing because the ideology is wrong, and the economics is wrong.

The worst obstacle to health care and to tax reform as well is the atmosphere of constant change. Even the best solution will be neutered by the belief in the market that it will only last until the next election.  How can medical practices, health insurers, businesses and individuals plan when every year they are confronted with significant changes.

I do not know that any economic model considers the lack of faith in the permanence of the solution, and this may be the costliest part of any reform proposal. How can the OMB ‘score’ an issue that is not acknowledged?

Our health care problem is an accumulation of tax policies, mandates, cross subsidies, regulations, wishful thinking, social engineering. What is missing is sound economics and thoughtful policy.

The ‘right to health care’ is a meaningless myth.  Health is a market for drugs, doctors, diagnostics, devices.  The ‘right to health care’ means nothing without providing these services and products. It means nothing without discussing quality and access (service). To declare a right to health care is to totally ignore that it is an economic problem and requires economic solutions.

Combining the issue of health care cost and insurance confuses the issue. The applies to mixing the problems of cost and access.  Using insurance to pay or even file routine expenses to insurance only adds to cost.

Preferential tax treatment for business provided insurance removes consumer choice.

Mandating coverage for pre-existing conditions without holding the consumer responsible for maintaining coverage is just another cross-subsidy hike in premiums.

For decades, the market has been polluted by government meddling, laws, regulations, rules and mandates.  Yet when prices continue to rise the market is blamed.

The health insurance controversy is the pragmatic apex of sharply conflicting ideologies and both will not easily coexist. It will take more than the repeal of Obamacare to fix. Obamacare was just a bad response to a history of bad policies. Trying a different bad response will not fix the problem either.

It is time to stop the tinkering around the edges and address the ideological failures and the accumulation of bad solutions enacted under the guise of pragmatism.

Only if we fix the ideology will we be able to address the problem with the permanence it requires.  It’s a tough sale and it does not appear that either party is up to the task.

The Cruz Option

from Kevin Williamson at National Review,  Apartment Fires and Health Insurance

The problem for health insurance is the same as the problem for condominium sprinklers: The benefits are desirable, but they are not free, and many people, given a choice, would spend their money in a different fashion. In the matter of health insurance, Senator Ted Cruz has offered an amendment that would allow insurers to sell relatively low-cost plans that do not cover everything that must be covered under current ACA regulations. Critics, including Senator Susan Collins, have protested that these policies are too “skimpy,” that they do not include all of the coverage and benefits that we might like to see people have. But all the Cruz amendment does is give buyers a choice. The danger isn’t that insurance companies will fail to offer more expensive and comprehensive policies — of course they will offer them; those are more profitable — but that many Americans will prefer less expensive and less comprehensive health-insurance plans.

Mortality Increase Under the ACA

from The Georgia Public Policy Foundation Friday Facts 7/7/17

Food for thought: A total of 31 states and the District of Columbia expanded Medicaid under ObamaCare. Oren Cass of the Manhattan Institute reports that in 2015, age-adjusted mortality rose and life expectancy declined for the first time since the early 1990s and mortality rose more in Medicaid expansion states. “Despite implementation of the ACA, there were 80,000 more deaths in 2015 than had mortality continued to decline during 2014–15 at the same rate as during 2000–2013.” 

HKO

Just a correlation. Yet if I were to claim that the ACA killed 80,000 people my statement would have much better logic and statistical support than the claims from the regular assortment on the left that the Republican Health Plan is going to kill however many they make up for their talking points.